Phase II trial of docetaxel, cisplatin and fluorouracil followed by carboplatin and radiotherapy in locally advanced oesophageal cancer

This study was performed to assess the efficacy and safety of docetaxel, cisplatin and fluorouracil combination in patients with unresectable locally advanced oesophageal squamous cell carcinoma. Treatment consisted of docetaxel 60 mg m−2, cisplatin 75 mg m−2 on day 1 and fluorouracil 750 mg m−2 day−1 on days 2–5, repeated every 3 weeks for three cycles, followed by carboplatin 100 mg m−2 week−1 for 5 weeks and concurrent radiotherapy (45 Gy in 25 fractions, 5 days week−1). After radiotherapy, eligible patients either underwent an oesophagectomy or received high dose rate endoluminal brachytherapy (HDR-EBT). Thirty-one out of 37 enrolled patients completed the planned chemotherapy and 30 completed chemoradiation. After completion of chemotherapy, 49% (95% CI: 32.2–66.2) had a clinical response. Twelve patients (32%) underwent a resection, which was radical in 60% (postoperative mortality: 0%). A pathological complete response was documented in four patients (11% of enrolled, 30% of resected). The median survival was 10.8 months (95% CI: 8.1–12.4), and the 1- and 2-year survival rates were 35.1 and 18.9%, respectively. Grade 3–4 toxicities were neutropoenia 32%, anaemia 11%, non-neutropoenic infections 18%, diarrhoea 6% and oesophagitis 5%. Nine patients (24%) developed a tracheo-oesophageal fistula during treatment. Even if the addition of docetaxel to cisplatin and 5-fluorouracil (5-FU) seems to be more active than the cisplatin and 5-FU combination, an incremental improvement in survival is not seen, and the toxicity observed in this study population is of concern. In order to improve the prognosis of these patients, new drugs, combinations and strategies with a better therapeutic index need to be identified

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

MEDITERRANEAN DIET RESHAPES PERIPHERAL SECRETOME AND LIPIDOME PROFILES IN PATIENTS WITH METABOLIC SYNDROME

La perdita di peso nei pazienti con sindrome metabolica ha effetti positivi sulle malattie cardiovascolari e sul rischio di diabete di tipo 2, ma i suoi effetti sul profilo lipidico e sul secretoma periferico sono tutt\u2019ora poco chiari. Al fine di determinare gli effetti della perdita di peso indotta dalla dieta sui parametri metabolici sono stati analizzati il profilo lipidico e il secretoma periferico in pazienti affetti da sindrome metabolica. In questo studio sono stati arruolati 18 soggetti adulti di sesso maschile con sindrome metabolica e BMI compreso tra 25 e 35 Kg/m2, che sono stati sottoposti a dieta Mediterranea ipocalorica bilanciata per 6 mesi. Lo scopo dell'approccio dietetico era quello di indurre nei pazienti una perdita di peso di almeno il 5% del peso corporeo iniziale. Dopo la perdita di peso abbiamo osservato un miglioramento significativo del BMI, dei livelli di insulina, della glicemia a digiuno, dell\u2019indice HOMA-I, dei livelli di trigliceridi, di LDL e HDL. L'analisi delle lipoproteine circolanti ha mostrato un cambiamento significativo nella loro composizione. In particolare, abbiamo osservato un trasferimento importante di triacilgliceroli dalle HDL alle LDL. A tale cambiamento si \ue8 associata una significativa riduzione delle citochine proinfiammatorie periferiche, come IL-6, TNF-\u3b1, IL-8 e MIP-1\u3b2. Abbiamo inoltre osservato un'interessante correlazione positiva tra i livelli di citochine e livelli periferici di CETP (cholesteryl ester transfer protein), un enzima con un ruolo chiave nel trasferimento di esteri del colesterolo tra le lipoproteine. La perdita di peso ottenuta attraverso la dieta Mediterranea ipocalorica ha determinato un miglioramento del profilo lipidico periferico, un cambiamento nella composizione delle lipoproteine e del secretoma. Questi risultati sono fondamentali per comprendere i benefici della perdita di peso e i meccanismi che possono avere un ruolo nel miglioramento del rischio cardiovascolare.Weight loss in patients with metabolic syndrome has positive effects on cardiovascular diseases and type 2 diabetes risk, but its effects on peripheral secretome and lipidome profiles are still poorly understood. In order to determine the effects of diet-induced weight loss on metabolic parameters, lipidome and secretome profiles were evaluated. In this study, 18 adult males with metabolic syndrome and BMI between 25 and 35 Kg/m2 were enrolled, and then subjected to a balanced hypocaloric Mediterranean diet for 6 months. The aim of the dietetic approach was to induce in patients a weight loss of at least 5% of the initial body weight. After weight loss, we observed a significant improvement in BMI, insulin, fasting blood glucose, HOMA-I, triglyceridemia, LDL, and HDL levels. The analysis of circulating lipoproteins showed a significant change in their composition. In particular, a massive transfer of triacylglycerols from HDL to LDL was observed. This result was associated with a significant reduction in peripheral pro-inflammatory cytokines, such as IL-6, TNF-\u3b1, IL-8, and MIP-1\u3b2. We also observed an interesting positive correlation among cytokines levels and peripheral levels of CETP (cholesteryl ester transfer protein), an enzyme with a key role in lipid metabolism. The results achieved suggest that weight loss obtained through the hypocaloric Mediterranean diet is associated with an improvement in peripheral lipidome and secretome profiles. Furthermore, this dietetic approach stimulated changes in lipoproteins composition. These results are fundamental to understand weight loss benefits and the mechanisms that may play a role in improving cardiovascular risk

L’importanza della nutrizione nella salute del capello = The importance of nutrition in hair healthcare

L\u2019alopecia \ue8 una condizione che affligge una buona parte della popolazione, in particolare i caucasici, prevalentemente uomini, ma anche donne. Esistono 5 tipi di alopecia, alopecia androgenetica (AGA) riguarda solo i capelli delle zone frontali e superiori del capo, Telogen Effluvium (TE) avviene un notevole incremento della perdita dei capelli in un breve periodo, Alopecia Areata (AA) si manifesta con chiazze prive di capelli, pu\uf2 avvenire in qualsiasi regione del cuoio capelluto, Totale con scomparsa di tutti i capelli del capo e Universale con perdita di tutti i peli del corpo. I meccanismi con cui sorge questa condizione non sono del tutto noti, ma i fattori coinvolti sono l\u2019infiammazione, l\u2019ambiente, la predisposizione genetica e gli ormoni. La crescita del capello \ue8 ciclica e consiste in 4 fasi: anagen, catagen, telogen and exogen. Questo ciclo \ue8 regolato da diversi fattori di crescita e citochine tra cui insulin-like growth factor 1 (IGF-1), fibroblast growth factor (FGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF) e transforming growth factor beta (TGF-\u3b2), inoltre ben noto \ue8 il meccanismo molecolare alla base dell\u2019alopecia, che coinvolge la conversione del testosterone in di-idrotestosterone (DHT) mediante l\u2019enzima 5\u3b1-reduttasi,. Un altro meccanismo sembra coinvolgere i transient receptor potential cation channel for vanniloid (TRPVs) ed anche il sistema degli endocannabinoidi (ECS). Questi potrebbero essere possibili target molecolari per agire tramite composti presenti negli alimenti ed introdotti con la dieta come ad esempio la capsaicina presente nel peperoncino (Capsicum annuum), il sulforafano dei broccoli (Brassica oleracea) e di recente scoperta l\u2019hair growth peptide (HGP) presente nel tuorlo d\u2019uovo. Inoltre di fondamentale importanza per la salute del capello \ue8 avere una corretta nutrizione evitando le carenze sia dei macronutrienti che dei micronutrienti e avendo una dieta antinfiammatoria. La dieta antinfiammatoria mira a soddisfare il fabbisogno proteico-energetico individuale, contiene un cospicuo consumo di vegetali, prevede un corretto rapporto di acidi grassi polinsaturi (PUFA) omega-6/omega-3, e un ridotto contenuto di zuccheri semplici, preferendo carboidrati con una ridotta risposta glicemica.Alopecia is a common condition affecting a large segment of population, in particular Caucasian people and mainly men, but even women. Five different kind of alopecia are known: androgenic alopecia (AGA) that concern hairs in frontal and superior part of the head; telogen effluvium (TE) consisting in noteworthy increase of hair loss in brief period; alopecia areata (AA) that manifest itself as patch without hairs in random region of scalp; total alopecia with all hairs scalp disappearance; and finally, universal, with whole body hairs loss. The mechanism underlying this condition must be clarified. Known factors involved in alopecia are inflammation, environment, genetic predisposition and hormones. The hair growth have a cycle consisting of 4 stages: anagen, catagen, telogen and exogen. This cycle is regulated by many growth factors and cytokine such as insulin-like growth factor 1 (IGF-1), fibroblast growth factor (FGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-\u3b2). Furthermore is well known the molecular mechanism underlying alopecia that involve the conversion of testosterone in di-hydrotestosterone (DHT) via 5\u3b1-reductase enzyme. Another process seems to involve transient receptor potential cation channel for vanniloid (TRPVs) and endocannabinoid system (ECS). These could be possible molecular target for the action of food compound introduced by diet such as capsaicin from chili pepper (Capsicum annuum), sulphoraphane from broccoli (Brassica oleracea) and by recent discovered hair growth peptide (HGP) from chicken egg yolk. Moreover a balanced nutrition have pivotal role for healthcare of hairs because the nutritional deficiencies of macro and micronutrients bring to damage in normal and healthy hair growth. The anti-inflammatory diet is the key for maintain healthy hair growth. This kind of diet seeks to satisfy individual protein and energy requirement, it contains high consume of fresh fruit and vegetables, have good intake of polyunsatured fatty acids (PUFA) with a balanced omega-6/omega-3 ratio, and reduced intake of mono and disaccharides, preferring complex carbohydrate with low glycaemic response

First insights of macadamia nut oil as dietary fat : Potential health benefits

Nowadays Macadamia oil (MO) is an attractive gour met oil because of its stability during cooking due to the high smoke p oint. Moreover, it attracts much attention for its particular fatty acid composition. Indeed, MO contains up to 80% of monounsaturatedfatty acids and is the main dietary source of palmitoleic acid (POA). In cell culture and animals models, MO and POA have been shown to improve lipid and glucose metabolism and reduce inflammation. These beneficial effects suggest that MO may be a valuable dietary fat, especially in the countries where other monounsaturated fatty acid rich oils are not available; however, more research is needed to elucidate the impact of dietary MO on health. Given the increased commercial and scientific interest in MO, we aimed to review the scientific literature on potential beneficial effects derived by its consumption