From SGAP-Model to SGAP-Score: A Simplified Predictive Tool for Post-Surgical Recurrence of Pheochromocytoma

A reliable prediction of the recurrence risk of pheochromocytoma after radical surgery would be a key element for the tailoring/personalization of post-surgical follow-up. Recently, our group developed a multivariable continuous model that quantifies this risk based on genetic, histopathological, and clinical data. The aim of the present study was to simplify this tool to a discrete score for easier clinical use. Data from our previous study were retrieved, which encompassed 177 radically operated pheochromocytoma patients; supervised regression and machine-learning techniques were used for score development. After Cox regression, the variables independently associated with recurrence were tumor size, positive genetic testing, age, and PASS. In order to derive a simpler scoring system, continuous variables were dichotomized, using > 50 mm for tumor size, ≤ 35 years for age, and ≥ 3 for PASS as cut-points. A novel prognostic score was created on an 8-point scale by assigning 1 point for tumor size > 50 mm, 3 points for positive genetic testing, 1 point for age ≤ 35 years, and 3 points for PASS ≥ 3; its predictive performance, as assessed using Somers’ D, was equal to 0.577 and was significantly higher than the performance of any of the four dichotomized predictors alone. In conclusion, this simple scoring system may be of value as an easy-to-use tool to stratify recurrence risk and tailor post-surgical follow-up in radically operated pheochromocytoma patients

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Perioperative hypertension

BACKGROUND Perioperative hypertension is a situation whose management is suggested by the clinical judgement much more than clinical evidences. JNC 7 guidelines give a classification of blood pressure (BP), without any mention specifically dedicated to patients undergoing surgery. The ACC/AHA guidelines recommend deferring surgery if diastolic BP is above 110 mmHg and systolic BP is above 180 mmHg. AIM OF THE STUDY In this review we considered pathogenetic, clinical and therapeutic factors related to perioperative management of hypertensive patients. DISCUSSION In actual trend of the preoperative evaluation, alone hypertension is considered as a minor risk factor. BP values ≤ 180/110 mmHg do not influence the outcomes in patients who underwent noncardiac surgery. Therefore, in these conditions it’s not necessary to delay surgery. Hypertensive picks are possible during the operation, mostly because of the intubation, but, much more dangerous, falls of pressure are possible. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by transdermic way. ACE-ihinibitors and angiotensin- II-antagonists are allowed, but with caution, like as dihydropiridinic calcium-antagonists. Sublingual nifedipin is not recommended, owing to the evidence of an increased morbidity and mortality. Diuretics can lead to dangerous liquids depletions and would not be used in absence of specific indications (such as congestive heart failure, etc.). In hypertensive crisis the most used drugs remain NPS, nitrates, i.v. β-blockers (labetalol, esmolol), fenoldopam. CONCLUSIONS Postoperative BP should always be reviewed with reference to the preoperative and intraoperative assessments

Porous biomaterials obtained using supercritical CO2-water emulsions

Highly porous, hydrophilic porous matrices were fabricated by using a high internal phase supercritical-CO2 (scCO2) emulsion templating technique. The novel aspect of the work resides in the combination of a natural biopolymer (dextran) as the building component of the matrices and of an environmentally benign solvent (supercritical-CO2) as the pore-generating phase. The synthetic route to the porous biomaterials involved the preliminary functionalization of the dextran chains with methacrylic moieties, formation of a scCO2-in-water concentrated emulsion, and curing of the external phase of the emulsion by radical polymerization. As the emulsion stabilizer a perfluoropolyether surfactant was chosen. The matrices obtained exhibit highly interconnected, trabecular morphologies. The porous biomaterial morphologies were qualitatively characterized by scanning electron microscopy (SEM) and the evaluation of void and interconnect sizes was carried out on the micrographs taken with the light microscope. To tailor the morphologies of the porous structures, the influence of the volume fraction of the internal phase and of the surfactant/internal phase ratio was investigated. It was established that the variation of the volume fraction of the internal phase exerted only a limited influence on void and interconnect sizes. On the contrary the increase of surfactant concentration alters dramatically the distribution of void size, a large proportion of the void space enclosed within the matrix being attributable to voids with a diameter exceeding 100 ?m. The free toxic solvent process of fabrication of the porous structures, the high water content, the expected biocompatibility, and the mechanical properties that resemble natural tissues make these porous hydrogels potentially useful for tissue engineering applications

Porous biomaterials by using supercritical fluids emulsions

Different authors have investigated the production of porous polymeric materials using supercritical CO2 as a solvent and/or foaming agent. The removal of the template phase is simple since CO2 reverts to gas phase upon depressurization. More recently and on the basis of the experience achieved on the synthesis of porous cross-linked polymers through oil-in-water emulsion templating, the authors demonstrated that the reaction conditions can be specifically modified to generate well-defined macroporous biopolymer monoliths by usign SCCO2 as a porogenic solvent. No organic solvent is required in this porcess: just water and CO2.Different authors have investigated the production of porous polymeric materials using supercritical CO2 as a solvent and/or foaming agent. The removal of the template phase is simple since CO2 reverts to gas phase upon depressurization. More recently and on the basis of the experience achieved on the synthesis of porous cross-linked polymers through oil-in-water emulsion templating, the authors demonstrated that the reaction conditions can be specifically modified to generate well-defined macroporous biopolymer monoliths by usign SCCO2 as a porogenic solvent. No organic solvent is required in this porcess: just water and CO2

Effect of Hyperglycemia on COVID-19 Outcomes: Vaccination Efficacy, Disease Severity, and Molecular Mechanisms

Background/Aims: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a positive-stranded single-stranded RNA virus, a member of the subgenus Sarbecovirus (beta-CoV lineage B) and responsible for the coronavirus disease 2019 (COVID-19). COVID-19 encompasses a large range of disease severity, from mild symptoms to severe forms with Intensive Care Unit admission and eventually death. The severe forms of COVID-19 are usually observed in high-risk patients, such as those with type two diabetes mellitus. Here, we review the available evidence linking acute and chronic hyperglycemia to COVID-19 outcomes, describing also the putative mediators of such interactions. Findings/Conclusions: Acute hyperglycemia at hospital admission represents a risk factor for poor COVID-19 prognosis in patients with and without diabetes. Acute and chronic glycemic control are both emerging as major determinants of vaccination efficacy, disease severity and mortality rate in COVID-19 patients. Mechanistically, it has been proposed that hyperglycemia might be a disease-modifier for COVID-19 through multiple mechanisms: (a) induction of glycation and oligomerization of ACE2, the main receptor of SARS-CoV-2; (b) increased expression of the serine protease TMPRSS2, responsible for S protein priming; (c) impairment of the function of innate and adaptive immunity despite the induction of higher pro-inflammatory responses, both local and systemic. Consistently, managing acute hyperglycemia through insulin infusion has been suggested to improve clinical outcomes, while implementing chronic glycemic control positively affects immune response following vaccination. Although more research is warranted to better disentangle the relationship between hyperglycemia and COVID-19, it might be worth considering glycemic control as a potential route to optimize disease prevention and management