Acrocyanosis, digital ischemia and acronecrosis as first manifestations of endometrial adenocarcinoma: case presentation and literature review

The association between digital ischemia and cancer is rarely reported in literature and the exact mechanism of this occurrence has not been completely understood. We report here a case of a 73 yearold woman who presented digital ischemia as first manifestation of endometrial adenocarcinoma. Reporting this rare clinical case and with a brief literature review, we recommend to consider an intensive search for primary and metastatic cancer in all patients who experience a digital ischemia, with the aim to early detect and treat the disease

Is the chemotherapy era in advanced non-small cell lung cancer really over? Maybe not yet

Lung cancer is one of the most frequently diagnosed tumors in both the male and female population. In Italy it is the leading cause of cancer deaths in men and the third in women. Although the 5-year survival rate has moderately increased in the last years, the diagnosis remains associated with a very poor prognosis. However, in the last decade significant progress has been made, also in the treatment of advanced-stage non-small cell lung cancer. The advent of targeted therapies and the recent explosion of immunotherapy seem to have limited the role of chemotherapy. But is this completely true? The aim of this editorial is to discuss some of the most controversial aspects of the therapeutic scenario in non-small cell lung cancer, with particular attention to the role that chemotherapy still play

Through-and-through nasal reconstruction with the bi-pedicled forehead flap

BackgroundNasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction.MethodsSeven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia.ResultsNasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary.ConclusionsThis bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource

Nasal anomalies review with CT or MRI: from congenital to malignant.

Learning Objectives. To describe imaging findings of a wide spectrum of uncommon nasal cavity masses evaluated at our institution by CT, CBCT and MR imaging, clinically and pathologically proven. Background. In this work we present a succinct review of disease illustrated by a retrospective case series of nasalcavity masses, evaluated at our institution. between 2010 and 2013. Patients have been studied with different imaging modalities including multiraw computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MR) to illustrate the findings and to summarize the main diagnostic keypoints for the differential diagnosis of nasal masses. Clinicopathological correlation is also reported and imaging findings we present have been isthopathologically proven. Images aid in recognition and characterization of the lesions. Many different types of lesions may involve the nasal cavities and imaging studies, CBCT, CT and MR, provide anatomical details and could be helpful first in differentiating benign to malignant lesions and secondary in characterization of the lesion. Referring to non neoplastic lesions, rinoliths, piogenic granuloma and septal mucocele are reported. Referring to benign and borderline tumors osteoma, hamartoma, hemangioma, hemangiopericytoma, cemento-ossifying fibroma, antrochoanal polip and inverted papilloma are reported. Referring to malignant neoplasms intestinal type adenocarcinoma, esthesioneuroblastoma and Non-Hodgkin lymphoma are reported. CONCLUSION. This review of uncommon nasal masses studied with different imaging modalities (CT, CBCT and MRI)should be useful in differential diagnosis of the wide spectrum of nasal tumors and non tumors masses

Hyperprogression and Immune Checkpoint Inhibitors: Hype or Progress?

There are currently seven approved immune checkpoint inhibitors (ICIs) for the treatment of various cancers. These drugs are associated with profound, durable responses in a subset of patients with advanced cancers. Unfortunately, in addition to individuals whose tumors show resistance, there is a minority subgroup treated with ICIs who demonstrate a paradoxical acceleration in the rate of growth or their tumors-hyperprogressive disease. Hyperprogressive disease is associated with significantly worse outcomes in these patients. This phenomenon, though still a matter of dispute, has been recognized by multiple groups of investigators across the globe and in diverse types of cancers. There are not yet consensus standardized criteria for defining hyperprogressive disease, but most commonly time to treatment failure less than 2 months and an increase in pace of progression of at least twofold between pre-immunotherapy and on-treatment imaging has been used. In some patients, the change in rate of progression can be especially dramatic-up to 35- to 40-fold. MDM2 amplification and EGFR mutations have been suggested as genomic correlates of increased risk of hyperprogression, but these correlates require validation. The underlying mechanism for hyperprogression is not known but warrants urgent investigation

Relationship Between Heart Rate Recovery After Exercise and Maximal Oxygen Uptake in Sedentary Patients with Type 2 Diabetes

AIMS: Heart rate recovery after exercise (HRR) is an estimate of autonomic modulation of the heart, and has been shown to be inversely associated with type 2 diabetes. Type 2 diabetes is associated with decreased maximal oxygen consumption (VO2max). Aim of our study was to assess the relationship between HRR and VO2max in sedentary patients with type 2 diabetes. METHODS: Maximal exercise testing to determine VO2max (ml ∙ Kg-1 ∙ min-1) was performed in 16 sedentary patients with type 2 diabetes (DP) and in 16 age-matched sedentary healthy controls (HS). HRR (bpm) 2 min after cessation of the exercise was recorded. Simple linear regression was used to assess the relations between HRR and VO2max. RESULTS: VO2max and HRR were significantly lower in DP compared to HS (P = 0.002 and P = 0.008 respectively). A correlation between HRR and VO2max has been found, stronger in DP (r = 0.672, P = 0.004) than HS (r = 0.620, P = 0.01). CONCLUSIONS: Our study suggests that regular physical activity aimed to improve the levels of VO2max in subjects with diabetes may improve the HRR and reduce the risk of cardiovascular events

Oral health status and periodontitis in Alzheimer's disease patients: A case control Study in a Sicilian rural community

Aim. Dementia is a common disorder among the elderly. Alzheimer’s disease (AD) is the most common cause of dementia. In addition to known risk factors (e.g. age and familiarity) of AD, recently it has been suggested a possible promoting role for chronic inflammatory infective diseases. Periodontal disease (PD) is a frequent chronic multi-bacterial infection involving the tissues supporting the teeth; in addition to promoting inflammation locally, the periodontal pathogens possess mechanisms able to influence the systemic balance of inflammatory mediators. Similarly to other systemic diseases (e.g. cardiovascular disease, diabetes, renal diseases and low birth weight), a possible link has been proposed between PD and the development and progression of AD. Aim of the present study was to evaluate the oral health status and the prevalence/severity of PD in a group of patients affected by AD compared to a control group of healthy subjects. Materials and methods. A case-controlled clinical trial was designed to compare patients with AD (Test group - T; n = 16; M: 8; F: 8, range age 64-93 yrs) with healthy controls (Control group - C; n = 16; M: 8; F:8; range age 64-92 yrs). The population study was named ZAP (Zabut Aging Project) and all participants, enrolled in a Sicilian rural community (Sambuca di Sicilia, AG, Italy), were matched for age and sex. Following variables were recorded: smoking and drinking habits, number of teeth, Decayed Missed Filled Teeth scoring (DMFT), measurement of the probing depth (CPI and PSR index). The association between AD and PD, socio-demographic and behavioural-clinical variables was assessed using the χ2 test or Fisher’s exact test, as appropriate. To measure the association level, crude OR and the 95% Confidence Interval (CI) were calculated. Statistical significance of the difference in the average DMFT between cases and controls was assessed using the Student’s t-test. A p value ≤0.05 was considered statistically significant. Results. One patient of T group was a smoker versus four of C group; four T patients were drinker versus two of C group. Seven of T group (43.7%) were totally edentulous, conversely only 2 (12.5%) of controls have the same condition (p=0.04). With respect to oral status, DMFT index was 23.7 ±9.0 in T patients versus 25.2±7.8 in controls (p=0.633). There were no significant differences between T and C groups regarding periodontal index: high PSR and CPI scores (>3) were recorded in 77.8% of AD patients and 46.1% of health cases (p >0.05). A similar distribution among two groups was observed regarding the other investigated variables (e.g. smoking and drinking habits). Conclusions. In this rural Sicilian adult/elderly community, poor oral health is frequent with a DMFT score higher than general population. The obtained data do not support the hypothesis of a major prevalence and severity of PD among AD patients. However, to confirm these preliminary results the recruitment of a wider sample size and further data, regarding proteomic salivary profiles and RT PCR-based microbiological investigation on sub-gingival plaque samples, still need in order to better clarify the role of PD and periodontal pathogens in the AD natural history

Engineering thermoplastics for additive manufacturing: a critical perspective with experimental evidence to support functional applications

Among additive manufacturing techniques, the filament-based technique involves what is referred to as fused deposition modeling (FDM). FDM materials are currently limited to a selected number of polymers. The present study focused on investigating the potential of using high-end engineering polymers in FDM. In addition, a critical review of the materials available on the market compared with those studied here was completed

Relationship between heart rate variability and repeated sprint exercise in young soccer players

Aim: The sport of soccer is characterized by neuromuscular performance resulting in short bursts interspersed by brief recovery periods over an extended period of time. Several studies suggest that the cardiac autonomic nervous system (ANS) assessed by heart rate variability (HRV) may provide useful information regarding the functional adaptations to training stimulus. Although HRV has often been associated with aerobic power and cardiovascular fitness, the influence of sympathovagal balance on neuromuscular performance in young athletes is not well assessed. The aim of this study was to assess the influence of the autonomic system on the performance of repeated sprints, involving predominantly muscular power and anaerobic metabolism, in young soccer players. Method: Twelve young soccer players, selected for the Sicilian Regional Representative of the Italian Football Federation, mean age 15 years, were recruited. Resting HRV was measured and indices of power spectral analysis (ratio LF/HF) were calculated to evaluate the sympathovagal balance. To assess the state of physical fitness of subjects, VO2max was determined by maximal graded treadmill test. Finally, the athletes performed 10 maximal all-out 6-sec cycling sprints (RS), interspersed with 30-sec of passive recovery, to measure the peak power (PP) represented by the highest value recorded during a single sprint, and the average of the values of maximum power (AP) recorded during all sprints. Results: On the basis of their VO2max (56.22 ± 3.93 ml/Kg/min), all subjects showed good levels of physical fitness. HRV index (LF/HF = 1.31 ± 0.74) showed an inverse correlation with PP (14.05 ± 0.89 W/Kg; r = -0.709, P = 0.01), and with AP (12.82 ± 0.88 W/Kg; r = -0.606, P = 0.04). Conclusion: Our study shows that a low ratio LF/HF, which reflects a parasympathetic predominance in the ANS balance, is associated with a better anaerobic contribution to performance resulting in higher values of PP and AP during brief repeated maximal cycling sprints. The assessment of resting HRV before exercise may be useful for performance monitoring of young soccer players

The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results.

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes