Pirosi funzionale: differenze pH-impedenziometriche in pazienti con differente risposta a terapia con inibitori di pompa protonica

TITOLO: PIROSI FUNZIONALE: DIFFERENZE PH-IMPEDENZIOMETRICHE IN PAZIENTI CON DIFFERENTE RISPOSTA A TERAPIA CON INIBITORI DI POMPA PROTONICA INTRODUZIONE E SCOPO DEL LAVORO: La malattia da reflusso gastroesofageo è una diagnosi molto frequente nei paesi occidentali. Almeno il 20% dei soggetti riferisce episodi di pirosi retrosternale settimanalmente. Recenti dati della letteratura indicano che i valori basali di impedenza (BI) dell'esofago, calcolati mediante pH-impedenziometria delle 24 ore (MII-pH), possano identificare una non completa integrità della mucosa esofagea e la conseguente aumentata sensibilità all'acido. In questo studio di tesi abbiamo comparato i livelli di BI in pazienti con pirosi e caratteristiche fisiopatologiche di pirosi funzionale (FH) divisi in due gruppi sulla base della scomparsa o meno dei sintomi dopo terapia con inibitori di pompa protonica (PPI). Inoltre abbiamo comparato i risultati con gli stessi parametri ottenuti da pazienti affetti da esofago ipersensibile (HE) e da volontari sani (HV). PAZIENTI E METODI: I pazienti con pirosi ed endoscopia (EGDS) normale, sono stati sottoposti a MII-pH previa sospensione della terapia con PPI. Coloro che sono risultati negativi alla MII-pH e quindi classificati come FH, sono stati sottoposti a terapia con PPI (esomeprazolo/pantoprazolo 40mg/die) per 8 settimane. Coloro che hanno avuto un miglioramento dei sintomi di almeno il 50% sono stati classificati come responsivi ai PPI (PPI+FH) mentre gli altri come non responsivi (PPI-FH). Abbiamo incluso anche 30 pazienti con HE definita come EGDS normale, esposizione all'acido normale e positiva associazione tra sintomi e reflussi durante la MII-pH. Infine abbiamo incluso anche 20 HV che si sono sottoposti a MII-pH. Per ogni paziente ed HV abbiamo valutato il tempo di esposizione all'acido (AET), il numero di episodi di reflusso, i livelli di BI rilevati a 3 cm dal bordo superiore dello sfintere esofageo inferiore, durante la notte in 3 momenti diversi. RISULTATI: I pazienti con PPI+FH hanno mostrato un maggior AET medio, numero di reflussi prossimali e numero di reflussi acidi rispetto agli PPI-FH (p<0.05). I pazienti con HE hanno mostrato un AET medio ed un numero totale di reflussi simile a quelli registrati negli PPI+FH (p=n.s.). I livelli di BI ed l'indice PSPW erano ridotti nei pazienti PPI+FH ed HE rispetto ai pazienti FH-PPI ed agli HV (p<0.05). CONCLUSIONI: Sulla base dei dati registrati possiamo affermare che i pazienti PPI+FH presentano caratteristiche simili ai pazienti con HE valutate mediante MII-pH. Questi dati ci permettono di affermare che i livelli di BI e l'indice PSPW potrebbero essere utili nella diagnosi di GERD nei pazienti PPI+FH, nei quali il tradizionale monitoraggio MII-pH non mostra alterazioni, probabilmente a causa della variabilità giornaliera e delle limitazioni degli attuali indici di associazione tra sintomi e reflussi

Anxiety, self-efficacy, and locus of control: impact on mathematical performance in fourth and fifth-grade children.

openLo studio esamina l’impatto che le variabili emotivo-motivazionali quali ansia per la matematica (MA), locus of control e autoefficacia hanno sulla prestazione matematica in bambini di quarta e quinta primaria. È stato possibile indagare il ruolo di questi fattori attraverso la somministrazione di questionari self-report e prove di matematica in un campione di 217 studenti. Lo studio ha inoltre validato due questionari self report che sono stati tradotti e adattati per il campione preso in esame. Per quanto riguarda le correlazioni esistenti tra i fattori e la performance, sono state individuate una relazione negativa tra MA e prestazione matematica e correlazioni positive tra i costrutti di locus of control, autoefficacia e il punteggio ottenuto nelle prove matematiche. Inoltre, MA è risultata essere correlata negativamente all’utilizzo di un locus of control esterno e a bassi livelli di autoefficacia. Da un’analisi di regressione lineare gerarchica è invece risultato come il principale predittore significativo della prestazione matematica sia il controllo percepito. Lo studio, pertanto, ha confermato il ruolo importante che i fattori emotivo-motivazionali ricoprono in relazione all’apprendimento della matematica, mettendo in evidenza in particolare il ruolo che le convinzioni e le percezioni di controllo esercitano sullo studente

Importance of Gamete Quality in Ecotoxicological Application: Natural versus Bred Population in Paracentrotus lividus

Several approaches have been tested to respond to the depletion of wild stocks, from the production of seeds to the setting up of closed echinoculture systems, starting with fertilization of eggs with the consequent development to adult sea urchins. Hence, in the last years, our research group has focused on the assessment of a feasible and sustainable strategy aimed to ensure a rapid and effective gonadal growth of healthy gametes in recirculating aquaculture system (RAS) to employ in ecotoxicological application. In order to compare the health of obtained gametes with wild populations, the effectiveness of diets was evaluated with different biological parameters, such as fertilization and embryo-development test, and with histological analysis of gonads to appraise the stage of maturation. Moreover, the information regarding different breeding conditions of adults and genetic variability should be combined with the analysis of larval settlement and its requirements, demonstrating the importance of these parameters for the possible closure of the echinoculture cycle in RAS. Results achieved so far in terms of gonadal development and health of gametes have provided evidence of success in overcoming natural gaps between reproductive events in natural populations and an efficient and standardize breeding condition in RAS

Preoperative insulin-like growth factor-binding protein-3 (IGFBP-3) blood level predicts gleason sum upgrading

In this study, we evaluated the ability of preoperative IGFBP-2, IGFBP-3, IL-6, and SIL-6R serum levels to predict Gleason score upgrade in 52 PCa patients

Stereotactic radiotherapy of pancreatic cancer: A systematic review on pain relief

Locally advanced pancreatic carcinoma (LAPC) has a poor prognosis and the purpose of treatment is survival prolongation and symptom palliation. Radiotherapy has been reported to reduce pain in LAPC. Stereotactic RT (SBRT) is considered as an emerging radiotherapy technique able to achieve high local control rates with acceptable toxicity. However, its role in pain palliation is not clear. To review the impact on pain relief with SBRT in LAPC patients, a literature search was performed on PubMed, Scopus, and Embase (January 2000\u2013December 2017) for prospective and retrospective articles published in English. Fourteen studies (479 patients) reporting the effect of SBRT on pain relief were finally included in this analysis. SBRT was delivered with both standard and/or robotic linear accelerators. The median prescribed SBRT doses ranged from 16.5 to 45 Gy (median: 27.8 Gy), and the number of fractions ranged from 1 to 6 (median: 3.5). Twelve of the 14 studies reported the percentage of pain relief (in patients with pain at presentation) with a global overall response rate (complete and partial response) of 84.9% (95% CI, 75.8%\u201391.5%), with high heterogeneity (Q2 test: P&lt;0.001; I2=83.63%). All studies reported toxicity data. Acute and late toxicity (grade 653) rates were 3.3%\u201318.0% and 6.0%\u20138.2%, respectively. Reported gastrointestinal side effects were duodenal obstruction/ ulcer, small bowel obstruction, duodenal bleeding, hemorrhage, and gastric perforation. SBRT achieves pain relief in most patients with pancreatic cancer with an acceptable gastrointestinal toxicity rate. Further prospective studies are needed to define optimal dose/fractionation and the best systemic therapies modality integration to reduce toxicity and improve the palliative outcome. Finally, the quality of life and, particularly, pain control should be considered as an endpoint in all future trials on this emerging treatment technique

Identification of the first synthetic allosteric modulator of the CB2receptors and evidence of its efficacy for neuropathic pain relief

The direct activation of cannabinoid receptors (CBRs) results in several beneficial effects, therefore numerous CB1R and CB2R ligands have been developed and tested in vitro and in vivo, but none of them reached an advanced stage of clinical development due to several side effects in particular on the CNS. Medicinal chemistry approaches are now engaged to develop allosteric modulators that might offer a novel therapeutic approach to achieve potential therapeutic benefits avoiding inherent side effects of orthosteric ligands. Here we identify the first ever synthetized positive allosteric modulator (PAM) that targets CB2Rs. The evidence for this was obtained using [3H]CP55940 and [35S]GTPγS binding assays. This finding will be useful for the characterization of allosteric binding site(s) on CB2Rs which will be essential for the further development of CB2R allosteric modulators. Moreover, the new CB2R PAM displayed antinociceptive activity in vivo in an experimental mouse model of neuropathic pain, raising the possibility that it might be a good candidate for clinical development

Predicting prostate biopsy outcome: Prostate health index (phi) and prostate cancer antigen 3 (PCA3) are useful biomarkers

Indication for prostate biopsy is presently mainly based on prostate-specific antigen (PSA) serum levels and digital-rectal examination (DRE). In view of the unsatisfactory accuracy of these two diagnostic exams, research has focused on novel markers to improve pre-biopsy prostate cancer detection, such as phi and PCA3. The purpose of this prospective study was to assess the diagnostic accuracy of phi and PCA3 for prostate cancer using biopsy as gold standard. Phi index (Beckman coulter immunoassay), PCA3 score (Progensa PCA3 assay) and other established biomarkers (tPSA, fPSA and %fPSA) were assessed before a 18-core prostate biopsy in a group of 251 subjects at their first biopsy. Values of %p2PSA and phi were significantly higher in patients with PCa compared with PCa-negative group (p<0.001) and also compared with high grade prostatic intraepithelial neoplasia (HGPIN) (p<0.001). PCA3 score values were significantly higher in PCa compared with PCa-negative subjects ( p<0.001) and in HGPIN vs PCa-negative patients (p<0.001). ROC curve analysis showed that %p2PSA, phi and PCA3 are predictive of malignancy. In conclusion, %p2PSA, phi and PCA3 may predict a diagnosis of PCa in men undergoing their first prostate biopsy. PCA3 score is more useful in discriminating between HGPIN and non-cancer. (C) 2012 Elsevier B.V. All rights reserved

Adaptive Individualized high-dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial

Purpose To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG-PET/CT).Methods The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of (18) F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed (18) F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore, a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m(2) twice daily orally) was prescribed for the entire treatment duration.Results Eighteen patients (13 males, 5 females; median age 55 years [range, 41-77 years]) were enrolled in the trial. Patients underwent surgical resection at 8-9 weeks after the end of neoadjuvant CRT. No patient showed grade &gt; 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1, 2, 3 (non pCR). Accepting p &lt; 0.05 as the level of significance, at the Kruskal-Wallis test, the medians of baseline-MTV, interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. (18) F-FDG-PET/CT was able to predict the pCR in 77.8% of cases through compared evaluation of both baseline PET/CT and interim PET/CT.Conclusions Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate