Robotic Heller-Dor myotomy: 10-year monocentric experience compared with POEM

Achalasia is a rare motility disorder caused by an incomplete relaxation of the lower esophageal sphincter and loss of esophageal peristalsis. As a consequence, the bolus swallowing is hindered and the patients complain dysphagia, regurgitation, chest pain, respiratory symptoms and weight loss. Achalasia’s treatment has been varied over time, from therapies aiming to relax the lower sphincter of the esophagus, including drugs andBotox injection or mechanical dilatations, to surgical myotomy. Robotic or laparoscopic Heller-Dor procedure is considered the gold standard surgical treatment for symptomatic achalasia as it is proved to be effective and safe. As an alternative, Per-Oral Endoscopic Myotomy (POEM) was applied over the past decade, aiming to combine the same results of mini-invasive procedure to the advantages of endoscopic approach. In this study, we are going to compare the medium-long term results of mini-invasive Heller-Dor procedure, routinely performed in our Department, with those of POEM reported in literature

Haemoptysis and fever in a young refugee from Somalia

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Extended Adjuvant Endocrine Treatment in Luminal Breast Cancers in the Era of Genomic Tests

In patients with early-stage endocrine receptor-positive (ER+) breast cancer (BC), adjuvant endocrine therapy (ET) for 5 years is the standard of care. However, for some patients, the risk of recurrence remain high for up to 15 years after diagnosis and extended ET beyond 5 years may be a reasonable option. Nevertheless, this strategy significantly increases the occurrence of side effects. Here we summarize the available evidence from randomized clinical trials on the efficacy and safety profile of extended ET and discuss available clinical and genomic tools helpful to select eligible patients in daily clinical practice

Presence of carbepenemase-producing Enterobacteriaceae in the River Lambro basin, Italy: might sediment represent an important resistance reservoir?

In the last years, the rapid spread in anthropized ecosystems of pathogens which are resistant to carbapenem antibiotics has raised great concern. In this study, KPC-producing Klebsiella pneumoniae was found in the River Lambro in June 2019, whereas KPC-producing Klebsiella oxytoca and Citrobacter braakii were identified in untreated wastewaters. Susceptibility profiles indicated resistance to imipenem, ertapenem and meropenem. Different carbapenamase genes (blaKPC, blaNDM, blaVIM, blaOXA-48) were also found in the River Lambro, although not associated to living bacteria. The presence of a wide set of carbapenemase genes and resistant pathogens show that river sediments could act as a reservoir of antibiotic resistance potentially threatening human health

Long-Term Outcome and Risk Stratification in Dilated Cardiolaminopathies

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The X-Ray Outburst of the Galactic Center Magnetar over Six Years of Chandra Observations

The magnetar SGR J1745−2900, discovered at a distance of parsecs from the Milky Way central black hole, Sagittarius A*, represents the closest pulsar to a supermassive black hole ever detected. Furthermore, its intriguing radio emission has been used to study the environment of the black hole, as well as to derive a precise position and proper motion for this object. The discovery of SGR J1745−2900 has led to interesting debates about the number, age, and nature of pulsars expected in the Galactic center region. In this work, we present extensive X-ray monitoring of the outburst of SGR J1745−2900 using the Chandra X-ray Observatory, the only instrument with the spatial resolution to distinguish the magnetar from the supermassive black hole (2"4 angular distance). It was monitored from its outburst onset in 2013 April until 2019 August, collecting more than 50 Chandra observations for a total of more than 2.3 Ms of data. Soon after the outburst onset, the magnetar emission settled onto a purely thermal emission state that cooled from a temperature of about 0.9–0.6 keV over 6 yr. The pulsar timing properties showed at least two changes in the period derivative, increasing by a factor of about 4 during the outburst decay. We find that the long-term properties of this outburst challenge current models for the magnetar outbursts.N.R., D.V., and A.B. are supported by the H2020 ERC Consolidator Grant “MAGNESIA” under grant agreement No. 817661 (PI: Rea). N.R., F.C.Z., D.V., A.B., and D.F.T. also acknowledge support from grants SGR2017-1383 and PGC2018-095512-BI00. F.C.Z. is supported by a Juan de la Cierva fellowship. A.P. acknowledges financial support from grants ASI/INAF I/037/12/0, ASI/INAF 2017-14-H.0 (PI: Belloni) and from INAF grant “Sostegno alla ricerca scientifica main streams dell’INAF,” Presidential Decree 43/2018 (PI: Belloni). D.H. acknowledges support from the Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant, the Fonds de recherche du Québec–Nature et Technologies (FRQNT) Nouveaux Chercheurs program, and the Canadian Institute for Advanced Research (CIFAR). G.L.I., S.M., and R.T. have been partially supported by PRIN-MIUR 2017. J.A.P. acknowledges support by the Generalitat Valenciana (PROMETEO/2019/071) and by Agencia Estatal de Investigación (PGC2018-095984-B-I00). G.P. is supported by the H2020 ERC Consolidator Grant “Hot Milk” under grant agreement No. 865637. L.S. acknowledges financial contributions from ASI-INAF agreements 2017-14-H.O and I/037/12/0 and from “iPeska” research grant (PI: Andrea Possenti) funded under the INAF call PRIN-SKA/CTA (resolution 70/2016). We acknowledge support from the PHAROS COST Action (CA16214)

Survival of patients with HCV cirrhosis and sustained virologic response is similar to the general population

Background & Aims: Life expectancy of patients with compensated hepatitis C virus (HCV) cirrhosis achieving sustained virologic response (SVR) is limited by liver events as compared to the general population. Thus, survival benefit of SVR remains to be measured. Methods: The study includes prospective surveillance data from three cohorts of Italian patients with compensated HCV cirrhosis who achieved SVR on an interferon-based (IFN) regimen, compared to simultaneously observed non-SVR, untreated and decompensated patients. Overall survival was calculated from the date of start of IFN to death. The number of deaths expected during the at-risk period was determined by applying age-and sex-specific mortality rates recorded in Italy for person-years adequate for the enrolment period. The standardized mortality ratio (SMR) determined the relative risk of death over that of the age and sex matched general population. Results: Overall, 28/181 patients followed-up for a median period of 9.6 years (range 1-25 years) died. The 10 and 20-year overall survival rates for the whole series were 90.9% (95% CI, 84.3-94.8) and 62.9% (95% CI, 45.9-75.9), respectively. The number of expected deaths in the corresponding age and sex matched general population was 28.1, corresponding to a SMR = 1.00 (95% CI, 0.72-1.35), with an SMR for non-SVR patients of 3.85 (95% CI,, for untreated of 3.01 (95% CI, 2.64-3.42) and for decompensated of 6.70 (95% CI,. Conclusions: Patients with compensated HCV cirrhosis achieving SVR by IFN obtain a main benefit levelling their survival curve to that of the general population. Wider applicability of IFN-free regimens will possibly make this achievement more generalizable

A strongly magnetized pulsar within the grasp of the milky way’s supermassive black hole

The center of our Galaxy hosts a supermassive black hole, Sagittarius (Sgr) A∗. Young, massive stars within 0.5 pc of Sgr A∗ are evidence of an episode of intense star formation near the black hole a few million years ago, which might have left behind a young neutron star traveling deep into Sgr A∗’s gravitational potential. On 2013 April 25, a short X-ray burst was observed from the direction of the Galactic center. With a series of observations with the Chandra and the Swift satellites, we pinpoint the associated magnetar at an angular distance of 2.4±0.3 arcsec from Sgr A∗, and refine the source spin period and its derivative (P = 3.7635537(2) s and ˙ P = 6.61(4) × 10−12 s s−1), confirmed by quasi simultaneous radio observations performed with the Green Bank Telescope and Parkes Radio Telescope, which also constrain a dispersion measure of DM = 1750 ± 50 pc cm−3, the highest ever observed for a radio pulsar. We have found that this X-ray source is a young magnetar at ≈0.07–2 pc from Sgr A∗. Simulations of its possible motion around Sgr A∗ show that it is likely (∼90% probability) in a bound orbit around the black hole. The radiation front produced by the past activity from the magnetar passing through the molecular clouds surrounding the Galactic center region might be responsible for a large fraction of the light echoes observed in the Fe fluorescence features.We acknowledge support by grants AYA 2012-39303, SGR2009-811, iLINK 2011-0303, AYA 2010-21097-C03-02, Prometeo 2009/103, AYA2010-17631, P08-TIC-4075, INAF 2010 PRIN grant, Chandra Awards GO2-13076X, G03-14060X, GO3-14099X and G03-14121X, and an EU Marie Curie IEF (FP7-PEOPLE-2012-IEF-331095)

Paclitaxel and concomitant radiotherapy in high-risk endometrial cancer patients: preliminary findings

BACKGROUND: There is still much debate about the best adjuvant therapy after surgery for endometrial cancer (EC) and there are no current guidelines. Radiotherapy (RT) alone does not seem to improve overall survival. We investigated whether concomitant Paclitaxel (P) and RT gave better clinical results. METHODS: Twenty-three patients with high-risk EC (stage IIB, IIIA, IIIC or IC G3 without lymphadenectomy or with aneuploid tumor) underwent primary surgery and were then referred for adjuvant therapy. P was given at a dose of 60 mg/m2 once weekly for five weeks during RT, which consisted of a total radiation dose of 50.4 Gy. Three further weekly cycles of P at a dose of 80 mg/m2 were given at the end of RT. Overall survival and disease-free survival were calculated from the time of surgery. Patterns of failure were recorded by the sites of failure. RESULTS: A total of 157 cycles of P were administered both during radiotherapy and consolidation chemotherapy. Relapses occurred in five patients (21.7%). Median time to recurrence was 18.6 months (range 3–28). Survival rate for all the patients was 78.2%. Overall survival for the patients who completed chemo-radiation was of 81%. In this group median time to recurrence was 19.2 months (range 3–28). All recurrences were outside the radiation field. Mortality rate was 14.2%. CONCLUSION: This small series demonstrates pelvic radiotherapy in combination with weakly P followed by three consolidation chemotherapy cycles as an effective combined approach in high risk endometrial carcinoma patients