Development of an Ex Vivo Organ Culture Technique to Evaluate Probiotic Utilization in IBD

The consistent technical and conceptual progress in the study of the microbiota has led novel impulse to the research for therapeutical application of probiotic bacteria in human pathologies, such as inflammatory bowel disease (IBD). Considering the heterogenous results of probiotics in clinical studies, the model of translational medicine may lead to a more specific and efficacious utilization of probiotic bacteria in IBD. In this regard, the selection and utilization of appropriate experimental models may drive the transition from pure in vitro systems to practical clinical application. We developed a simple and reproducible ex vivo organ culture method with potential utilization for the evaluation of probiotic bacteria efficacy in IBD patients

Application of clinical indexes in ulcerative colitis patients in regular follow-up visit. correlation with endoscopic 'mucosal healing' and implication for management

OBJECTIVE: Ulcerative Colitis (UC) is a chronic inflammatory disease of the colon of unknown etiology. Several clinical indexes have been proposed for UC disease activity evaluation, but none have been properly validated. Moreover, the reference parameter for the scores and their prognostic value is not clear. Mucosal healing has been recently proposed as an important end-point. Aim of the present study was to evaluate the correlation of four clinical indexes with objective diagnostic tools for UC evaluation, the discriminative ability in identifying patients with endoscopic mucosal healing, and to analyze the possible prognostic indication for disease course in 1 year of follow-up. PATIENTS AND METHODS: We analyzed data of 75 patients recorded in regular follow-up visit in IBD clinic at S. Andrea Hospital, Rome, between 2007-2011. We recorded clinical data and lab tests at the time of the visit, and endoscopic/ histological repor ts performed within 1 month. Clinical indexes (Seo' activity index, Simple Clinical Colitis Activity Index, partial Mayo score and Endoscopic-Clinical Correlation Index) were calculated and correlation to endoscopic and histologic activity, and to C-reactive protein increment, was assessed by mean of Spearman's rank correlation. Discriminative ability of the indexes for patients with and without endoscopic mucosal healing was tested by calculation of area under ROC curve (AUC). Patients with low and high clinical scores were compared for number of flares and increment of therapy during 1 year of follow-up. RESULTS: Clinical indexes had a good correlation with endoscopic activity (mean r = 0.73 ± 0.06), a fair correlation with CRP-increment (mean r = 0.55 ± 0.01) and a poor one with histologic activity (mean r = 0.35 ± 0.01). The discriminatory ability of the indexes for endoscopic mucosal healing was good for all the indexes (mean AUC = 0.87 ± 0.05). Patients with high clinical score had more flares and required more frequently increase of therapy at 1 year of follow up compared with patients with low score. CONCLUSIONS: Clinical indexes have a good correlation with endoscopic activity and can discriminate patients with and without mucosal healing. Patients with low and high score have different risk of disease flare and of need to increase therapy at 1 year. Clinical indexes may represent a useful tool for disease assessment in clinical practice in UC outpatients with mildmoderate disease

Italian Validation of the Meaning in Life Questionnaire: Factor Structure, Reliability, Convergent and Discriminant Validity

Several studies highlighted the role of meaning in life as a major component of well-being. Researchers developed different instruments to assess the features of this construct. In the present study the psychometric properties of the Meaning in Life Questionnaire (MLQ; Steger, Frazier, Oishi, & Kaler, 2006) were investigated in the Italian context. The MLQ is a 10-item scale measuring perceived presence of and search for meaning in life, conceptualized as two separate factors. The former refers to perceived meaning and purpose in life, the latter to the active commitment to find meaning in life. Participants were 464 adults aged 20-60 (M=39.34; SD=10.86; 54.7% women). Factor structure was inspected through exploratory and confirmatory factor analyses using a split-sample approach. Internal consistency was assessed through Cronbach\u2019s alphas, inter-item and item-scale correlations. Convergent and discriminant validity with measures of well-being, personality, mental and physical health were also evaluated. Factor analyses supported the adequacy of the MLQ two-factor structure in the Italian context; internal consistency measures corroborated the instrument\u2019s reliability; and correlation matrix coefficients sustained convergent and discriminant validity. Results showed that the MLQ is a valid and reliable measure to assess meaning in life and its relationship with well-being within the Italian context

Sharing optimal experiences and promoting good community life in a multicultural society

This study focused on immigrants' quality of daily experience, sources of well-being and future expectations. Theoretical frameworks were research on cross-cultural adaptation and studies on optimal experience. Participants were 159 first-generation immigrants, who moved to Italy from Africa, India, South America, and Eastern Europe. Data were collected through Flow Questionnaire and Life Theme Questionnaire, providing information on optimal experience and associated activities, present challenges and future goals, and on the quality of experience perceived in daily life domains. Results showed that the occurrence of optimal experiences and the features of the associated activities, as well as perceived challenges and goals were primarily connected with the life opportunities offered by the hosting country, along with participants' cultural distance and length of stay. This suggests that information on optimal experiences, perceived quality of daily life and future goals can be useful in designing programs to support immigrants' psychological well-being and socio-cultural adjustment

Resilience as a moderator between Objective and Subjective Burden among parents of children with ADHD

The caring related challenges reported by parents of children with Attention Deficit and Hyperactivity Disorder (ADHD) were widely investigated. Little information is instead available on the resources mobilized by these parents in facing caring burden. In the attempt to fill this gap, the present study aimed at exploring the moderating role of resilience in the relationship between the amount of time parents of children with ADHD devote to caring tasks (objective burden) and their emotional and social burden (subjective burden). A multidimensional model of resilience was adopted, comprising six components: Self-Perception, Planned Future, Structured Style, Social Competence, Family Cohesion, and Social Resources. Participants were 44 parents (81.8% females, aged 31-53) of children with ADHD (86.4% males, aged 6-14). They completed the Caregiver Burden Inventory, the Resilience Scale for Adults, and the 36-Item Short Form Health Survey. Hierarchical regressions were performed to test the moderating role of resilience as a global construct, and of each resilience dimension separately, on the relation between objective and subjective burden; participants\u2019 gender and mental health scores were employed as control variables. Total resilience, Family Cohesion and Self-Perception emerged as protective factors, weakening the relationship between subjective and objective burden. Findings suggest that the potential of individual and family resources in promoting parents\u2019 adjustment to caring burden could be more effectively exploited in clinical interventions addressed to parents of children with ADHD. Overall, the identification of caregivers\u2019 strengths and resources could help practitioners to better support children with ADHD and their families

Hypergastrinemia and enterochromaffin-like cell hyperplasia.

The enterochromaffin-like (ECL) cells, the most frequent endocrine cells of the oxyntic mucosa of the stomach, are under the trophic stimulus of gastrin. These cells undergo a hyperplastic increase in variety of hypergastrinemic diseases. The most widely accepted nomenclature for the description of hyperplastic proliferation has been retrospectively arranged in a sequence presumed to reflect a temporal evolution of the proliferative process. A comparative, prospective study aimed to verify, in human hypergastrinemic diseases such as atrophic body gastritis (ABG), Zollinger-Ellison syndrome (ZES) and antral gastrin cell hyperfunction (AGCH), the effect of exposure of ECL cells to different pattern of gastrin hypersecretion, is lacking. To this purpose, we studied a series of consecutive patients with ABG, ZES and AGCH at the time of first diagnosis. Material and Methods: The patients included in this study (124 ABG, 18 ZES and 10 AGCH) were selected on the basis of two previously performed screening studies aimed to diagnose these diseases. All patients at the time of diagnosis underwent gastroscopy, with multiple biopsies of the gastric body mucosa for the evaluation of qualitative pattern of ECL cells hyperplasia, and basal fasting gastrin determination. A sample of hypergastrinemic patients from each group was further investigated by meal-stimulation of gastrin secretion and quantitative morphometry for CgA positive gastric body endocrine cells. Results: AGCH patients showed only the normal or simple hyperplasia pattern. In the ZES group, simple and linear grades accounted for 38.4 percent and 46.1 percent, respectively. MEN-I patients showed only these two patterns. The majority of ABG patients showed the presence of micronodular pattern (59.7 percent). A correlation analysis between fasting gastrin levels and grade of hyperplasia (r = 0.5580, p < 0.0001), indicates that the greater the gastrin levels, the higher is the degree of severity of ECL hyperplasia pattern. In conclusion, our data support the role of gastrin as the selective contributor to the progression of ECL cell hyperplasia in humans

The prevalence of pancreatic cystic lesions in patients with liver cirrhosis is double that in controls

Background and aims: Pancreatic cystic lesions (PCLs) are commonly diagnosed incidentally and are often preneoplastic. Their presence may influence the management of patients with chronic diseases such as liver cirrhosis (LC). This study evaluated the prevalence and nature of PCLs in LC patients. Methods: The images of 192 LC patients and 192 controls who underwent either computed tomography scan or nuclear magnetic resonance were reviewed for the presence and nature of PCLs. The prevalence of PCLs in both groups and differences between LC patients with and without PCLs were analysed. Multiple logistic regression analysis was used to investigate factors associated with PCLs. Results: Thirty-five of 192 LC patients (18%) and 19/192 controls (10%) had PCLs (p =.027). The prevalence of presumptive intraductal pancreatic mucinous neoplasm (IPMN) was double in LC patients compared with controls (14% vs 7%; p =.065). In multivariate analysis, age, LC and having undergone a magnetic resonance cholangiopancreatography were factors associated with PCLs and IPMNs. LC patients with PCLs were older at the time of imaging and had a longer history of liver disease (67 vs. 43 months; p = 0.039) compared with LC patients without PCLs. Conclusions: PCLs are more common in LC patients than in controls, and most are IPMNs. The occurrence of PCLs in LC patients seems to be related to age and disease duration

Vitamins D and K as Factors Associated with Osteopathy in Chronic Pancreatitis. A Prospective Multicentre Study (P-BONE Study)

Background: Osteopathy is common in patients with chronic pancreatitis (CP), but previous studies carry several limitations. Vitamin K is essential for bone metabolism, but its role in this setting has never been investigated. Our aim is to assess the prevalence of osteoporosis and osteopenia in CP patients, and to investigate the association between osteopathy and CP features and nutritional parameters, especially vitamin D and K levels. Methods: Multicentre cross-sectional study on CP patients diagnosed according to M-ANNHEIM criteria. Bone density was evaluated by dual-energy X-ray absorptiometry and pancreatic function by faecal elastase. Nutritional evaluation included vitamin D and vitamin K. Differences between patients with or without osteopathy were evaluated. The association between investigated variables and bone density were analysed with logistic regression analysis. Results: In total, 211 CP patients were enrolled at eight Centres (67% men; mean age 60). In total, 18% had advanced-marked CP, 56% suffered from pancreatic exocrine insufficiency and disease aetiology was alcoholic in 43%. Vitamin D and K were deficient in 56% and 32%, respectively. Osteopenia was diagnosed in 42% and osteoporosis in 22%. In the multivariate analysis, female sex (OR 2.78), age (OR 1.07 per year) and higher BMI (OR 0.84) were associated with the presence of osteoporosis. In male patients, the only factor associated with osteoporosis was vitamin K deficiency (OR 4.23). Conclusion: The present data confirm a high rate of osteopathy in CP patients and highlight the relevance of vitamin K deficiency as only factor associated with osteoporosis in male patients for the first time

Chromogranin A as a marker of neuroendocrine neoplasia: an Italian Multicenter Study

Elevated circulating chromogranin A (CgA) levels are found in neuroendocrine tumors (NETS), but the diagnostic usefulness of this marker is still debatable. To assess the role of CgA for the diagnosis of gastroenteropancreatic (GEP) NETS and the identification of metastatic patients, an Italian multicenter observational study has been performed. CgA was evaluated in 202 GEP NET patients by IRMA and ELISA. The cutoffs for diagnosis and presence of metastases were identified by receiver-operating characteristic (ROC) curve. We found good correlation between IRMA and ELISA. The ROC analysis identified a cutoff of 53 ng/ml for IRMA and 16 U/I for ELISA as discriminating between controls and patients with active disease (sensitivity 71.3 and 84%; specificity 71 and 85% respectively). Metastases were present in 123 patients, having significantly higher CgA levels than patients without metastases. ROC analysis identified a cutoff of 146 ng/ml for IRMA and 67.3 U/I for ELISA as discriminating between patients with and without metastases (sensitivity 57 and 63.3%; specificity 55.6 and 71.4% respectively). For pancreatic NETS positive and negative predictive values were 84 and 78% respectively (90% specificity and 68% sensitivity). We found lower CgA levels in patients with extensive metastatic spread than in those with liver metastases only. These data assess the role of CgA evaluation in GEP NETS, and demonstrate that higher CgA levels associate with metastatic disease, confirming that CgA levels can provide a helpful practical biochemical marker for the clinical management of NETS, but with low sensitivity and specificity

Results of surveillance in individuals at high-risk of pancreatic cancer: A systematic review and meta-analysis

Background: Data on surveillance for pancreatic ductal adenocarcinoma (PDAC) in high-risk individuals (HRIs) with “familial pancreatic cancer” (FPC) and specific syndromes are limited and heterogeneous. Objective: We conducted a systematic review and meta-analysis of PDAC surveillance studies in HRIs. Methods: Prevalence of solid/cystic pancreatic lesions and of lesions considered a successful target of surveillance (proven resectable PDAC and high-grade precursors) was pooled across studies. The rate of lesions diagnosed by endoscopic ultrasonography (EUS)/magnetic resonance imaging (MRI) and across different HRI groups was calculated. Results: Sixteen studies incorporating 1588 HRIs were included. The pooled prevalence of pancreatic solid and cystic lesions was 5.8% and 20.2%, respectively. The pooled prevalence of patients with lesions considered a successful target of surveillance was 3.3%, being similar to EUS or MRI and varying across subgroups, being 3% in FPC, 4% in hereditary pancreatitis, 5% in familial melanoma, 6.3% in hereditary breast/ovarian cancer, and 12.2% in Peutz-Jeghers syndrome. The pooled estimated rate of lesions considered a successful target of surveillance during follow-up was 5/1000 person-years. Conclusion: Surveillance programs identify successful target lesions in 3.3% of HRIs with a similar yield of EUS and MRI and an annual risk of 0.5%. A higher rate of target lesions was reported in HRIs with specific DNA mutations