A prospective study on survival in cancer patients with and without venous thromboembolism

Retrospective population-based studies showed that in cancer patients venous thromboembolism (VTE) is associated with reduced survival. Master Oncology is a multicenter study in patients with solid advanced cancer aimed at assessing (1) risk factors for VTE using a case-control design, and (2) survival in cases (patients with VTE) and controls (patients without VTE). Survival data were prospectively collected for at least 10 months. Overall, 237 cases and 339 controls were included in the analysis. The following factors were found to be associated with an increased risk of VTE: body mass index (BMI; OR 2.02; 95% CI 1.31-3.12 for 6526 vs. <23 kg/m(2)), ECOG score (OR 2.14; 95% CI 1.47-3.11 for grade 1, and 3.32; 95% CI 1.64-6.00 for grade 2-3, compared to grade 0) and recent diagnosis of cancer (OR 1.90; 95% CI 1.33-2.71 for <12 vs. 6512 months). After an average prospective observation of 8.3 months, 136 cases (57.4%) and 127 controls (37.5%) died with a median survival of 8.7 (95% CI 7.5-10.9) and 14.3 months (95% CI 12.2-18.7), respectively, (Wilcoxon = 27.72, p < 0.001; multivariate hazard ratio 1.55; 95% CI 1.21-2.00). Median survival time was reduced for both patients with symptomatic (Wilcoxon = 35.22, p < 0.001) and asymptomatic VTE (Wilcoxon = 4.63, p = 0.031). Patients with advanced solid cancer, high BMI, high ECOG score, and recent diagnosis of cancer are associated with an increased risk for VTE. Patients with both symptomatic and asymptomatic VTE have a reduced survival compared to those without VTE

Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo

The need for Class I and II studies on the efficacy of Semont's liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix-Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B

Analysis of the Expression and Single-Nucleotide Variant Frequencies of the Butyrophilin-like 2 Gene in Patients With Uveal Melanoma

IMPORTANCE Chromosome 6p amplification is associated with more benign behavior for uveal melanomas (UMs) with an otherwise high risk of metastasis conferred by chromosome 3 monosomy. Chromosome 6p contains several members of the B7 family of immune regulator genes, including butyrophilin-like 2 (BTNL2; OMIM, 606000), which is associated with prostate cancer risk and autoimmune diseases. OBJECTIVE To investigate the expression and variant allele frequencies of BTNL2, a candidate gene for chromosome 6 amplification, in patients with UM. DESIGN, SETTING, AND PARTICIPANTS In this case-control study,we analyzed the expression of BTNL2 in UM cell lines and human macrophages in patients with UM. Variants of BTNL2 were analyzed using probes for polymerase chain reaction and high-resolution melting. The association of missense variants rs28362679 and rs41441651 with tumor risk was analyzed in 209 patients with UM and 116 matched control patients as well as 12 UM and 64 other tumor cell lines. Genes that were differentially expressed in M1- and M2-polarized macrophages were identified by microarray analysis of 111 patients with UM, and the association of the expression of these genes with disease-free survival was analyzed by Cox regression analysis. Data were collected from September 2013 to November 2015. MAIN OUTCOMES AND MEASURES Butyrophilin-like 2 single-nucleotide variantswere associated with UM risk; M1 and M2 macrophage-specific gene expression was associated with disease-free survival. RESULTS We genotyped a total of 325 patients. Of the 209 patients with UM, 124 (59.3%) were male, 114 (54.5%) were Italian, and 95 (45.5%) were German; the mean (range) age was 65 (27-94) years. Of the 116 Italian control patients, 67 (57.8%) were female, and the mean (range) age was 39 (21-88) years. Butyrophilin-like 2 is expressed in patients with UM and macrophages. The frequency of the rs28362679 variant was higher in patients with UM (16 of 209 [7.7%]; 95%CI, 4.7-12.2) than frequencies from European Variation Archive and Exome Aggregation Consortium data (2134 of 118 564 [1.8%]; 95%CI, 1.7-1.9) and Exome Sequencing Project data (100 of 4540 [2.2%]; 95%CI, 1.8-2.7) but were not higher compared with Italian control patients (10 of 116 [8.6%]; 95%CI, 4.6-15.4). The rs41441651 variant was present in 5 patients with UM (2.4%; 95%CI, 0.9-5.7), 2 Italian control patients (1.7%; 95%CI, 0.1-6.5), 2846 patients from European Variation Archive and Exome Aggregation Consortium data (2.4%; 95%CI, 2.3-2.5), and 23 patients from Exome Sequencing Project data (0.5%; 95%CI, 0.3-0.8). Human UM cells express M1 and M2 macrophage-specific genes, whose expression is associated with disease-free survival. CONCLUSIONS AND RELEVANCE Butyrophilin-like 2, expressed at various levels by UM cells and macrophages, might interfere with the immune control of the tumor. Butyrophilin-like 2 variants showed highly variable frequencies among ethnically related cohorts. There was noenrichment of BTNL2 variants in patients with UM compared with control patients

WSES Guidelines for emergency repair of complicated abdominal wall hernia

46nonerestrictedMassimo Sartelli; Federico Coccolini; Gabrielle H van Ramshorst; Giampiero Campanelli; Vincenzo Mandalà; Luca Ansaloni; Ernest E Moore; Andrew Peitzman; George Velmahos; Fredrick Alan Moore; Ari Leppaniemi1; Clay Cothren Burlew; Walter Biffl; Kaoru Koike1; Yoram Kluger; Gustavo P Fraga; Carlos A Ordonez; Salomone Di Saverio; Ferdinando Agresta; Boris Sakakushev; Igor Gerych; Imtiaz Wani; Michael D Kelly; Carlos Augusto Gomes; Mario Paulo Faro; Korhan Taviloglu; Zaza Demetrashvili; Jae Gil Lee; Nereo Vettoretto; Gianluca Guercioni; Cristian Tranà; Yunfeng Cui; Kenneth YY Kok; Wagih M Ghnnam; Ashraf El-Sayed Abbas; Norio Sato; Sanjay Marwah; Muthukumaran Rangarajan; Offir Ben-Ishay; Abdul Rashid K Adesunkanmi; Helmut Alfredo Segovia Lohse; Jakub Kenig; Stefano Mandalà; Andrea Patrizi; Rodolfo Scibé; Fausto CatenaMassimo, Sartelli; Federico, Coccolini; van Ramshorst, Gabrielle H.; Campanelli, GIAMPIERO GIORGIO SALVATORE CIRO; Vincenzo, Mandalà; Luca, Ansaloni; Moore, Ernest E.; Andrew, Peitzman; George, Velmahos; Fredrick Alan Moore, ; Ari, Leppaniemi1; Clay Cothren Burlew, ; Walter, Biffl; Kaoru, Koike1; Yoram, Kluger; Fraga, Gustavo P.; Ordonez, Carlos A.; DI SAVERIO, Salomone; Ferdinando, Agresta; Boris, Sakakushev; Igor, Gerych; Imtiaz, Wani; Kelly, Michael D.; Carlos Augusto Gomes, ; Mario Paulo Faro, ; Korhan, Taviloglu; Zaza, Demetrashvili; Jae Gil Lee, ; Nereo, Vettoretto; Gianluca, Guercioni; Cristian, Tranà; Yunfeng, Cui; Kenneth YY Kok, ; Ghnnam, Wagih M.; Ashraf El Sayed Abbas, ; Norio, Sato; Sanjay, Marwah; Muthukumaran, Rangarajan; Offir Ben Ishay, ; Adesunkanmi, Abdul Rashid K.; Helmut Alfredo Segovia Lohse, ; Jakub, Kenig; Stefano, Mandalà; Andrea, Patrizi; Rodolfo, Scibé; Fausto, Caten

Multiple primary melanomas (MPMs) and criteria for genetic assessment: MultiMEL, a multicenter study of the Italian Melanoma Intergroup

Multiple primary melanoma (MPM), in concert with a positive family history, is a predictor of cyclin-dependent kinase (CDK) inhibitor 2A (CDKN2A) germline mutations. A rule regarding the presence of either 2 or 3 or more cancer events (melanoma and pancreatic cancer) in low or high melanoma incidence populations, respectively, has been established to select patients for genetic referral

Correlation of BRAF mutational status with clinical characteristics and survival outcomes of patients with ameloblastoma: the experience of 11 Italian centres

Background: Ameloblastoma is a rare odontogenic tumor with an aggressive local behavior. Mutations in the mitogen-activated protein kinase (MAPK) pathway, namely BRAF V600E mutations, are a common finding. To date there is no clear correlation between BRAF V600 mutation and clinical outcome. Methods: We retrospectively reviewed records of all patients undergoing surgery for ameloblastoma between February 2017 and March 2019 at 11 participating Italian centers. The primary endpoints of the study were to determine the BRAF mutational status in primitive and relapsed ameloblastoma, and to assess the relapse free interval (RFI); the secondary endpoint was to investigate the correlation of BRAF mutational status with clinical characteristics and survival outcomes. Results: Overall, 74 patients were included: 33 (44.5%) were BRAF wild type and 41 (55.4%) BRAFV600 mutated. BRAFV600 mutated ameloblastomas were more frequently in younger patients (p=0.0031), located at mandible site (p=0.0009), and with unicystic histotype. After a median follow up of 60 months, 21 (28.3%) patients relapsed (30.3% and 26.8% of in the BRAF wild type and BRAF mutated cases, respectively). At univariable Cox models, none of the analyzed variables, including microscopic margin involvement, appeared to be correlated with RFI. Conclusions: Local recurrence occurs in 30% of patients with ameloblastoma. BRAFV600 mutation is associated with younger age, a mandible site of the disease and with unicystic histotype. Neither BRAF mutation nor microscopic involved margins are associated with RFI. Further studies are needed to elucidate outcomes of this rare disease according to clinical, histopathological and comprehensive molecular features