Integrative Hematology: State of the Art

Blood cancers are a group of diseases with thus far frequently poor prognosis. Although many new drugs, including target therapies, have been developed in recent years, there is still a need to expand our therapeutic armamentarium to better deal with these diseases. Integrative hematology was conceived as a discipline that enriches the patient’s therapeutic possibilities with the use of supplements, vitamins and a nutritional approach aiming at improving the response to therapies and the clinical outcome. We will analyze the substances that have proved most useful in preclinical and clinical studies in some of the most frequent blood diseases or in those where these studies are more numerous; the importance of the nutritional approach and the role of the intestinal microbiota will also be emphasized

Serum osteoprotegerin and renal osteodystrophy

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Integrated Cancer Treatment in the Course of Metastatic Pancreatic Cancer: Complete Resolution in 2 Cases

Pancreatic cancer (PC) has a very low average survival, but its prognosis is further reduced in the case of metastatic spread. Medical therapy in these cases is the only applicable methodology in the international guidelines. During anticancer treatments, common side effects are nausea, vomiting, arthralgia, neuropathy, and alopecia as well as a myelosuppressive effect. The toxicity of various drugs not only affects the quality of life of the patient, but often its severity requires a reduction in if not the termination of drug administration. Scientific studies have shown that a combined use of chemotherapy and certain natural substances, in the form of standardized extracts, can lead to an enhancement of the action of the chemotherapy. Here, we describe 2 cases of metastatic PC. The first case concerns the integrated treatment of a patient with cancer of the pancreas tail with metastatic involvement ab initio of peripancreatic lymph nodes and liver parenchyma, with numerous secondary lesions greater than 9.5 cm. The second case concerns the integrated treatment of a patient with cancer of the pancreatic body with metastatic involvement of the liver parenchyma, with a small secondary lesion. In both cases, an integrated cancer treatment approach, combining chemotherapy with natural remedies, extracts, and hyperthermia, induced a notable remission of primary and metastatic lesions

Prevalence of demoralization and depressive symptoms in a sample of patients with supraventricular tachyarrhythmias: preliminary results

IntroductionSupraventricular tachyarrhythmias (ST) are the most common cardiac arrhythmias. Little is known about the potential impact of demoralization, which is considered as partially distinct from depression, on the course of ST. A correct assessment of both depressive symptoms and demoralization appears relevant for the treatment of these cardiac diseases, potentially influencing their course.MethodsThe sample consisted of 110 subjects affected by different ST, such as atrial fibrillation (AF), atrial flutter (AFL) and paroxysmal supraventricular tachycardia (PSVT). They all underwent a psychiatric evaluation; the Italian version of 9-item Patient Health Questionnaire (PHQ-9) and the Italian version of Demoralization Scale (DS) were administered. Descriptive statistics, pairwise comparisons, and correlational analysis have been implemented.Results26 individuals (23.6%) presented high levels of demoralization. Of these, 20 (76.9%) had a diagnosis of AF and six patients (23.1%) received a diagnosis of other ST. No differences in demoralization levels resulted in regard of sex, cardiac diagnoses and anticoagulant therapies. Amongst people with high levels of demoralization, 13 (50%) received no formal psychiatric diagnosis, and 12 (46.2%) showed moderate/severe depressive symptoms. Demoralization levels and PHQ-9 scores showed a significant positive correlation in the whole sample (r=0.550, p<0.001).DiscussionThe present study found that in a sample of patients suffering from ST, high levels of demoralization were more frequent than clinically relevant depressive symptoms. We propose that demoralization and depression show partially distinguished psychopathological features, potentially associated with different therapeutic trajectories

Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review

Objectives Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care. The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD. Methods A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed. Results Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression. Conclusion Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review

Enhancing Palliative Care With Mindful Touch: Impact of a Manual and Movement Therapy Training Program in an International Multidisciplinary Integrative Oncology Setting

Context. Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training

The Combination of AHCC and ETAS Decreases Migration of Colorectal Cancer Cells, and Reduces the Expression of LGR5 and Notch1 Genes in Cancer Stem Cells: A Novel Potential Approach for Integrative Medicine

none12noThe AHCC standardized extract of cultured Lentinula edodes mycelia, and the standardized extract of Asparagus officinalis stem, trademarked as ETAS, are well known supplements with immunomodulatory and anticancer potential. Several reports have described their therapeutic effects, including antioxidant and anticancer activity and improvement of immune response. In this study we aimed at investigating the effects of a combination of AHCC and ETAS on colorectal cancer cells and biopsies from healthy donors to assess the possible use in patients with colorectal cancer. Our results showed that the combination of AHCC and ETAS was synergistic in inducing a significant decrease in cancer cell growth, compared with single agents. Moreover, the combined treatment induced a significant increase in apoptosis, sparing colonocytes from healthy donors, and was able to induce a strong reduction in migration potential, accompanied by a significant modulation of proteins involved in invasiveness. Finally, combined treatment was able to significantly downregulate LGR5 and Notch1 in SW620 cancer stem cell (CSC) colonospheres. Overall, these findings support the potential therapeutic benefits of the AHCC and ETAS combinatorial treatment for patients with colorectal cancer.openPaganelli, Francesca; Chiarini, Francesca; Palmieri, Annalisa; Martinelli, Marcella; Sena, Paola; Bertacchini, Jessika; Roncucci, Luca; Cappellini, Alessandra; Martelli, Alberto M; Bonucci, Massimo; Fiorentini, Carla; Hammarberg Ferri, IvanoPaganelli, Francesca; Chiarini, Francesca; Palmieri, Annalisa; Martinelli, Marcella; Sena, Paola; Bertacchini, Jessika; Roncucci, Luca; Cappellini, Alessandra; Martelli, Alberto M; Bonucci, Massimo; Fiorentini, Carla; Hammarberg Ferri, Ivan

Diagnosi differenziale "difficile" fra liposarcoma ben differenziato gigante e lipoma tipico gigante retroperitoneale. caso clinico e revisione della letteratura

OBIETTIVI. Il LipoSarcoma Ben Differenziato (LSBD) retroperitoneale è un raro tumore mesenchimale, indolente, a origine multicentrica e diagnosi tardiva. In assenza di dedifferenziazione è privo di potenziale metastatico. È spesso difficile distinguere il LSBD dal lipoma tipico (LT). Il decorso clinico è scarsamente influenzato dalla natura della lesione ma dipende dal progressivo aumento di volume. TC e RM sono fondamentali per diagnosi e stadiazione. La resezione chirurgica è il trattamento di prima scelta ma a causa della sede anatomica è spesso difficile ottenere margini chirurgici microscopicamente indenni. Per tale motivo la percentuale di recidiva locale è elevata. Il follow-up consiste in controlli clinico strumentali nel tempo per evidenziare precocemente recidive locali o metastasi a distanza. In caso di malattia non resecabile o metastatica adriamicina, docetaxel e gemcitabina sono utilizzati come chemioterapici palliativi. MATERIALI E METODI. Pz di 53aa, diagnosi ecografica incidentale di voluminosa massa solida epimesogastrica, ipoecogena. All’esame fisico addome disteso nei quadranti sup, neoformazione palpabile a limiti indefiniti, indolente. Alla TC massa di densità adiposa, diametro di 18x12cm senza significativo enhancement dopo mdc, origine retroperitoneale a ridosso del pancreas, delle fasce renali e della porzione trasversa del duodeno, modicamente compresso, con sottile capsula interrotta in prossimità della fascia renale dx. Anteriormente un sottile piano di clivaggio la separa dal peritoneo parietale. Disloca le anse intestinali nelle docce parietocoliche, ingloba tripode celiaco, a mesenterica sup ed inf, a colica sx, aa sigmoidee e i corrispondenti tronchi venosi. Alla laparotomia lesione giallastra a esteso contatto con la parete addominale ant. Si eseguiva biopsia di 1.5×0.5x1cm. Reperto istologico di tessuto adiposo maturo congesto, fenomeni liponecrotici, tessuto mixoide con lipoblasti e microcalcificazioni distrofiche, compatibile con LSBD. Sottoposto alla revisione della Rete Nazionale Tumori Rari il reperto istologico risultava non diagnostico. Al followup a 6 e 12 mesi modesto aumento della distensione addominale e delle dimensioni della lesione alla TC (22×12.5cm).CONCLUSIONI. Il caso riportato conferma la difficoltà nella diagnosi differenziale fra LSBD e LT gigante retroperitoneale. Il reperto istologico non è stato considerato sufficiente, nonostante il quadro clinico e strumentale fossero altamente suggestivi. Nell’impossibilità di una diagnosi di certezza, il pz è stato sottoposto a follow-up clinico e strumentale ogni 6 mesi. Il coinvolgimento del tripode celiaco, dei vasi mesenterici sup. ed inf. ha rappresentato controindicazione assoluta all’intervento demolitivo con intento di radicalità, la cui morbilità e mortalità sarebbe risultata superiore ai benefici di una sopravvivenza libera da malattia. Ad oggi non esiste un regime chemioterapico in grado di migliorare la sopravvivenza