Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis

A previous systematic review reported that topical NSAIDs were effective in relieving pain in chronic conditions like osteoarthritis and tendinitis. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. Studies were identified by searching electronic databases, and writing to manufacturers. We identified randomised, double blind trials comparing topical NSAID with either placebo or another active treatment, in adults with chronic pain. The primary outcome was a reduction in pain of approximately 50% at two weeks, and secondary outcomes were local and systemic adverse events and adverse event-related withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative harm and number-needed-to-harm (NNH) were calculated, and the effects of trial quality, validity and size, outcome reported, and condition treated, were examined by sensitivity analyses. Twelve new trials were added to 13 trials from a previous review. Fourteen double blind placebo-controlled trials had information from almost 1,500 patients. Topical NSAID was significantly better than placebo with relative benefit 1.9 (95% confidence interval 1.7 to 2.2), NNT 4.6 (95% confidence interval 3.8 to 5.9). Results were not affected by trial quality, validity or size, outcome reported, or condition treated. Three trials with 764 patients comparing a topical with an oral NSAID found no difference in efficacy. Local adverse events (6%), systemic adverse events (3%), or the numbers withdrawing due to an adverse event were the same for topical NSAID and placebo. Topical NSAIDs were effective and safe in treating chronic musculoskeletal conditions for two weeks. Larger and longer trials are necessary to fully elucidate the place of topical NSAIDs in clinical practice

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Volatile organic compound emissions in Myzus persicae resistant and susceptible peach cultivars

Volatile compounds from plants play a central role in plant-environment interaction phenomena, being involved in key life processes such as reproduction, defense and communication. They are produced in normal metabolic processes as well as in response to biotic and abiotic stresses. In particular, volatiles exert an important role in shaping plant-insect interactions, for instance acting as pollinators and seed dispersers attractants. The study of plant-insect interaction mechanisms represents an important topic for many scientists, because of the economic implications in agricultural, environmental and ecological fields. Our attention was focused on Volatile Organic Compounds (VOCs) emissions from leaf of different peach cultivars (Prunus persica (L.) Batsch) susceptible or resistant to the green peach aphid, Myzus persicae (Sulzer), one of the major pests in peach farming. A Headspace Solid-Phase-Microextraction coupled with Gas-Chromatography/Mass Spectrometry (HS-SPME-GC/MS) method was used to study the volatile compounds profile emitted from the different peach cultivars. Several differences in emitted VOCs were observed among peach genotipes. Benzaldehyde, (Z)-3-hexenyl acetate, 2-hexenal, methyl benzoate, ethyl benzoate, trans-2-hexen-1-ol were the most abundant volatile compounds isolated from the sample headspaces. Many of these compounds are known as Green Leaf Volatiles (GLV) typically released from damaged leaves and used as kairomones by many herbivorous insects for host plant location. Benzaldehyde, 2-hexenal, trans-2-hexen-1-ol and trans-caryophyllene showed a decreasing trend from the resistant to the susceptible genotypes; at the opposite, 3-hexen-1-ol acetate seems to be higher in the susceptible genotypes. This approach could give a contribute in finding new strategies to limit insect pests in an ecologically friendly way, improving both environment and production quality

Characterization of “in vivo” sampled VOCs of Bixa orellana and its seeds extracts properties

The purpose of this study was to identify the volatile organic compounds (VOCs) profile of different organs of Bixa orellana plants sampled \u201cin vivo\u201d in the North of Par\ue1 State, Brazil. Sampling was done during an expedition on February 2011 within the Itaputyr project, an Italian-Brazilian experience of bottom-up cooperation for development. (1,2). Moreover, antioxidant capacity, phenolic content and insect repellent activity of powdered seeds extracts (aqueous and ethanolic) were tested. Branches, leaves, fruits and seeds were sampled "in vivo" using Divinylbenzene/Carboxen/Polydimethylsiloxane (DVB/CAR/PDMS) fibers with the HS-SPME technique. Each plant\u2019s part was enclosed in a customised teflon cage (manufactured by SNK, Inc, Fullerton, CA: 11 x 21 cm) into which a manual SPME holder was inserted to extract the headspace. HS-SPME analyses were performed using a Trace GC Ultra Gas Chromatograph coupled to a quadrupole Mass Spectrometer Trace DSQ (Thermo-Fisher Scientific; Waltham, MA, USA). Volatile compounds detected in Bixa orellana seed headspace consisted mainly of sesquiterpenes, monoterpenes, and arenes. Most monoterpenes and sesquiterpenes have been previously detected in other spices and plants (3). \u3b1-humulene is the major volatile present in Bixa orellana seed extracts followed by D-germacrene, \u3b1-and \u3b2-pinene and \u3b3-elemene. Some of the monoterpenes and sesquiterpenes found in plant extracts have been previously described as having antimicrobial and repellent properties (4). Phenolic content and antioxidat capacity, evaluated with Folin-Ciocalteur and DPPH tests respectively, were not so high, while preliminary data on repellency against Aedes aegypti of three different dried seeds extracts (ethanol, hexane, ethanol /water) indicated a significant activit

Ethnobotanical study of medicinal plants traditionally used in the North of Pará State, Brazil

Traditional knowledge about the use of natural resources is becoming increasingly important in defining the basis of sustainable strategies and actions for conservation, valorization and development of rural and marginal areas. In this study is presented an ethnobotanical survey on medicinal plants used by an Indio tribe leaving in the Amazon rainforest, in the North of Brazil inside the Indigenous Reserve Alto Rio Guam\ue0, Par\ue0 state. First step has been conducted by collecting information directly from the Indio Temb\ue8 population, during an expedition on February 2011, done within the Itaputyr project, an Italian-Brazilian experience of bottom-up cooperation for development (1,2). The methods of participant observation, semi-structured interviews and informal discussions with indigenous people and plant specialists were used. 10 different medicinal plant species commonly used by natives resulted to be interesting for further investigations. Andira anthelmintica, Bauhinia forficata, Bauhinia splendens, Bixa orellana, Copaifera langsdorfii, Parahancornia fasciculata, Pilocarpus jaborandi, Ptychopetalum olacoides, Stryphnodendron adstringens, Symphonia globulifera were analysed to verify antioxidant capacity and phenol content using DPPH. and Folin-Ciocalteau assay respectively. Characterization of volatile compounds of Andira anthelmintica, Ptychopetalum olacoides and Bauhinia splendens by SPME-GC/MS was also conducted. Almost all investigated plant species resulted to be good sources of phenolic compounds with high antioxidant capacity as compare to other plant species (3). Sustainable harvesting method and domestication of the highly used or traded species could be proposed in the study area to preserve biodiversity and also to create a sustainable development opportunity for Indio population based on traditional knowledge

Secondary metabolites and antioxidant capacities of Waldheimia glabra (Decne.) Regel from Nepal

BACKGROUND: The phenolic content, volatile compound fingerprint and antioxidant capacity of Waldheimia glabra (Decne.) Regel (Asteraceae), a wild plant from the Himalayan mountains used in Sherpa religious rituals and in traditional medicine, were determined for the first time to investigate its suitability as a source of natural antioxidants. RESULTS: The total phenolic content and antioxidant capacity of dried and powdered plants from two different altitudes (5000 and 5200mabove sea level) in Khumbu Valley, Nepalwere estimated by the Folin\u2013Ciocalteu and 2,2-diphenyl-1-picrylhydrazyl radical methods respectively. The volatile organic compound (VOC) fingerprints from leafing plants (in vivo and in situ VOC sampling) and from dried plant samples were evaluated by headspace solid phase microextraction. The results indicated that W. glabra was a good source of phenolics with antioxidant properties. A correlation between total phenolic content and antioxidant capacity was found (r2 = 0.9111). Seychellene, a volatile compound that characterises patchouli oil, was detected for the first time in a species of the Asteraceae family. CONCLUSION: Waldheimia glabra was proved to be a good source of antioxidants, partially supporting its traditional uses. Further studies aimed at deepening knowledge on W. glabra bioactivity and its possible useswill be of interest, considering the lack of proper scientific awareness regarding these aspects

COMPARISON OF VOLATILE COMPOUNDS INDUCED BY APHIDS AND MECHANICAL DAMAGE IN ACHILLEA COLLINA

This work describes the application of a Headspace Solid-Phase Microextraction method (HS-SPME) to characterize the volatile organic compounds (VOCs) emitted in vivo by Achillea collina plants infested by the aphid species Myzus persicae. VOCs induced by mechanical damage simulating the aphid\u2019s damage were also investigated. Many volatiles appeared as new compounds after infestation as well as after mechanical damage. In particular, among terpenes we found \u3b1- fenchene, cis\u3b2-terpinol, pinocarvone, aromadendrene, iso-caryophyllene, Dgermacrene and \u3b1-patchoulene. (3Z)-hex-3-enyl acetate was the most abundant volatile compound isolated in mechanically damaged plants. New insight in plantinsect interaction may positively reflect on new pest and crop management strategies in the future

Comparative evaluation of VOCs emitted by Achillea collina infested by aphids and mechanically damaged

Plants along the centuries evolved wide range of mechanisms to cope with biotic and abiotic stresses, including the emission of induced volatile organic compounds (VOCs), whose production is trigged by mechanical damage or pathogen infestation of plant tissues, providing them defensive tools (Arimura et al. 2005). This study focuses on VOCs emitted by Achillea collina Becker ex Rchb. as a results of aphid infestation and mechanical damages. In particular it takes account of differences between compounds induced by the generalist Myzus persicae (Sulzer), the specialist Macrosiphoniella millefolii DeGeer aphid species infestation and two different types of mechanical injury (pin shoot and extended pressure). Headspace Solid-Phase-Microexctraction-Gas Chromatography-Mass Spectrometry (HS-SPME-GC/MS) \u201cin vivo\u201d method was used to evaluate A. collina VOCs. We observe, in both aphids infestation a decrease of trans-2-hexenal associate with an increase of 2-hexen-1-ol and 1-hexanol, suggesting the activation of the methabolic pathway that leads to production of green leaf volatile compounds (Gatehouse 2002). The same result was recorded in mechanically induced damages suggesting that in A. collina the production of these compounds is a non specific response to induced both by mechanically and aphids provoked injuries. Furthermore a decrease of some terpenes (\u3b2 and \u3b3-pinene) and the increase of others (\u3b1-phellandrene and isocaryophyllene) were recorded. The involvement of significantly varying compounds in tritrophic interaction mechanisms is also discussed

P220 DEVELOPMENT OF A NEW PSYCHOLOGICAL TOOL TO IMPROVE PATIENT ABILITIES TO DEAL WITH ESOPHAGECTOMY: PRELIMINARY RESULTS

Aim This study aims to create a tool for evaluation of patient ability to deal with postoperative course after esophagectomy for cancer. Background & Methods Esophagectomy requires patient to be active and compliant to face up to postoperative impairments. Health related quality of life (HRQoL) data in short and medium-term after surgery show that competences used by patients are not appropriate. Lack of patient abilities to manage postoperative course influences patient recovery and reduces HRQoL. Psychological analysis of patient clinical needs was conducted to identify peculiar patient competences involved after esophagectomy. Four competences (future forethought; context evaluation; consequences of own actions forethought; use of available resources), each relevant to four areas (clinical; familiar; working; daily-activities) were identified and converted in open-ended questions to assess patient level of skills: a 16 questions structured interview was composed. From April to June 2019 we performed a feasibility study on 18 consecutive patients between 3rd and 15th postoperative day. They underwent esophagectomy for esophageal or esophagogastric junction cancer in two high volume centers. Patients with metastasis, with language problems due to neurological impairment or age <18 were excluded. M.A.D.I.T.-Methodology of Computerized Textual Data Analysis (University of Padua) was used. Results Each interview was administered orally to all patients and took 15 minutes. 5 questions were asked to be repeated. No complaints or negative comments were received. Non-responding percentage was 0,4% (one question in one interview). Textual corpus was composed of 3210 words, passable of analysis. No differences between postoperative days administration were found. M.A.D.I.T. analysis showed that answers were adequate and pertinent and allowed us to stratify patients in three different levels of competences (low, median, high). No need of additional competences or areas was observed. Conclusion This new psychological tool shows content validity, adequacy and pertinence to the study aim. It is understandable, easy, quick to be answered during any postoperative day and useful to identify patients with low abilities to deal with esophagectomy. Therefore a multicentric study will be conducted to use this tool further in multiple-choice format with a larger number of patients, in order to identify which patients will benefit of psychological intervention for HRQoL improvement