Adrenomedullin in pancreatic carcinoma. a case-control study of 22 patients

Pancreatic carcinoma is a leading cause of cancer-related death. Reduction of the diagnostic delay is mandatory. Adrenomedullin (AM) is overexpressed in pancreatic cancer. A case-control study including 12 patients with pathological diagnosis of pancreatic carcinoma and 10 healthy controls was conducted at our Institution. Blood samples were obtained at the time of hospitalization and post-operatively for cases. Controls’ samples were obtained from healthy volunteers. AM was measured by using enzyme immunoassay method. AM showed significant increase in pancreatic carcinoma patients vs controls (4.51 ng/ml vs 1.91 ng/ml, p value = 0.04) regardless of tumor stage, differentiation, resecability/unresecability, diabetes. A cut-off of 1.75 ng/ml reaches a sensibility of 83% and a specificity of 70% (p value = 0.0147; CL 95%; AUC 0.767). The increase of AM didn’t correlate with the increase of other common tumor markers (CA 19-9 and CEA), nor direct bilirubin. These data confirm the utility of studying the role of AM in pancreatic cancer, in order to achieve an early diagnosis in high risk populations

Management of duodenal stump fistula after gastrectomy for gastric cancer: systematic review

AIM: To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer. METHODS: A systematic review of the literature was performed. PubMed, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and UpToDate databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients' characteristics, type of treatment, short and long-term outcomes were extracted and analyzed. RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach (3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodeno-jejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy (32 cases) and percutaneous biliary diversion (13 cases). The median healing time in this group was 43 d. CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail

Immagine contro natura

Qual è il rapporto tra immagine e natura nella cultura contemporanea? Poche vicende sono in grado di riassumere, in breve, la parabola percorsa nella modernità di questo rapporto come quella cui è andata incontro la parola panorama. Oggi, anche se molti continuano ad usare questo termine come equivalente di paesaggio, pochi sanno che il ‘panorama’ nacque, alla fine del Settecento, per indicare uno «spettacolo ottico» destinato a riscuotere grande successo lungo tutto il secolo seguente: il ‘panorama’ era, in origine, una grande tela dipinta, disposta a trecentosessanta gradi intorno a uno spettatore. Nel corso dell’Ottocento, le foto presero gradatamente il posto della pittura, nei panorami, fino a che, all’inizio del Novecento, le nuove forme di riproduzione dell’immagine, come il cinema, resero obsoleto questo tipo di spettacolo. Ma non la parola, che era già transitata a indicare la cosa naturale osservata e non più l’apparecchio destinato a riprodurla, la realtà e non la rappresentazione. Ed è proprio questo passaggio, per cui l’immagine soppianta la natura, la sostituisce, si pone al suo posto, ed impedisce un rapporto reale con la cosa rappresentata, ciò che si impone a chi prende a considerare il rapporto tra immagine e natura nel mondo contemporaneo. A partire dalla seconda metà del Novecento, molti artisti hanno cercato di dare attraverso le loro opere delle esperienze del nostro rapporto con la natura, o, per meglio dire, di trasformare in opera la propria esperienza della natura. Un tratto accomuna le esperienze dei land artist americani degli anni Sessanta con quelle dell’arte ambientale europea dei decenni successivi: il fatto che entrambe hanno compreso che il patto mimetico che legava l’arte alla natura è andato in pezzi e che nulla è più vano che cercare di ricomporlo, ragione per cui l’arte non potrà recuperare un legame con la natura riproducendola, ma solo operando all’interno di essa. Tuttavia, il necessario ricorso, da parte degli artisti, ai mezzi di comunicazione visiva, come fotografie e video, per documentare e divulgare le loro opere, spesso realizzate in luoghi sperduti ed inaccessibili ai più, ha determinato un vero e proprio paradosso: un’arte che era nata in antitesi all’immagine torna ad essere pura immagine.

Recurrence following anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction. a systematic review

BACKGROUND: Esophageal cancer is the ninth most common cancer. The only potentially curative treatment is surgical resection, which unfortunately is still associated with major complications, the most important being anastomotic leakage, currently with an overall rate of up to 26% morbidity. The aim of this systematic review was to evaluate the relationship between anastomotic leakage and recurrence of disease. MATERIALS AND METHODS: A literature search was systematically performed. Seven out of 312 articles dated between 2009 and 2018 fulfilled the selection for a total of 5,433 patients. RESULTS: The frequency of anastomotic leakage ranged from 7.2 to 11.2%. Patients affected by anastomotic leakage had a recurrence rate of 9-56%. CONCLUSION: Closer follow-up or even more aggressive oncological therapy should be considered for patients affected by anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction

Measurement and Numerical Modeling of Cell-Free Protein Synthesis: Combinatorial Block-Variants of the PURE System

Protein synthesis is at the core of bottom-up construction of artificial cellular mimics. Intriguingly, several reports have revealed that when a transcription–translation (TX–TL) kit is encapsulated inside lipid vesicles (or water-in-oil droplets), high between-vesicles diversity is observed in terms of protein synthesis rate and yield. Stochastic solute partition can be a major determinant of these observations. In order to verify that the variation of TX–TL components concentration brings about a variation of produced protein rate and yield, here we directly measure the performances of the 'PURE system' TX–TL kit variants. We report and share the kinetic traces of the enhanced Green Fluorescent Protein (eGFP) synthesis in bulk aqueous phase, for 27 combinatorial block-variants. The eGFP production is a sensitive function of TX–TL components concentration in the explored concentration range. Providing direct evidence that protein synthesis yield and rate actually mirror the TX–TL composition, this study supports the above-mentioned hypothesis on stochastic solute partition, without excluding, however, the contribution of other factors (e.g., inactivation of components)

Extrinsic stochastic factors (solute partition) in gene expression inside lipid vesicles and lipid-stabilized water-in-oil droplets: a review

Abstract The encapsulation of transcription–translation (TX–TL) machinery inside lipid vesicles and water-in-oil droplets leads to the construction of cytomimetic systems (often called 'synthetic cells') for synthetic biology and origins-of-life research. A number of recent reports have shown that protein synthesis inside these microcompartments is highly diverse in terms of rate and amount of synthesized protein. Here, we discuss the role of extrinsic stochastic effects (i.e. solute partition phenomena) as relevant factors contributing to this pattern. We evidence and discuss cases where between-compartment diversity seems to exceed the expected theoretical values. The need of accurate determination of solute content inside individual vesicles or droplets is emphasized, aiming at validating or rejecting the predictions calculated from the standard fluctuations theory. At the same time, we promote the integration of experiments and stochastic modeling to reveal the details of solute encapsulation and intra-compartment reactions

Cancer rate of the indeterminate lesions at low or high risk according to italian system for reporting of thyroid FNA

Background: Italian consensus for the classification and reporting of thyroid cytology (ICCRTC) has been used in almost all Italian institutions since 2014. High reliability of ICCRTC in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively) was demonstrated. Here we reviewed our casuistry of thyroid indeterminate lesions to analyze the histologic outcome. Methods: All lesions undergone FNA and final histology at S. Andrea Hospital of Rome after a cytologic assessment of Tir 3A and Tir 3B, according to ICCRTC, were included in the study. Results: A number of 157 indeterminate FNA was found after the introduction of ICCRTC. Of these, 75 undergone surgery and were finally included for the study. At histology we found a 33.3% of cancers and a 67.7% of benign lesions. Out of the overall series, 25 were classified as Tir 3A and 50 as Tir 3B. Cancer rate observed in Tir 3A (1/25, 4%) was significantly (p = 0.0002) lower than that of Tir 3B (24/50, 48%). No significant difference was found in age and size between the two subcategories. Conclusions: We confirm in our series that Italian consensus for the classification and reporting of thyroid cytology allows to discriminate indeterminate lesions at low and high risk of malignancy

Presence in foreign markets, ethnic minority ownership and financial performance of high-tech SME’s

Small and medium enterprises (SMEs) face strong competition with larger incumbents in a fast-changing globalized economy that undermine their financial performance. For this reason, operating in foreign market could be a valuable solution to pursue growth opportunities and improve their financial performance. The purpose of the paper is to understand the relationship between SMEs internationalization and their financial performance, and whether this effect is moderated by the presence of ethnic minority ownership. Based on a sample of 10.326 high-tech manufacturing US SMEs, our study reveals a positive relation between the number of foreign markets where SMEs operate and their financial performance. In addition, we demonstrate that this effect is positively moderated by the presence of ethnic minorities in the SMEs’ ownership. Therefore, our findings provide evidence of the strong relationship between strategic choice, in the form of presence in foreign markets, and economic results, as well as on the influence exerted by individual-level mechanism

Neoadjuvant treatment in pancreatic cance. Evidence-based medicine? A systematic review and meta-analysis

Neoadjuvant treatment in non-metastatic pancreatic cancer (PaC) has the theoretical advantages of downstaging the tumor, sterilizing any present systemic undetectable disease, selecting patients for surgery and administering therapy to each patient. The aim of this systematic review is to analyze the state of the art on neoadjuvant protocols for non-metastatic PaC. A literature search over the last 10 years was conducted, and papers had to be focused on resectable, borderline resectable (BLR) or locally advanced (LA) histo- or cytologically proven PaC; to be prospective studies or prospectively collected databases; to report percentage of protocol achievement and survival data at least in an intention-to-treat (ITT) analysis. Twelve studies were eligible for systematic review. Studies included a total of 624 patients: 248 resectable, 268 BLR, 71 LA and 37 non-specified. All studies were included for meta-analysis. ITT overall survival (OS) was 16.7 months (95% CI 15.16-18.26 months); for resected patients OS was 22.78 months (95% CI 20.42-25.16), and for eventually non-resected patients it was 9.89 months (95% CI 8.84-10.96). Neoadjuvant approaches for resectable, BLR and LA PaC are spreading. Outcomes tend to be better outside an RCT context, but strong evidences are lacking. Actually such treatments should be performed only in a randomized clinical trial setting

Comparative Effectiveness of DPP-4 Inhibitors Versus Sulfonylurea for the Treatment of Type 2 Diabetes in Routine Clinical Practice: A Retrospective Multicenter Real-World Study

Introduction: DPP-4 inhibitors (DPP4i) and sulfonylureas are popular second-line therapies for type 2 diabetes (T2D), but there is a paucity of real-world studies comparing their effectiveness in routine clinical practice. Methods: This was a multicenter retrospective study on diabetes outpatient clinics comparing the effectiveness of DPP4i versus gliclazide extended release. The primary endpoint was change from baseline in HbA1c. Secondary endpoints were changes in fasting plasma glucose, body weight, and systolic blood pressure. Automated software extracted data from the same clinical electronic chart system at all centers. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Results: We included data on 2410 patients starting DPP4i and 1590 patients starting gliclazide (mainly 30–60 mg/day). At baseline, the two groups differed in disease duration, body weight, blood pressure, HbA1c, fasting glucose, HDL cholesterol, triglycerides, liver enzymes, eGFR, prevalence of microangiopathy, and use of metformin. Among DPP4i molecules, no difference in glycemic effectiveness was detected. In matched cohorts (n = 1316/group), patients starting DPP4i, as compared with patients starting gliclazide, experienced greater reductions in HbA1c (− 0.6% versus − 0.4%; p < 0.001), fasting glucose (− 14.1 mg/dl versus − 8.8 mg/dl; p = 0.007), and body weight (− 0.4 kg versus − 0.1 kg; p = 0.006) after an average 6 months follow-up. DPP4i improved glucose control more than gliclazide, especially in patients who had failed with other glucose-lowering medications or were on basal insulin. Conclusions: This large retrospective real-world study shows that, in routine clinical practice, starting a DPP4i allows better glycemic control than starting low-dose gliclazide. Funding: The Italian Diabetes Society, with external support from AstraZeneca