An Easier Technique for End to End Pancreatlcojejunostomy

Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains the most common and troublesome complication

First report of Leptopilina japonica in Europe

5openInternationalItalian coauthor/editorDrosophila suzukii (Matsumura; Diptera: Drosophilidae) is a key pest of sweet cherry and small fruits worldwide. Biological control remains unutilized in the framework of D. suzukii management. Nonetheless, natural enemies may play an important role in regulating this pest. We report for the first time the presence of Leptopilina japonica Novković and Kimura (Hymenoptera: Figitidae) in Europe. Two specimens emerged from ripened fruits and one was collected after direct observation on a cherry tree in June 2019. They showed the distinctive morphological traits already described and shared more than 99% sequence similarity with specimens of L. japonica collected in Asia. This first finding was confirmed by a wider survey carried out in 2020; L. japonica emerged from cherry fruit samples collected in five other sites across the Trentino region, suggesting that L. japonica has already colonized a wide area. Detection of this Asian species is relevant to the future direction in managing D. suzukii, both in Europe and North America. In fact, L. japonica showed similarity with Ganaspis brasiliensis (Ihering) (Hymenoptera: Figitidae), the most promising candidate for the classical biological control, in terms of developmental time, egg maturation, host age preference and lifetime fecundityopenPuppato, S.; Grassi, A.; Pedrazzoli, F.; De Cristofaro, A.; Ioriatti, C.Puppato, S.; Grassi, A.; Pedrazzoli, F.; De Cristofaro, A.; Ioriatti, C

Imaging in nasopharyngeal carcinoma: the value of 18-Florine Fluorodeoxyglucose PET/CT in comparison to conventional imaging modalities CT and MRI

Background. The aim of the study was to evaluate the clinical usefulness of 18F Fluorodeoxyglucose (FDG) positron emission tomography / computed tomography (PET/CT) in the management of nasopharyngeal carcinoma (NPC) in comparison to conventional imaging modalities. Methods. This retrospective study was done at Ospedale Niguarda, Milan, Italy. Data were acquired from 24 NPC patients between May 2003 and December 2006. They had FDG PET/CT and CT or MRI during the initial diagnosis and at follow-up. Each finding was tabulated and compared with tissue biopsy at diagnosis and clinical status during the follow up after the therapy. A statistical calculation was done to derive the value of each modality. Results. The sensitivity and accuracy of PET/CT and CT/MRI were equally high at diagnosis. At the follow up, a negative PET/CT finding suggested a complete remission with sensitivity and negative predictive value of 100%. Conclusions. 18F FDG PET/CT is a potential modality to be utilized in following up NPC patients for evaluating a response to therapy

Contribution of 18 F-FDG PET/CT in the Staging of Pancreatic Solid Pseudopapillary Neoplasms: A Case Report

: Solid pseudopapillary neoplasm (SPN) is an extremely rare pancreatic epithelial neoplasm with low malignancy that affects mainly young females. It is characterized by a good prognosis, even in the presence of metastases. SPNs have a particular avidity for 18F-fluorodeoxyglucose (18F-FDG). Nonetheless, there are very few papers in the literature on the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F- FDG PET/CT) in the diagnosis and staging of SPNs. A 23-year-old woman presented to our attention with gastric outlet obstruction due to a bulky solid pseudopapillary neoplasm of the pancreatic head. A 18F-FDG PET/CT showed a marked 18F-FDG uptake at the pancreatic head with no abnormal metabolic activity in other abdominal organs. Given the particular avidity for 18F-FDG, SPNs can be easily recognized on 18F-FDG PET/CT. However, this exam is not useful in differentiating this neoplasm from other malignant pancreatic solid lesions, but it could give a contribution to the staging by the ability to identify potential metastases or recurrences

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon