Shifting paradigms in two common abdominal surgical emergencies during the pandemic

During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled

Messina 1908-2008: understanding crust dynamics and subduction in Southern Italy

To mark the centennial anniversary of the 1908 earthquake that shook Messina, Italy, the Istituto Nazionale di Geofisica e Vulcanologia (INGV) has begun the "Messina 1908- 2008" research project. The aim is to clarify the extension deformation processes that occur in the Messina Strait and to understand relationships between subduction and crustal deformation there by merging existing data and studies, and by collecting new and more detailed seismological, geodetic, historical, and satellite observations. More than 20 permanent seismic stations and about 15 temporary stations are located in the study region. A dense permanent geodetic network also operates in the region, several campaign surveys are newly available, and new geodetic campaign measurements were performed in March 2008. In addition, during July 2008, five ocean bottom seismometers (OBS) were deployed to better monitor the area largely covered by the sea. Records of historical earthquakes that struck the Strait of Messina will be analyzed, and synthetic aperture radar images will help define surface deformation of the region. The Messina 1908-2008 project's assemblage of a database and integration of innovative technologies could transform our understanding of the crust and mantle structure of the active tectonics and seismic hazards of the Strait of Messina

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's

Objective: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. / Methods: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. / Results: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14–1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33–1.57); P < 0.05). / Conclusions: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. / Clinical relevance: MIS procedures represent a reliable treatment for isolated intra-bony defect

Efficacy and safety of first-line treatment strategies for anaplastic lymphoma kinase-positive non-small cell lung cancer: a Bayesian network meta-analysis.

Background: Targeted therapies have led to significant improvement in the management and prognosis of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). We performed a network meta-analysis of frontline treatment options of ALK-positive NSCLC to provide clinical guidance. Methods: PubMed, Embase, ClinicalTrials.gov, and international conference databases were searched to identify relevant trials from inception to June 30, 2021. Phase III randomized controlled trials (RCTs) comparing treatments for patients with ALK-positive advanced NSCLC in the first-line setting were included in a Bayesian network meta-analysis. Eligible studies reported at least one of the following clinical outcomes: progression-free survival (PFS), overall survival (OS), risk of the central nervous system (CNS) progression, adverse events (AEs) of grade (G) 3 or higher (G3 AEs), or serious AEs (SAEs). Hazard ratios (HRs) and CI for primary outcome of PFS and secondary outcome of OS and risk of CNS progression were obtained. A multivariate, consistency model, fixed-effects analysis was used in the network meta-analysis. Data on G3 AEs and SAEs were abstracted and meta-analyzed. Risk of bias (RoB) was assessed using the Cochrane Collaboration's tool. Results: Nine RCTs comprising 2,484 patients were included with seven treatments: alectinib, brigatinib, ceritinib, crizotinib, ensartinib, lorlatinib, and chemotherapy. Compared with chemotherapy, ALK-tyrosine kinase inhibitors (TKIs) significantly prolong PFS and reduced risk of CNS progression except for ceritinib. Lorlatinib appears superior at reducing risk of CNS progression. None of the ALK-TKIs have a significantly prolonged OS as compared with chemotherapy. Lorlatinib increases the risk of G3 AEs as compared with alectinib (odds ratio 4.26 [95% CrI 1.22 to 15.53]), while alectinib caused the fewest G3 AEs. Conclusions: Lorlatinib is associated with the highest PFS benefit and lowest risk of CNS progression benefits for patients with advanced ALK-positive NSCLC, compared with other first-line treatments, but with higher toxicity. The implementation of a newer generation of ALK-TKIs in the first-line treatment of ALK-positive NSCLC into current clinical practice is evolving rapidly

Camelina sativa (L. Crantz) Fresh Forage Productive Performance and Quality at Different Vegetative Stages: Effects of Dietary Supplementation in Ionica Goats on Milk Quality

The research meant to study the productive performances of Camelina sativa and the effects of feeding Camelina fresh forage harvested during five phenological stages (I: main stem elongation; II: maximum stem elongation: III: inflorescence appearance; IV: flowering; V: fruit set visible) on the yield, chemical composition and fatty acid profile of milk from autochthonous Ionica goats. Goats were randomly assigned to two groups (n = 15) that received a traditional forage mixture (Control) or Camelina forage harvested at different stages (CAM). The field experiment was conducted in two years; no significant differences between years were recorded for any of the Camelina production traits. The total biomass increased (p &lt; 0.05) from phase I (1.4 t/ha) to phase V (5.2 t/ha). The distribution of stem, leaves and pod also changed during growth, showing a significant increase of stem from 40.8 to 45.6% and of pod from 0 to 19.4%, whereas leaves decreased from 59.2 to 35.1%. The milk yield and chemical composition were unaffected by the diet, while supplementation with Camelina forage increased milk CLA content (on average 1.14 vs. 0.78%). A markedly higher concentration of PUFAs was found in milk from goats fed Camelina harvested during the last three phenological stages. The index of thrombogenicity of milk from the CAM fed goats was significantly lower compared to the control group. In conclusion, Camelina sativa is a multi-purpose crop that may be successfully cultivated in Southern Italy regions and used as fresh forage for goat feeding. Milk obtained from Camelina fed goats showed satisfactory chemical and fatty acid composition, with potential benefits for human health

Follow-up Study to Evaluate the Long-term Safety and Efficacy of Darvadstrocel (Mesenchymal Stem Cell Treatment) in Patients With Perianal Fistulizing Crohn’s Disease: ADMIRE-CD phase 3 randomized controlled trial

BACKGROUND: Darvadstrocel is an expanded allogeneic adipose-derived mesenchymal stem cell therapy for the treatment of complex perianal fistulas in patients with Crohn’s disease. Safety and efficacy outcomes from the clinical trial known as “Adipose derived mesenchymal stem cells for induction of remission in perianal fistulizing Crohn’s disease,” or ADMIRE-CD (NCT01541579), from up to 52 weeks posttreatment were previously reported. Here, the outcomes from an extended 104-week follow-up are reported. OBJECTIVE: The goal of this study was to assess the long-term safety and efficacy of darvadstrocel at 2 years post-treatment in patients with Crohn’s disease and complex perianal fistulas. DESIGN: This was a phase 3 double-blind randomized controlled study (ADMIRE-CD) in patients with perianal fistulizing Crohn’s disease. SETTINGS: This study extension was conducted in multiple hospitals across 7 European countries and Israel. PATIENTS: Forty patients entered the extended follow-up period: 25 patients in the darvadstrocel treatment group and 15 in the control group. INTERVENTIONS: Darvadstrocel or saline solution (control group) was administered once, locally, after fistula tract curettage and internal opening closure (with previous seton placement). All patients were permitted to continue ongoing medical treatments for fistulas. MAIN OUTCOME MEASURES: Treatment-emergent serious adverse events were recorded through week 104. Clinical remission, defined as closure of all treated external openings that were draining at baseline despite gentle finger compression, was assessed at week 104. RESULTS: Of 40 patients, 37 completed the extended follow-up. Through week 104, 7 treatment-emergent serious adverse events were reported, of which 4 occurred between weeks 52 and 104. At week 104, clinical remission was reported in 14/25 (56%) patients in the darvadstrocel group and 6/15 (40%) patients in the control group. LIMITATIONS: Limitations include the small number of patients who entered the extended follow-up period, and no imaging examinations were performed at the 104-week time point. CONCLUSIONS: Darvadstrocel was well tolerated and clinical remission after treatment with darvadstrocel may be sustained for up to 104 weeks in patients with perianal fistulizing Crohn’s disease