CORRELATES TO ABDOMINAL PAIN IN CONSTIPATION PREVALENT IBS PATIENTS

Background and aim: Symptoms of irritable bowel syndrome (IBS) have been associated to altered motility and sensation. In constipated prevalent-IBS patients, a clear association between bowel habit and abdominal pain remains to be established, and it is not known whether factors related to patients daily life may play a role in symptoms generation. Our aim was to evaluate the association between abdominal pain, bowel habit, demographic factors, alimentary/voluptuary habits and colonic transit in constipated-IBS patients. Material and methods: 68 patients complaining of chronic constipation were selected on the basis of the Rome 3 criteria for IBS. Colonic transit time (CTT) was studied and alimentary attitudes and smoking habit were recorded. Presence of mild or severe abdominal pain was scored, as well as the prevalent pain characteristics, defined as diffuse or localized, chronic or acute, with cramps or gradually distending. Data were analysed by univariate and stepwise multiple logistic regression analysis was also used to verify the risk association between pain and all other variables. Results: 40 patients were classified as constipated and 28 had alternating evacuation. Constipated patients had a lower scholar degree, consumed more laxatives, had a longer transit time in the right colon and scored more chronic pain than alternating ones, but it was not confirmed by multivariate analysis. When severity of abdominal pain was used as discriminating factor, a significant number of subjects reporting severe pain were males (16/30 vs 4/38, p<0.01) and smokers (20/30 vs 4/38, p<0.001). Multivariate analysis confirmed that only smoking was an independent factor associated with severe abdominal pain (OR 14.3, CI 2–99, p= 0.007). Conclusions: Abdominal pain is similarly reported by constipated or alternating IBS patients and it is not associated with colonic transit time or demographics. Smoking is the only factor constantly and independently associated to severe abdominal pain. As smoking does not seem likely to affect colonic transit time we suggest that smoking may act on the visceral perception in IBS-constipated patients

Eosinophilic esophagitis: From pathophysiology to treatment.

Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments

CHRONIC CONSTIPATION IS A RISK FACTOR FOR METABOLIC SYNDROME

Background and aim: A recent epidemiologic survey in the U.S. provides indirect evidence that constipation is a risk factor for cardiovascular disease in postmenopausal females. To characterize the related factors involved in and to further analyse if this assumption also applies to an Italian population, we studied the impact of chronic constipation on ischemic cardiopathy and predisposing risk factors in a large population of female patients in a primary care setting. Material and methods: We retrospectively evaluated 754 female patients (mean age 46±20 years) on data file of a primary care setting. All subjects requiring medical referral for constipation were screened and presence of chronic constipation was confirmed by standardized questionnaires. The presence of clinical and/or instrumental diagnosis of ischemic cardiopathy, metabolic syndrome, diabetes and blood hypertension was scored in patients with and without chronic constipation. In all patients the consumption of drugs potentially delaying colonic transit (calcium channel blockers and beta blockers) was recorded. Patients on opioid or analgesic treatment were excluded. Results: The overall prevalence of chronic constipation was 9.4% (71/754) with the age being similar in patients with and without constipation (46±19 vs. 51±22, p=NS). The prevalence of metabolic syndrome was significantly higher in subjects with chronic constipation (5/66 vs 16/667, OR=3.1, 95% CI 1.1–8.9, p=0.03). Conversely, prevalence of diabetes, blood hypertension, ischemic cardiopathy was similar in patients with and without constipation (59/624 vs 10/61; 204/478 vs 28/43; 46/637 vs 6/65, respectively p= all NS). No significant difference was also observed as far as calcium channel blockers (64/619 vs 9/62) and beta blockers (81/602 vs 9/62) consumption in patients with or without constipation respectively. Conclusions: We showed that chronic constipation is a risk factor for metabolic syndrome in female patients. Although we did not find any significant association between chronic constipation and ischemic cardiopathy, our findings support the hypothesis that constipation may act as cardiovascular risk factor. Whether this association is dependent on dietary or hormonal factors deserves further investigation

An annotated T2-weighted magnetic resonance image collection of testicular germ and non-germ cell tumors

open7noTesticular cancer is a rare tumor with a worldwide incidence that has increased over the last few decades. The majority of these tumors are testicular non-germ (TNGCTs) and germ cell tumors (TGCTs); the latter divided into two broad classes - seminomatous (SGCTs) and non-seminomatous germ cell tumors (NSGCTs). Although ultrasonography (US) maintains a primary role in the diagnostic workup of scrotal pathology, magnetic resonance imaging (MRI) has emerged as the imaging modality recommended for challenging cases, providing additional information to clarify inconclusive/equivocal US. In this work we describe and publicly share a collection of 44 images of annotated T2-weighted MRI lesions from 42 patients. Given that testicular cancer is a rare tumor, we are confident that this collection can be used to validate statistical models and to further investigate TNGCT and TGCT peculiarities using medical imaging features.openFeliciani G.; Mellini L.; Loi E.; Piccinini F.; Galeotti R.; Sarnelli A.; Parenti G.C.Feliciani G.; Mellini L.; Loi E.; Piccinini F.; Galeotti R.; Sarnelli A.; Parenti G.C

Radiomics in the characterization of lipid-poor adrenal adenomas at unenhanced CT: time to look beyond usual density metrics

Objectives: In this study, we developed a radiomic signature for the classification of benign lipid-poor adenomas, which may potentially help clinicians limit the number of unnecessary investigations in clinical practice. Indeterminate adrenal lesions of benign and malignant nature may exhibit different values of key radiomics features. Methods: Patients who had available histopathology reports and a non-contrast-enhanced CT scan were included in the study. Radiomics feature extraction was done after the adrenal lesions were contoured. The primary feature selection and prediction performance scores were calculated using the least absolute shrinkage and selection operator (LASSO). To eliminate redundancy, the best-performing features were further examined using the Pearson correlation coefficient, and new predictive models were created. Results: This investigation covered 50 lesions in 48 patients. After LASSO-based radiomics feature selection, the test dataset’s 30 iterations of logistic regression models produced an average performance of 0.72. The model with the best performance, made up of 13 radiomics features, had an AUC of 0.99 in the training phase and 1.00 in the test phase. The number of features was lowered to 5 after performing Pearson’s correlation to prevent overfitting. The final radiomic signature trained a number of machine learning classifiers, with an average AUC of 0.93. Conclusions: Including more radiomics features in the identification of adenomas may improve the accuracy of NECT and reduce the need for additional imaging procedures and clinical workup, according to this and other recent radiomics studies that have clear points of contact with current clinical practice. Clinical relevance statement: The study developed a radiomic signature using unenhanced CT scans for classifying lipid-poor adenomas, potentially reducing unnecessary investigations that scored a final accuracy of 93%. Key Points: • Radiomics has potential for differentiating lipid-poor adenomas and avoiding unnecessary further investigations. • Quadratic mean, strength, maximum 3D diameter, volume density, and area density are promising predictors for adenomas. • Radiomics models reach high performance with average AUC of 0.95 in the training phase and 0.72 in the test phase

The treatment of achalasia patients with esophageal varices: an international study

Background: Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk. Methods: Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group. Results: Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller’s myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; p < 0.0001) at 6 months follow-up, with treatment outcomes resembling those of 20 non- cirrhotic achalasia patients who underwent similar therapy. No patients had recorded complications of bleeding or perforation. Conclusion: This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices

The potential role of MR based radiomic biomarkers in the characterization of focal testicular lesions

How to differentiate with MRI-based techniques testicular germ (TGCTs) and testicular non-germ cell tumors (TNGCTs) is still under debate and Radiomics may be the turning key. Our purpose is to investigate the performance of MRI-based Radiomics signatures for the preoperative prediction of testicular neoplasm histology. The aim is twofold: (i), differentiating TGCTs and TNGCTs status and (ii) differentiating seminomas (SGCTs) from non-seminomatous (NSGCTs). Forty-two patients with pathology-proven testicular neoplasms and referred for pre-treatment MRI, were retrospectively enrolled. Thirty-two out of 44 lesions were TGCTs. Twelve out of 44 were TNGCTs or other histologies. Two radiologists segmented the volume of interest on T2-weighted images. Approximately 500 imaging features were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) was applied as method for variable selection. A linear model and a linear support vector machine (SVM) were trained with selected features to assess discrimination scores for the two endpoints. LASSO identified 3 features that were employed to build fivefold validated linear discriminant and linear SVM classifiers for the TGCT-TNGCT endpoint giving an overall accuracy of 89%. Four features were employed to build another SVM for the SGCT-SNGCT endpoint with an overall accuracy of 86%. The data obtained proved that T2-weighted-based Radiomics is a promising tool in the diagnostic workup of testicular neoplasms by discriminating germ cell from non-gem cell tumors, and seminomas from non-seminomas

In vitro irradiation system for radiobiological experiments

Background: Although two-dimensional (2-D) monolayer cell cultures provide important information on basic tumor biology and radiobiology, they are not representative of the complexity of three-dimensional (3-D) solid tumors. In particular, new models reproducing clinical conditions as closely as possible are needed for radiobiological studies to provide information that can be translated from bench to bedside. Methods: We developed a novel system for the irradiation, under sterile conditions, of 3-D tumor spheroids, the in vitro model considered as a bridge between the complex architectural organization of in vivo tumors and the very simple one of in vitro monolayer cell cultures. The system exploits the same equipment as that used for patient treatments, without the need for dedicated and highly expensive instruments. To mimic the passage of radiation beams through human tissues before they reach the target tumor mass, 96-multiwell plates containing the multicellular tumor spheroids (MCTS) are inserted into a custom-built phantom made of plexiglass, the material most similar to water, the main component of human tissue. Results: The system was used to irradiate CAEP- and A549-derived MCTS, pre-treated or not with 20 \u3bcM cisplatin, with a dose of 20 Gy delivered in one session. We also tested the same treatment schemes on monolayer CAEP and A549 cells. Our preliminary results indicated a significant increment in radiotoxicity 20 days after the end of irradiation in the CAEP spheroids pre-treated with cisplatin compared to those treated with cisplatin or irradiation alone. Conversely, the effect of the radio- chemotherapy combination in A549-derived MCTS was similar to that induced by cisplatin or irradiation alone. Finally, the 20 Gy dose did not affect cell survival in monolayer CAEP and A549 cells, whereas cisplatin or cisplatin plus radiation caused 100% cell death, regardless of the type of cell line used. Conclusions: We set up a system for the irradiation, under sterile conditions, of tumor cells grown in 3-D which allows for the use of the same dose intensities and schedules utilized in clinical practice. This irradiation system, coupled with 3-D cell cultures, has the potential to generate information that could be used to individually tailor radiotherap