Ricerca di cellule staminali tumorali nel carcinoma colorettale

Colorectal cancer is the most frequent cancer of the digestive system; it is the second cause of death after that one for lung tumor in man, and for breast tumor in women. The highest incidence is between 60 and 70 years (higher in the USA and in Eastern Europe). The disease affects men and women with equal frequency, although rectal tumors show a higher prevalence in men. In the European Community population over the age of 65 the estimated incidence for rectal cancer is 95 new cases / year per 100.000 men and 53 new cases / year per 100.000 women. Every year in our country about 27.000 people get cancer of the colon-rectum and, of these, just over half die from the disease. Five-year survival exceeds 50%. Therapy is based on surgery and chemotherapy. The prospects for research on the role of cancer stem cells (CSC) in cancer are extensive. In many cancer histotypes, in fact, CSC seem to determine the aggressiveness of neoplastic disease; CSC’s research in colorectal carcinoma (CRC) is important for prognostic and therapeutic objectives. In fact, metastases are the main cause of death linked to cancer and determine the transition from localized neoplastic disease to systemic neoplastic disease. The discovery of CSC represents a strategy for the control and prevention of overt metastatic disease. The molecular characterization of CSC may allow to identify drug targets and personalized antimetastatic therapies. While in breast, lung and prostate cancer CSC have been extensively characterized, these molecular features are still to be discovered in colorectal cancer. Therefore, the development of in vitro and in vivo models for the expansion and analysis of colorectal CSC is of primary importance for identifying novel prognostic and therapeutic approaches. In this experimental study, we searched for CSC in 22 colorectal cancers surgically excised. In the materials and methods, the technologies used for the research of CSC are widely described. CSC were isolated and characterized in 5 patients, as shown in the results table : 1 cancer of the cecum, 1 cancer of the ascending colon, 2 cancers of the transverse colon, 1 cancer of the rectum. The cell lines that have developed from the CSC discovered in the 5 patients are found in the CSC Bank of the Istituto Superiore di Sanità and are used for numerous experiments. In these patients there was a worse prognosis than in others confirming the negative prognostic role of the CSCs. The research therefore aims to identify these patients early in order to be able to submit them to a closer follow-up and to realize targeted therapies that have specific targets for CSCs, considered responsible for the aggressiveness and the possible recurrence of the disease

Cancer stem cells as functional biomarkers

According to the American Association of Cancer Research (AACR), a Cancer Stem Cell is a cell within a tumor that possesses the capacity to self-renew and to cause the heterogeneous lineages of cancer cells that constitutes the tumor [1]. Cancer Stem Cells (CSCs) are involved in the metastatic process, in the resistance to therapeutic treatments of many types of human cancers and consequently in the onset of recurrences. Numerous translational studies have been conducted to understand CSC characteristics and evaluate association between CSC-related biomarkers and clinical outcomes. The CSC theory can explain also a tumor relapse after that a tumor has been completely surgically removed (R0 macroscopical zero residual resection) or after an apparently complete response to chemoteraphy. CSCs, in fact, showed a marked ability to reduce intracellular accumulation of chemotherapic agents by active drug extrusion, increased chemoresistance and survival, as well as elevated membrane transporter activity. In addition, it is possible that these cancer stem cells may nest in the "secured" (niche) sites of our body, where they may remain undisturbed for a long time, even years, until a stimulus arrives to awaken them, causing the disease to resume. CSCs, in fact, are able to use a variety of cellular pathways to survive to anticancer treatments. More recently CSCs have been described in several solid tumors, expressing specific biomarkers. Another field of research should be focused on the realization of diagnostic instruments to follow up patients after R0 surgical resection or after a complete response for an early detection and management of relapse and metastasis

Does anxiety or waiting time influence patients′ tolerance of upper endoscopy?

Background/Aims: Endoscopy is an essential and very commonly used procedure for the evaluation of a multitude of gastrointestinal symptoms. Although it is increasingly required, patients often wait on arrival at the endoscopy unit until they are called for the procedure. It is not clear whether or not this waiting time may have an impact on patient′s tolerance during upper endoscopy. Our study attempts to address this. Patients and Methods: We studied consecutive outpatients who underwent endoscopy from September to December, 2013. Gender, age, body mass index (BMI), previous endoscopic experiences, antidepressant therapy, and the time interval between arrival at the endoscopy unit and the onset of examination was recorded. Anxiety before the procedure, pain, and discomfort were rated by a numeric rating scale (0 = no pain/discomfort encountered to 10 = extremely painful/uncomfortable). Results: One hundred and five consecutive outpatients (male = 52; mean age = 45.3 years; age range = 20-86 years) were included in the study. The mean BMI was 25 ± 4.8; mean waiting time from registration to the procedure was  172 min (time range = 30 - 375 mins). Mean patients′ pre-examination anxiety level was 3 ± 3.84, mean discomfort score was 4.3 ± 3.09 and mean pain score was 3.4 ± 3.03. The level of pain and discomfort was significantly higher in patients with higher levels of pre-procedure anxiety. No differences were found in terms of anxiety, pain and discomfort among patients divided according to waiting time. Conclusions: According to our data, waiting time does not have a significant impact on the perception of pain and discomfort related to the endoscopic procedure. On the other hand, high pre-procedural levels of anxiety were associated with a low tolerance. Further multicenter randomized trials are needed to clarify the impact of waiting time

Celiac Disease and Helicobacter Pylori Infection: an Ups and Downs Correlation

Background: Several studies showed an involvement of the gastric mucosa in celiac disease (CD). Helicobacter pylori (Hp) is the major agent of gastric damage. The aim of this article was to present a literature review of a possible correlation between the two conditions. Methods: A literature search was conducted in Medline, Scopus and Directory of Open Access Journal (DOAJ) using appropriate keywords. We included only articles written in English over the period July 1996 - May 2014. Results: The search for Medline, Scopus and DOAJ provided a total of 530 citation. Twenty five studies met the inclusion criteria and were included in quantitative analysis. The prevalence of Hp infection in celiac children and adults from different geographical areas has been reported. The possible correlation between Hp infection and the increase of intraepithelial lymphocytes (IEL) has also been reported. Conclusion: Several studies showed a wide heterogeneity. This is probably due to differences in Hp prevalence, small series of patients, lack of histological confirmation of Hp and lack of adjustment for sociodemographic characteristics. More studies to clarify the possible correlation between these two conditions are necessary

Breath test as non-invasive assessment for the initial screening of non-ulcerous dyspepsia

.Considering the important role of Helicobacter Pylori (Hp) in the most common gastro-intestinal pathologies, the Authors want to test the effectiveness of a non-invasive diagnostic technique for detection of the Hp in the gastric mucosa. At the end of experience they think, like the most of Literature, that the Breath Test, concerning sensibility and specificity, represent the gold standard for detection of the Hp

Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient

Perianal fistula is a complex and frequent disease. At present, no treatment nor technique has shown an absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between faecal continence preservation and disease eradication. Rarely concomitant perianal abscess and fistula are treated at the same time, and often time to complete recovery is long

Determinant Characteristics of Stunting in Babies and Toddlers in Sungai Rengit Murni, South Sumatra, Indonesia

Stunting is a condition where a child fails to optimally grow and develop his/her bodily organs. Due to the high rate of stunting case in Indonesia, particularly in South Sumatra, this study aimed to determine the causes of stunting in children of 0 yr to 5 yr old as the dependent variable. Independent variables of infection, birth weight, gender, and age were studied accordingly. The purposive sampling method selected 100 babies and toddlers in Sungai Rengit Murni, Banyuasin, South Sumatra, Indonesia. The cross-sectional design applied univariate, bivariate (chi-square test), and multivariate (multiple logistic regression and backward regression tests) analyses. The result showed that while age was insignificant (0.649, P > 0.25) and infection was less significant (0.077, P > 0.05), low birth weight (0.044, P < 0.05) and gender (0.045, P < 0.05) are significant in affecting stunting.Being 61 % accurate, the independent variables of this study covered 15.1 % of known stunting cause