The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Future hydrological regimes and glacier cover in the Everest region: The case study of the upper Dudh Koshi basin

Assessment of future water resources under climate change is required in the Himalayas, where hydrological cycle is poorly studied and little understood. This study focuses on the upper Dudh Koshi river of Nepal (151 km2, 4200–8848 m a.s.l.) at the toe of Mt. Everest, nesting the debris covered Khumbu, and Khangri Nup glaciers (62 km2). New data gathered during three years of field campaigns (2012–2014) were used to set up a glacio-hydrological model describing stream flows, snow and ice melt, ice cover thickness and glaciers' flow dynamics. The model was validated, and used to assess changes of the hydrological cycle until 2100. Climate projections are used from three Global Climate Models used in the recent IPCC AR5 under RCP2.6, RCP4.5 and RCP8.5. Flow statistics are estimated for two reference decades 2045–2054, and 2090–2099, and compared against control run CR, 2012–2014. During CR we found a contribution of ice melt to stream flows of 55% yearly, with snow melt contributing for 19%. Future flows are predicted to increase in monsoon season, but to decrease yearly (− 4% vs CR on average) at 2045–2054. At the end of century large reduction would occur in all seasons, i.e. − 26% vs CR on average at 2090–2099. At half century yearly contribution of ice melt would be on average 45%, and snow melt 28%. At the end of century ice melt would be 31%, and snow contribution 39%. Glaciers in the area are projected to thin largely up to 6500 m a.s.l. until 2100, reducing their volume by − 50% or more, and their ice covered area by − 30% or more. According to our results, in the future water resources in the upper Dudh Koshi would decrease, and depend largely upon snow melt and rainfall, so that adaptation measures to modified water availability will be required

New Perspectives in the Treatment of Colorectal Metastases

BACKGROUND: In recent years, the management of metastatic colorectal cancer has become more aggressive and more multidisciplinary. New treatment options have been proposed in addition to the standard approach of resection of liver metastases and chemotherapy. SUMMARY: Selected patients with synchronous limited peritoneal and liver disease (peritoneal cancer index <12 and <3 liver metastases) can be scheduled for aggressive treatment, including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and liver resection. This approach has achieved survival benefits, even if the treatment is unlikely to be curative in most patients. Moreover, liver transplantation has been recently reconsidered for liver-only metastases, resulting in the de facto reinstatement of the chance of surgery for some unresectable patients. Even though indications for liver transplantation remain to be standardized, preliminary studies have reported extremely promising outcomes. Radio-embolization has proven to be an effective additional tool for the treatment of unresectable tumors, and its potential role in association with chemotherapy for resectable disease is currently being investigated. Stereotactic body radiation therapy is a safe, non-invasive, and effective therapeutic option for patients with inoperable oligometastatic disease. Thanks to recent technical progress, high radiation doses can now be delivered in fewer fractions with excellent local disease control and a low risk of radiation-induced liver injury. Finally, radiofrequency ablation (RFA) for colorectal metastases has become more effective, with results approaching those of surgical series. New interstitial treatments, such as microwave ablation and irreversible electroporation, could overcome some of the limitations of RFA, thereby further expanding indications and optimizing outcomes. KEY MESSAGES: Currently, a multidisciplinary approach to patients with colorectal liver metastases is mandatory. Aggressive surgical treatments should be integrated with all the available non-surgical options to maximize disease control and patient survival

Osseointegration of implants with dendrimers surface characteristics installed conventionally or with Piezosurgery®. A comparative study in the dog

Aim: The first aim of the present experiment was to compare bone healing at implants installed in recipient sites prepared with conventional drills or a piezoelectric device. The second aim was to compare implant osseointegration onto surfaces with and without dendrimers coatings. Material and Methods: Six Beagles dogs were used in this study. Five implants with two different surfaces, three with a ZirTi® surface (zirconia sand blasted, acid etched), and two with a ZirTi®-modified surface with dendrimers of phosphoserine and polylysine were installed in the right side of the mandible. In the most anterior region (P2, P3), two recipient sites were prepared with drills, and one implant ZirTi® surface and one coated with dendrimers implants were installed at random. In the posterior region (P4 and M1), three recipient sites were randomly prepared: two sites with a Piezosurgery® instrument and one site with drill and two ZirTi® surface and one coated with dendrimers implants installed. Three months after the surgery, the animals were sacrificed for histological analysis. Results: No complications occurred during the healing period. Three implants were found not integrated and were excluded from analysis. However, n = 6 was obtained. The distance IS-B at the buccal aspect was 2.2 ± 0.8 and 1.8 ± 0.5 mm, while IS-C was 1.5 ± 0.9 and 1.4 ± 0.6 mm at the Piezosurgery® and drill groups, respectively. Similar values were obtained between the dendrimers-coated and ZirTi® surface implants. The BIC% values were higher at the drill (72%) compared to the Piezosurgery® (67%) sites. The BIC% were also found to be higher at the ZirTi® (74%) compared to the dendrimers-coated (65%) implants, the difference being statistically significant. Conclusion: This study has revealed that oral implants may osseointegrate equally well irrespective of whether their bed was prepared utilizing conventional drills with abundant cooling or Piezosurgery®. Moreover, the surface coating of implants with dendrimers phosphoserine and polylysine did not improve osseointegration. © 2012 John Wiley & Sons A/S

New Perspectives in the Treatment of Colorectal Metastases

Background: In recent years, the management of metastatic colorectal cancer has become more aggressive and more multidisciplinary. New treatment options have been proposed in addition to the standard approach of resection of liver metastases and chemotherapy.Summary: Selected patients with synchronous limited peritoneal and liver disease (perito-neal cancer index <12 and <3 liver metastases) can be scheduled for aggressive treatment, including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and liver re-section. This approach has achieved survival benefits, even if the treatment is unlikely to be curative in most patients. Moreover, liver transplantation has been recently reconsidered for liver-only metastases, resulting in the de facto reinstatement of the chance of surgery for some unresectable patients. Even though indications for liver transplantation remain to be standardized, preliminary studies have reported extremely promising outcomes. Radio-embolization has proven to be an effective additional tool for the treatment of unresect-able tumors, and its potential role in association with chemotherapy for resectable disease is currently being investigated. Stereotactic body radiation therapy is a safe, non-invasive, and effective therapeutic option for patients with inoperable oligometastatic disease. Thanks to recent technical progress, high radiation doses can now be delivered in fewer fractions with excellent local disease control and a low risk of radiation-induced liver injury. Finally, radiofrequency ablation (RFA) for colorectal metastases has become more effective, with results approaching those of surgical series. New interstitial treatments, such as microwave ablation and irreversible electroporation, could overcome some of the limitations of RFA, thereby further expanding indications and optimizing outcomes. Key Messages: Currently, a multidisciplinary approach to patients with colorectal liver metastases is mandatory. Aggres-sive surgical treatments should be integrated with all the available non-surgical options to maximize disease control and patient survival

PSieroprevalenza dell’infezione da Toxoplasma gondii nella popolazione femminile, italiana e straniera, residente nell’area di Legnano (MI)

Introduction. Anti-Toxoplasma antibodies prevalence varies worldwide, showing to be lower in industrializes countries of Northern Europe, and higher in developing countries. In Europe from the 80s’ to 2000 a progressive lessening of the prevalence within different ages was observed. Aim of our survey is to analyze the prevalence of anti-Toxoplasma antibodies among Italian and foreign women afferent to Legnano Hospital from 2000 till 2005. Method. The IgG antibody level of anti-Toxoplasma was tested in 11246 women, aged between 15 and 44 years, 1230 of which (10.9%) were foreigners. Results. The prevalence of IgG anti-Toxoplasma decreased from the 31.2% in 2000 to the 21.4,% in the 2005 (P&lt;0.01). Foreign women constituted 6.7% of our sample in 2000, growing up to 14.7% in 2005 (p&lt;0.01). Seroprevalence among Italian women shifted from 31.4% in 2000 to 19.5% in 2005 (p&lt;0.01), while among foreign women the seroprevalence remains stable around 30%. Conclusion. According to our data a decrease of immunity to the toxoplasmosis becomes apparent between 2000 and 2005, notwithstanding an increase of foreign women with higher seroprevalence

PSieroprevalenza dell'infezione da Toxoplasma gondii nella popolazione femminile, italiana e straniera, residente nell'area di Legnano (MI)

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