Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

OPTIMIZATION OF FUNCTIONAL PASTA BASED ON DURUM WHEAT SEMOLINA

The aim of the research was the production of functional pasta with a low glycemic index (GI). So the manufacturing of spaghetti based on durum wheat semolina (obtained from roll-milling), wholemeal flour (stone-milling) and durum wheat semolina enriched with bran was studied. First of all the effect of two milling technique (roll-milling and stone milling) of durum wheat on pasta cooking and nutritional quality was evaluated. In particular, spaghetti was manufactured using semolina and wholemeal flour obtained by six durum wheat cultivars, Anco Marzio, Claudio, Core, Iride and Saragolla, Cappelli. The instrumental (i.e., texture analysis), sensorial (i.e., elasticity, firmness, adhesiveness) and nutritional (i.e., protein, ash and fibres contents, glycemic index,) analysis of the produced spaghetti was run on produced samples. All wholemeal spaghetti showed a highest protein, total dietary fibre (mainly insoluble fibres) content value and a lower available carbohydrate content with respect to semolina spaghetti. Concerning the cooking quality, the wholemeal spaghetti had a greater cooking loss in comparison to semolina spaghetti. The wholemeal spaghetti showed a lower overall quality due to the low the elasticity, firmness and color score. Moreover, the wholemeal spaghetti had lower glycemic index in comparison to semolina spaghetti. In conclusion, the wholemeal flour improved the nutritional composition of the pasta and contributed to a low glycemic response. Specially the variety Cappelli was found a good compromise between sensory and nutritional quality. The second step was aimed to optimize the pasta formulation. Therefore, different cultivars as Timilia, Pr22d89, Pr22d89 enriched in Selenium, in addition to Cappelli were taken into account. Among them, Pr22d89(+Se) variety has been chosen for the great quality and the low glycemic index of related pasta The third step was aimed to evaluate the effects of substituting semolina with durum wheat bran. The proper amount of bran was optimized (20%) and further hydrocolloids were selected at different concentrations (1%, 2% and 3%) to improve pasta quality. Among the tested hydrocolloids, CMC exerted the best results. It was tested at different concentrations and 2% seemed to be the optimal amount to improve the technological, sensorial and nutritional value of pasta. The several analyses carried out on the final funtional pasta assessed that a good formulation was optimized. To sum up, the development of enriched pasta with a higher dietary fibre content represents a good way to increase the fibre intake and reduce the glycemic index of pasta, which would result in a product for specific nutritionalpurpose. L'obiettivo della ricerca è stato produrre una pasta funzionale con un basso indice glicemico (GI). Per far ciò, sono stati prodotti spaghetti a base di semola di grano duro (ottenuta dalla molitura tradizionale a rulli), farina integrale (molitura a pietra) e semola di grano duro arricchita con crusca. In primis è stata valutato l'effetto delle due tecniche di molitura del frumento duro (tradizionale e a pietra) sulla cottura della pasta e sulla qualità nutrizionale. Gli spaghetti sono stati prodotti con semola e farina integrale ottenuta da sei cultivar di frumento duro, Anco Marzio, Claudio, Core, Iride, Saragolla e Cappelli. Sui campioni prodotti sono state eseguite analisi della struttura, analisi sensoriali (ossia, elasticità, compattezza, adesività) e nutrizionali (cioè, proteine, ceneri, fibre e indice glicemico). Tutti gli spaghetti integrali hanno dimostrato di avere un alto contenuto proteico, un alto contenuto in fibre alimentari (principalmente fibre insolubili) e un valore inferiore di carboidrati disponibili rispetto ai spaghetti di semola. Per quanto riguarda la qualità in cottura, gli spaghetti integrali avevano una maggiore perdita di cottura rispetto ai spaghetti di semola. Gli spaghetti integrali hanno mostrato una qualità complessiva inferiore a causa della bassa elasticità, compattezza e colore. Inoltre, gli spaghetti integrali avevano l’indice glicemico più basso rispetto ai spaghetti di semola. In conclusione, la farina integrale ha migliorato la composizione nutrizionale della pasta e ha contribuito ad una bassa risposta glicemica. Specialmente con la varietà Cappelli è stato trovato un buon compromesso tra qualità sensoriale e nutrizionale. Il secondo step è stato quello di ottimizzare la formulazione della pasta. Pertanto, diverse cultivar come Timilia, Pr22d89, Pr22d89 arricchito in selenio, oltre al Cappelli, sono state prese in considerazione. Tra queste varietà , è stato scelto il Pr22d89 (+ Se) per la sua alta qualità e per il basso indice glicemico. Il terzo passo è stato quello di valutare gli effetti di sostituzione della semola di grano duro con la crusca. La giusta quantità di crusca è stato ottimizzata (20%) e alcuni idrocolloidi sono stati selezionati a differenti concentrazioni (1%, 2% e 3%) per migliorare la qualità della pasta. Tra gli idrocolloidi testati, CMC presentava i migliori risultati. È stato dosato a varie concentrazioni e 2% sembrava essere la quantità ottimale per migliorare il valore tecnologico, sensoriale e nutrizionale della pasta. In sintesi, la produzione di pasta arricchita con un elevato contenuto di fibra alimentare rappresenta un buon modo per aumentare l'assunzione di fibre e ridurre l'indice glicemico della pasta, diventando così un prodotto per specifici fini nutrizionali

Paraneoplastic Neurological Syndromes: Study of Prevalence in a Province of the Lombardy Region, Italy

Paraneoplastic neurological syndromes (PNSs) are a heterogeneous group of rare immune-mediated diseases associated with cancer. The aim of this study was to investigate the prevalence of PNSs in the province of Brescia. PNS prevalence was calculated using the Lombardy regional hospital admission records from 1998 to 2003. We used the website “Epidemiologic and Economic Atlas of Hospital Activities in Lombardy” and the “International Statistical Classification of Diseases and Related Health Problems”. In the province of Brescia, we found 54 cases of PNSs, 29 with subacute neuropathies, five with paraneoplastic cerebellar degeneration and 20 with encephalomyelitis. Peripheral nervous system diseases were the most frequent neurological disorders. In Lombardy, the number of PNS patients admitted was 322 (133 with encephalomyelitis, 21 with paraneoplastic cerebellar degeneration, 166 with polyneuropathies and two with optic degeneration). In Lombardy, the prevalence of PNSs was 25 in 100,000 hospital admissions and 5.92 in 100,000 for the Lombardy population. Our results show a discrete presence of PNS patients in the province of Brescia and in the Lombardy region as a whole

Avaliação da notificação no Distrito Federal de casos de tuberculose residentes em dez municípios goianos do entorno e análise da incidência de tuberculose nestas localidades

OBJETIVO: Avaliar a notificação, no Distrito Federal (DF), de casos de tuberculose em residentes nos municípios goianos da região do Entorno e possíveis influências no Plano de Controle da Tuberculose; analisar a taxa de incidência da tuberculose nos municípios e a interferência da situação socioeconômica e das características demográficas sobre esta taxa. MÉTODO: Analisaram-se dados relativos à incidência de tuberculose, taxas de cura, abandono, falência de tratamento, óbito, transferência e informações socioeconômicas e demográficas de dez municípios goianos. RESULTADOS: No período de 2000 a 2004, foram notificados 714 casos novos de tuberculose em residentes nos municípios estudados, sendo que 436 (61,0%) foram atendidos no DF, não sendo registrados no Sistema de Informação de Goiás. Considerando-se os casos atendidos somente em Goiás, a média de incidência de tuberculose do grupo variou de 4,40 a 10,02/100.000 habitantes; somando-se os atendidos no DF, a incidência aumentou significativamente, variando de 15,16 a 20,54/100.000 habitantes (p < 0,001). A taxa de contatos examinados foi baixa e os resultados de tratamento insatisfatórios, tanto em Goiás como no DF. Os dados socioeconômicos e demográficos foram compatíveis com as taxas de incidência. CONCLUSÃO: O número de casos de tuberculose atendidos pelos próprios municípios foi abaixo do esperado e o atendimento fora do município de residência pode comprometer o controle da tuberculose. A incidência de tuberculose recalculada é compatível com o perfil socioeconômico e demográfico da região. Um sistema de vigilância com base territorial pode ter sua eficiência otimizada, melhor contribuindo para o controle da enfermidade

History of Extensive Disease Small Cell Lung Cancer Treatment: Time to Raise the Bar? A Review of the Literature

Several trials have tried for decades to improve the outcome of extensive disease small cell lung cancer (ED-SCLC) through attempts to modify the standard treatments. Nevertheless, platinum/etoposide combination and topotecan have remained respectively the first and the second line standard treatments for the last 40 years. With the advent of immunotherapy, this scenario has finally changed. Our review aims to provide an overview of the primary studies on the actual therapeutic strategies available for ED-SCLC patients, and to highlight emerging evidence supporting the use of immunotherapy in SCLC patients

History of Extensive Disease Small Cell Lung Cancer Treatment: Time to Raise the Bar? A Review of the Literature

Several trials have tried for decades to improve the outcome of extensive disease small cell lung cancer (ED-SCLC) through attempts to modify the standard treatments. Nevertheless, platinum/etoposide combination and topotecan have remained respectively the first and the second line standard treatments for the last 40 years. With the advent of immunotherapy, this scenario has finally changed. Our review aims to provide an overview of the primary studies on the actual therapeutic strategies available for ED-SCLC patients, and to highlight emerging evidence supporting the use of immunotherapy in SCLC patients

Targeting Angiogenesis in the Era of Biliary Tract Cancer Immunotherapy: Biological Rationale, Clinical Implications, and Future Research Avenues

Although biliary tract cancers are traditionally considered rare in Western countries, their incidence and mortality rates are rising worldwide. A better knowledge of the genomic landscape of these tumor types has broadened the number of molecular targeted therapies, including angiogenesis inhibitors. The role of immune checkpoint inhibitors (ICIs) could potentially change the first-line therapeutic approach, but monotherapy with ICIs has shown disappointing results in CCA. Several clinical trials are evaluating combination strategies that include immunotherapy together with other anticancer agents with a synergistic activity. The tumor microenvironment (TME) composition plays a pivotal role in the prognosis of BTC patients. The accumulation of immunosuppressive cell types, such as tumor-associated macrophages (TAMs) and regulatory T-cells, together with the poor infiltration of cytotoxic CD8+ T-cells, is known to predispose to a poor prognosis owing to the establishment of resistance mechanisms. Likewise, angiogenesis is recognized as a major player in modulating the TME in an immunosuppressive manner. This is the mechanistic rationale for combination treatment schemes blocking both immunity and angiogenesis. In this scenario, this review aims to provide an overview of the most recent completed or ongoing clinical trials combining immunotherapy and angiogenesis inhibitors with/without a chemotherapy backbone