The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey

Background The spread of multi-resistant infections represents a continuously growing problem in cirrhosis,particularly in patients in contact with the healthcare environment. Aim Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multiresistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. Methods All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community- Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. Results One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Conclusions Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential

Effect of aging on extracellular matrix and collagen turnover related pathways in human tendons and cultured human tenocytes

The aging process involves different organs, including the musculoskeletal system. Age-related modifications affecting the tendon such as reduced cell proliferation and decreased glycosaminoglycan and proteoglycan content were previously described, but data are incomplete and discordant. Therefore, aim of our study was to characterize the effect of aging on tendons, with particular attention to collagen turnover. For this purpose, tendons and cultured tenocytes were obtained by healthy young (age <65 years) and aging subjects (≥65 years), and analyzed by morphological and molecular methods. Our data show that aging tenocytes have a reduced proliferation rate. Haematoxylin and eosin, Sirius red and Alcian blue staining, respectively, revealed that tendon structure is maintained, and that collagen and proteoglycan content is similar in young and aging tendons. However, decreased lysyl hydroxylase 2b gene expression was observed in aging tenocytes, suggesting that differences in collagen maturation could be responsible for a decreased ability to resist mechanical loading. By fluorescence microscopy, actin cytoskeleton modifications such as fewer and shorter stress fibers were observed in some aging tenocytes, consistent with a decreased ability to form focal adhesions and, therefore, a reduced migration potential. Intermediate filaments and microtubules were not modified by aging. Considered as a whole, our results suggest that the structure of aged tendons is preserved, but the biomechanical properties could be impaired by reduced collagen cross-linking. Moreover, modifications of actin filaments could affect the mechanotransduction system allowing tenocytes to adapt their ability for extracellular matrix remodeling in response to mechanical loading. Therefore, aged tendons could be likely more prone to develop tendinopathies

Effect of extracellular matrix components on the expression of epithelial-to-mesenchymal transition markers in cultured human pancreatic ductal adenocarcinoma cells

Epithelial-to-mesenchymal transition (EMT) is a step-wise process leading to the phenotypic switch of epithelial to mesenchymal cells, providing these cells with a metastatic phenotype. During EMT epithelial cells loose adhesion by down regulation of E-cadherin and express N-cadherin, display cytoskeleton reorganization by expressing vimentin and α-smooth muscle actin (αSMA), acquire motile properties and become invasive by secretion of matrix metalloproteinases (MMPs). Cancer cell phenotype is influenced by the tumor microenvironment in relation to tumor progression, as well as to cell proliferation and invasion. The role of the extracellular matrix (ECM) in the microenvironment is particularly relevant in pancreatic ductal adenocarcinoma (PDAC) since this carcinoma is characterized by an intense desmoplastic reaction, representing the environment where the complex interplay between tumor cells, stromal fibroblasts and ECM components occurs. We aimed at analyzing in vitro the effect of the crosstalk between PDAC cells and their microenvironment by characterizing PDAC cell phenotype in cells cultured on different ECM proteins used as a substrate, in order to better understand the relationship between cancer cell behaviour and the proteins occurring in the desmoplastic tissue. We analyzed by immunofluorescence the expression of the main EMT markers such as E-cadherin, N-cadherin, β-catenin, αSMA, vimentin and collagen type I (COL-I) in PDAC cells cultured on laminin, fibronectin, COL-I and without coating (NC). Moreover, we investigated cell proliferation and MMPs activity in cell culture supernatants by SDS-zymography. Cell morphology was similar in PDAC cells cultured on laminin, fibronectin, COL-I, and in NC, as well as the E-cadherin/β-catenin complex, αSMA and COLI expression; by contrast, vimentin was undetectable in all the experimental conditions. N-cadherin was slightly detectable in cells cultured on fibronectin, COL-I, and laminin, and at lower extent in NC cells. Cell proliferation resulted similar in NC and in cells cultured on fibronectin, decreased on laminin and increased on COL-I. MMP-9 activity exhibited a similar trend, resulting similar on fibronectin, decreased on laminin and stimulated on COL-I. These preliminary results provide new insights in the characterization of the mutual effects elicited by the tumor-stroma interplay on the cancer cell, and will contribute to better understand the influence of the stroma on PDAC cancer cell phenotype, in order to develop new therapeutic strategies

Analysis of tissue structure and remodeling ion alveolar ridges augmented with human palate or tuberosity mucosa

Previous clinical reports found different clinical outcomes of localized alveolar ridge augmentation with soft tissue harvested either from the palate or from the tuberosity over time, showing that the palatal grafts had a better tissue stability than those from the tuberosity, which tended to a hyperplastic reaction. The mechanisms responsible for a different maturation of the grafted tissue using the two donor sites are still unclear, very likely depending on differences of the structure and extracellular matrix of connective tissue (CT). The current study aimed at comparing the morphology and collagen turnover-related molecular pathways of sites grafted with CT from either the palate (group A = 7 patients) or the tuberosity (group B = 7 patients) one year after surgical procedures for ridge augmentation. Cultured fibroblasts were obtained to analyze by real-time PCR the mRNA levels for collagen type I and III (COL-I, COL-III), matrix metalloproteinases (MMP-1 and 2), long lysyl hydroxylase 2b (LH2b). Collagen protein levels were assessed by slot blot, collagen degradation by SDS-zymography. No significant differences in collagen content were found. COLI and III, MMP-1 and 2 expression was similar in cell culture supernatants from palate and tuberosity fibroblasts, although COL-I and COL-III protein levels resulted up-regulated, respectively, in 57% and 66% of the samples. LH2b/COL-I mRNA ratio 69% was higher in the tuberosity fibroblasts, suggesting that the tuberosity collagen could be cross-linked at a higher extent, and therefore less susceptible to degradation by MMPs, leading to its excessive accumulation. Our data show that in group B the higher LH2b/COL-I mRNA ratio may be responsible for differences in collagen maturation as the major determinants in the hyperplastic response, and that grafting using the maxillary tuberosity could avoid unwanted tissue contraction over time

Epithelial-to-mesenchymal transition in pancreas adenocarcinoma cells: effect of 2D versus 3D arrangement

It was shown that three-dimensional (3D) cell cultures allow mimicking the functions of living tissues and provide pivotal information encoded in the tissue architecture [1]. Considered the primary role of epithelial-to-mesenchymal transition (EMT) in carcinoma progression [2], we aimed at investigating the effect of the 3D arrangement on the expression of some key markers of EMT in cultured human pancreas adenocarcinoma cells (PDAC). HPAC cells were cultured in both two-dimensional (2D) monolayers and in 3D spheroids, and were analyzed by morphological and molecular approaches. Immunofluorescence analysis for E-cadherin, β-catenin, actin, vimentin and collagen type I was performed on cells grown on 12 mm coverslips or on free-floating spheroids after 4% paraformaldehyde fixation. E-cadherin gene expression was assessed by real time PCR. Fluorescence and confocal microscopy analysis revealed that the E-cadherin/β-catenin complex was similarly expressed at the cell boundaries on the plasma membrane in 2D monolayers as well as in the 3D spheroids. Phalloidin-stained F-actin was mainly arranged into cortical actin filaments while vimentin was undetectable, suggesting an epithelial-like phenotype for HPAC cells in 2D and 3D arrangement. Interestingly, after 3D arrangement decreased E-cadherin mRNA levels and some cells expressing collagen type I were observed in spheroids. Our findings suggest that the 3D arrangement induced the expression of mesenchymal phenotype-related markers in HPAC cells, providing a model to better understand the biology of PDAC

Pseudo-rheumatic manifestations of limping: Camptodactyly–arthropathy–coxa vara–pericarditis syndrome: Single case report and review of the literature

Camptodactyly–arthropathy–coxa vara–pericarditis (CACP) syndrome is a rare genetic disease characterized by tetrad camptodactyly, noninflammatory arthropathy, coxa vara deformity, and pericardial effusion. Arthropathy typically affects large joints and presents with joint swelling in the absence of other signs of inflammation. We described the case of a girl affected by CACP syndrome caused by a novel compound heterozygous variant in proteoglycan 4 gene (c.2831_2832insT; c.3892C > T) and associated with temporomandibular involvement. The patient received treatment with intra-articular hyaluronic acid injections, which presented rapid but transient improvements of pain and range of motion. A literature review of previously reported CACP patients has been performed. Of the patients. 69.2% (101 out of 146) were Middle Eastern, and 65.7% (96) were consanguineous. The median age of onset was 24 months (interquartile range of 12–36 months), and median age of diagnosis was 96 months (interquartile range of 48–156 months). Arthropathy was always present, mainly involving hips (95.2%), knees (92.4%), wrists (87.7%), elbows (79.5%), and ankles (57.5%). Camptodactyly and pericardial effusion were described, respectively, in 97.3% (142) and 15.1% (22) of patients. The main radiological findings were coxa vara (95.2%), femoral changes (64.4%), intraosseus cysts (14.4%), and bone erosion (5%). Of the patients, 32.9% (48) had received a previous juvenile idiopathic arthritis diagnosis. CACP syndrome can be easily misdiagnosed with juvenile idiopathic arthritis. A prolonged lack of response to immunosuppressive therapy associated with typical clinical and radiological features should prompt consideration of this rare syndrome

Detection and quantification of mammaglobin in the blood of breast cancer patients: can it be useful as a potential clinical marker? Preliminary results of a GOIM (Gruppo Oncologico dell'Italia Meridionale) prospective study.

BACKGROUND: Mammaglobin is expressed mainly in mammary tissue, overexpressed in breast cancer (BC) and rarely in other tissue. The aim of this study was to assess the sensitivity and specificity of transcript MGB1 detection and to evaluate the role of MGB1 as potential clinical marker for the detection of disseminated cancer cells in the blood of BC patients. PATIENTS AND METHODS: A consecutive series of 23 BC tissues, 36 peripheral blood BC samples and 35 healthy peripheral blood samples was prospectively recruited to investigate MGB1 expression by means of a quantitative Real Time RT-PCR assay. RESULTS: MGB1 overexpression in tissue samples of BC patients is significantly associated only with high level of Ki67 (P <0.05). None of the samples from peripheral blood of 35 healthy female individuals were positive for MGB1 transcript. In contrast MGB1 mRNA expression was detected in three of 36 (8%) peripheral blood of BC patients. CONCLUSIONS: Our preliminary results demonstrate that the detection of MGB1 transcript in peripheral blood of BC patients was specific but with low sensitivity. MGB1 overexpression by itself or in combination with Ki67 might be considered an index of BC progression

TP53 mutations and S-Phase fraction are independent prognostic indicators in locally advanced laryngeal squamous cell carcinoma

Larynx tumor is a rare neoplasia that represent only the 2% of all human tumor. In particular, the 90% of tumor that occur in this organ correspond to the laryngeal squamous cell carcinoma (LSCC). From the biomolecular point of view, it was shown that the TP53 gene mutations are the most common events observed in the early phases of LSCC carcinogenesis. However, them prognostic significance remains controversial. Besides, the prognostic significance of DNA ploidy has been well established for other solid tumors, but its role in LSCC is still controversial. The aim of this study was, therefore, to prospectively evaluate the prognostic significance of TP53 mutations, DNA-ploidy and S-phase fraction (SPF) in LSCC patients. Prospective analysis of 81 patients who underwent resective surgery for primary operable locally advanced LSCC patients (stages III and IV) was performed. Tumor DNA was screened for TP53 mutations by PCR/SSCP and sequencing; DNA flow cytometry was performed on mechanically disaggregated sample of frozen tumor tissue. The median follow-up time in our study group was 71 months (range 11-137 months). Fourthy-four percent of patients (36/81) have, at least, a mutation in the TP53 gene. Of them, 22% (8/36) have double mutations and 6% (2/36) have triple mutations. In total, 47 TP53 mutations were observed. The majority (42%) of these occur in exon 5 (20/47), while the mutations in exons 6, 7 and 8 are represented in 14, 7 and 6 patients respectively (30%, 15% and 13%). The flow cytometry analysis showed that sixty-three percent of the cases (51/81) were DNA aneuploidy and 14% of these (7/51) were multiclonal. LSCC patients were divided into two groups using median SPF level as cut-off point: low SPF 15.1 % and high SPF >15.1 %, Even though it seems that TP53 mutations promotes the LSCC carcinogenesis in young people (p< 0.05), there was not any association between this variable and the clinicopathological or the other biomolecular variables. At univariate analysis, the Kaplan and Meier text show that DNA aneuploidy, high SPF, any TP53 mutations and, in particular, the mutations that occur in exons 5 and 8 proved to be significantly related to quicker disease relapse and short OS. At multivariate analysis, the Cox proportional hazards model show that the major significant predictors for both disease relapse and death were high SPF and any TP53 mutations. In conclusion, any TP53 mutations, more than specific mutations in exon 5 and 8, are important biological indicators to predict the outcome of patients indicating these mutations have biological relevance in terms of LSCC disease course. Our study has also identify high SPF as independent prognostic factors in locally advanced LSCC patients

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy

IntroductionIn recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.Materials and methodsAnnex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p&lt;0.05). The statistical analyses were performed by SPSS and Stata software.ResultsA total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). ConclusionsThis study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside