CD4 T lymphocyte autophagy is upregulated in the salivary glands of primary Sjögren’s syndrome patients and correlates with focus score and disease activity

Background: Primary Sjögren’s syndrome (pSS) is a common chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands and peripheral lymphocyte perturbation. In the current study, we aimed to investigate the possible pathogenic implication of autophagy in T lymphocytes in patients with pSS. Methods: Thirty consecutive pSS patients were recruited together with 20 patients affected by sicca syndrome a nd/or chronic sialoadenitis and 30 healthy controls. Disease activity and damage were evaluated according to SS disease activity index, EULAR SS disease activity index, and SS disease damage index. T lymphocytes were analyzed for the expression of autophagy-specific markers by biochemical, molecular, and histological assays in peripheral blood and labial gland biopsies. Serum interleukin (IL)-23 and IL-21 levels were quantified by enzyme-linked immunosorbent assay. Results: Our study provides evidence for the first time that autophagy is upregulated in CD4+ T lymphocyte salivary glands from pSS patients. Furthermore, a statistically significant correlation was detected between lymphocyte autophagy levels, disease activity, and damage indexes. We also found a positive correlation between autophagy enhancement and the increased salivary gland expression of IL-21 and IL-23, providing a further link between innate and adaptive immune responses in pSS. Conclusions: These findings suggest that CD4+ T lymphocyte autophagy could play a key role in pSS pathogenesis. Additionally, our data highlight the potential exploitation of T cell autophagy as a biomarker of disease activity and provide new ground to verify the therapeutic implications of autophagy as an innovative drug target in pSS

Rituximab modulates IL-17 expression in the salivary glands of patients with primary Sjögren's syndrome

OBJECTIVE: The aim of this study was to evaluate the role of rituximab (RTX) in modulating the expression of the IL-17/IL-23 pathway in the salivary glands (SGs) of patients with primary SS (pSS). METHODS: Consecutive SG biopsies were obtained from 15 patients with pSS before and after 1 year of RTX therapy. The SG expression of IL-17, IL-23p19 and p-STAT3 was evaluated by immunohistochemistry at baseline and after RTX therapy. The role of mast cells in pSS patients in modulating the Th17 response and the immunologic effect of RTX on mast cells were also studied in in vitro experiments. RESULTS: IL-17 was overexpressed in the SGs of patients with pSS mainly by infiltrating T cells and mast cells. After RTX therapy, the SG expression of IL-17, but not of IL-23p19 and p-STAT3, was significantly reduced and was accompanied by the depletion of tissue mast cells. In in vitro experiments with heterologous peripheral lymphocytes RTX significantly induced the apoptosis of isolated mast cells. Finally, mast cells isolated from peripheral blood mononuclear cells of pSS patients in vitro significantly increased Th17 lymphocytes. CONCLUSION: RTX acts on pSS patients by globally reducing the expression of IL-17 and specifically inducing a pronounced apoptotic depletion of mast cells

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI

Early orthodontic treatment of Class II malocclusions with no-compliance appliances: study project with Forsus device system

Aim: Class II malocclusion is considered as a sagittal discrepancy between the maxillary bases characterized by a protrusion of the maxilla and/ or a retrusion of the mandible. There are several therapeutic approaches where the most suitable choise depends, for example, on the different level of patient’s cooperation. During childhood, the most used appliances for Class II malocclusion are the removable functional devices that need a good patient’s cooperation to be successful. The aim of this study was to evaluate the dental-alveolar and skeletal effects of an interceptive orthodontic treatment with a mandibular propulsive orthodontic appliance named Forsus in Class II growing patients with lack of compliance for functional appliances. Methods: A group of growing patients was selected to be treated with Forsus device following inclusion and exclusion methods. Some inclusion methods were: Class II malocclusion, OVJ more than 4 mm, stage of vertebral development Cs2-Cs3, lack of compliance for functional appliances. Some exclusion methods were though: permanent dentition, stage of vertebral development Cs4, presence of temporary mandibular disorders. The device wasn’t associated with a multibrackets orthodontic therapy but it presented a new design studied to be applied in mixed dentition. The telescopic system of Forsus device, that consists of a pushrod inside a Ni-Ti spring, was combined with a palatal arch and a double mandibular ferule. The upper and lower first molars presented orthodontic bands. The telescopic system connected the maxilla to the mandible from distal to mesial having contact, respectively, with the vestibular tubes of the upper first molars and with the mesial stops located in the vestibular sides of the mandibular ferule, at the level of the interproximal zone between canine and first deciduous molar or first premolar. A first patient was chosen to be treated to evaluate the effectiveness of the therapy with this new design, to underline both strengths and weaknesses of the therapy. A complete photographic intraoral record was carried out before installation of Forsus device as well as during the different stages of the treatment. Cephalometric radiograph analysis was taken before therapy and at the completion of comprehensive therapy. A comparison between initial and final digital study models was as well realized. The treatment lasted 8 months. Results: The overall therapeutic effects were mainly dento-alveolar while the skeletal effects were less significant as a slight improvement of ANB angle from 7,7° to 5,4°. The overjet decreased significantly from 7,1 mm to 3,2 mm and the overbite from 4,5 to 0,1. A new molar relationship of Class 1 of Angle was achieved. Conclusion: Forsus device is a valid option of no- compliance interceptive orthodontic treatment in Class II growing patients. Although the therapy had mainly dento-alveolar effects, it will be possible to achieve more skeletal effects for example taking care to apply the device for the whole period of the peak of growth

Ultrasound-guided dilatation and curettage in life-threatening cesarean scar ectopic pregnancy

[No abstract available

An atypical presentation of sporadic ovarian Burkitt's lymphoma: case report and review of the literature

Primary non-Hodgkin's lymphoma of the ovary is a rare occurrence. An ovarian involvement by non-Hodgkin lymphoma (NHL) may include one of the four subtypes of lymphoma: diffuse large B-cell lymphoma, Burkitt's lymphoma (BL), lymphoblastic lymphoma or anaplastic large cell lymphoma. Burkitt's lymphoma is a rare entity with a specific poorly differentiated pattern. Most women experience an ovarian BL with abdominal pelvic pain, abnormal vaginal bleeding, bowel obstruction, urinary frequency, incontinence and abdominal mass. Sometimes these warning signs may be absent, causing a late and more difficult diagnosis. Here we report a case of a primary ovarian Burkitt's lymphoma with bilateral involvement in a 57 year old patient. She firstly presented neurological symptoms in the upper limbs and she was treated with surgery and combined chemotherapy. The diagnosis of malignant lymphoma was established after bilateral adnexectomy and histological study of the excised tissue

Exergames in Childhood Obesity Treatment: A Systematic Review

In the last decade, active video games (exergames) have been proposed in obesity prevention and treatment as a potential tool to increase physical activity. This review was aimed to assess the possible role of exergames in reducing weight-related outcomes among overweight/obese children and/or adolescents. The databases PubMed, Scopus, Web of Science and SPORTDiscus were interrogated to detect controlled studies involving healthy overweight/obese children and adolescents in interventions based exclusively on exergames. Out of a total of 648 articles found, 10 met the inclusion criteria and were included in the review. The included studies differ for duration, setting and type of intervention, frequency of active game sessions, and outcomes considered. Seven out of ten studies reported better outcomes in children/adolescents involved in the interventions, with significant differences between groups in four, while three studies found better outcomes in control groups. These results suggest a possible positive effect of active video games on weight-related outcomes in obese children and adolescents. However, further research is still needed to define if they can be effectively used in childhood obesity treatment and which may be the most effective approach. The potentiality of the new digital media in this field should be explored