CD4(+)IL-13(+) cells in peripheral blood well correlates with the severity of atopic dermatitis in children

In atopic dermatitis (AD) a Th1/Th2 imbalance has been reported, and interleukin (IL)-13 seems to play a pivotal role in the inflammatory network. We tried to assess the correlation between the immunological marker CD4(+)IL-13(+) and the clinical phase of extrinsic AD in children

Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study

Laparoscopic adrenalectomy is today considered the gold standard of treatment for adrenal tumors. The development of high definition cameras does not eliminate the major limitation of two-dimensional (2D) laparoscopy: lack of depth perception and loss of spatial orientation. Tree-dimensional (3D) HD laparoscopy was developed as an alternative to conventional 2D laparoscopy

In vitro generation of pancreatic endocrine cells from human adult fibroblast-like limbal stem cells

Stem cells might provide unlimited supply of transplantable cells for β-cell replacement therapy in diabetes. The human limbus is a highly specialized region hosting a well-recognized population of epithelial stem cells, which sustain the continuous renewal of the cornea, and the recently identified stromal fibroblast-like stem cells (f-LSCs), with apparent broader plasticity. However, the lack of specific molecular markers for the identification of the multipotent limbal subpopulation has so far limited the investigation of their differentiation potential. In this study we show that the human limbus contains uncommitted cells that could be potentially harnessed for the treatment of diabetes. Fourteen limbal biopsies were obtained from patients undergoing surgery for ocular diseases not involving the conjunctiva or corneal surface. We identified a subpopulation of f-LSCs characterized by robust proliferative capacity, expressing several pluripotent stem cell markers and exhibiting self-renewal ability. We then demonstrated the potential of f-LSCs to differentiate in vitro into functional insulin-secreting cells by developing a four-step differentiation protocol that efficiently directed f-LSCs towards the pancreatic endocrine cell fate. The expression of specific endodermal, pancreatic, islet, and β-cell markers, as well as functional properties of f-LSC-derived insulin-producing cells, were evaluated during differentiation. With our stage-specific approach, up to 77% of f-LSCs eventually differentiated into cells expressing insulin (also assessed as C-peptide) and exhibited phenotypic features of mature β-cells, such as expression of critical transcription factors and presence of secretory granules. Although insulin content was about 160-fold lower than what observed in adult islets, differentiated cells processed ∼98% of their proinsulin content, similar to mature β-cells. Moreover, they responded in vitro in a regulated manner to multiple secretory stimuli, including glucose. In conclusion, f-LSCs represent a possible relevant source of autologous, transplantable, insulin-producing cells that could be tested for the reversal of diabetes

Adrenal cavernous hemangioma: which correct decision making process?

Introduction: Cavernous hemangioma of the adrenal gland is a rare benign tumor characterized by the presence of blood-fil- led, dilated vascular spaces. These adrenal masses are usually non-functioning and the patients have no symptoms so the diagnosis is incidental. Methods: We performed a systematic literature review for all articles published until April 2015. The initial search identified 98 publications. We considered some characteristics: the mean age of the patients at diagnosis was 59 years (range 19 - 84); there were approximately 1.7 times more female patients than male patients; mean diameter of the lesions was 10.3 cm (range 2 - 25). Surgical treatment was more often open with midline or subcostal incision. Results: From literature analysis we know that small adrenal hemangiomas are usually asymptomatic. Only four patients in our literature review show endocrinologic disturbances with three cases of subclinical Cushing’s syndrome and a case of hyperaldo- steronism. The pre-operative radiologic features play a fundamental role for correct surgical approach. On enhanced Computed Tomography (CT) scan adrenal hemangiomas tend to be heterogeneous, hypodense lesions with high-density rim of tissue at the periphery. On Magnetic Resonance Imaging (MRI) common findings associated with adrenal hemangiomas are hypointense inhomo- geneous masses with central hyperintensity on T1 images and a high intensity peripheral rim on T2 images due to hemorrhage or necrosis. Conclusion: Laparoscopic adrenalectomy is considered the standard treatment in case of benign lesions. Some authors sugge- st that the main limitation during laparoscopic dissection for large and potentially malign adrenal tumors is incomplete resection and capsular disruption with increased risk of local recurrence and intra-abdominal neoplastic dissemination. We recommend for these patients an integrated multidisciplinary approach that considers endocrine studies, preoperative radiologic findings and the expe- rience of surgical team

Predictors of microvascular complications in type 1 diabetic patients at onset: The role of metabolic memory

Background Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications. Methods 376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up = 10.93 ± 4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy. Results The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01–3.28; p = 0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63–4.83; p < 0.001), longer duration of disease (HR 1.98; 95% CI 1.10–3.57; p = 0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03–0.92; p = 0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34–4.12, p = 0.003), as well as at onset (HR 1.85; 95% CI 1.06–3.24; p = 0.030). Conclusions Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM

Liraglutide Improved Cardiometabolic Parameters More in Obese than in Non-obese Patients with Type 2 Diabetes: A Real-World 18-Month Prospective Study

Introduction The glucagon-like peptide-1 agonist (GLP1-RA) liraglutide is currently approved for the treatment of both obesity and type 2 diabetes (T2DM). We investigated whether the effect of this agent on cardiometabolic parameters in subjects with T2DM varied in relation to the concomitant presence of obesity. Methods One hundred thirty-five subjects (78 men and 57 women; age: 62 +/- 10 years) naive to incretin-based therapies were treated with low-dose liraglutide (1.2 mg/day) as an add-on to metformin for 18 months. Patients were divided into two subgroups based on their body-mass index (BMI): (a) obese (BMI &gt;= 30) and (b) non-obese (BMI &lt; 30). Clinical and laboratory analyses were assessed at baseline and every 6 months. Results During follow-up, significant improvements were seen in both groups in fasting glycemia, glycated hemoglobin, waist circumference, and carotid intima-media thickness (cIMT), while body weight, BMI, total cholesterol, and low-density lipoprotein cholesterol decreased significantly in obese subjects only. Correlation analysis revealed that changes in subclinical atherosclerosis (assessed by cIMT) were associated with changes in triglycerides (r = 0.488, p &lt; 0.0001) in the obese group only. Conclusion Liraglutide had beneficial actions on glycemic parameters and cardiometabolic risk factors in both non-obese and obese patients with T2DM, with a greater efficacy in the latter. These findings reinforce the benefits of liraglutide for the cardiometabolic outcomes of obese patients with T2DM in the real-world setting. This has critical importance during the current pandemic, since patients with diabetes and obesity are exposed globally to the most severe forms of COVID-19, related complications, and death

Laparoscopic adrenalectomy: Preoperative data, surgical technique and clinical outcomes

Background: laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (&lt; 5-6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (&gt; 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods: at the University Hospital Policlinico "P. Giaccone" of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. Results: Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75-240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p &lt; 0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95 ml (range 50-350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7 days (range 3-6 days). Conclusions: Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications