Combined Modality Treatment Including Methotrexate-Based Chemotherapy For Primary CENTRAL Nervous System Lymphoma: A Single Institution Experience

Chemotherapy including high-dose methotrexate (HD-MTX), with or without radiotherapy, is standard treatment for primary central nervous system lymphoma (PCNSL). It remains controversial whether addition of other drugs will add to therapeutic efficacy. We report here on 41 patients with PCNSL treated using a combined treatment modality, including HD-MTX (3.5 g/m2 for 2 cycles) prior to whole brain radiotherapy (WBRT). In 22 patients, the chemotherapy was intensified by adding high-dose cytosine arabinoside (HD-AraC) (2g/m2 for 4 doses for 2 cycles). Complete remission at the end of the combined treatment was obtained in 23 of 34 assessable patients (67%), and the predicted 5-year overall and disease-free survival rates were 24% and 46%, respectively, without differences between treatment groups. The addition of HD-AraC was complicated by severe infections in 17/22 (77%) patients, resulting in 3 toxic deaths. Our study indicates that addition of HD-AraC may not improve clinical outcome in PCNSL, while it increases toxicity. More targeted and less toxic therapies are warranted

Retrospective Observational Study on Microbial Contamination of Ulcerative Foot Lesions in Diabetic Patients

According to recent studies, there are almost 435 million people worldwide with diabetes mellitus. It is estimated that of these 148 million will develop Diabetic foot ulcers (DFUs) during their lifetime, of which 35 to 50% will be infected. In this scenario, the presence and frequency of pathogenic microorganisms and their level of susceptibility to the most frequent classes of antibiotics used to treat this pathological condition from patients with DFUs admitted to the outpatient clinic of vascular surgery of the Federico II University Hospital of Naples from January 2019 to March 2021 were investigated. Furthermore, the diabetic population characteristics under study (i.e., general, clinical, and comorbidities) and the pathogenic bacteria isolated from lesions were also considered. Bacterial strains poorly susceptible to antibiotics were more frequent in polymicrobial infections than in monomicrobial infections. β-Lactams showed the highest levels of resistance, followed by fluoroquinolones, aminoglycosides, and finally macrolides. The main findings of the study demonstrated that the occurrence of resistant microorganisms is the dominant factor in ulcer healing; thus it is essential to investigate the antibiotics’ susceptibility before setting antibiotic therapy to avoid inappropriate prescriptions that would affect the treatment and increase the development and spread of antibiotic resistanc

Epstein-Barr Virus (EBV)-Associated Haemophagocytic Syndrome

We describe the case of a 17- year old female who developed fatal haemophagocytic syndrome (HPS) one month following acute infection caused by Epstein-Barr virus (EBV). Despite initiation of treatment and reduction of EBV load, laboratory signs of HPS as severe cytopenia, hypofibrinogenemia, hyperferritinemia and hypertriglyceridemia persisted, and the patient died of multiorgan failure. HPS is a rare, but life-threatening complication of EBV infection

Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study

Background and aims: We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age.Methods: From the Italian LIPIGEN cohort, we selected 1188 (>= 18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation.Results: The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives.Conclusions: In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age

Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study

Background and aims: We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age. Methods: From the Italian LIPIGEN cohort, we selected 1188 (≥18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation. Results: The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives. Conclusions: In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age

Twelve Variants Polygenic Score for Low-Density Lipoprotein Cholesterol Distribution in a Large Cohort of Patients With Clinically Diagnosed Familial Hypercholesterolemia With or Without Causative Mutations

: Background A significant proportion of individuals clinically diagnosed with familial hypercholesterolemia (FH), but without any disease-causing mutation, are likely to have polygenic hypercholesterolemia. We evaluated the distribution of a polygenic risk score, consisting of 12 low-density lipoprotein cholesterol (LDL-C)-raising variants (polygenic LDL-C risk score), in subjects with a clinical diagnosis of FH. Methods and Results Within the Lipid Transport Disorders Italian Genetic Network (LIPIGEN) study, 875 patients who were FH-mutation positive (women, 54.75%; mean age, 42.47±15.00 years) and 644 patients who were FH-mutation negative (women, 54.21%; mean age, 49.73±13.54 years) were evaluated. Patients who were FH-mutation negative had lower mean levels of pretreatment LDL-C than patients who were FH-mutation positive (217.14±55.49 versus 270.52±68.59 mg/dL, P<0.0001). The mean value (±SD) of the polygenic LDL-C risk score was 1.00 (±0.18) in patients who were FH-mutation negative and 0.94 (±0.20) in patients who were FH-mutation positive (P<0.0001). In the receiver operating characteristic analysis, the area under the curve for recognizing subjects characterized by polygenic hypercholesterolemia was 0.59 (95% CI, 0.56-0.62), with sensitivity and specificity being 78% and 36%, respectively, at 0.905 as a cutoff value. Higher mean polygenic LDL-C risk score levels were observed among patients who were FH-mutation negative having pretreatment LDL-C levels in the range of 150 to 350 mg/dL (150-249 mg/dL: 1.01 versus 0.91, P<0.0001; 250-349 mg/dL: 1.02 versus 0.95, P=0.0001). A positive correlation between polygenic LDL-C risk score and pretreatment LDL-C levels was observed among patients with FH independently of the presence of causative mutations. Conclusions This analysis confirms the role of polymorphisms in modulating LDL-C levels, even in patients with genetically confirmed FH. More data are needed to support the use of the polygenic score in routine clinical practice

Avaliação da hemodinâmica em pacientes com doença cardíaca persistente: uma revisão bibliográfica

Introdução: A avaliação da hemodinâmica em pacientes com cardiopatia persistente é um tópico complexo e multifacetado que requer uma compreensão abrangente da fisiopatologia subjacente e dos fatores de risco associados. Esta revisão bibliográfica fornece um resumo valioso da pesquisa atual no campo e destaca vários temas-chave que surgiram de estudos recentes. Metodologia: foi realizada uma revisão de literatura conduzida para investigar os aspectos clínicos, fisiológicos, patológicos e hemodinâmicos em pacientes com cardiopatia persistente. Foram realizadas buscas em várias bases de dados entre 2010 e 2022, utilizando termos específicos. Os critérios de inclusão foram estudos de coorte, estudos de caso-controle e revisões sistemáticas com amostras maiores que 10 indivíduos. Após uma triagem inicial, 33 artigos foram selecionados para análise. Os artigos foram avaliados quanto à qualidade metodológica e os dados foram agrupados e analisados qualitativamente. Os resultados foram apresentados de forma descritiva, destacando as principais informações encontradas sobre os aspectos clínicos, fisiológicos, patológicos e hemodinâmicos em pacientes cardiopatas resistentes.&nbsp; Discussão: Uma descoberta notável é que a insuficiência cardíaca crônica continua sendo um grande problema de saúde pública, com quase 5 milhões de casos relatados apenas nos EUA. Apesar dos avanços no tratamento, a taxa de mortalidade dessa condição permanece alta, enfatizando a necessidade de pesquisas contínuas sobre os mecanismos subjacentes e intervenções mais eficazes. Além disso, a revisão identifica vários fatores de risco potenciais para doença cardíaca persistente, incluindo doença renal crônica, obesidade e inflamação. Esses achados sugerem que uma abordagem multidisciplinar para o manejo da doença, incorporando intervenções médicas e de estilo de vida, pode ser mais eficaz para melhorar os resultados dos pacientes. Conclusão: No geral, esta revisão ressalta a necessidade crítica de pesquisas contínuas sobre a fisiopatologia, fatores de risco e tratamento de doenças cardíacas persistentes e fornece informações valiosas sobre possíveis caminhos para futuras investigações

Stand Up University, break sedentary behaviors.

Gli stili di vita moderni sono caratterizzati da una pratica insufficiente di attività fisica, da abitudini alimentari scorrette e da numerosi comportamenti sedentari. Questi stili di vita moderni sono correlati a fattori di rischio per numerose malattie croniche degenerative (ipertensione, malattie cardiovascolari, diabete 2, cancro). Numerosi studi scientifici hanno dimostrato come le attività sedentarie, ovvero quelle attività caratterizzate da un dispendio energetico inferiore a 1.5 METs (ad esempio: guardare la televisione o stare seduti ad una scrivania), siano associate ad un aumentato rischio di malattie cardio-metaboliche (ad esempio: diabete), ad una peggiore salute mentale (ad esempio: ansia e depressione) e ad un maggiore rischio di mortalità per tutte le cause.Tra le possibili strategie per limitare la sedentarietà, le “pause attive” o “active breaks”, si stanno dimostrando una tipologia di intervento efficace per migliorare la salute e il benessere sia fisico che mentale. Si tratta di brevi interruzioni (dai 2-10 minuti) di un comportamento sedentario per eseguire una serie di esercizi fisic

Influence of total solids concentration and temperature on the changes in redox potential of tomato pastes

The influence of total solid concentration, heating time and temperature on the changes in redox potential of tomato pastes was studied. Results showed that the reducing properties of the tomato samples were greatly affected by these parameters. In particular, low temperature long time treatments led to the greatest increase in redox potential, which can be attributable to a loss of naturally occurring anti-oxidants. On the contrary, treatments at high temperatures caused little overall change in the redox potential. It was concluded that when severe heating is applied, the formation of heat-induced Maillard reaction products, with anti-oxidant properties, might balance the increase in the redox potential caused by the thermal degradation of tomato natural anti-oxidants