The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several decades.Nonetheless,infection with Echinococcus granulosus(E.granulosus)remains a major public health issu...The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several decades.Nonetheless,infection with Echinococcus granulosus(E.granulosus)remains a major public health issue in several countries and regions,even in places where it was previously at low levels,as a result of a reduction of control programmes due to economic problems and lack of resources.Geographic distribution differs by country and region depending on the presence in that country of large numbers of nomadic or semi-nomadic sheep and goat flocks that represent the intermediate host of the parasite,and their close contact with the final host,the dog,which mostly provides the transmission of infection to humans.The greatest prevalence of cystic echinococcosis in human and animal hosts is found in countries of the temperate zones,including several parts of Eurasia(the Mediterranean regions,southern and central parts of Russia,central Asia,China),Australia,some parts of America(especially South America)and north and east Africa.Echinococcosis is currently considered an endemic zoonotic disease in the Mediterranean region.The most frequent strain associated with human cystic echinococcosis appears to be the common sheep strain(G1).This strain appears to be widely distributed in all continents.The purpose of this review is to examine the distribution of E.granulosus and the epidemiology of a re-emerging disease such as cystic echinococcosis.展开更多
Colorectal cancer(CRC) is a major cause of cancer death worldwide. CRC has poor prognosis and there is a crucial need for new diagnostic and prognostic biomarkers to avoid CRC-related deaths. CRC can be considered a s...Colorectal cancer(CRC) is a major cause of cancer death worldwide. CRC has poor prognosis and there is a crucial need for new diagnostic and prognostic biomarkers to avoid CRC-related deaths. CRC can be considered a sporadic disease in most cases(75%-80%), but it has been suggested that crosstalk between gene mutations(i.e., mutations of BRAF, KRAS, and p53 as well as microsatellite instability) and epigenetic alterations(i.e., DNA methylation of Cp G island promoter regions) could play a pivotal role in cancer development. A number of studies have focused on molecular testing to guide targeted and conventional treatments for patients with CRC, sometimes with contrasting results. Some of the most useful innovations in the management of CRC include the possibility to detect the absence of KRAS, BRAF, NRAS and PIK3 CA gene mutations with the subsequent choice to administer targeted adjuvant therapy with anti-epidermal growth factor receptor antibodies. Moreover, CRC patients can benefit from tests for microsatellite instability and for the detection of loss of heterozygosity of chromosome 18 q that can be helpful in guiding therapeutic decisions as regards the administration of 5-FU. The aim of this review was to summarize the most recent evidence on the possible use of genetic or epigenetic biomarkers for diagnosis, prognosis and response to therapy in CRC patients.展开更多
In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to de...In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.展开更多
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conv...Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.展开更多
Biliary tract carcinomas are relatively rare,representing less than 1%of cancers.However,their incidence has increased in Japan and in industrialized countries like the USA.Biliary tract tumors have a poor prognosis a...Biliary tract carcinomas are relatively rare,representing less than 1%of cancers.However,their incidence has increased in Japan and in industrialized countries like the USA.Biliary tract tumors have a poor prognosis and a high mortality rate because they are usually detected late in the course of the disease;therapeutic treatment options are often limited and of minimal utility.Recent studies have shown the importance of serum and molecularmarkers in the diagnosis and follow up of biliary tract tumors.This review aims to introduce the main features of the most important serum and molecular markers of biliary tree tumors.Some considerable tumor markers are cancer antigen 125,carbohydrate antigen 19-9,carcinoembryonic antigen,chromogranin A,mucin 1,mucin 5,alpha-fetoprotein,claudins and cytokeratins.展开更多
The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects und...The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects undergo less elective surgical procedures than younger patients mainly due to the high rates of postoperative morbidity and mortality. Some authors suggest extensive surgery, including multistage procedures, as carried out in younger patients while others promote less aggressive surgery. In older patients, laparoscopic-assisted colectomy showed a number of advantages compared to conventional open surgery that include lower stress, higher rate of independency after surgery, quicker return to prior activities and a decrease in costs. The recent advances in chemotherapy and the introduction of new surgical procedures such as the endoluminal stenting, suggest the need for a revisitation of surgical practice patterns and the role of palliative surgery, mainly for patients with advanced disease. In this article, we discuss the current role of surgery for elderly patients with colorectal cancer.展开更多
Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively ...Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.展开更多
To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.METHODSPubMed and EMBASE databases were searched until March 2016 for the articles reporting on t...To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.METHODSPubMed and EMBASE databases were searched until March 2016 for the articles reporting on the circulating levels of inflammatory markers, including: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and risk of colorectal adenoma. Random-effects models were used to calculate summary odds ratios (ORs) with 95%CIs for the highest vs lowest category of exposure. Heterogeneity was assessed by using the Q test and I<sup>2</sup> statistic. Subgroup analyses were also performed to test for potential source of heterogeneity.RESULTSA total of 14 case-control studies were included. Ten studies on CRP including a total of 3350 cases and 4168 controls showed non-significant summary (OR = 1.23, 95%CI: 0.98-1.54; I<sup>2</sup> = 54%, P<sub>heterogeneity</sub> = 0.01) in the general analysis, but significant increased odds when considering only advanced adenoma (OR = 1.59, 95%CI: 1.09-2.32; I<sup>2</sup> = 44%, P<sub>heterogeneity</sub> = 0.15). Subgroup and stratified analyses revealed a potential influence of smoking status and aspirin use on the association between CRP levels and colorectal adenoma. Five studies examined the association between circulating levels of TNF-α and colorectal adenoma risk, including a total of 1,568 cases and 2,832 controls. The summary OR for the highest vs the lowest category of exposure was 1.00 (95%CI: 0.77-1.29). The relationship between circulating IL-6 levels and colorectal adenoma risk was investigated in 7 studies including a total of 1936 cases and 3611 controls. The summary OR for the highest vs the lowest category of exposure was 1.19 (95%CI: 0.92-1.55).CONCLUSIONSummary of current evidence suggests a positive association of CRP levels and advanced colorectal adenoma risk. The role of potential confounding factors should be further evaluated.展开更多
Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predi...Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.展开更多
European mountain systems have played a crucial role in shaping the distribution of species and of their genetic diversity during the Quaternary climatic changes,with the establishment of allopatric patterns across ma...European mountain systems have played a crucial role in shaping the distribution of species and of their genetic diversity during the Quaternary climatic changes,with the establishment of allopatric patterns across main mountain ranges.Here we investigated the evolutionary history of fea beetles of the Longitarsus candidulus species-group showing an uncommon disjunct biogeographic pattern across the Apennine and the Pyrenees.We applied a multilocus molecular approach and multispecies coalescent models to establish a phylogenetic and systematic framework for this morphologically homogeneous species-group and to estimate the time of main cladogenetic events underlying the origin of the Apennine-Pyrenees pattern.We found strong support for the monophyly of the candidulus group with a sister relationship between Longitarsus laureolae and L.leonardii endemic to the Apennine and the Pyrenees mountains respectively.The timing of speciation events in the candidulus species-group coincides with 2 major climatic transitions during the Early and Middle Pleistocene which resulted in signifcant environmental changes in Europe and suggest a scenario of allopatric isolation and divergence on distinct mountain ranges.The split between the thermophilic species L.candidulus and the ancestor of the temperate species L.laureolae and L.leonardii is estimated at~3 Ma during the transition from Pliocene to Pleistocene and was probably triggered by their segregation in xerophilous and temperate habitats.The speciation between L.laureolae and L.leonardii,estimated at~1 Ma during the Mid-Pleistocene Transition,can be explained by the establishment of unfavorable conditions in West Alps and Central Massif underlying the onset of the Apennine-Pyrenees disjunct pattern.Finally,the strict association between members of the candidulus group and distinct Thymelaeaceae plants suggests further studies to address the hypothesis that speciation in these fea beetles might have been also associated with Pleistocene range changes of their host plants.展开更多
BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complication...BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023.Clinical outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when feasible.RESULTS Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic state.Fifty-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus.The mean time to resolution was 54.95±52.64 days,with a median of 35.5 days.No severe complications were recorded.Ten patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was recorded.Seven patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the problem.Mortality was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.展开更多
The aim of this work was to investigate the FUT2 gene, the secretor status and the expression of CD44 protein in epithelial cells obtain from saliva and urine samples from patients with urogenital tumours. We studied ...The aim of this work was to investigate the FUT2 gene, the secretor status and the expression of CD44 protein in epithelial cells obtain from saliva and urine samples from patients with urogenital tumours. We studied 104 subjects. Half of them had urogenital tumours, while the other half was the healthy control group. We determined the secretor status in saliva with the haemagglutination inhibition technique. We analyzed the FUT2 polymorphism by allele specific oligonucleotide–polymerase chain reaction (ASO-PCR) with specific primers for the G428 allele and the wild type allele of FUT2 gene. We found higher intensity of urogenital disease in the non-secretor group (OR = 3.44). In contrast with the healthy population, 51.6% of the patients with potential malignant urogenital lesions and cancerous lesions were non-secretors. We also investigate by confocal microscopy, the expression of CD44 protein in epithelial cells obtained from urine samples from these patients. The results obtained also showed fluorescence corresponding to the presence of CD44 protein in samples from patients diagnosed with cancer. Our study suggests that the lack of wild type FUT2 gene and a nonsecretor status appear to be an associated risk marker for the development of urogenital tumors. Several mechanisms, based on the properties of CD44 as the major hyaluronan CD44 in cell carcinomas receptor, have been proposed to explain the role of elevated CD44 expression during tumour development and progression. CD44 might be a good candidate as a predictor of prognosis in this group of cancers.展开更多
The purpose of the research was to investigate two-dimensional modeling of efficiency of mixing, resulting from the reflection of a linear internal wave field (IWF) off a continental slope. Efficiency of deep ocean mi...The purpose of the research was to investigate two-dimensional modeling of efficiency of mixing, resulting from the reflection of a linear internal wave field (IWF) off a continental slope. Efficiency of deep ocean mixing was associated with the energy balance of the radiating IWF into an interior of the ocean in the vicinity of a sloping bottom topography. Since waves are generated not only at the fundamental frequency but also at all of its harmonics <em>ω</em><sub><em>n</em></sub> = <em>nω</em> less than buoyancy frequency <i>N</i> and greater than Coriolis frequency <i>f</i>, our analysis includes, in general, an infinite number of discrete internal wave modes <i>n</i> satisfying the dispersion relationship for internal waves. However, since we are interested only in the radiating part of the field, the mode numbers are limited. Due to multiple singularities of order two caused by resonance in the vicinity of critical slope, the energy is visualized in <em>L</em><sub><em>δ</em></sub> -norm with <em>δ</em> > 2. Research results include the visualization of the effects of the continental slope and the Earth’s rotation on resulting energy in the vicinity of the slope.展开更多
Many physiological effects of natural antioxidants, their extracts or their major active components, have been reported in recent decades. Most of these compounds are characterized by a phenolic structure, similar to ...Many physiological effects of natural antioxidants, their extracts or their major active components, have been reported in recent decades. Most of these compounds are characterized by a phenolic structure, similar to that of o-tocopherol, and present antioxidant properties that have been demonstrated both in vitro and in vivo. Polyphenors may increase the capacity of endogenous antioxidant defences and modulate the cellular redox state. Changes in the cellular redox state may have wide-ranging consequences for cellular growth and differentiation. The majority of in vitro and in vivo studies conducted so far have attributed the protective effect of bioactive polyphenols to their chemical reactivity toward free radicals and their capacity to prevent the oxidation of important intracellular components. However, in recent years a possible novel aspect inthe mode of action of these compounds has been suggested; that is, the ultimate stimulation of the heme oxygenase-1 （HO-1） pathway is likely to account for the established and powerful antioxidant/anti-inflammatory properties of these polyphenols. The products of the HO-catalyzed reaction, particularly carbon mon- oxide （CO） and biliverdin/bilirubin have been shown to exert protective effects in several organs against oxidative and other noxious stimuli. In this context, it is interesting to note that induction of HO-1 expression by means of natural compounds contributes to protection against liver damage in various experimental models. The focus of this review is on the significance of targeted induction of HO-1 as a potential therapeutic strategy to protect the liver against various stressors in several pathological conditions.展开更多
Mesenchymal stem cells(MSC) are cells of stromal origin which exhibit unlimited self-renewal capacity and pluripotency in vitro.It has recently been observed that MSC may also exert a profound immunosuppressive and an...Mesenchymal stem cells(MSC) are cells of stromal origin which exhibit unlimited self-renewal capacity and pluripotency in vitro.It has recently been observed that MSC may also exert a profound immunosuppressive and anti-inflammatory effect both in vitro and in vivo with consequent potential use in autoimmune disorders.We present the case of a patient suffering from childhood-onset, multidrug resistant and steroiddependent Crohn's disease who underwent systemic infusions of MSC, which led to a temporary reduction in CCR4, CCR7 and CXCR4 expression by T-cells, and a temporary decrease in switched memory B-cells, In addition, following MSC infusion, lower doses of steroids were needed to inhibit proliferation of the patient's peripheral blood mononuclear cells.Despite these changes, no significant clinical benefit was observed, and the patient required rescue therapy with infliximab and subsequent autologous hematopoietic stem cell transplantation.The results of biological and in vitro observations after MSC use and the clinical effects of infusion are discussed, and a brief description is provided of previous data on MSC-based therapy in autoimmune disorders.展开更多
The advanced and personalised experience that modern cars offer makes them more and more data-hungry.For example,the cabin preferences of the possible drivers must be recorded and associated to some identity,while suc...The advanced and personalised experience that modern cars offer makes them more and more data-hungry.For example,the cabin preferences of the possible drivers must be recorded and associated to some identity,while such data could be exploited to deduce sensitive information about the driver’s health.Therefore,drivers’privacy must be taken seriously,requiring a dedicated risk assessment framework,as presented in this paper through a double assessment combining the asset-oriented ISO approach with the threat-oriented STRIDE approach.The framework is tailored to the level of specific car brand and demonstrated on the ten top-selling brands as well as,due to its innovative character,Tesla.The two approaches yield different,but complementary findings,demonstrating the additional insights gained through their parallel adoption.展开更多
Background:Magnolia bark extract(MBE)is a natural supplement with antioxidant,anti-inflammatory,and antimicrobial activities.Its properties suggest that the dietary supplementation in livestock could improve the quali...Background:Magnolia bark extract(MBE)is a natural supplement with antioxidant,anti-inflammatory,and antimicrobial activities.Its properties suggest that the dietary supplementation in livestock could improve the quality of products.Therefore,the aim of this study was to investigate,for the first time,the effect of dietary MBE supplementation(0.33 mg/kg)in finishing pigs on the oxidative stability of meat.Oxidative stability is of paramount importance for pork,as it affects storage,retail,and consumer acceptance.For the purpose,the fatty acid profile,cholesterol,fatsoluble vitamins,antioxidant enzymes(catalase,glutathione peroxidase,and superoxide dismutase),non-enzymatic antioxidant capacity(TEAC,FRAP,and Folin-Ciocalteu assays),color stability,and lipid stability of pork were assessed.Results:Concerning carcass characteristics,dietary MBE did not affect cold carcass yield,but reduced(P=0.040)the chilling weight loss.The meat from pigs fed MBE had a lower(P=0.031)lightness index than the control meat.No effect on intramuscular fat,cholesterol,and fatty acid profile was observed.Dietary MBE did not affect the content of vitamin E(α-tocopherol andγ-tocopherol)in pork,whereas it reduced(P=0.021)the retinol content.The catalase activity was 18%higher(P=0.008)in the meat from pigs fed MBE compared with the control group.The MBE supplementation reduced(P=0.039)by 30%the thiobarbituric acid reactive substances(TBARS)in raw pork over 6 d of aerobic refrigerated storage.Instead,no effect on lipid oxidation was observed in cooked pork.Last,the meat from pigs fed MBE reduced Fe3+-ascorbate catalyzed lipid oxidation in muscle homogenates,with a lower(P=0.034)TBARS value than the control group after 60 min of incubation.Conclusions:Dietary MBE supplementation in finishing pigs delayed the lipid oxidation in raw meat.This effect was combined with an increased catalase concentration.These results suggest that dietary MBE could have implications for improving the shelf-life of pork.展开更多
文摘The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several decades.Nonetheless,infection with Echinococcus granulosus(E.granulosus)remains a major public health issue in several countries and regions,even in places where it was previously at low levels,as a result of a reduction of control programmes due to economic problems and lack of resources.Geographic distribution differs by country and region depending on the presence in that country of large numbers of nomadic or semi-nomadic sheep and goat flocks that represent the intermediate host of the parasite,and their close contact with the final host,the dog,which mostly provides the transmission of infection to humans.The greatest prevalence of cystic echinococcosis in human and animal hosts is found in countries of the temperate zones,including several parts of Eurasia(the Mediterranean regions,southern and central parts of Russia,central Asia,China),Australia,some parts of America(especially South America)and north and east Africa.Echinococcosis is currently considered an endemic zoonotic disease in the Mediterranean region.The most frequent strain associated with human cystic echinococcosis appears to be the common sheep strain(G1).This strain appears to be widely distributed in all continents.The purpose of this review is to examine the distribution of E.granulosus and the epidemiology of a re-emerging disease such as cystic echinococcosis.
文摘Colorectal cancer(CRC) is a major cause of cancer death worldwide. CRC has poor prognosis and there is a crucial need for new diagnostic and prognostic biomarkers to avoid CRC-related deaths. CRC can be considered a sporadic disease in most cases(75%-80%), but it has been suggested that crosstalk between gene mutations(i.e., mutations of BRAF, KRAS, and p53 as well as microsatellite instability) and epigenetic alterations(i.e., DNA methylation of Cp G island promoter regions) could play a pivotal role in cancer development. A number of studies have focused on molecular testing to guide targeted and conventional treatments for patients with CRC, sometimes with contrasting results. Some of the most useful innovations in the management of CRC include the possibility to detect the absence of KRAS, BRAF, NRAS and PIK3 CA gene mutations with the subsequent choice to administer targeted adjuvant therapy with anti-epidermal growth factor receptor antibodies. Moreover, CRC patients can benefit from tests for microsatellite instability and for the detection of loss of heterozygosity of chromosome 18 q that can be helpful in guiding therapeutic decisions as regards the administration of 5-FU. The aim of this review was to summarize the most recent evidence on the possible use of genetic or epigenetic biomarkers for diagnosis, prognosis and response to therapy in CRC patients.
文摘In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.
文摘Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
文摘Biliary tract carcinomas are relatively rare,representing less than 1%of cancers.However,their incidence has increased in Japan and in industrialized countries like the USA.Biliary tract tumors have a poor prognosis and a high mortality rate because they are usually detected late in the course of the disease;therapeutic treatment options are often limited and of minimal utility.Recent studies have shown the importance of serum and molecularmarkers in the diagnosis and follow up of biliary tract tumors.This review aims to introduce the main features of the most important serum and molecular markers of biliary tree tumors.Some considerable tumor markers are cancer antigen 125,carbohydrate antigen 19-9,carcinoembryonic antigen,chromogranin A,mucin 1,mucin 5,alpha-fetoprotein,claudins and cytokeratins.
文摘The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects undergo less elective surgical procedures than younger patients mainly due to the high rates of postoperative morbidity and mortality. Some authors suggest extensive surgery, including multistage procedures, as carried out in younger patients while others promote less aggressive surgery. In older patients, laparoscopic-assisted colectomy showed a number of advantages compared to conventional open surgery that include lower stress, higher rate of independency after surgery, quicker return to prior activities and a decrease in costs. The recent advances in chemotherapy and the introduction of new surgical procedures such as the endoluminal stenting, suggest the need for a revisitation of surgical practice patterns and the role of palliative surgery, mainly for patients with advanced disease. In this article, we discuss the current role of surgery for elderly patients with colorectal cancer.
文摘Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.
文摘To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.METHODSPubMed and EMBASE databases were searched until March 2016 for the articles reporting on the circulating levels of inflammatory markers, including: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and risk of colorectal adenoma. Random-effects models were used to calculate summary odds ratios (ORs) with 95%CIs for the highest vs lowest category of exposure. Heterogeneity was assessed by using the Q test and I<sup>2</sup> statistic. Subgroup analyses were also performed to test for potential source of heterogeneity.RESULTSA total of 14 case-control studies were included. Ten studies on CRP including a total of 3350 cases and 4168 controls showed non-significant summary (OR = 1.23, 95%CI: 0.98-1.54; I<sup>2</sup> = 54%, P<sub>heterogeneity</sub> = 0.01) in the general analysis, but significant increased odds when considering only advanced adenoma (OR = 1.59, 95%CI: 1.09-2.32; I<sup>2</sup> = 44%, P<sub>heterogeneity</sub> = 0.15). Subgroup and stratified analyses revealed a potential influence of smoking status and aspirin use on the association between CRP levels and colorectal adenoma. Five studies examined the association between circulating levels of TNF-α and colorectal adenoma risk, including a total of 1,568 cases and 2,832 controls. The summary OR for the highest vs the lowest category of exposure was 1.00 (95%CI: 0.77-1.29). The relationship between circulating IL-6 levels and colorectal adenoma risk was investigated in 7 studies including a total of 1936 cases and 3611 controls. The summary OR for the highest vs the lowest category of exposure was 1.19 (95%CI: 0.92-1.55).CONCLUSIONSummary of current evidence suggests a positive association of CRP levels and advanced colorectal adenoma risk. The role of potential confounding factors should be further evaluated.
文摘Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.
文摘European mountain systems have played a crucial role in shaping the distribution of species and of their genetic diversity during the Quaternary climatic changes,with the establishment of allopatric patterns across main mountain ranges.Here we investigated the evolutionary history of fea beetles of the Longitarsus candidulus species-group showing an uncommon disjunct biogeographic pattern across the Apennine and the Pyrenees.We applied a multilocus molecular approach and multispecies coalescent models to establish a phylogenetic and systematic framework for this morphologically homogeneous species-group and to estimate the time of main cladogenetic events underlying the origin of the Apennine-Pyrenees pattern.We found strong support for the monophyly of the candidulus group with a sister relationship between Longitarsus laureolae and L.leonardii endemic to the Apennine and the Pyrenees mountains respectively.The timing of speciation events in the candidulus species-group coincides with 2 major climatic transitions during the Early and Middle Pleistocene which resulted in signifcant environmental changes in Europe and suggest a scenario of allopatric isolation and divergence on distinct mountain ranges.The split between the thermophilic species L.candidulus and the ancestor of the temperate species L.laureolae and L.leonardii is estimated at~3 Ma during the transition from Pliocene to Pleistocene and was probably triggered by their segregation in xerophilous and temperate habitats.The speciation between L.laureolae and L.leonardii,estimated at~1 Ma during the Mid-Pleistocene Transition,can be explained by the establishment of unfavorable conditions in West Alps and Central Massif underlying the onset of the Apennine-Pyrenees disjunct pattern.Finally,the strict association between members of the candidulus group and distinct Thymelaeaceae plants suggests further studies to address the hypothesis that speciation in these fea beetles might have been also associated with Pleistocene range changes of their host plants.
文摘BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023.Clinical outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when feasible.RESULTS Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic state.Fifty-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus.The mean time to resolution was 54.95±52.64 days,with a median of 35.5 days.No severe complications were recorded.Ten patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was recorded.Seven patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the problem.Mortality was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.
文摘The aim of this work was to investigate the FUT2 gene, the secretor status and the expression of CD44 protein in epithelial cells obtain from saliva and urine samples from patients with urogenital tumours. We studied 104 subjects. Half of them had urogenital tumours, while the other half was the healthy control group. We determined the secretor status in saliva with the haemagglutination inhibition technique. We analyzed the FUT2 polymorphism by allele specific oligonucleotide–polymerase chain reaction (ASO-PCR) with specific primers for the G428 allele and the wild type allele of FUT2 gene. We found higher intensity of urogenital disease in the non-secretor group (OR = 3.44). In contrast with the healthy population, 51.6% of the patients with potential malignant urogenital lesions and cancerous lesions were non-secretors. We also investigate by confocal microscopy, the expression of CD44 protein in epithelial cells obtained from urine samples from these patients. The results obtained also showed fluorescence corresponding to the presence of CD44 protein in samples from patients diagnosed with cancer. Our study suggests that the lack of wild type FUT2 gene and a nonsecretor status appear to be an associated risk marker for the development of urogenital tumors. Several mechanisms, based on the properties of CD44 as the major hyaluronan CD44 in cell carcinomas receptor, have been proposed to explain the role of elevated CD44 expression during tumour development and progression. CD44 might be a good candidate as a predictor of prognosis in this group of cancers.
文摘The purpose of the research was to investigate two-dimensional modeling of efficiency of mixing, resulting from the reflection of a linear internal wave field (IWF) off a continental slope. Efficiency of deep ocean mixing was associated with the energy balance of the radiating IWF into an interior of the ocean in the vicinity of a sloping bottom topography. Since waves are generated not only at the fundamental frequency but also at all of its harmonics <em>ω</em><sub><em>n</em></sub> = <em>nω</em> less than buoyancy frequency <i>N</i> and greater than Coriolis frequency <i>f</i>, our analysis includes, in general, an infinite number of discrete internal wave modes <i>n</i> satisfying the dispersion relationship for internal waves. However, since we are interested only in the radiating part of the field, the mode numbers are limited. Due to multiple singularities of order two caused by resonance in the vicinity of critical slope, the energy is visualized in <em>L</em><sub><em>δ</em></sub> -norm with <em>δ</em> > 2. Research results include the visualization of the effects of the continental slope and the Earth’s rotation on resulting energy in the vicinity of the slope.
基金Grants (ex 60%) from MURST (Ministero dell’ Università e della Ricerca Scientifica e Tecnologica),Rome,Italy
文摘Many physiological effects of natural antioxidants, their extracts or their major active components, have been reported in recent decades. Most of these compounds are characterized by a phenolic structure, similar to that of o-tocopherol, and present antioxidant properties that have been demonstrated both in vitro and in vivo. Polyphenors may increase the capacity of endogenous antioxidant defences and modulate the cellular redox state. Changes in the cellular redox state may have wide-ranging consequences for cellular growth and differentiation. The majority of in vitro and in vivo studies conducted so far have attributed the protective effect of bioactive polyphenols to their chemical reactivity toward free radicals and their capacity to prevent the oxidation of important intracellular components. However, in recent years a possible novel aspect inthe mode of action of these compounds has been suggested; that is, the ultimate stimulation of the heme oxygenase-1 （HO-1） pathway is likely to account for the established and powerful antioxidant/anti-inflammatory properties of these polyphenols. The products of the HO-catalyzed reaction, particularly carbon mon- oxide （CO） and biliverdin/bilirubin have been shown to exert protective effects in several organs against oxidative and other noxious stimuli. In this context, it is interesting to note that induction of HO-1 expression by means of natural compounds contributes to protection against liver damage in various experimental models. The focus of this review is on the significance of targeted induction of HO-1 as a potential therapeutic strategy to protect the liver against various stressors in several pathological conditions.
文摘Mesenchymal stem cells(MSC) are cells of stromal origin which exhibit unlimited self-renewal capacity and pluripotency in vitro.It has recently been observed that MSC may also exert a profound immunosuppressive and anti-inflammatory effect both in vitro and in vivo with consequent potential use in autoimmune disorders.We present the case of a patient suffering from childhood-onset, multidrug resistant and steroiddependent Crohn's disease who underwent systemic infusions of MSC, which led to a temporary reduction in CCR4, CCR7 and CXCR4 expression by T-cells, and a temporary decrease in switched memory B-cells, In addition, following MSC infusion, lower doses of steroids were needed to inhibit proliferation of the patient's peripheral blood mononuclear cells.Despite these changes, no significant clinical benefit was observed, and the patient required rescue therapy with infliximab and subsequent autologous hematopoietic stem cell transplantation.The results of biological and in vitro observations after MSC use and the clinical effects of infusion are discussed, and a brief description is provided of previous data on MSC-based therapy in autoimmune disorders.
文摘The advanced and personalised experience that modern cars offer makes them more and more data-hungry.For example,the cabin preferences of the possible drivers must be recorded and associated to some identity,while such data could be exploited to deduce sensitive information about the driver’s health.Therefore,drivers’privacy must be taken seriously,requiring a dedicated risk assessment framework,as presented in this paper through a double assessment combining the asset-oriented ISO approach with the threat-oriented STRIDE approach.The framework is tailored to the level of specific car brand and demonstrated on the ten top-selling brands as well as,due to its innovative character,Tesla.The two approaches yield different,but complementary findings,demonstrating the additional insights gained through their parallel adoption.
基金the University of Catania,Department of Agriculture,Food and Environment(project“QUALIGEN”Linea 2–Piano di Incentivi per la Ricerca di Ateneo 2020/2022+1 种基金principal investigator:G.Luciano)A.Natalello benefits from PON“RICERCA E INNOVAZIONE”2014–2020 research contract(Azione IV.6—CUP E61B21004280005)Ministero dell’Universitàe della Ricerca。
文摘Background:Magnolia bark extract(MBE)is a natural supplement with antioxidant,anti-inflammatory,and antimicrobial activities.Its properties suggest that the dietary supplementation in livestock could improve the quality of products.Therefore,the aim of this study was to investigate,for the first time,the effect of dietary MBE supplementation(0.33 mg/kg)in finishing pigs on the oxidative stability of meat.Oxidative stability is of paramount importance for pork,as it affects storage,retail,and consumer acceptance.For the purpose,the fatty acid profile,cholesterol,fatsoluble vitamins,antioxidant enzymes(catalase,glutathione peroxidase,and superoxide dismutase),non-enzymatic antioxidant capacity(TEAC,FRAP,and Folin-Ciocalteu assays),color stability,and lipid stability of pork were assessed.Results:Concerning carcass characteristics,dietary MBE did not affect cold carcass yield,but reduced(P=0.040)the chilling weight loss.The meat from pigs fed MBE had a lower(P=0.031)lightness index than the control meat.No effect on intramuscular fat,cholesterol,and fatty acid profile was observed.Dietary MBE did not affect the content of vitamin E(α-tocopherol andγ-tocopherol)in pork,whereas it reduced(P=0.021)the retinol content.The catalase activity was 18%higher(P=0.008)in the meat from pigs fed MBE compared with the control group.The MBE supplementation reduced(P=0.039)by 30%the thiobarbituric acid reactive substances(TBARS)in raw pork over 6 d of aerobic refrigerated storage.Instead,no effect on lipid oxidation was observed in cooked pork.Last,the meat from pigs fed MBE reduced Fe3+-ascorbate catalyzed lipid oxidation in muscle homogenates,with a lower(P=0.034)TBARS value than the control group after 60 min of incubation.Conclusions:Dietary MBE supplementation in finishing pigs delayed the lipid oxidation in raw meat.This effect was combined with an increased catalase concentration.These results suggest that dietary MBE could have implications for improving the shelf-life of pork.
