Urinary neutrophil gelatinase-associated lipocalin time course during cardiac surgery

Background:

NGAL is one of the most promising AKI biomarkers in cardiac surgery. However, the best timing to dose it and the reference values are still matter of discussion.

Aim of the Study:

We performed a uNGAL perioperative time course, to better understand its perioperative kinetics and its role in AKI diagnosis.

Setting of the Study:

San Raffaele University Hospital, cardiac surgery department.

Material and Methods:

We enrolled in this prospective observational study 19 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Based on preoperative characteristics, they were divided in low-risk and high-risk patients. uNGAL measurements were collected at pre-defined times before, during, and up to 24 hours after surgery.

Statistical Analysis:

Data were analysed by use of SAS 1999-2001 program or IBM SPSS Statistics.

Results:

In low-risk patients, uNGAL had the highest value immediately after general anesthesia induction (basal dosage: uNGAL: 12.20ng×ml^-1, IQR 14.00). It later decreased significantly (3.40 ng×ml^-1, IQR 4.80; P = 0.006) during CPB, and finally return to its original value 24 hours after surgery. In high-risk patients, uNGAL increased immediately after surgery; it had the highest value on ICU arrival (38,20 ng×ml^-1; IQR 133,10) and remained high for several hours. A difference in uNGAL levels between the two groups was already observed at the end of surgery, but it became statistically significant on ICU arrival (P = 0.002).

Conclusion:

This study helps to better understand the different kinetics of this new biomarker in low-risk and high-risk cardiac patients.     

Transdermal Clonidine in the Prophylaxis of Episodic Cluster Headache: An Open Study

Transdermal clonidine has recently been reported to be efficacious in the prophylaxis of cluster headache. A 2-week course of transdermal clonidine (5 mg the first week, 7.5 mg the second week) prceded by a 5-day run-in period, was administered to 16 patients with episodic cluster headache in an active cluster period. In 5 patients, the painful attacks. disappeared after the seventh day of treatment. For the group as a whole, no significant variations in headache frequency. pain intensity, or attack duration were observed between the run-in period and the first and second weeks of treatment (ANOVA). Further studies are necessary to clarify the effectiveness of transdermal clonidine in the prophylaxis of episodic cluster headache.     

Management of Dietary Habits and Diarrhea in Fap Individuals: A Mediterranean Low-Inflammatory Dietary Intervention

Background: A total colectomy and a frequent life-long endoscopic surveillance are guaranteed to patients with Familial Adenomatous Polyposis (FAP) to reduce their risk of duodenal and rectal stump cancers. However, after surgery, individuals with FAP suffer from an increased number of diarrheal discharges that force them to dietary restrictions. A non-randomized pilot study was conducted to assess whether a three-month low-inflammatory Mediterranean dietary intervention reduces gastro-intestinal markers of inflammation in FAP individuals. The aim of the present work is to evaluate the participant’s adherence to the proposed dietary recommendations and the change in their number of diarrheal discharges. Methods: 26 FAP individuals aged >18 years, who underwent a total colectomy with ileo-rectal anastomosis and were involved in the surveillance program at the Fondazione IRCCS Istituto Nazionale Tumori of Milan, were included in the present analysis. Results: FAP individuals significantly reduced the Not recommended foods (p-value: 0.002) and increased the consumption of the Recommended ones (p-value: 0.075). The adherence to the proposed dietary recommendations was accompanied by a significant decrease in the number of diarrheal discharges (p-value: 0.008). Conclusions: This study suggests that adhering to a low-inflammatory Mediterranean diet has a potential protective effect on the number of diarrheal discharges in FAP individuals.     

Polybrominated Diphenyl Ethers (PBDEs) and Polychlorinated Biphenyls (PCBs) in 0+ Juvenile Cyprinids and Sediments of the Po River

PBDE and PCB content has been determined in 0+ bleak (Cyprinus alburnus), nase (Chondrostoma soetta), gudgeon (Cyprinus gobio), chub (Cyprinus cephalus), and barbel (Barbus sp.) as well as in bed sediments sampled from the River Po upstream and downstream of the confluence of a tributary draining a highly industrialized and urbanized subbasin. Both groups of chemicals were present at higher levels in fish and sediments downstream from the confluence. In addition, whole-body concentrations of PBDEs and PCBs were different among species despite the young specimen age. The fact that PBDEs and PCBs were higher in benthivorous versus planktivorous fish, as well as in carnivorous versus herbivorous species, suggests that feeding behavior is a major controlling factor that may help differentiate the accumulation levels of 0+ juveniles. Of the five species, the pelagic/planktivorous cyprinid bleak (C. alburnus) showed the lowest concentrations (111 ng PBDE/g lipid weight [l.w.], 2016 ng PCB/g l.w.), whereas the benthic dweller and feeder barbel (Barbus sp.) had the highest concentrations of both groups of chemicals (259 ng PBDE/g l.w., 4785 ng PCB/g l.w.). The rank order of species contamination was essentially stable upstream and downstream from the tributary, and the congener contribution of PBDEs was also similar. In general, BDE-47 was the dominant congener, followed by BDE-100, -154, -153, and -28. BDE-209 dominated the PBDE congener profiles of sediments but was not found in any fish sample. Conversely, an unidentified hexa-BDE congener, which was not detected in sediments, was found in all fish species. The levels of PBDEs and PCBs determined in adult goby (Padogobius martensii), a small demersal predator also examined in the same river stretches, provided additional useful insights with which to interpret results.     

Clinical and immunologic responses in melanoma patients vaccinated with MAGE‐A3‐genetically modified lymphocytes

Cancer vaccines have recently been shown to induce some clinical benefits. The relationship between clinical activity and anti‐vaccine T cell responses is somewhat controversial. Indeed, in many trials it has been documented that the induction of vaccine‐specific T cells exceeds the clinical responses observed. Here, we evaluate immunological and clinical responses in 23 MAGE‐A3⁺ melanoma patients treated with autologous lymphocytes genetically engineered to express the tumor antigen MAGE‐A3 and the viral gene product thymidine kinase of the herpes simplex virus (HSV‐TK). HSV‐TK was used as safety system in case of adverse events and as tracer antigen to monitor the immune competence of treated patients. The increase of anti‐TK and anti‐MAGE‐A3 T‐cells after vaccination was observed in 90 and 27% of patients, respectively. Among 19 patients with measurable disease, we observed a disease control rate of 26.3%, with one objective clinical response, and four durable, stable diseases. Three patients out of five with no evidence of disease (NED) at the time of vaccination remained NED after 73+, 70+ and 50+ months. Notably, we report that only patients experiencing MAGE‐A3‐specific immune responses showed a clinical benefit. Additionally, we report that responder and non‐responder patients activate and expand T cells against the tracer antigen TK in a similar way, suggesting that local rather than systemic immune suppression might be involved in limiting clinically relevant antitumor immune responses.     

Concomitant EGFR mutation and ALK rearrangement in lung adenocarcinoma is more frequent than expected: Report of a case and review of the literature with demonstration of genes alteration into the same tumor cells

Oncogenic drivers in lung non-small-cell lung cancer (NSCLC) are considered mutually exclusive, but a review of the literature reveals that concomitant EGFR mutations and ALK rearrangement may occur in a subset of NSCLC. We report here a case of pulmonary adenocarcinoma with concomitant EGFR mutation in exon 21 (L858R) and ALK rearrangement in naive and relapsed tumors. Tumor cells seem to harbor both gene alterations and the patient had a long-lasting response both to EGFR inhibitor in second line and ALK inhibitor once tumor progressed. A speculative discussion on molecular mechanisms underlying this uncommon phenomenon and practical points about epidemiologic, clinicopathologic features and therapeutic options in this intriguing subset of double-positive tumor are reported.