TGF alpha has low protein expression in nonsyndromic clefts

Genetic studies have demonstrated that nonsyndromic cleft is composed of two separate entities: the cleft palate only and cleft of the lip, alveolus with or without cleft palate; both have a heterogeneous genetic background and environmental factors contribute to the onset of these malformations. The role of transforming growth factor alpha (TGF-A) was considered possible, but conflicting results have been reported. To detect if TGF-A is involved in the onset of cleft diseases, a series of patients with nonsyndromic clefts and control subjects were analyzed with regard to protein expression. Forty-three patients with nonsyndromic clefts and 21 unaffected subjects were enrolled in this study. Paraffin-embedded specimens were matched with TGF-A antibody and then scanned with a computerized image analyzer. TGF-A was scored as absent, moderately (from 10% to 30%), and highly expressed in epithelium, gland, and muscle. Data were statistically analyzed with a Kruskal-Wallis test. Comparison between control subjects and patients with clefts showed that only gland and epithelium reached a significant P value. A subsequent comparison between cleft of the lip, alveolus with or without cleft palate and cleft palate only groups demonstrated a statistically significant difference only for gland. TGF-A was decreasingly expressed in unaffected, cleft of the lip, alveolus with or without cleft palate, and patient with cleft palate only and thus further strength has been given to its role in the onset of the disease.     

Proton pump inhibitors and hospital discharge rates for gastrointestinal events in Italy: a national ecological study

BACKGROUND: Several meta-analyses have supported the efficacy of proton pump inhibitors (PPIs) both in the treatment of peptic ulcers and in the prevention of ulceration, perforation, and hemorrhage from the upper gastrointestinal tract. PPIs have been associated with reducing the risk for recurrent ulcer bleeding and ulcer-related surgery, but they have not been associated with reduced mortality rate. OBJECTIVES: The aim of the current analysis was to conduct a national ecological study exploring the relationship between the consumption of PPIs and hospital discharge rates for gastrointestinal events. We also analyzed the potential savings for the Italian National Health Service (INHS) obtained by a reduction in hospitalizations for gastrointestinal events. METHODS: Data provided by the Italian Ministry of Health allowed us to calculate the annual number of hospital discharge rates from 2000 to 2003 for gastrointestinal events and the national expenditure and consumption rates (expressed as defined daily doses [DDDs] per 1000 population per day) for histamine-2-receptor antagonists, prostaglandins, PPIs, and for other drugs prescribed for peptic ulcer and gastroesophageal reflux disease. RESULTS: The results of this study suggest that there was a statistically significant relationship between the rate of hospital discharge for gastrointestinal events and PPI consumption r = -0.99; P = 0.003). An estimated mean increase of 180.8% in the number of DDDs for PPIs was found among all Italian regions. This drug's consumption increase was associated with an increase of 61.1% in the drug expenditure for treatment of peptic ulcer and gastroesophageal reflux diseases. At the same time, there was a 23.3% reduction in hospital discharge rates for gastrointestinal events and a reduction of 24.5% in the expenditure sustained by INHS for reimbursement of diagnosis-related group tariffs. In Italy there was an absolute increase of 353 Euro million in the expenditure for gastroprotective drugs and a reduction of 39.6 million Euro in the expenditure for reimbursements due to hospitalization for gastrointestinal events. CONCLUSIONS: Based on the results of this study in the Italian population, an increase of PPI consumption was observed to coincide with a reduction of hospital admissions for gastrointestinal events. Although this was not a cost-effectiveness analysis, and some relevant societal costs were not considered, this study found that for each 1000 Euro spent for gastroprotective drugs a reduction of 112 Euro was observed in the expenditure for hospital admissions due to gastrointestinal events. This finding also suggests that there is room for improvement in the utilization of PPIs for public health protection in Italy.     

Radiation‐induced nausea and vomiting in head and neck cancer: Is it something worth considering in the intensity modulated radiotherapy era? “A narrative review”

Radiation therapy is one of the cornerstones in the treatment of head and neck squamous cell carcinomas (HNSCC), alone or in combination with chemotherapy or surgery. Technological advances which occurred over the last few decades have increased the efficacy of radiotherapy (RT), particularly, intensity‐modulated RT (IMRT). IMRT can deliver treatments on complex tumoral targets with dose escalation while sparing organs at risk; anyway IMRT deposits dose in unpredictable patterns outside of the target volume with the purpose of improving conformality. Radiation‐induced nausea and vomiting (RINV) is a frequent albeit neglected side effect of RT that can lead to delays in treatment with serious consequences on cure rates. According to several guidelines (MASCC 2016, NCCN 2018), RT for HNSCC has traditionally been regarded as a low emetic risk treatment. Nevertheless, several works suggest that IMRT could increase RINV. Further studies are needed to define the exact incidence and the detailed pathophysiology of RINV in patients with HNSCC treated with state of art IMRT techniques, with and without concurrent chemotherapy.     

Prevalence of renal disease within an urban HIV-infected cohort in northern Italy

Background

Renal disease is an increasingly recognized noninfectious comorbidity associated with human immunodeficiency virus (HIV) infection.

Methods

Our retrospective, cross-sectional study evaluated prevalence of nephropathy among HIV-infected patients followed up in our outpatient clinic during the year 2011. Renal dysfunction and chronic kidney disease (CKD) were defined as estimated glomerular filtration rate (eGFR) <90 ml/min per 1.73 m² and as renal damage or eGFR <60 ml/min per 1.73 m² over a 3-month or greater period, respectively.

Results

We enrolled 894 HIV-infected patients with a mean age of 44.2 years and a mean current CD4 lymphocyte count of 508 cells/mm³. The prevalence of renal dysfunction and CKD was 27.4 and 21.3 %, respectively. Older age, male gender, hypertension, diabetes, proteinuria, hypertriglyceridemia, lower nadir CD4 cell count, current use of tenofovir or tenofovir plus a ritonavir-boosted protease inhibitor were independently associated with renal dysfunction.

Conclusion

Renal dysfunction is a frequent comorbidity among HIV-infected persons and requires a careful clinical and laboratory monitoring of renal function.     

Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience

Purpose

Controversy prevails on the impact of preoperative biliary drainage (PBD) on postoperative complications and clinical outcome of pancreatic cancer. We determined whether PBD is associated with increased morbidity and mortality rates after pancreaticoduodenectomy.

Methods

A total of 131 consecutive patients who underwent pancreaticoduodenectomy (93 jaundiced, 38 with no jaundice) were included in this study. Overall, 57 % of jaundiced patients underwent PBD, while 43 % were not drained. The impact of PBD on postoperative morbidity and mortality was evaluated by means of logistic regression analysis. The Kaplan–Meier method was applied to determine the effect of PBD on survival of patients with malignant lesions.

Results

Mortality and morbidity rate was 3 % and 54.6 %, respectively. PBD was demonstrated to be the unique predictor of complications (odds ration [OR]?=?10.18; 95 % confidence interval [CI], 3.65–28.39, p?<?0.001). The jaundiced patients who were drained exhibited high frequencies of wound infection (p?<?0.001), post-pancreatectomy haemorrhage (p?=?0.0185) and hyperglycaemia (p?<?0.001). In addition, an increased frequency of pancreatic fistula emerged among drained patients compared to those who were not drained (p?=?0.036). PBD did not affect survival of patient with malignant lesions.

Conclusions

With the exception of the classical indications, PBD should be carefully evaluated in patients with resectable pancreatic cancer.     

Tumor detectability and conspicuity comparison of standard b1000 and ultrahigh b2000 diffusion-weighted imaging in rectal cancer

Abdominal Radiology - To compare tumor detectability and conspicuity of standard b = 1000&nbsp;s/mm2 (b1000) versus ultrahigh b = 2000&nbsp;s/mm2 (b2000)...