The prevalence of constipation at admission and after 1 week of palliative care: a multi-center study

Aim: To assess the prevalence and intensity of constipation in advanced-cancer patients referred to palliative care, and to assess changes after 1 week of specialist palliative care.

Methods: This was a prospective multi-center study in advanced patients for a period of 1 year. At admission (T0), age, gender, primary tumor, concomitant diseases, Karnofsky status, Palliative prognostic score (PaP), Edmonton Symptom Assessment scale (ESAS), Memorial Delirium Assessment Scale (MDAS), and bowel function index (BFI) were collected. In BFI, high values represent severe constipation. The use of medication was also recorded, as well as possible causes of constipation. The same parameters were recorded 1 week after admission for palliative care (T7).

Results: A total of 246 patients were screened for constipation. The mean BFI at T0 was 42.4 (SD?=?26.92). One hundred and sixty-three patients (66.3%) had a BFI >28. The mean BFI at T7 was 35.7 (SD?=?28.8), with a significant decrease from T0 to T7 (p?=?.000). A significant decrease of BFI in patients with a BFI >28 was reported (p?=?.000). In patients with a BFI ≤28 there was a significant worsening of constipation (p?=?.000). In patients with a BFI >28 at T0 there was a significant increase in the use of laxatives at T7 in comparison with patients having a BFI ≤28 (p?=?.002). In patients with a BFI ≤28 at T0, who had a significant worsening of BFI (Δ?>?12), the use of laxatives was significantly lower in comparison to patients who had a BFI >28 (p?=?.000). In the multivariate analysis, dehydration and the use of benzodiazepines were independently associated with higher BFI scores.

Conclusion: Constipation is present in approximately two-thirds of patients, and is principally associated with dehydration and the use of benzodiazepines. Patients with normal bowel function at initial assessment may see a worsening in their condition a week later due to lack of prevention or subsequent under-treatment.     

Polyphenolic extract attenuates fatty acid-induced steatosis and oxidative stress in hepatic and endothelial cells

Purpose

Phenolic compounds (PC) of virgin olive oil exert several biochemical and pharmacological beneficial effects. Some dietary PC seem to prevent/improve obesity and metabolic-related disorders such as non-alcoholic fatty liver disease (NAFLD). We investigated the possible effects of PC extracted from olive pomace (PEOP) and of the main single molecules present in the extract (tyrosol, apigenin, oleuropein, p-coumaric and caffeic acid) in protecting hepatocytes and endothelial cells against triglyceride accumulation and oxidative stress.

Methods

Rat hepatoma and human endothelial cells were exposed to a mixture of oleate/palmitate to mimic the condition of NAFLD and atherosclerosis, respectively. Then, cells were incubated for 24 h in the absence or in the presence of PC or PEOP. Different parameters were evaluated, such as lipid accumulation and oxidative stress-related markers.

Results

In hepatic cells, expression of peroxisome proliferator-activated receptors (PPARs) and of stearoyl-CoA desaturase 1 (SCD-1) were assessed as index of lipid metabolism. In endothelial cells, expression of intercellular adhesion molecule-1 (ICAM-1), activation of nuclear factor kappa-B (NF-kB), release of nitric oxide (NO), and wound-healing rate were assessed as index of inflammation.

Conclusion

PEOP extract ameliorated hepatic lipid accumulation and lipid-dependent oxidative imbalance thus showing potential applications as therapeutic agent tuning down hepatosteatosis and atherosclerosis.

     

Nano-topography: Quicksand for cell cycle progression?

The 3-D spatial and mechanical features of nano-topography can create alternative environments, which influence cellular response. In this paper, murine fibroblast cells were grown on surfaces characterized by protruding nanotubes. Cells cultured on such nano-structured surface exhibit stronger cellular adhesion compared to control groups, but despite the fact that stronger adhesion is generally believed to promote cell cycle progression, the time cells spend in G1 phase is doubled. This apparent contradiction is solved by confocal microscopy analysis, which shows that the nano-topography inhibits actin stress fiber formation. In turn, this impairs RhoA activation, which is required to suppress the inhibition of cell cycle progression imposed by p21/p27. This finding suggests that the generation of stress fibers, required to impose the homeostatic intracellular tension, rather than cell adhesion/spreading is the limiting factor for cell cycle progression. Indeed, nano-topography could represent a unique tool to inhibit proliferation in adherent well-spread cells.     

Efficient computation of the joint probability of multiple inherited risk alleles from pedigree data

The Elston–Stewart peeling algorithm enables estimation of an individual's probability of harboring germline risk alleles based on pedigree data, and serves as the computational backbone of important genetic counseling tools. However, it remains limited to the analysis of risk alleles at a small number of genetic loci because its computing time grows exponentially with the number of loci considered. We propose a novel, approximate version of this algorithm, dubbed the peeling and paring algorithm, which scales polynomially in the number of loci. This allows extending peeling‐based models to include many genetic loci. The algorithm creates a trade‐off between accuracy and speed, and allows the user to control this trade‐off. We provide exact bounds on the approximation error and evaluate it in realistic simulations. Results show that the loss of accuracy due to the approximation is negligible in important applications. This algorithm will improve genetic counseling tools by increasing the number of pathogenic risk alleles that can be addressed. To illustrate we create an extended five genes version of BRCAPRO, a widely used model for estimating the carrier probabilities of BRCA1 and BRCA2 risk alleles and assess its computational properties.     

Incidence and Risk Factors for Hepatitis C Virus Infection among Illicit Drug Users in Italy

So far, only three small outdated studies have investigated hepatitis C virus (HCV) incidence and risk factors among illicit drug users (DUs) in Italy. Thus, during 2007–2010, we conducted a prospective cohort study among DUs attending 17 Italian rehabilitation centers serving urban areas. Two hundred eighty-four HCV-uninfected DUs were prospectively followed by interview and anti-HCV antibody and RNA testing every 6 months. Incidence was calculated using the person-years method. Infection predictors were assessed by time-dependent Cox analysis. Participants were mostly male (83.4%), under opioid substitution therapy (OST) (78.9%), non-injecting DUs (67.9%), and with a mean age of 30.8. Ninety-one of 224 DUs initially under OST interrupted treatment during the follow-up. Overall HCV incidence was 5.83/100 person-years at risk (PYAR) [95% confidence intervals (CI), 3.63–9.38]. The incidence did not significantly differ according the participants’ sociodemographic characteristics or the degree of urbanization of the towns involved in the study. The incidence was higher for DUs under than for those not under OST (6.23 vs 4.50/100 PYAR; p = 0.681). Incidence was also higher for those with than for those without OST interruption (7.17 vs 5.04/100 PYAR; p = 0.55). However, all these differences were non-significant. At last follow-up visit, a significant decrease in frequency of sharing equipment for preparation/using drugs (by injection or not) was observed by analyzing either the whole cohort or DUs under OST only. Anti-HCV seroconversion resulted independently associated with sharing drug preparation/use equipment, backloading, having a HCV-positive sexual partner, or household and (marginally) intravenous injection. In this study, HCV incidence was non-negligible and OST seemed to lack effectiveness in reducing it. In Italy, implementation of combined harm reduction interventions and antiviral treatment of chronically infected DUs would be needed.     

Effect of post-retained composite restoration of MOD preparations on the fracture resistance of endodontically treated teeth

PURPOSE: The present study aimed to compare the fracture resistance and failure patterns of endodontically treated premolars with MOD preparations restored using different material combinations. The null hypothesis postulated that there was no association between the fracture resistance of endodontically treated premolars and the resin composite materials or the post-and-core system used to build up the restorations. MATERIALS AND METHODS: Eighty single-rooted maxillary premolars were used. After endodontic treatment and preparation of MOD preparations, 8 groups of 10 samples each were created, using the following material combinations: group 1 (control), flowable and microhybrid resin composites; group 2, flowable A; group 3, flowable B; group 4, microhybrid resin A; group 5, microhybrid resin B; group 6, flowable B + microhybrid resin B; group 7, flowable A + microhybrid resin A + post A; group 8, flowable B + microhybrid resin B + post B. Mechanical static fracture tests were performed loading the specimens till fracture. RESULTS: The mean failure loads (N) were 502 (control), 470 (group 7), 445 (group 8), 441 (group 6), 405 (group 5), 364 (group 4), 317 (group 2), and 302 (group 3). Statistically significant differences were found between groups 1 vs 2, 1 vs 3, and 3 vs 7 (p < 0.05). CONCLUSION: The fracture resistance of endodontically treated premolars with MOD preparations was enhanced by the use of the sandwich technique. The samples restored with posts predominantly showed restorable fractures, while teeth restored without posts mostly displayed unrestorable failures.     

Effect of air-drying temperature on the effectiveness of silane primers and coupling blends in the repair of a microhybrid resin composite

PURPOSE: To evaluate the effect of different silane agents and air-drying temperatures on the repair strength of a microfilled hybrid composite. MATERIALS AND METHODS: Composite cylinders (8 x 4 mm) of Gradia Direct Anterior (GC, N=36), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (50-microm aluminium oxide), cleaned (35% phosphoric acid) and randomly divided into six groups (n=6). Two prehydrolyzed silane primers (Monobond-S, Ivoclar-Vivadent, Porcelain Primer, Bisco), a non prehydrolyzed silane primer (Porcelain Liner M, Sun Medical) and three silane/adhesive coupling agents (Porcelain Bond Activator-PBA/Clearfil New Bond, PBA/Clearfil SE Bond, PBA/Clearfil Tri-S Bond, Kuraray) were investigated. Silane-coated surfaces were air dried at two different temperatures (23 degrees C and 38 degrees C) and repairs (8 x 8 mm) were fabricated (Gradia Direct Anterior). Unrepaired composite cylinders (8 x 8 mm, n=6) were used as control to evaluate the cohesive strength of the material. Microtensile bond strength measurements (microTBS) were performed. Results: The silane agent applied (p < 0.001), the airdrying temperature (p < 0.001) and their interaction (p < 0.001) were significant factors (two-way ANOVA, Tukey test; p < 0.05). Silane primers achieved inferior microTBS when air dried at 23 degrees C as compared to silane/adhesive blends. Warm air-drying was significantly beneficial to composite repairs mediated by silane primers. Comparable results were achieved by silane/adhesive couplings at 23 degrees C and 38 degrees C. At 38 degrees C all the intermediate agents resulted in repair microTBS that were comparable to the 24-h cohesive strength of the composite (one-way ANOVA, Dunnett t-tests; p < 0.05). CONCLUSION: The chemical interactions between silane primers and compozite substrate may be optimized through warm airdrying. Silane/adhesive couplings were not influenced by the air drying temperature.     

Self-inflicted oral trauma in a baby with Moebius syndrome

Moebius syndrome (MS) is a rare disorder mainly characterized by bi- or unilateral palsy of the facial and abducens nerves. Among the various orofacial characteristics related to this syndrome, the following are pointed out, difficulty with sucking, tongue malformation, mandibular hypoplasia, saliva drooling, arched palate and micrognathia. In spite of the diversity of oral features described for these patients, self-inflicted oral trauma has not yet been reported. Therefore, the purposes of the present report were to describe an unusual case of a baby with Moebius syndrome who had a parafunctional habit that resulted in a persistent traumatic lesion of the lower lip, and discuss the treatment performed.