Use of the ALN permanent/removable vena cava filter. A multi-centre experience

AIM: Vena cava filters are used for the prevention of pulmonary embolism in cases of contraindication, failure or complications of the anticoagulant therapy. There are no certain data in the literature concerning the effectiveness of vena cava filters and, above all, the possible long-term complications are not known. For this reason increasing attention is paid to permanent/removable filters that permit exploitation of the short-term advantages of vena cava interruption, eliminating the possible long-term complications. We have reported the results of a multicentre experience concerning ALN permanent/removable vena cava filters in a total of 276 patients. METHODS: Vena cava filters were placed in 276 patients via the jugular, femoral and brachial vein. The filter was removed in 43 patients after 3 months and in 28 patients after 6 months. RESULTS: In 1 case, due to incomplete opening of the filter, immediate percutaneous removal was performed and another filter was positioned. In 5 cases it was not possible to remove the filter, in 1 case due to inexperience and in the remaining cases due to adhesion of the head or claws of the filter to the wall of the vein. No problems occurred in the other cases. CONCLUSIONS: The ALN vena cava filter is safe, easy to position and remove even a long time after placement. Currently permanent filters should be used only for patients with poor survival expectancy whereas in all other cases the use of removable filters is preferable.     

MicroRNA-130b Promotes Tumor Development and Is Associated with Poor Prognosis in Colorectal Cancer

MicroRNA-130b (miR-130b) is involved in several biologic processes; its role in colorectal tumorigenesis has not been addressed so far. Herein, we demonstrate that miR-130b up-regulation exhibits clinical relevance as it is linked to advanced colorectal cancers (CRCs), poor patients'' prognosis, and molecular features of enhanced epithelial-mesenchymal transition (EMT) and angiogenesis. miR-130b high-expressing cells develop large, dedifferentiated, and vascularized tumors in mouse xenografts, features that are reverted by intratumor injection of a specific antisense RNA. In contrast, injection of the corresponding mimic in mouse xenografts from miR-130b low-expressing cells increases tumor growth and angiogenic potential while reduces the epithelial hallmarks. These biologic effects are reproduced in human CRC cell lines. We identify peroxisome proliferator-activated receptor γ (PPARγ) as an miR-130b direct target in CRC in vitro and in vivo. Notably, the effects of PPARγ gain- and loss-of-function phenocopy those due to miR-130b down-regulation or up-regulation, respectively, underscoring their biologic relevance. Furthermore, we provide mechanistic evidences that most of the miR-130b-dependent effects are due to PPARγ suppression that in turn deregulates PTEN, E-cadherin, Snail, and vascular endothelial growth factor, key mediators of cell proliferation, EMT, and angiogenesis. Since higher levels of miR-130b are found in advanced tumor stages (III–IV), we propose a novel role of the miR-130b-PPARγ axis in fostering the progression toward more invasive CRCs. Detection of onco-miR-130b and its association with PPARγ may be useful as a prognostic biomarker. Its targeting in vivo should be evaluated as a novel effective therapeutic tool against CRC.     

Analysis of production factors,costs, and process efficacy in the radiology department of a local health agency in Italy

PURPOSE: To calculate the itemised and overall costs (including staff, technical equipment, and materials) of the services of a radiology department in order to ensure clearer communications between the service providers and clients concerning the service and its costs. The analysis was carried out in the radiology department of a city general hospital. MATERIALS AND METHODS: An Activity Based Cost Analysis was used to study the production process for each type of service delivered, considering all the direct and indirect costs. These calculations resulted in an itemised list of costs per service that included all of the cost components of a radiological examination, overcoming the limits of cost accounting based on specific factors only (e.g. physician time used). The contents of the itemised cost analysis - human resources, equipment and consumables, gathered from the staff were compared with the actual consumption data for a 4-month period of normal activity. The evaluation was completed by an analysis of the quality perceived by clients relative to the levels and costs of the service. RESULTS: Itemised cost analyses were obtained and verified for 72 categories of services defined by similar types and costs. Thanks to this process-oriented approach, costs could also be differentiated by patient referral group (in-patient, out-patient, emergency department) to compare the impact on the organisation of the three patient categories. Emergency department and in-patient services were found to have a greater impact than out-patient services, and the latter proved more cost-effective than the other two. Emergency department services were found to be considerably less cost-effective due to the fact that the service is guaranteed 24 hours a day / 7 days a week, but seldom fully exploited. While confirming that the Regional charges are inadequate, our analysis supplied all the data needed to precisely evaluate the cost drivers and to update the charges to reflect the actual costs. As regards quality, the patients judged the processes positively, but as a result of their growing expectations they expressed a need for more information. CONCLUSIONS: This itemized cost analysis has proved to be an excellent tool for communicating service costs, and can be used effectively as a benchmarking instrument to verify the cost-effectiveness of similar services, especially if integrated with an in-depth quality analysis (to be carried out by all clients). The results obtained have allowed us to determine the impact of service delivery processes on patients from various referral categories and to develop an up-to-date internal price list that better reflects the actual costs compared to current charges.     

Emerging role of the β-catenin-PPARγ axis in the pathogenesis of colorectal cancer

Multiple lines of evidence indicate that Wnt/β-catenin signaling plays a fundamental role in colorectal cancer (CRC) initiation and progression. Recent genome-wide data have confirmed that in CRC this pathway is one of the most frequently modified by genetic or epigenetic alterations affecting almost 90% of Wnt/β-catenin gene members. A major challenge is thus learning how the corrupted coordination of this pathway is tied to other signalings to enhance cell growth. Peroxisome proliferator activated receptor γ (PPARγ) is emerging as a growth-limiting and differentiation-promoting factor. In tumorigenesis it exerts a tumor suppressor role and is potentially linked with the Wnt/β-catenin pathway. Based on these results, the identification of new selective PPARγ modulators with inhibitory effects on the Wnt/β-catenin pathway is becoming an interesting perspective. Should, in fact, these molecules display such properties, new research avenues would be opened aimed at developing new molecular targeted drugs. Herein, we review the basic principles and present new hypotheses underlying the crosstalk between Wnt/β-catenin and PPARγ signaling. Furthermore, we discuss the advances in our understanding as to how their altered regulation can culminate in colon cancer and the efforts aimed at designing novel PPARγ agonists endowed with Wnt/β-catenin inhibitory effects to be used as therapeutic and/or preventive agents.