Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock...Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.展开更多
BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and h...BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.展开更多
Functional pain syndromes are very common diseases that negatively impact the quality of life of patients with important socio-economic repercussions. The clinical alterations associated with these pathologies are mul...Functional pain syndromes are very common diseases that negatively impact the quality of life of patients with important socio-economic repercussions. The clinical alterations associated with these pathologies are multiple and have a complex psycho-organic character that moves along the micorobiome-gut-brain-axis. For the present study, 45 patients of both sexes (19 male, 26 female) aged 30 - 59 years were enrolled because of a diagnosis of Functional pain syndromes (FPS) that lasted for more than 6 months. All patients underwent pre-treatment clinical assessments (T0) for anxiety disorder, multidimensional assessment of pain, monitoring of baseline values of Alpha-Theta cerebral rhythm in occipital region and monitoring of salivary cortisol levels. All the patients underwent a clinical treatment combined with central neuromodulation with neurofeedback—Alpha Theta increase protocols (once a week for three months), administration of multispecies probiotic (one dose per day for 3 months) and clinical psychological interviews (once a week for three months). At the end of treatment (T1), patients were re-evaluated. Results show statistically relevant improvements of each feature considered: the Relief from Pain provided by the medication increases on average from 36.6% to 87.3%, the salivary Cortisol level at 11 pm decreases from 6.4 ng/ml to a physiological value of 1.2 ng/ml, and the anxiety rating score is reduced from 28 to 12. Moreover, the 23.9% increase in α-θ relative power shows the positive outcome of the brain autoregulation. This study highlights that the combined approach of Neurofeedback with drugs and multispecies probiotic results in great improvements in the patients’ life.展开更多
BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term...BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.展开更多
The study of parental food provisioning is essential for understanding the breeding ecology of birds.We conducted the first study using accelerometry to detect food provisioning in birds,using Support Vector Machine(S...The study of parental food provisioning is essential for understanding the breeding ecology of birds.We conducted the first study using accelerometry to detect food provisioning in birds,using Support Vector Machine(SVM)models to identify when adults feed chicks of three different age classes.Accelerometers were attached to the head of adult female Imperial Shags(Leucocarbo atriceps),and various attributes derived from the acceleration signals were used to train SVM models for each chick age class.Model performance improved with chick age class,with SVM models achieving high overall accuracy(>88%)and highest sensitivity in older chick categories(>91%).However,precision values,especially for younger chicks,remained relatively low(between 26%and 45%).The application of a time filter based on the minimum duration of the observed food provisioning behaviours for each chick age category,improved model performance by reducing false provisioning behaviours,particularly in the model for older chicks,which showed the highest precision(72.4%).This study highlights the effectiveness of accelerometry and machine learning in studying parental food provisioning in birds,providing a rapid and accurate data collection method to complement traditional techniques.The described methodology can be applied to any bird species that exhibits distinctive movements while feeding its offspring and has suitable characteristics for attaching an accelerometer to the body part that best captures this movement.Finally,it is hoped that the results of this study will contribute to future research on key questions in parental investment theory and reproductive strategies in birds.展开更多
Metal-halide perovskites are revolutionizing the world of X-ray detectors,due to the development of sensitive,fast,and cost-effective devices.Self-powered operation,ensuring portability and low power consumption,has a...Metal-halide perovskites are revolutionizing the world of X-ray detectors,due to the development of sensitive,fast,and cost-effective devices.Self-powered operation,ensuring portability and low power consumption,has also been recently demonstrated in both bulk materials and thin films.However,the signal stability and repeatability under continuous X-ray exposure has only been tested up to a few hours,often reporting degradation of the detection performance.Here it is shown that self-powered direct X-ray detectors,fabricated starting from a FAPbBr_(3)submicrometer-thick film deposition onto a mesoporous TiO_(2)scaffold,can withstand a 26-day uninterrupted X-ray exposure with negligible signal loss,demonstrating ultra-high operational stability and excellent repeatability.No structural modification is observed after irradiation with a total ionizing dose of almost 200 Gy,revealing an unexpectedly high radiation hardness for a metal-halide perovskite thin film.In addition,trap-assisted photoconductive gain enabled the device to achieve a record bulk sensitivity of 7.28 C Gy^(−1)cm^(−3)at 0 V,an unprecedented value in the field of thin-film-based photoconductors and photodiodes for“hard”X-rays.Finally,prototypal validation under the X-ray beam produced by a medical linear accelerator for cancer treatment is also introduced.展开更多
Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation ...Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation and patient’s clinical and hormonal parameters. Methods: We enrolled 22 acromegalic patients with apnea hypopnea index (AHI) ≥ 5 if symptomatic, or ≥15 in the absence of sleep related symptoms. Patients underwent the following evaluations: GH and IGF-1 serum levels, arterial blood gas test, spirometry, carbon monoxide diffusing capacity (DLCO), home-based cardiorespiratory sleep and pulmonary function test. Results: The prevalence of OSAS was 66.6%. Patients with a severe form of OSAS appeared to be affected from acromegaly for more years than those with a lower severity of disease and those with acromegaly duration > 10 years had significantly higher levels of glycated hemoglobin. We observed a positive correlation between GH level at diagnosis and DLCO value, showing that acromegalic patients have an increase in static and dynamic respiratory volumes and alveolar-capillary exchange surface compared to the general population. We also observed a positive correlation between baseline serum IGF-1 level and DLCO/VA and between years of disease and DLCO/VA, showing the association of increased lung volume and increase of the exchange surface. Conclusions: The results of this study add new information on lung volume and alveolar gas exchange in acromegaly. Our findings highlight the role of SSA as therapy with positive impact on complication and comorbidities of acromegaly.展开更多
Polycystic ovary syndrome(PCOS)is one of the most common endocrine disorders,affecting 5%-10%of women of reproductive age.The importance of this syndrome lies in the magnitude of associated comorbidities:infertility,m...Polycystic ovary syndrome(PCOS)is one of the most common endocrine disorders,affecting 5%-10%of women of reproductive age.The importance of this syndrome lies in the magnitude of associated comorbidities:infertility,metabolic dysfunction,cardiovascular disease(CVD),plus psychological and oncological complications.Insulin resistance(IR)is a prominent feature of PCOS with a prevalence of 35%-80%.Without adequate management,IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS.Furthermore,epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance,gestational diabetes mellitus and type 2 diabetes.In addition,metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS.Indeed,the severity of IR in women with PCOS is associated with the amount of abdominal obesity,even in lean women with PCOS.Given these drastic implications,it is important to diagnose and treat insulin resistance as early as possible.Many markers have been proposed.However,quantitative assessment of IR in clinical practice remains a major challenge.The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp.However,it is not used routinely because of the complexity of its procedure.Consequently,there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations.Despite this,many of them are either difficult to apply in routine clinical practice or useless for women with PCOS.Considering this difficulty,there is still a need for an accurate marker for easy,early detection and assessment of IR in women with PCOS.This review highlights markers of IR already used in women with PCOS,including new markers recently reported in literature,and it establishes a new classification for these markers.展开更多
Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within ...Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes.A more advanced form of NAFLD,nonalcoholic steatohepatitis,includes inflammation and liver cell injury,progressive to cryptogenic cirrhosis.NAFLD has become the most common cause of chronic liver disease in children and adolescents.The recent rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide.NAFLD is strongly associated with abdominal obesity,type 2 diabetes,and dyslipidemia,and most patients have evidence of insulin resistance.Thus,NAFLD shares many features of the metabolic syndrome(MetS),a highly atherogenic condition,and this has stimulated interest in the possible role of NAFLD in the development of atherosclerosis.Accumulating evidence suggests thatNAFLD is associated with a significantly greater overall mortality than in the general population,as well as with increased prevalence of cardiovascular disease(CVD),independently of classical atherosclerotic risk factors.Yet,several studies including the pediatric population have reported independent associations between NAFLD and impaired flow-mediated vasodilatation and increased carotid artery intimal medial thickness-two reliable markers of subclinical atherosclerosis-after adjusting for cardiovascular risk factors and MetS.Therefore,the rising prevalence of obesity-related MetS and NAFLD in childhood may lead to a parallel increase in adverse cardiovascular outcomes.In children,the cardiovascular system remains plastic and damage-reversible if early and appropriate interventions are established effectively.Therapeutic goals for NAFLD should address nutrition,physical activity,and avoidance of smoking to prevent not only end-stage liver disease but also CVD.展开更多
BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS w...BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.展开更多
Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatiti...Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome(CP/CPPS).Methods:Patients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months.Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),the International Prostate Symptom Scores(IPSS),International Index of Erectile Function(IIEF),four-glass test,uroflowmetry,and prostate-specific antigen assessments at baseline and at Week 4,and Week 12.Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score.Secondary outcomes included improvement of micturition and quality of life(QoL)domains of NIH-CPSI questionnaire.Results:A total of 61 males were enrolled.No adverse events were reported.Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score(mean difference:-9.2;p<0.01),NIH-CPSI pain domain(mean difference:-5.5;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score(mean difference:-5.6;p<0.01).No significant changes from baseline in terms of IIEF score or maximum flow rate were observed.At final follow-up(Day 90),further significant improvements in terms of NIH-CPSI total score(mean difference:-12.2;p<0.01),NIH-CPSI pain domain(mean difference:-6.6;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score were reported.Conclusion:Rectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.展开更多
Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing seg...Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.展开更多
BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment...BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment of patients with femoral deformities caused by PDF or MAS treated by osteotomies and stabilized with different methods,by analyzing the most relevant studies on the topic.METHODS A literature search was performed in Medline database(PubMed).Articles were screened for patients affected by PFD or MAS surgically managed by osteotomies and stabilized with different methods.RESULTS The initial search produced 184 studies,with 15 fulfilling the eligibility criteria of our study.Selected articles(1987-2019)included 111 patients overall(136 femurs).CONCLUSION Based on our results,the preferred method to stabilize corrective osteotomies is intramedullary nailing with neck cross pinning.When the deformity is limited to the proximal part of the femur,a screw or blade plate may be used,although there is a high risk of fracture below the plate.When the femur is entirely involved,a two-stage procedure may be considered.展开更多
Short bowel syndrome(SBS)with intestinal failure(IF)is a rare but severe complication of Crohn’s disease(CD),which is the most frequent benign condition that leads to SBS after repeated surgical resections,even in th...Short bowel syndrome(SBS)with intestinal failure(IF)is a rare but severe complication of Crohn’s disease(CD),which is the most frequent benign condition that leads to SBS after repeated surgical resections,even in the era of biologics and small molecules.Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of SBS-IF.These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBSIF patients on parenteral support or nutrition.Teduglutide has been approved for the treatment of SBS-IF,and apraglutide is currently in clinical development.The use of these drugs was examined with a focus on their use in CD patients.展开更多
In the past decades liver transplantation(LT) has become the treatment of choice for patients with end stage liver disease(ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of ...In the past decades liver transplantation(LT) has become the treatment of choice for patients with end stage liver disease(ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death(DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease(CKD). Acute kidney injury(AKI) post-LT has been recently recognized as an important risk factor for the occurrence of denovo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome(PRS) that can influence recipient's morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since preLT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A Pub Med search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on Pub Med search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRSinduced AKI, avoiding confounding factors, we have limited our study to "acute kidney injury AND DCD AND liver transplantation". Accordingly, three out of five studies were selected for our purpose.展开更多
AIM To evaluate the prevalence of nodular lymphoid hyperplasia(NLH) in adult patients undergoing colonoscopy and its association with known diseases. METHODS We selected all cases showing NLH at colonoscopy in a three...AIM To evaluate the prevalence of nodular lymphoid hyperplasia(NLH) in adult patients undergoing colonoscopy and its association with known diseases. METHODS We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome(IBS)-type symptoms or suspected inflammatory bowel disease(IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening.Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.RESULTS One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals(only 3%), while it was significantly more prevalent in symptomatic cases(32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis. CONCLUSION About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.展开更多
AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asympt...AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts(age 15-38 years) with PJS have been collected; six under-went polypectomy using single balloon enteroscopy(Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit(OBCU Olympus Balloon Control Unit) and a dispos-able silicone splinting tube with balloon(ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endos-copy(WCE). Prophylactic polypectomy was reservedmainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from-6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm(range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgi-cal resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussuscep-tions. No gastrointestinal tumors were found in sub-sequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper en-doscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps(> 15 mm).CONCLUSION: The effective of prophylactic polyp-ectomy of small bowel large polyps(> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.展开更多
In December 2019 a novel coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),started spreading from Wuhan city of Chinese Hubei province and rapidly became a gl...In December 2019 a novel coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic.Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease.Typical symptoms of the initial phase include fever and cough,with possible progression to acute respiratory distress syndrome.Gastrointestinal manifestations such as diarrhoea,vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2.The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses.Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations,such as fatigue and psychological impairment.To date,there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection.Since COVID-19 can directly or indirectly affect the gut physiology in different ways,it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations(dysbiosis,disruption of the intestinal barrier,mucosal microinflammation,post-infectious states,immune dysregulation and psychological stress).In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.展开更多
The occurrence of Metabolic Syndrome (MS) represents an independent risk factor for developing cardiovascular disease states in patients suffering from type 2 diabetes mellitus. Moreover, both the size of LDL particle...The occurrence of Metabolic Syndrome (MS) represents an independent risk factor for developing cardiovascular disease states in patients suffering from type 2 diabetes mellitus. Moreover, both the size of LDL particles and liver dysfunction identified as non alcoholic fatty liver disease (NAFLD) represent important biomarkers for the development of cardiometabolic risk in patients with MS. Here we studied the effect of bergamot polyphenolic fraction (BPF) in patients with MS and NAFLD. 107 patients were enrolled at the San Raffaele IRCCS (Rome). All of them showed ultrasonografic evidences of NAFLD and at least three out of five previous identified criteria for the diagnosis of MS. Patients were divided into two groups: one receiving placebo and the second receiving BPF 650 mg twice a day for 120 consecutive days. In the group receiving BPF 650 mg twice a day, a significant reduction of fasting plasma glucose, serum LDL cholesterol and triglycerides alongside with an increase of HDL cholesterol was found. This effect was accompanied by significant reduction of both ultrasonographic and metabolic biomarkers of NAFLD. Moreover, a significant reduction of small dense LDL particles, as detected via proton NMR Spectroscopy, was found after BPF treatment. In conclusion, our data confirm the beneficial effect of bergamot-extract in patients with MS an effect highlighted by significant reduction of small dense LDL particles and by improvement of NAFLD biomarkers. This suggests a potential preventive role of bergamot derivatives in reducing cardiometabolic risk.展开更多
A procedure based on the QuEChERS methodology and Liquid Chromatography Tandem Mass Spectrometry （LC/MS/MS） is described, for the determination of Nicotine in mushrooms. QuEChERS methodology was used to determine Ni...A procedure based on the QuEChERS methodology and Liquid Chromatography Tandem Mass Spectrometry （LC/MS/MS） is described, for the determination of Nicotine in mushrooms. QuEChERS methodology was used to determine Nicotine in dried and fresh mushrooms under basic conditions with primary secondary amino sorbent （PSA） clean up. The chromatography was performed on C 18 reversed phase column using a gradient of acetonitrile and ammonium formiate lmM pH = 3.4 as mobile phase at a flow rate of 0.3 mL min^-1. Nicotine was determined by using Nicotine-d3 as internal standard. Limit of quantification （LOQ） was 0.01 mg kg^-1 for both fresh and dried mushrooms. Calibration curve was linear over the concentration range of 0.01-2.3 mg mL^-1, with r2 〉 0.99. As for recoveries in dried mushrooms, spiking levels of 0.32 mg kg^-1 and 2 mg kg^-1 were considered whereas for the fresh mushrooms the recoveries were determined at 0.036 mg kg^-1 and 0.36 mg kg^-1. Satisfactory results were obtained for both matrices and the recoveries proved to range from 105% to 135%, with a standard deviation in the range 17-20. The method was applied to the analysis of Nicotine to assess the levels of nicotine in fresh and dried mushrooms.展开更多
文摘Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.
文摘BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.
文摘Functional pain syndromes are very common diseases that negatively impact the quality of life of patients with important socio-economic repercussions. The clinical alterations associated with these pathologies are multiple and have a complex psycho-organic character that moves along the micorobiome-gut-brain-axis. For the present study, 45 patients of both sexes (19 male, 26 female) aged 30 - 59 years were enrolled because of a diagnosis of Functional pain syndromes (FPS) that lasted for more than 6 months. All patients underwent pre-treatment clinical assessments (T0) for anxiety disorder, multidimensional assessment of pain, monitoring of baseline values of Alpha-Theta cerebral rhythm in occipital region and monitoring of salivary cortisol levels. All the patients underwent a clinical treatment combined with central neuromodulation with neurofeedback—Alpha Theta increase protocols (once a week for three months), administration of multispecies probiotic (one dose per day for 3 months) and clinical psychological interviews (once a week for three months). At the end of treatment (T1), patients were re-evaluated. Results show statistically relevant improvements of each feature considered: the Relief from Pain provided by the medication increases on average from 36.6% to 87.3%, the salivary Cortisol level at 11 pm decreases from 6.4 ng/ml to a physiological value of 1.2 ng/ml, and the anxiety rating score is reduced from 28 to 12. Moreover, the 23.9% increase in α-θ relative power shows the positive outcome of the brain autoregulation. This study highlights that the combined approach of Neurofeedback with drugs and multispecies probiotic results in great improvements in the patients’ life.
文摘BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.
基金supported by a grant from the National Agency for the Promotion of Science and Technology of Argentina(grant PICT,2017-1996 to AGL)by two awards,one from the Association of Field Ornithologists and the other from Aves Argentinas to MDC。
文摘The study of parental food provisioning is essential for understanding the breeding ecology of birds.We conducted the first study using accelerometry to detect food provisioning in birds,using Support Vector Machine(SVM)models to identify when adults feed chicks of three different age classes.Accelerometers were attached to the head of adult female Imperial Shags(Leucocarbo atriceps),and various attributes derived from the acceleration signals were used to train SVM models for each chick age class.Model performance improved with chick age class,with SVM models achieving high overall accuracy(>88%)and highest sensitivity in older chick categories(>91%).However,precision values,especially for younger chicks,remained relatively low(between 26%and 45%).The application of a time filter based on the minimum duration of the observed food provisioning behaviours for each chick age category,improved model performance by reducing false provisioning behaviours,particularly in the model for older chicks,which showed the highest precision(72.4%).This study highlights the effectiveness of accelerometry and machine learning in studying parental food provisioning in birds,providing a rapid and accurate data collection method to complement traditional techniques.The described methodology can be applied to any bird species that exhibits distinctive movements while feeding its offspring and has suitable characteristics for attaching an accelerometer to the body part that best captures this movement.Finally,it is hoped that the results of this study will contribute to future research on key questions in parental investment theory and reproductive strategies in birds.
基金supported by the project“PARIDE”(Perovskite Advanced Radiotherapy&Imaging Detectors),funded under the Regional Research and Innovation Programme POR-FESR Lazio 2014-2020(project number:A0375-2020-36698).
文摘Metal-halide perovskites are revolutionizing the world of X-ray detectors,due to the development of sensitive,fast,and cost-effective devices.Self-powered operation,ensuring portability and low power consumption,has also been recently demonstrated in both bulk materials and thin films.However,the signal stability and repeatability under continuous X-ray exposure has only been tested up to a few hours,often reporting degradation of the detection performance.Here it is shown that self-powered direct X-ray detectors,fabricated starting from a FAPbBr_(3)submicrometer-thick film deposition onto a mesoporous TiO_(2)scaffold,can withstand a 26-day uninterrupted X-ray exposure with negligible signal loss,demonstrating ultra-high operational stability and excellent repeatability.No structural modification is observed after irradiation with a total ionizing dose of almost 200 Gy,revealing an unexpectedly high radiation hardness for a metal-halide perovskite thin film.In addition,trap-assisted photoconductive gain enabled the device to achieve a record bulk sensitivity of 7.28 C Gy^(−1)cm^(−3)at 0 V,an unprecedented value in the field of thin-film-based photoconductors and photodiodes for“hard”X-rays.Finally,prototypal validation under the X-ray beam produced by a medical linear accelerator for cancer treatment is also introduced.
文摘Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation and patient’s clinical and hormonal parameters. Methods: We enrolled 22 acromegalic patients with apnea hypopnea index (AHI) ≥ 5 if symptomatic, or ≥15 in the absence of sleep related symptoms. Patients underwent the following evaluations: GH and IGF-1 serum levels, arterial blood gas test, spirometry, carbon monoxide diffusing capacity (DLCO), home-based cardiorespiratory sleep and pulmonary function test. Results: The prevalence of OSAS was 66.6%. Patients with a severe form of OSAS appeared to be affected from acromegaly for more years than those with a lower severity of disease and those with acromegaly duration > 10 years had significantly higher levels of glycated hemoglobin. We observed a positive correlation between GH level at diagnosis and DLCO value, showing that acromegalic patients have an increase in static and dynamic respiratory volumes and alveolar-capillary exchange surface compared to the general population. We also observed a positive correlation between baseline serum IGF-1 level and DLCO/VA and between years of disease and DLCO/VA, showing the association of increased lung volume and increase of the exchange surface. Conclusions: The results of this study add new information on lung volume and alveolar gas exchange in acromegaly. Our findings highlight the role of SSA as therapy with positive impact on complication and comorbidities of acromegaly.
文摘Polycystic ovary syndrome(PCOS)is one of the most common endocrine disorders,affecting 5%-10%of women of reproductive age.The importance of this syndrome lies in the magnitude of associated comorbidities:infertility,metabolic dysfunction,cardiovascular disease(CVD),plus psychological and oncological complications.Insulin resistance(IR)is a prominent feature of PCOS with a prevalence of 35%-80%.Without adequate management,IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS.Furthermore,epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance,gestational diabetes mellitus and type 2 diabetes.In addition,metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS.Indeed,the severity of IR in women with PCOS is associated with the amount of abdominal obesity,even in lean women with PCOS.Given these drastic implications,it is important to diagnose and treat insulin resistance as early as possible.Many markers have been proposed.However,quantitative assessment of IR in clinical practice remains a major challenge.The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp.However,it is not used routinely because of the complexity of its procedure.Consequently,there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations.Despite this,many of them are either difficult to apply in routine clinical practice or useless for women with PCOS.Considering this difficulty,there is still a need for an accurate marker for easy,early detection and assessment of IR in women with PCOS.This review highlights markers of IR already used in women with PCOS,including new markers recently reported in literature,and it establishes a new classification for these markers.
文摘Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes.A more advanced form of NAFLD,nonalcoholic steatohepatitis,includes inflammation and liver cell injury,progressive to cryptogenic cirrhosis.NAFLD has become the most common cause of chronic liver disease in children and adolescents.The recent rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide.NAFLD is strongly associated with abdominal obesity,type 2 diabetes,and dyslipidemia,and most patients have evidence of insulin resistance.Thus,NAFLD shares many features of the metabolic syndrome(MetS),a highly atherogenic condition,and this has stimulated interest in the possible role of NAFLD in the development of atherosclerosis.Accumulating evidence suggests thatNAFLD is associated with a significantly greater overall mortality than in the general population,as well as with increased prevalence of cardiovascular disease(CVD),independently of classical atherosclerotic risk factors.Yet,several studies including the pediatric population have reported independent associations between NAFLD and impaired flow-mediated vasodilatation and increased carotid artery intimal medial thickness-two reliable markers of subclinical atherosclerosis-after adjusting for cardiovascular risk factors and MetS.Therefore,the rising prevalence of obesity-related MetS and NAFLD in childhood may lead to a parallel increase in adverse cardiovascular outcomes.In children,the cardiovascular system remains plastic and damage-reversible if early and appropriate interventions are established effectively.Therapeutic goals for NAFLD should address nutrition,physical activity,and avoidance of smoking to prevent not only end-stage liver disease but also CVD.
文摘BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.
文摘Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome(CP/CPPS).Methods:Patients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months.Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),the International Prostate Symptom Scores(IPSS),International Index of Erectile Function(IIEF),four-glass test,uroflowmetry,and prostate-specific antigen assessments at baseline and at Week 4,and Week 12.Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score.Secondary outcomes included improvement of micturition and quality of life(QoL)domains of NIH-CPSI questionnaire.Results:A total of 61 males were enrolled.No adverse events were reported.Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score(mean difference:-9.2;p<0.01),NIH-CPSI pain domain(mean difference:-5.5;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score(mean difference:-5.6;p<0.01).No significant changes from baseline in terms of IIEF score or maximum flow rate were observed.At final follow-up(Day 90),further significant improvements in terms of NIH-CPSI total score(mean difference:-12.2;p<0.01),NIH-CPSI pain domain(mean difference:-6.6;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score were reported.Conclusion:Rectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.
文摘Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.
文摘BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment of patients with femoral deformities caused by PDF or MAS treated by osteotomies and stabilized with different methods,by analyzing the most relevant studies on the topic.METHODS A literature search was performed in Medline database(PubMed).Articles were screened for patients affected by PFD or MAS surgically managed by osteotomies and stabilized with different methods.RESULTS The initial search produced 184 studies,with 15 fulfilling the eligibility criteria of our study.Selected articles(1987-2019)included 111 patients overall(136 femurs).CONCLUSION Based on our results,the preferred method to stabilize corrective osteotomies is intramedullary nailing with neck cross pinning.When the deformity is limited to the proximal part of the femur,a screw or blade plate may be used,although there is a high risk of fracture below the plate.When the femur is entirely involved,a two-stage procedure may be considered.
文摘Short bowel syndrome(SBS)with intestinal failure(IF)is a rare but severe complication of Crohn’s disease(CD),which is the most frequent benign condition that leads to SBS after repeated surgical resections,even in the era of biologics and small molecules.Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of SBS-IF.These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBSIF patients on parenteral support or nutrition.Teduglutide has been approved for the treatment of SBS-IF,and apraglutide is currently in clinical development.The use of these drugs was examined with a focus on their use in CD patients.
基金Supported by An international research grant 2014 of the Italian Society of NephrologyThe study sponsor provided logistic support but had no role in the collection and analysis of data or in the writing of the review and in the decision to submit the paper for publication+1 种基金The study also received support from the NIHR Birmingham Liver Biomedical Research UnitThe opinions expressed are those of the authors and not necessarily those of the NHS,the NIHR or the Department of Health
文摘In the past decades liver transplantation(LT) has become the treatment of choice for patients with end stage liver disease(ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death(DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease(CKD). Acute kidney injury(AKI) post-LT has been recently recognized as an important risk factor for the occurrence of denovo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome(PRS) that can influence recipient's morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since preLT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A Pub Med search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on Pub Med search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRSinduced AKI, avoiding confounding factors, we have limited our study to "acute kidney injury AND DCD AND liver transplantation". Accordingly, three out of five studies were selected for our purpose.
文摘AIM To evaluate the prevalence of nodular lymphoid hyperplasia(NLH) in adult patients undergoing colonoscopy and its association with known diseases. METHODS We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome(IBS)-type symptoms or suspected inflammatory bowel disease(IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening.Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.RESULTS One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals(only 3%), while it was significantly more prevalent in symptomatic cases(32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis. CONCLUSION About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.
基金Supported by “Generazione e Sviluppo” Onlus,ASTALDI s.p.a.and Fondazione Charlemagne Onlus
文摘AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts(age 15-38 years) with PJS have been collected; six under-went polypectomy using single balloon enteroscopy(Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit(OBCU Olympus Balloon Control Unit) and a dispos-able silicone splinting tube with balloon(ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endos-copy(WCE). Prophylactic polypectomy was reservedmainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from-6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm(range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgi-cal resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussuscep-tions. No gastrointestinal tumors were found in sub-sequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper en-doscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps(> 15 mm).CONCLUSION: The effective of prophylactic polyp-ectomy of small bowel large polyps(> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.
文摘In December 2019 a novel coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic.Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease.Typical symptoms of the initial phase include fever and cough,with possible progression to acute respiratory distress syndrome.Gastrointestinal manifestations such as diarrhoea,vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2.The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses.Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations,such as fatigue and psychological impairment.To date,there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection.Since COVID-19 can directly or indirectly affect the gut physiology in different ways,it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations(dysbiosis,disruption of the intestinal barrier,mucosal microinflammation,post-infectious states,immune dysregulation and psychological stress).In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.
文摘The occurrence of Metabolic Syndrome (MS) represents an independent risk factor for developing cardiovascular disease states in patients suffering from type 2 diabetes mellitus. Moreover, both the size of LDL particles and liver dysfunction identified as non alcoholic fatty liver disease (NAFLD) represent important biomarkers for the development of cardiometabolic risk in patients with MS. Here we studied the effect of bergamot polyphenolic fraction (BPF) in patients with MS and NAFLD. 107 patients were enrolled at the San Raffaele IRCCS (Rome). All of them showed ultrasonografic evidences of NAFLD and at least three out of five previous identified criteria for the diagnosis of MS. Patients were divided into two groups: one receiving placebo and the second receiving BPF 650 mg twice a day for 120 consecutive days. In the group receiving BPF 650 mg twice a day, a significant reduction of fasting plasma glucose, serum LDL cholesterol and triglycerides alongside with an increase of HDL cholesterol was found. This effect was accompanied by significant reduction of both ultrasonographic and metabolic biomarkers of NAFLD. Moreover, a significant reduction of small dense LDL particles, as detected via proton NMR Spectroscopy, was found after BPF treatment. In conclusion, our data confirm the beneficial effect of bergamot-extract in patients with MS an effect highlighted by significant reduction of small dense LDL particles and by improvement of NAFLD biomarkers. This suggests a potential preventive role of bergamot derivatives in reducing cardiometabolic risk.
文摘A procedure based on the QuEChERS methodology and Liquid Chromatography Tandem Mass Spectrometry （LC/MS/MS） is described, for the determination of Nicotine in mushrooms. QuEChERS methodology was used to determine Nicotine in dried and fresh mushrooms under basic conditions with primary secondary amino sorbent （PSA） clean up. The chromatography was performed on C 18 reversed phase column using a gradient of acetonitrile and ammonium formiate lmM pH = 3.4 as mobile phase at a flow rate of 0.3 mL min^-1. Nicotine was determined by using Nicotine-d3 as internal standard. Limit of quantification （LOQ） was 0.01 mg kg^-1 for both fresh and dried mushrooms. Calibration curve was linear over the concentration range of 0.01-2.3 mg mL^-1, with r2 〉 0.99. As for recoveries in dried mushrooms, spiking levels of 0.32 mg kg^-1 and 2 mg kg^-1 were considered whereas for the fresh mushrooms the recoveries were determined at 0.036 mg kg^-1 and 0.36 mg kg^-1. Satisfactory results were obtained for both matrices and the recoveries proved to range from 105% to 135%, with a standard deviation in the range 17-20. The method was applied to the analysis of Nicotine to assess the levels of nicotine in fresh and dried mushrooms.
