Archivio istituzionale della ricerca - Università dell'Insubria
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Blended diets and effects on gastrointestinal symptoms in children with gastrostomy tubes: A survey study
No full textObjectives: Interest is growing in the use of blended diets (BD) in children with gastrostomy. Evidence supporting the benefits of BD is conflicting, with limited data to assist physicians in clinical practice. The present survey aims to evaluate current use of BD in children and adolescents with gastrostomy. Methods: An online survey evaluating the use of BD in children with gastrostomy was sent to members of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition with expertise on gastrointestinal motility. The questions assessed clinical indications, level of experience, preferred diet composition, and clinical outcomes. Results: We collected 26 questionnaires filled out by members from 13 different countries. Most of the respondents (84.6%) are pediatric gastroenterologists, with 69.2% visiting gastrostomy patients on a daily/weekly basis. The majority of the sample (61.5%) declares to use BD, but only in selected conditions, and only 38.5% reports an advanced experience with BD. The main reason for BD prescription is parental request (53.8%). In addition, 57.7% prefers homemade BD compared to only 15.4% that relies on commercial BD. Finally, 69.2% states to find an impact on gastrointestinal symptoms. Positive clinical outcomes are reported for vomiting (61.1%), constipation (50%), nausea (38.9%), and bloating (38.9%). The main reason for not using BD is the non-standard nutritional composition. Conclusions: BD are commonly used in clinical practice. However, due to the lack of conclusive evidence and well-designed studies, there is great variability in diet composition and clinical indications. Given the increasing demand from caregivers and the potential positive outcomes, further studies are needed to provide insights and guide healthcare professionals in their clinical practice
Patterns of lymph node recurrence in sinonasal cancers: risk factors and oncological outcomes
No full textPurpose: Sinonasal tumors are rare and heterogeneous diseases with a low incidence of neck node metastasis. This study aims to analyze the risk of neck nodes recurrences and to assess patterns and predictors of nodal recurrence in sinonasal malignancies. Methods: Retrospective observational cohort study on 574 patients affected by sinonasal malignant tumor who were treated via endoscopic-assisted approaches between January 1998 and December 2023 in our tertiary-care referral University hospital. Nodal recurrence-free survival (N-RFS) was analyzed using Kaplan-Meier curves, with univariate and multivariate Cox regression identifying prognostic factors. Results: Nodal involvement at diagnosis was observed in 3.1% (18/574) of patients. During a median follow-up of 62.9 months, nodal recurrence occurred in 6.8% (39/574). Histologies with the highest recurrence included sinonasal neuroendocrine carcinoma (23.5%), sinonasal undifferentiated carcinoma (18.8%), and olfactory neuroblastoma (12.8%). Univariate analysis revealed pT classification (pT > 3), tumor grading (G3/G4), and surgical approach as significant predictors of nodal recurrence. In multivariate analysis, high-grade tumors (HR = 3.109, p = 0.003) and craniofacial/cranio-endoscopic approaches (HR = 2.495, p = 0.023) remained independently associated with worse N-RFS. Conclusions: Histotype is the most important factor in determining the incidence and pattern of regional recurrence. Both high tumor grade and more extensive surgical procedures are independent predictors of regional failure. Therefore, long-term follow-up is essential, especially for specific histologies such as olfactory neuroblastoma and sinonasal neuroendocrine carcinoma. Elective neck treatment should be personalized, taking into account the tumor’s histology, grading and overall disease extent to optimize patient outcomes
Durvalumab in Advanced Biliary Tract Cancer: Real-World Data From a Large Cohort of Patients Across Multiple International Centers
No full textBackground: We recently published the first real-world multicenter and multi-institutional study of cisplatin, gemcitabine, and durvalumab in patients with advanced biliary tract cancer (BTC). Here we present an expanded patient cohort with an increased sample size and longer median follow-up. Methods: The study population included patients with advanced BTC, who received cisplatin/gemcitabine plus durvalumab at 55 centers across 12 countries in Europe, the United States, and Asia. The primary endpoints of the study were progression-free survival (PFS) and overall survival (OS). Secondary endpoints were overall response rate (ORR) and safety. Results: Overall, 1358 patients were enrolled. Median PFS was 7.6 months (95% CI: 7.2–8.1), and median OS was 15.6 months (95% CI: 14.8–16.5). ORR was 35.6%, and DCR was 82.7%. Any grade AEs occurred in 1213 patients (89.3%). Grade 3–4 AEs occurred in 597 patients (43.2%). The rate of immune-related AEs (irAE) was 20.3%. Grade 3–4 irAE occurred in 3.0% of patients. At the multivariate analysis for OS, normal albumin level (HR 0.68, 95% CI 0.57–0.81, p < 0.0001), CEA levels within normal ranges (HR 0.68, 95% CI 0.57–0.82, p < 0.0001), NLR < 3 (HR 0.62, 95% CI 0.52–0.74, p < 0.0001), ECOG PS 0 (HR 0.51, 95% CI 0.42–0.61, p < 0.0001), and prior surgery (HR 0.80, 95% CI 0.65–0.99, p = 0.036) were positive prognostic factors. Conclusion: The updated findings, derived from an expanded cohort, further support the adoption of durvalumab in combination with gemcitabine and cisplatin in routine clinical practice, reinforcing the efficacy and safety outcomes demonstrated in the phase III TOPAZ-1 trial
Recensione del volume di Curtis Brad Faught, "L'invenzione del Medio Oriente. Cairo 1921", Vicenza, Neri Pozza Editore.
No full textRecension
Biobased triblock thermoplastic elastomer with betulin- or carvacryl-methacrylate end-blocks by RAFT polymerization
No full textIn this work, fully biobased acrylic ABA triblock copolymers were synthesized via reversible addition-fragmentation chain-transfer (RAFT) polymerization using VISIOMER (R) Terra C13 (ET13) as the "soft" midblock and two terpenoid-derived methacrylates, betulin methacrylate (BetuMA) and carvacryl methacrylate (CaMA), as the glassy blocks. An "R-linked" bifunctional chain transfer agent (bis-CTA) enabled the formation of ET13 macro-CTAs with controlled molecular weights and narrow dispersity (M-n = 84-229 kg mol(-1), & Dstrok; approximate to 1.1). RAFT homo-polymerizations of BetuMA and CaMA yielded well-defined homopolymers (M-n = 20-33 kg mol(-1), & Dstrok; < 1.4) with selective methacrylate reactivity. Chain extension of ET13 macro-CTAs produced a series of ABA triblocks featuring 8-39 mol% glassy content. GPC confirmed molecular weights in the range M-n = 97-415 kg mol(-1) (& Dstrok; < 1.7), while DSC and TGA analyses showed distinct glass transitions for soft block, close to -50 degrees C, and good thermal stability. AFM evidenced clear microphase separation. Mechanical testing revealed that BetuMA-based copolymers (BEB series) achieved tensile strengths up to 3.9 MPa and elongations up to 760%, outperforming CaMA-based analogs (CEC series: sigma <= 1.2 MPa, epsilon <= 710%). These results demonstrate the efficacy of RAFT polymerization of terpenoid methacrylates in producing high-performance, sustainable thermoplastic elastomers, offering a viable alternative to petroleum-derived thermoplastic elastomers (TPEs)
Advanced reconstructive techniques following orbital exenteration: The role of LCFA free flaps
No full textBackground: Orbital exenteration is a severe and disabling surgical procedure that involves the removal of all orbital contents. Effective reconstruction is crucial to managing the resulting defects. This study aims to propose a reconstructive algorithm utilizing free flaps derived from the lateral circumflex femoral artery (LCFA) system for orbital exenteration defects, based on our clinical experience. Patients and methods: Patients who underwent orbital exenteration and subsequent reconstruction using LCFA-based free flaps between January 2013 and January 2022 were included in this study. Results: A total of 44 patients underwent orbital exenteration, followed by LCFA free flap reconstruction. The choice of reconstructive technique depended on defect type and dura mater exposure, adhering to the proposed algorithm. The procedures included 20 standard ALT (Anterolateral thigh) flaps, 13 chimeric ALT flaps, 1 SALT chimeric flap with skin grafting, 7 SALT flaps with skin grafting, and 3 buried SALT flaps. Complications were recorded in 10 cases at the recipient site and 2 cases at the donor site. Conclusion: Orbital exenteration presents significant challenges both surgically and reconstructively, with a high risk of local recurrence and postoperative mortality. The reconstruction algorithm using LCFA-based free flaps, as proposed in this study, may guide surgeons in selecting the most appropriate technique, tailored to the specific defect and considering postoperative treatments such as adjuvant radiotherapy
Expert-Based Narrative Review on Compression UltraSonography (CUS) for Diagnosis and Follow-Up of Deep Venous Thrombosis (DVT)
Get PDFDeep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information
Antibacterial profile and antiproliferative activities over human tumor cells of new silver(I) complexes containing two distinct trifluoromethyl uracil isomers
No full textNew silver(I) complexes of 5-(trifluoromethyl)uracil (5TFMU) and 6-(trifluoromethyl)uracil (6TFMU) isomers were synthesized, characterized, and evaluated as antibacterial and antiproliferative agents. Based on elemental and thermogravimetric analyses, the Ag-5TFMU and Ag-6TFMU species are formulated as AgC5H2F3N2O2 and Ag2C5HF3N2O2, respectively. Infrared and 13C solid-state nuclear magnetic resonance spectroscopies suggest coordination of the trifluoromethyluracil isomers to silver by both nitrogen and oxygen atoms. Confirmation of their structure and connectivity was achieved, in the absence of single crystals of suitable quality, by state-of-the-art structural powder diffraction methods. In Ag-5TFMU, the organic ligand is tridentate and two distinct metal coordination environments are found (linear AgN2 as well as C2v AgO4 geometries), whereas Ag-6TFMU contains a complex polymeric structure with tetradentate dianionic 6TFMU moieties and five distinct AgX2 (X = N, O) fragments, further stabilized by ancillary (longer) Ag...O contacts. These species presented modest activity over Gram-positive and Gram-negative bacterial strains, whereas Ag-6TFMU was active over a set of tumor cells, with the best activity over prostate (PC-3) and kidney cell lines and selectivity indices of 4.6 and 1.3, respectively. On the other hand, Ag-5TFMU was active over all considered tumor cells except MCF-7 (breast cancer). The best activity was found for PC-3 cells, but no selectivity was observed. The Ag-5TFMU and Ag-6TFMU species also reduced the proliferation of tongue squamous cell carcinoma cell lines SCC − 4 and SCC-15. Preliminary biophysical assays by circular dichroism suggest that the Ag-5TFMU complex interacts with DNA by intercalation, an effect not seen in Ag-6TFMU
Midline Anterior Neck Inclusion Cyst in a Pediatric Patient: A Case Report and Literature Review with a Dermatologic Perspective
Get PDFMidline Anterior Neck Inclusion Cysts (MANICs) are rare congenital anomalies caused by improper embryonic fusion. These superficial benign lesions typically appear yellowish and cystic without deeper anatomic connections. We describe an 11-month-old boy with a stable, asymptomatic, yellow, elastic cystic lesion on the midline of the anterior neck, measuring 4 mm and present since shortly after birth. Clinical, dermoscopic, and ultrasound evaluations confirmed the diagnosis of MANIC. Over six months of observation, the lesion remained stable without growth, infection, or symptoms. MANICs are benign epidermoid cysts with minimal risk of complications that are often mistaken for thyroglossal duct cysts, dermoid cysts, or other congenital anomalies. Unlike thyroglossal duct cysts, they do not move during swallowing or tongue protrusion. Management is usually conservative, with surgery reserved for symptomatic or cosmetically significant cases. This case highlights the importance of parental reassurance and avoiding unnecessary intervention for asymptomatic lesions. Recognition of MANICs is essential for dermatologists and pediatricians evaluating midline neck lesions. A conservative approach with regular monitoring ensures optimal care while minimizing interventions. Further research may clarify the pathogenesis and long-term outcomes of these rare lesions