1,721,007 research outputs found
Manuale di medicina generale. Sintesi e schemi teorici
No full textIl volume è rivolto ai candidati alle selezioni del Concorso Nazionale per le Scuole di Specializzazione e del Corso di Formazione in Medicina Generale, finalizzato in modo specifico alla preparazione di prove selettive costituite da test a risposta multipla: interamente a colori, ricco di illustrazioni e immagini esplicative, è caratterizzato infatti da una trattazione per punti chiave e fa ampio ricorso a tabelle e schemi di sintesi per consentire un rapido ripasso e facilitare la memorizzazione delle principali nozioni. Questa seconda edizione è stata aggiornata ed ampliata sulla base delle ultime evidenze scientifiche, contiene due nuovi capitoli dedicati rispettivamente all'Oftalmologia e alla Medicina del lavoro e una maggiore attenzione prestata alle discipline afferenti all'area preclinica e alle branche fondamentali della medicina oggetto dei quesiti di area previsti dal concorso (come Cardiologia, Pneumologia e Chirurgia Generale). Al termine di ciascun capitolo alcune batterie di quiz a risposta multipla favoriscono la verifica delle conoscenze e sono stati ampliati con i quesiti ufficiali del primo Concorso Nazionale per le Specializzazioni mediche
Manuale di medicina generale per medici di base e specializzazioni mediche
No full textIl volume rappresenta un sintetico compendio di tutte le discipline caratterizzanti il programma d’esame per l’ammissione al Corso triennale in Medicina Generale e una parte rilevante degli argomenti richiesti al test di accesso alle Specializzazioni Mediche.
Il testo è finalizzato alla preparazione di prove selettive costituite da test a risposta multipla: interamente a colori, ricco di illustrazioni e immagini esplicative, trattazione per punti chiave, tabelle e schemi di sintesi per consentire un rapido ripasso e facilitare la memorizzazione delle principali nozioni.
Questa terza edizione è stata aggiornata ed ampliata con nuove sezioni di Embriologia per ciascun capitolo e con specifica attenzione alle discipline afferenti all’area preclinica e alle branche fondamentali della medicina oggetto dei quesiti. Ciascun capitolo contiene quiz ufficiali assegnati negli anni precedenti per dare evidenza delle materie proposte in sede d'esame, e a fine capitolo batterie di quesiti a risposta multipla per la verifica delle conoscenze
Rediscovering biomarkers in for the diagnosis and early treatment response in NEN. Reborn Study
Full text linkIntroduction: Neuroendocrine neoplasms (NENs) are heterogeneous in terms of primary site, behavior, and response to treatment. The possibility to rely on diagnostic and prognostic circulating biomarkers is an unmet need in NENs. Despite promising, the clinical role of circulating angiogenic markers remains unclear. In addition, liquid biopsy is currently receiving growing attention in oncology, but data in NENs are available only for circulating nucleic acids and tumor cells while the potential role of circRNA sequencing from tumor educated platelets (TEPs) has never been explored. The aim of this study was to evaluate the role of angiogenic markers and circRNA sequencing from TEPs in NENs diagnosis and prognosis.
Materials and Methods: We performed a prospective observational study including 46 consecutive patients with proven NENs of pulmonary and gastro-entero-pancreatic (GEP) origin and 29 controls. Circulating pro-angiogenic factors were measured by ELISA assay, and ANG2 tissue expression was evaluated by immunohistochemistry. A limited subgroup of patients, affected by well-differentiated GEP NET, grade G1 or G2, naïve to any medical treatment, was also included in a proof-of-concept pilot study, for analyzing the expression profile of circRNA derived from TEPs, both at baseline and early follow-up (after 3 months of treatment).
Results: The study demonstrated a significantly higher level of ANG2, ANG1, sTIE2, and PROK2 in patients affected by NENs compared to controls. In the subgroup of patients with NENs, ANG2 levels were higher in poorly differentiated NENs (4.9, 2.8–7.4) than in well-differentiated (3.2, 1.7–6.4) ng/ml, p = 0.046 and in tumor stage 3–4 compared to stage 1–2: 4.2 (2.7–8.7) vs 2.7 (1.5–5.7), p = 0.044. ANG2 and PROK2 were significantly higher in patents with progressive disease compared to stable disease at the moment of sampling: ANG2 = 6.3 (4.0–11.0) vs 2.7 (1.7–4.7) pg/ml, p = 0.001; PROK2 = 29.2 (28.4–32.3) vs 28.4 (28.1–28.9) pg/ml, p = 0.035. ANG2 was also higher in patients who developed progression (or died) during the follow-up (one year after the enrollment) than in patients with stable disease (2.3 (1.5-3.8) ng/ml vs 6.3 (4.2-10.1) ng/ml, p<0.001). Immunohistochemistry confirmed ANG2 and PROK2 expression in tumor specimens. We identified a large number of circRNA in this study (98,735), of which 63,562 were not previously annotated and 35,173 annotated. To investigate the potential role of circRNAs expression profile from TEPs as diagnostic and prognostic biomarkers, a bioinformatic analysis is ongoing to evaluate differently expressed circRNA from TEPs between patients and controls and in the same patients before and after treatment.
Conclusions: We demonstrated higher levels of angiogenic markers in NENs, with a correlation between ANG2 serum levels and NENs morphology and staging. In both GEP and lung NENs, ANG2 and PROK2 are higher in case of tumor progression, suggesting a potential role as prognostic markers in NENs patients. The study also demonstrated that TEPs are a good source of circRNA in patients affected by NENs. The bioinformatics analyses are currently ongoing and could be the base for the development of novel markers for the diagnosis and follow-up of patients affected by NENs
Manuale di medicina generale per specializzazioni mediche
No full textRivolto ai candidati alle selezioni del Concorso Nazionale per le Scuole di Specializzazione e del Corso di Formazione in Medicina Generale, il volume rappresenta un sintetico compendio di tutte le discipline caratterizzanti il corso di laurea (clinica medica, chirurgia, diagnostica, discipline precliniche) che al contempo costituiscono il programma d’esame per l’ammissione al Corso triennale in Medicina Generale e una parte rilevante degli argomenti richiesti al test di accesso alle Specializzazioni Mediche (70 domande su 110).
Il testo è finalizzato in modo specifico alla preparazione di prove selettive costituite da test a risposta multipla: interamente a colori, ricco di illustrazioni e immagini esplicative, è caratterizzato infatti da una trattazione per punti chiave e fa ampio ricorso a tabelle e schemi di sintesi per consentire un rapido ripasso e facilitare la memorizzazione delle principali nozioni.
Questa seconda edizione è stata aggiornata ed ampliata sulla base delle ultime evidenze scientifiche, contiene due nuovi capitoli dedicati rispettivamente all’Oftalmologia e alla Medicina del lavoro e una maggiore attenzione prestata alle discipline afferenti all’area preclinica e alle branche fondamentali della medicina oggetto dei quesiti di area previsti dal concorso (come Cardiologia, Pneumologia e Chirurgia Generale). Al termine di ciascun capitolo le batterie di quiz a risposta multipla favoriscono la verifica delle conoscenze e sono stati ampliati con i quesiti ufficiali del primo Concorso Nazionale per le Specializzazioni mediche
How much does obesity affect the male reproductive function?
Full text linkObesity is considered a worldwide epidemic disease. Many pathological conditions have been associated to obesity but the evidence relating to impaired fertility in males with obesity are contrasting. The aim of this review was to evaluate the interplay between obesity and male fertility, analyzing evidence from in vitro and in vivo studies to clinical trials. Obesity seems to be responsible of secondary hypogonadism. Here, we propose a new classification including central, peripheral and testicular factors that may affect the hypothalamic-pituitary-gonadal axis. Moreover, some studies demonstrated a direct action of obesity on sperm count and sperm characteristics, mediated by impaired Sertoli cells function, increased scrotal temperature, oxidative stress and accumulation of toxic substances and liposoluble endocrine disruptors in fat tissue. Recent studies have explored obesity-related epigenetic effects in sperm cells which may cause diseases in offspring. Moreover, not only in females but also males, obesity has been linked to reduced outcomes of in vitro fertilization, with a reduction of pregnancy rate and an increase of pregnancy loss. Finally, we reviewed the effects of weight modifications through diet or bariatric surgery on obesity-related reproductive dysfunction. In this regard, several studies have demonstrated that weight loss has been associated with a restoration of gonadal hormones levels
Neuroendocrine Neoplasms with Peculiar Biology and Features. MEN1, MEN2A, MEN2B, MEN4, VHL, NF1
No full textA relevant number of neuroendocrine neoplasms (NENs) show a hereditary background being associated with a genetic endocrine neoplastic syndrome. Multiple endocrine neoplasia type 1 (MEN1), multiple endocrine neoplasia type 2 (MEN2), variants MEN2A and MEN2B, and multiple endocrine neoplasia type 4 (MEN4) present NENs as main and typical manifestations, while Von Hippel–Lindau disease (VHL) and neurofibromatosis type 1 (NF1) are mainly characterized by neoplasms of non-neuroendocrine origin.
Among NENs, pancreatic and thyroid tumors are most frequently associated with hereditary syndromes, the former being found in MEN1, MEN4, VHL, NF1, and the latter in MEN2A and B. Rare NEN sites are lung, thymus, and stomach, while pituitary and parathyroid adenomas are common in MEN1 and MEN4, as well as pheochromocytoma and paragangliomas in MEN2, VHL, NF1.
The diagnosis of hereditary NENs is anticipated of approximately two to three decades as compared to the sporadic counterpart. At histology the neuroendocrine tumors associated with genetic syndromes associated with hereditary syndromes are generally well differentiated, low proliferating, multiple, and multifocal. They are also frequently functioning, thus resulting in different types of endocrine syndromes, such as hyperinsulinemic hypoglycemia, Zollinger–Ellison, hyperprolactinemia, hyperparathyroidism, hypersecretion of catecholamines, and other rarer syndromes. Neuroendocrine carcinomas are extremely rare
Syndrome of inappropriate antidiuresis and diabetes insipidus as two sides of the same coin in hypothalamic lymphoma: A case report
No full textBackground: Hypothalamic-pituitary region lymphoma is rare and diabetes insipidus (DI) represents one of the most common endocrine manifestations. We report the first case of hypothalamic lymphoma associated with both the syndrome of inappropriate antidiuresis (SIAD) and DI. Case report: A 64-year-old woman with a history of stage IV large B-cell non-Hodgkin lymphoma, underwent atypical right lung resection for pulmonary nodules. A few days after surgery, the patient presented severe normovolemic hyponatremia and serum hypo-osmolarity, therefore, we suspected a paraneoplastic syndrome (SIAD) related to the lung neoplasm, histologically diagnosed as typical carcinoid. The brain magnetic resonance imaging (MRI) showed a 9 mm lesion in the hypothalamic region that significantly increased one month later with the onset of neurological symptoms. A trans-sphenoidal biopsy showed localization of the large B-cell lymphoma. After surgery, the patient presented with polyuria and polydipsia, so desmopressin therapy was started. In the following days, serum osmolarity and sodium fluctuated between normal and low values, then DI was excluded, and SIAD became more likely. Desmopressin therapy was discontinued and hyponatremia was treated with sodium infusion. Hypothalamic lymphoma was treated with chemotherapy and radiotherapy with substantial shrinkage. The hyponatremia persisted during anticancer treatments and improved only after radiotherapy, confirming paraneoplastic SIAD. Conclusion: Lymphomas of the hypothalamic region can cause electrolyte imbalance for various causes. The differential diagnosis between SIAD, DI and impaired thirst centers may not be straightforward and they must be evaluated step by step in all different stages of the disease
New Insights in PRRT: Lessons From 2021
No full text: Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse events, even though 1.8% of treated patients developed a second malignancy. Finally, there is a lack of prognostic and predictive factors for PRRT, with the exception of the crucial role of nuclear imaging for both patient selection and treatment response estimation
Role of FGF System in Neuroendocrine Neoplasms. Potential Therapeutic Applications
Full text linkNeuroendocrine neoplasms (NENs) are a heterogeneous group of tumors originating from neuroendocrine cells dispersed in different organs. Receptor tyrosine kinases are a subclass of tyrosine kinases with a relevant role in several cellular processes including proliferation, differentiation, motility and metabolism. Dysregulation of these receptors is involved in neoplastic development and progression for several tumors, including NENs. In this review, we provide an overview concerning the role of the fibroblast growth factor (FGF)/fibroblast growth factor receptor (FGFR) system in the development and progression of NENs, the occurrence of fibrotic complications and the onset of drug-resistance. Although no specific FGFR kinase inhibitors have been evaluated in NENs, several clinical trials on multitarget tyrosine kinase inhibitors, acting also on FGF system, showed promising anti-tumor activity with an acceptable and manageable safety profile in patients with advanced NENs. Future studies will need to confirm these issues, particularly with the development of new tyrosine kinase inhibitors highly selective for FGFR
Ruolo diagnostico, prognostico e predittivo di risposta del NETest nelle neoplasie neuroendocrine
Full text linkIl NETest è una metodica di biologia molecolare e, in particolare, di biopsia liquida, applicata alle neoplasie neuroendocrine (NEN), che si propone come nuovo biomarcatore altamente sensibile e specifico. Il NETest consente una sorta di gene signature del tumore, definendone il profilo trascrizionale mRNA, estratto dal sangue periferico. L’applicazione pratica è nella diagnosi, dove il NETest sembra identificare anche piccoli tumori localizzati, nella definizione prognostica, con l’identificazione dei tumori con maggiore tendenza alla progressione e alla recidiva post-chirurgica, nella riposta ai trattamenti, con l’identificazione precoce di progressione nel corso di terapie anti-tumorali. A fronte di risultati iniziali estremamente promettenti, il NETest necessita di una conferma su larga scala, in ampie casistiche multicentriche
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