First COVID-19 wave in the province of Bergamo, Italy: epidemiological and clinical characteristics, outcome and management of the first hospitalized patients.

BACKGROUND: Northern Italy was the first European country affected by the spread of the SARS-CoV-2, with the epicenter in the province of Bergamo. AIM: This study aims to analyze the characteristics of patients who experienced more severe symptoms during the first wave of COVID-19 pandemic. MATERIALS AND METHODS: We retrospectively collected epidemiological and clinical data on patients with laboratory-confirmed wild-type SARS-CoV-2 infection who were admitted to the "ASST Bergamo Ovest" hospital between February 21 and May 31, 2020. RESULTS: A total of seven hundred twenty-three inpatients met the eligible criteria and were included in the study cohort. Among the inpatients who survived, the average hospital length of stay was more than two weeks, with some lasting up to three months. Among the 281 non-survivors, death occurred in 50% within five days. Survivors were those whose first aid operators recorded higher oxygen saturation levels at home. The request for first aid assistance came more than one week after symptom onset, within three days in 10% of cases. CONCLUSION: In similar future scenarios, based on our data, if we aim to enhance the survival rate, we need to improve the territorial healthcare assistance and admit to hospitals only those patients who are at risk of severe illness requiring specialized and urgent interventions within two, three, or, at most, five days from the onset of symptoms. This implies that the crucial factor is, has been, and will be the ability of a healthcare system to react promptly in its entirety within a few days.

Prognosis of elderly gastric cancer patients after surgery: a nomogram to predict survival.

This study aimed to identify clinicopathological factors associated with the outcome of elderly patients with gastric cancer (GC), and to construct a nomogram for individual risk prediction. Tumor characteristics of 143 patients aged ≥ 80 years underwent surgery for GC were collected and analyzed by uni- and multivariate analyses. A prognostic nomogram was constructed using the factors which resulted to be significantly associated with overall survival. Discrimination of nomogram was tested by Kaplan-Meier (KM) curves and boxplots. With a median follow up of 18.37 months, overall 1-year survival rate was 51% and it was 60 and 40% for older and younger than 83 years, respectively (P = 0.003). Univariate analysis indicated that age (P = 0.008), pre-operatory performance status (P < 0.001), depth of invasion (P = 0.007), lymph nodes involvement (P < 0.001), and residual tumor (P < 0.001) were significant prognostic factors. Based on these variables, a nomogram to predict 3, 6, 12, and 24 months survival probability after GC surgery was developed. KM and boxplots according to the range of nomogram total points highlighted the appropriateness of distinguish the patients' survival in all the subgroups. Moreover, this nomogram exhibited superior prognostic discrimination between intermediate stages (II-III) than AJCC-TNM classification. This study showed that after good surgical selection, the prognosis of elderly GC patients may be influenced by several clinicopathological factors. Therefore, a predictive nomogram to distinguish more accurately fit patients may allow physicians to individualize treatments and to detect those patients who may benefit from an intensive multidisciplinary approach.

Casein phosphopeptides promote calcium uptake and modulate the differentiation pathway in human primary osteoblast-like cells.

Casein phosphopeptides (CPPs), originating by in vitro and/or in vivo casein digestion, are characterized by the ability to complex and solubilize calcium ions preventing their precipitation. Previous works demonstrated that CPPs improve calcium uptake by human differentiated intestinal tumor cell lines, are able to re-mineralize carious lesions in a dental enamel, and, as components of a diet, affect bone weight and calcium content in rats. The aim of the present study was to evaluate if CPPs can directly modulate bone cells activity and mineralization. Primary human osteoblast-like cells were established in culture from trabecular bone samples obtained from waste materials during orthopedic surgery. Commercial mixtures of bovine casein phosphopeptides were used. The CPP dependent intracellular calcium rises were monitored at the single cell level through fura2-fluorescence assays. Results show that CPPs: (i) stimulate calcium uptake by primary human osteoblast-like cells; (ii) increase the expression and activity of alkaline phosphatase, a marker of human osteoblast differentiation; (iii) affect the cell proliferation rate and the apoptotic level; (iv) enhance nodule formation by human SaOS-2. Taken together these results confirm the possibility that CPPs play a role as modulator of bone cell activity, probably sustained by their ability as calcium carriers. Although the exact mechanism by which CPPs act remains not completely clarified, they can be considered as potential anabolic factors for bone tissue engineering.