EBV infection of primary colonic epithelial cells causes inflammation, DDR and autophagy dysregulation, effects that may predispose to IBD and carcinogenesis.

EBV is a gammaherpesvirus strongly associated to human cancer. The virus has been shown to play a role also in inflammatory diseases, including IBD, in the context of which colon cancer more frequently arise. In this study, we show for the first time that EBV infects primary colonic epithelial cells (HCoEpC), promotes pro-inflammatory cytokine secretion and activates molecular pathways bridging inflammation and cancer, such as ERK1/2. These effects, occurring in the course of the lytic phase of the viral life cycle, led to DDR and autophagy dysregulation. Such cellular responses, playing a key role in the maintenance of proteostasis and genome integrity, are essential to prevent carcinogenesis. Interestingly, we found that the use of the demethylating agent 5-AZA could counteract most of the effects induced by EBV infection in HCoEpC, suggesting that DNA hyper-methylation may strongly contribute to viral-driven inflammation and colon cancer predisposition.

Non-surgical treatment of congenital left ventricle to coronary sinus fistula and Wolf-Parkinson-White.

Congenital left ventricle to coronary sinus fistula is a rare entity. We report a case of an infant with prenatal finding of left ventricle to right atrial shunt. The anatomy was defined by multi-modality imaging. Baseline electrocardiogram was notable for a Wolff-Parkinson-White pattern. He underwent successful catheter device closure of the left ventricle to coronary sinus fistula. The patient developed supraventricular tachycardia and underwent successful ablation of the accessory pathway.

[Relation between sleep deprivation and nursing errors during the night shift]. / Il legame tra la privazione del sonno e gli errori commessi dagli infermieri durante il turno di notte.

INTRODUCTION: Nurses who work at night often experience high levels of sleepiness, which are the biological consequence of the circadian rhythm, which induces sleep at particular hours of the night, increasing the risk of errors and accidents. OBJECTIVE: According to the latest data declared by the World Organization of Healthcare (WHO), at least 134 million patients are victims every year adverse events that occur due to the lack of safety in the health care and and 2.6 million those who die from it, but most of these deaths are avoidable. The study aims to investigate the relationship between sleep deprivation and errors in patient care by the nursing staff who works the night shift. In the aviation and transportation sectors, studies conducted revealed as sleep deprivation increases the risk of mistakes. Few researches have investigated nighttime nursing. METHODS: A literature search was conducted by interrogating banks PubMed and Cochrane data limiting article selection to the last 10 years. Only one study met our benchmarks: "Sleep deprivation and error in Nurses who work the night shift "of 2014, by Arlene L. Johnson, whose questionnaire it was adapted to the Italian situation and administered to a sample of 41,000 nurses, to which 3358 responded. RESULTS: 94.7% of the interviewees, during the night shift, carry out ordinary activities. 16.8 of respondents made mistakes in the last two night shifts; in 59.5% of the cases only one mistake was made. Lack of sleep (3-5 hours of sleep during the 24 hours of the day before the interview) seems to determine a higher frequency of errors. This trend is particularly marked a nurses working in critical wards (23.9%). Even the number of nights, affects the propensity to make mistakes, with an error rate of 20.5%.

Cardiac screening in infants with infantile hemangiomas before propranolol treatment.

There is no uniform pretreatment cardiac evaluation for infants treated with oral propranolol, which is now the drug of choice for hemangiomas of infancy requiring systemic medical intervention. The aim of this study was to report and evaluate the findings of pretreatment cardiac evaluation. Data were reviewed for patients evaluated by a single hemangioma specialist and a single pediatric cardiologist prior to initiation of propranolol for infantile hemangioma. Cardiac evaluation included a complete echocardiogram. From July 2009 through January 2013, 239 consecutive patients 12 months of age or younger (median 2.7 months) were screened. No patients had cardiac contraindications to propranolol. However, 50 patients (21%) had an abnormal echocardiogram: 39 atrial septal defects (5 associated with right heart enlargement), 6 ventricular septal defects, 2 patent ductus arteriosus, 1 aortic coarctation, 1 pulmonary valve stenosis, and 1 aberrant subclavian artery. Overall, 69 patients had an audible heart murmur, 44 of which were not associated with pathologic findings on echocardiogram. All patients with a ventricular septal defect and 16 of 39 with an atrial septal defect had a murmur. Two of seven patients with PHACE syndrome had cardiac anomalies. None of the findings precluded the use of propranolol. Assisted reproductive technologies were used in 18% of pregnancies, including in vitro fertilization in 12%. Cardiac contraindications to propranolol treatment are uncommon in patients with infantile hemangioma. However, anatomic abnormalities were more common than reported in the general population. Further study is necessary to determine whether there is a pathogenic relationship between cardiac defects and nonsyndromic infantile hemangioma.

Vein of Galen malformations in neonates: new management paradigms for improving outcomes.

BACKGROUND: Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved. OBJECTIVE: To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs. METHODS: From 2005 to 2010, 16 neonatal patients with VGAM presented to our institution. Medical care from the prenatal to perinatal stages was undertaken according to specified institutional guidelines. Nine patients with refractory heart failure required neonatal endovascular intervention. All patients were treated by transarterial deposition of n-butyl cyanoacrylate into fistula sites. Short- and long-term angiographic studies and clinical outcomes were reviewed. RESULTS: Control of heart failure was achieved in 8 patients. One premature baby died shortly after treatment. Long-term angiographic follow-up shows total or near-total angiographic obliteration in all 8 patients. One patient has a mild hemiparesis from treatment. Another has a mild developmental delay. One patient developed a severe seizure disorder and developmental delay. Overall, 66.7% patients have normal neurological development with near-total or total obliteration of the malformation. CONCLUSION: Treatment of refractory heart failure in neonatal VGAM with modern prenatal, neurointensive, neuroanesthetic, and pediatric neuroendovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most.