Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery.

BACKGROUND: Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost-effectiveness of enhanced recovery implementation. METHODS: The first 50 consecutive patients treated during implementation of an enhanced recovery programme were compared with 50 consecutive patients treated in the year before its introduction. The enhanced recovery protocol principally implemented preoperative counselling, reduced preoperative fasting, preoperative carbohydrate loading, avoidance of premedication, optimized fluid balance, standardized postoperative analgesia, use of a no-drain policy, as well as early nutrition and mobilization. Length of stay, readmissions and complications within 30 days were compared. A cost-minimization analysis was performed. RESULTS: Hospital stay was significantly shorter in the enhanced recovery group: median 7 (interquartile range 5-12) versus 10 (7-18) days (P = 0·003); two patients were readmitted in each group. The rate of severe complications was lower in the enhanced recovery group (12 versus 20 per cent), but there was no difference in overall morbidity. The mean saving per patient in the enhanced recovery group was €1651. CONCLUSION: Enhanced recovery is cost-effective, with savings evident even in the initial implementation period.

Recent advances in the rationale design of GPER ligands.

G-Protein Coupled Receptor (GPCR) superfamily, which comprises approximately 900 members, is the largest family of protein targets with proven therapeutic value. Although at least 500 GPCRs have been identified as therapeutically relevant, only thirteen GPCRs have been structurally characterized in apo-form or in complex with ligands. GPCRs share relatively low sequence similarity making hard the process of homology modelling, nevertheless some successful hits have been determined. Recently, the G-protein-coupled estrogen receptor 1 (GPER, formerly known as GPR30) has attracted increasing interest due to its ability in mediating estrogen signaling in different normal and cancer tissues. In this regard, the identification of selective GPER ligands has provided valuable tools in order to differentiate the specific functions elicited by this novel estrogen receptor respect to those exerted by the classical estrogen receptors (ERs). In this review, we focus on GPER examining "in silico" docking simulations and evaluating the different binding modes of diverse natural and synthetic ligands.

Genomic aberrations in normal appearing mucosa fields distal from oral potentially malignant lesions.

OBJECTIVES: Oral fields of visually normal and non-dysplastic mucosa (ODFs) may represent the precursors of oral potentially malignant lesions (OPMLs). Aim of the study was to provide new evidence for the concept of the "field carcinogenesis" model by comparing the ODF and OPML genomic aberration profiles obtained by high resolution DNA flow cytometry (hr DNA-FCM) and array-Comparative Genomic Hybridization (a-CGH). A second aim was to investigate if specific CGH aberrations were associated with DNA aneuploidy. METHODS: Nineteen patients with single OPMLs were recruited for the study. In parallel with obtaining samples of OPML tissue from 11 leukoplakias without dysplasia (nd-OPMLs) and 8 with dysplasia (d-OPMLs), we also obtained samples from distant ODFs. DNA aneuploid nuclei detected by hr DNA-FCM were physically separated, based on DNA content, from the DNA diploid components with a DNA-FCM-Sorter. These relatively pure subpopulations of epithelial nuclei were then submitted to DNA extraction and a-CGH for a genome-wide analysis of DNA copy number aberrations (CNAs). RESULTS: The frequencies of DNA aneuploidy (DI ≠ 1) among ODFs and OPMLs were respectively 5.3% and 32%. The DI aneuploid values of ODFs and nd-OPMLs were all near-diploid (DI ≠ 1 and DI ≤ 1.4), while for d-OPMLs were high-aneuploid (DI > 1.4) in 40% of the cases. CNA averages were 1.9 in ODFs and 6.5 in OPMLs. The gain of the chromosomal region 20q13.33-qter was observed in 37% of both ODFs and corresponding OPMLs. Additional common regions included 7p22.2-pter, 11p15.5-pter and 16p13.3-pter where gains were observed. Furthermore, gains of 20q13.31-q13.33 and of 5p13.33-pter and loss of 9p21.3 were detected at high frequency (respectively, at 62.5%, 50% and 50%) only in d-OPMLs. In particular, loss at 9p21.3, gain at 5p13.33-pter and gain of 20q13.31-q13.33 were associated with DNA aneuploidy (p = 0.00004; p = 0.0005; p = 0.01). CONCLUSIONS: ODFs and OPMLs showed common CNAs in specific chromosomal regions suggesting that they may represent early events of the natural history of oral carcinogenesis according to the field effect cancerization and may contribute to the ODF-OPML transition. In addition, loss at 9p21.3 and gains at 5p13.33-pter and 20q13.31-q13.33 may contribute to DNA aneuploidization.

The human ITGB4BP gene is constitutively expressed in vitro, but highly modulated in vivo.

The ITGB4BP gene encodes for a highly conserved protein, named p27BBP (also known as eIF6), originally identified in mammals as a cytoplasmic interactor of beta4 integrin. In vitro and in vivo studies demonstrated that p27BBP is essential for cell viability and has a primary function in the biogenesis of the 60S ribosomal subunit. Here we report the genomic organization of the human ITGB4BP gene and show that its gene product is expressed with features of a housekeeping element in vitro, but is regulated in a cell specific fashion in vivo. The human gene spans 10 kb and comprises seven exons and six introns. The 5' flanking region shows a TATA-less promoter, canonical CpG islands, and binding sites for serum responsive elements. In cultured cells, p27BBP mRNA and protein are constitutively expressed and stable. A gradual loss of p27BBP mRNA can be observed only after prolonged serum starvation, and heat shock treatment. In contrast, p27BBP mRNA and protein levels in vivo are variable among different organs. More strikingly, immunohistochemical analysis shows that the p27BBP protein is present in a cell specific fashion, even within the same tissue. Taken together, these data show that ITGB4BP gene expression is highly regulated in vivo, possibly by the combination of tissue specific factors and protein synthesis pathways.

Expression of a highly conserved protein, p27BBP, during the progression of human colorectal cancer.

The highly conserved protein p27BBP is a cytoplasmic interactor of integrin beta4 expressed in epithelia. p27BBP is found in two pools: one nuclear pool enriched in the perinucleolar region, and one cytoplasmic pool. Deletion of p27BBP in yeast is lethal as a result of loss of the ribosomal 60S subunit. The aim of this study was to investigate the distribution of p27BBP in gut epithelium and its behavior during progression of human colorectal carcinomas. Results indicated that p27BBP is high in rapidly cycling cells and decreased in villous cells committed to apoptotic cell death. In dysplastic adenomas and carcinomas, p27BBP displayed a large increase of its nucleolar component that was superimposable to argyrophylic nucleolar organizing region-associated proteins and was associated with the nuclear matrix. Western blotting confirmed increased p27BBP in dysplastic adenomas and in carcinomas. In particular, p27BBP increased progressively from adenomas to carcinomas and, in the latter, was related to the tumor stage. The overexpression of p27BBP corresponded to mRNA up-regulation in carcinomas, supporting the idea of transcriptional or post-transcriptional regulation of its expression. Results suggested that p27BBP alterations are an early event in the transition from benign to malignant colorectal phenotypes and provide a novel tool in surgical pathology.

Diamond-Gardner syndrome: a case report.

We present a 13-year-old girl who came to our attention for an erythematous bruised lesion which appeared spontaneously without any apparent coagulopathy. The history, histology, and positive "skin-test," carried out by subcutaneously injecting autologous erythrocytes obtained from heparinized blood, confirmed the suspected diagnosis of Diamond-Gardner syndrome. No alterations of blood vessel walls or thromboses were found. Evaluation of hemocoagulative parameters revealed an increased factor VIII level and reduced platelet aggregation after stimulation by adenosine diphosphate (ADP.)

Selenium plasma levels in psoriasis.

Little is known about factors that may have modulating effects on inflammatory diseases such as psoriasis. Recently it has been proposed that trace elements like selenium may play an active role. Selenium concentrations were determined in plasma and in whole blood from 64 patients with psoriasis. Values were compared with those of matched controls: no significant reduction was observed in contrast with previous reports of reduced selenium levels in psoriasis.

Helicobacter pylori infection and chronic gastritis: clinical, serological, and histologic correlations in children treated with amoxicillin and colloidal bismuth subcitrate.

Twenty-three children with Helicobacter (Campylobacter) pylori-associated chronic gastritis are reported. Family history of peptic disease, previous digestive procedures, and nonspecific epigastric pain were the most frequently encountered clinical features. Antral nodularity at endoscopy and histologic evidence of follicular gastritis were characteristic morphological aspects. Rapid urease tests suggested the diagnosis in 90% of patients. Significant increases of serum IgG and IgA against Helicobacter pylori allowed the identification of infected children with 95% cumulative sensitivity. Treatment with amoxicillin and bismuth subcitrate eradicated the infection and improved gastritis in 13 of 19 children. These findings provide further evidence for the etiologic role of Helicobacter pylori in chronic antral gastritis in children.

[A clinical study on the use of norfloxacin in the therapy of urethritis caused by Chlamydia trachomatis]. / Studio clinico sull'impiego della norflossacina nella terapia delle uretriti da Chlamydia trachomatis.

Norfloxacin (NOR) was given to 37 patients affected by urethritis due to Chlamydia trachomatis (CT), as demonstrated by clinical findings and fluorescent monoclonal antibody in urethral swab. The patients were divided into two groups according to a randomization list, and given either: NOR 400 mg t.i.d. or NOR 800 mg b.i.d. for 10 days. The 2 groups were comparable in terms of age, clinical presentation and duration of symptoms. Six out of 18 patients treated by regimen 2 had persistence of CT at the end of treatment (2 cases were clinically improved), while 4 out of 19 patients in group 1 dit not respond to the treatment. Overall 12 patients in group 2 (66.6%) and 15 patients in group 1 (79%) were asymptomatic and negative for fluorescent antibody at the end of the treatment. Both regimens were well tolerated. Our data show that NOR given at dosage higher than those usually recommended (e.g. 400 mg b.i.d.), may be of value for the treatment of urethritis due to Chlamydia trachomatis.

[Thallium-induced alopecia]. / Alopecia da Tallio.

A case of accidental Thallium intoxication showing, as the only sign, alopecia of the scalp with depigmentation of the hair, is described. A 21 year old woman developed acute loss of hair after ingestion of contaminate tomatoes. No further signs of intoxication were evident. The diagnosis has been made by evidencing Thallium in the urine (colorimetric method) and in the hair (atomic absorption spectrophotometry). Moreover, the clinical and histopathological findings of Thallium alopecia are described.

[Cutaneous, muscular and cerebral cysticercosis]. / Cisticercosi cutanea, muscolare e cerebrale.

We present a case of cysticercosis with cutaneous subcutaneous muscular and cerebral involvement. The patient, a 34 years old man, developed over ten years multiple calcified cysts diffusely on the body. Analysis of a calcified cyst revealed the presence of cysticercus. A therapy with praziquantel proved successful.

[Plasma levels of Zn, Cu and Ni in healthy controls and in psoriatic patients. Possible correlations with vitamins (author's transl)]. / Livelli plasmatici di zinco, rame e nichel nell'individuo normale e nello psoriasico: possibili correlazioni con le vitamine.

Plasma levels of Zn, Cu and Ni were determined in psoriatic patients by atomic absorption spectrophotometry. In psoriatic patients, plasma Cu levels were significantly higher, whilst plasma Zn and Ni were significantly lower than in healthy controls.