A tool to predict survival in stage IV entero-pancreatic NEN.

PURPOSE: Well-differentiated stage IV neuroendocrine neoplasms (NEN) have an extremely heterogeneous, unpredictable clinical behavior. Survival prognostic markers, such as the recently proposed NEP-Score, would be very useful for better defining therapeutic strategies. We aim to verify NEP-Score applicability in an independent cohort of stage IV well-differentiated (WD) gastroentero-pancreatic (GEP) NEN, and identify a derivate prognostic marker taking into account clinical and pathological characteristics at diagnosis. METHODS: Age, site of primary tumor, primary tumor surgery, symptoms, Ki67, timing of metastases of 27 patients (10 females; mean age at diagnosis 60.2 ± 2.9 years) with stage IV WD GEP NEN were evaluated to calculate the NEP-Score at the end of follow-up (NEP-T). We calculated the NEP-Score at diagnosis (NEP-D), which does not consider the appearance of new metastases during follow-up. Patients were subdivided according to whether they were alive or not at the end of follow-up (EOF) and an NEP-Score threshold was investigated to predict survival. RESULTS: Mean NEP-T and mean NEP-D were significantly lower in 15 live patients as compared to 12 deceased patients (p < 0.01) at EOF. We identified an NEP-D = 116 as the cutoff that significantly predicts survival. No gender differences were identified. CONCLUSIONS: In our series, we confirmed NEP-Score applicability. In addition, we propose NEP-D as a simple, quick and cheap prognostic score that can help clinicians in decision making. NEP-D threshold can predict NEN aggressiveness and may be used to define the best personalized therapeutic strategy.

[Assessment of risk of burden in construction: improvement interventions and contribution of the competent physician]. / Valutazione del rischio da movimentazione carichi in edilizia: interventi migliorativi e contributo del medico competente.

Three construction companies in three years have changed the operating modes, making use of innovative carpentry, with little amount of equipment, improved usability of the site, reduced cleaning time, less manual handling and reduced risk of accidents. The Competent Doctor has participated in the review of the risk assessment of manual handling: data has been acquired on musculoskeletal disorders to compare, in terms of this innovation, the average trend and changes, with encouraging results in terms of incidence of musculoskeletal disorders, absenteeism due to illness by these causes, new cases of lumbar diseases. It remains difficult in building to assess manual handling risk, but the collaboration between the Employer, Prevention and Protection Service and Competent Doctor, thanks to the greater attention that the design subject to these issues, suggests improvements and further steps to extend to all phases of operation of building.

[Comparison of shift work and night shifts: impacts on health and wellbeing among sanitary workers]. / Lavoro a turni e notturno: studio conoscitivo e valutazione clinico-anamnestica in una popolazione di lavoratori della sanità.

The generally agreed view is that there is no ideal shift system, and that most systems will have both advantages and disadvantages. As such, attention has been placed on trying to identify good and bad features of shift systems, with a view to minimising the possible ill health as a consequence of shiftwork. The present study focuses on the quality of the shift and looks at the implications for individual health and wellbeing, during the wellbeing, during the shift. Three groups of sanitary workers, one working in the morning, one working two shifts, and the other working three, took part. All completed a version of the standard shiftwork index (SSI), a set of self reported questionnaires related to health and wellbeing. The three groups differed on many outcome measures, although the differences that did exist didn't suggested advantages for one shift system over the others.

[Cervical, thoracic and upper limb load assessment in dental professionals]. / Studio del carico posturale cervico-dorsale e dell'arto superiore nell'attività dell'odontoiatra.

In order to analyze the effect of working posture on the level of neck, back and shoulder muscular activity, a clinico-anamnestic, electromyographic and postural study of 34 dentistry was undertaken. Using surface electrodes, the level of muscular activity was recorded. The results showed that neck flexed working posture is prevalent: using stereomicroscope gave lower levels than with or without enlarging systems, such as glasses.

[Risk assessment in upper limb overload]. / Studio del sovraccarico biomeccanico dell'arto superiore attraverso l'applicazione di quattro diversi metodi di valutazione del rischio.

One of the most important factors of the work-related musculoskeletal disorders of the upper extremities (WMSDs) is the biomechanical overload. The purpose of this study is to evaluate the possibility to predict the upper limb repetitive stress, according to risk assessment procedures. In order to this aim, we gathered clinical-anamnestic data and risk assessment considerations of a cohort of workers in a car industry.

[Is it possible to use sex ratio at birth as indicator of the presence of endocrine disrupters in environmental pollution?]. / E possibile utilizzare il sex ratio alla nascita come indicatore di presenza di endocrine disrupters in contaminazioni ambientali?

The sex ratio at birth (male births/total births) seems to be influenced by both biological and environmental factors. Endocrine Disrupters such as dioxin, DBCP and other pesticides have been studied as possible determinants of the decline in the sex ratio observed in some western countries. High serum concentration of dioxin in about two hundred fathers exposed during the well-known Seveso accident (1976), have been found associated with a significant decline in male births. The present study examines the possible variation of the sex ratio at birth in the offspring of the entire populations residing in the municipalities around the site of the Seveso accident. We observed a reduction of male births in the eight years following the accident (1977-1984) in the two municipalities with the highest level of contamination (Meda and Seveso). This effect was no longer detectable in the subsequent decades. No reduction in the sex ratio was observed when all considered municipalities are grouped in three exposure categories, according to their distance from the centre of the contaminated area. It is concluded that variations of the sex ratio may be detected only in populations with high exposure to dioxin, but this effect is concealed when the analysis of the sex ratio is based on large populations, with lower levels of exposure.

Prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal mucosal injury: risk factors for serious complications.

BACKGROUND: 1-2% of all patients under non-steroidal anti-inflammatory drug therapy are exposed to serious upper gastrointestinal complications. The policy of prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal mucosal injury by using misoprostol or suppressing acid secretion is still a matter of debate. AIMS: To discuss the effectiveness of prophylaxis of a gastrointestinal complication during non-steroidal anti-inflammatory drug treatment, according to the number and relevance of risk factors. PATIENTS: A total of 8.843 patients with rheumatoid arthritis, admitted to the widest prospective multicentre mega-trial, on 6-month complication prevention of non-steroidal anti-inflammatory drug-induced ulcers. METHODS: The results are presented in terms of the number of patients to be treated (number needed to treat) in order to prevent one serious upper gastrointestinal complication, and corrected for the number of patients, that receiving the prophylaxis therapy, would lead to one additional withdrawal (number needed to harm). RESULTS: The base-line risk for a complication strongly depended on the number and relevance of risk factors: history of peptic ulcer disease, of gastrointestinal bleeding, of cardiovascular disease, and age. In the general study population, the relative risk reduction of gastrointestinal complications with misoprostol was 40%: thus the number needed to treat to prevent 1 event was 250 in the experimental period (6 months) or 125 when normalized at one-year treatment (1 year number needed to treat]. When considering the prophylaxis gain in intermediate (risk 1-2%) or high risk subjects (patients with a probability of an event over 2%, for the presence of 1 important risk factor or multiple factors), the 1-year number needed to treat rapidly drops from about 100 to about 17. The number needed to harm for one withdrawal was 18. The number needed to treat corrected for withdrawals in order to avoid major complications rises from 125 to 132 in the general population of non-steroidal anti-inflammatory drug users; from 102 to 105 in subjects at intermediate risk, such as patients with history of cardiovascular disease; in the groups at high risk, from 26 to 27 (patients with history of peptic ulcer disease), and from 16 to 17 (patients with history of peptic ulcer disease, cardiovascular disease and aged over 65 years). CONCLUSIONS: Patients at intermediate and high risk for complications from non-steroidal anti-inflammatory drug-induced ulcers should be considered for prophylaxis. In this group of patients, misoprostol prevention of severe complications is effective, and its clinical relevance similar to that of other preventive measures in medical practice.

[The otilonium bromide-benzodiazepine combination in the therapy of the irritable colon syndrome]. / L'associazione ottilionio bromuro-benzodiazepina nella terapia della sindrome del colon irritabile.

The irritable bowel syndrome is classified ad "disturbance of intestinal motility without an identifiable anatomic substrate". However, the clear etiopathogenetic implications of a psychosomatic nature complicate the search for an adequate therapeutic strategy. Based on this clinical experience, we set out to check the importance of a spasmolytic with a benzodiazepine and the tolerability of this type of combination. We therefore compared the results in 60 patients with irritable bowel syndrome of 8 weeks' treatment with tablets containing octylonium bromide (OB) 20 mg plus diazepam (DZ) 2 mg or OB 40 mg + 2 mg DZ. The doubling of the spasmolytic without increasing the daily dose of anxiolytic appeared to be useful for reducing the symptoms typical for the irritable bowel syndrome. In addition, the combination was found to be perfectly tolerated.

Clinical evaluation of serum N-acetyl-beta-D-glucosaminidase as a liver function test.

Serum N-acetyl-beta-D-glucosaminidase has been shown to be a sensitive indicator of liver function. The enzyme activity in serum from patients with different forms of hepatic disease was found to be elevated. A comparison is also made with routine liver parameters. The frequencies of pathological serum levels of the routine measurements made are in relatively good agreement with earlier reports.

Cytometrically determined relative DNA content as an indicator of neoplasia in gastric lesions.

Cellular samples from human gastric endoscopic biopsies were analysed in order to detect possible DNA content alterations as markers of cancerous and precancerous lesions of the digestive tract. Samples were derived from the stomach of normal donors (17 cases), and from patients clinically classified as affected by stomach adenocarcinoma (18 cases), chronic atrophic gastritis (20 cases), or other nonneoplastic lesions (17 cases). Sample processing was performed by mechanical and enzymatic treatment to obtain monodispersed cells. Staining for flow cytometric analysis was achieved with ethidium bromide and mithramycin. Samples from normal donors constantly exhibited a single cell population with diploid DNA content. All but three neoplastic specimens exhibited both a diploid and an aneuploid cell subpopulation, with the DNA index of the aneuploid peak ranging from 1.10 to 1.85 (except a single instance with a value of 3.13). The presence of a recognizable aneuploid subpopulation was also observed in 9 out of 20 chronic atrophic gastritis specimens. Such aneuploidy is similar to that observed for the adenocarcinoma, even if the fraction of aneuploid cells appears to be generally higher in the tumor than in the gastritis cases. All other cases of gastritis and of nonneoplastic disease exhibited diploid cells only. The meaning of aneuploidy in some gastritis specimens is a phenomenon not yet fully explained. Still, aneuploidy appears to be a useful marker for recognizing the presence of suspect malignant cells in gastric lesions.