Mesenteric root pseudocyst: finding in an asymptomatic patient-a case report

BACKGROUND

Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.

CASE PRESENTATION

This article describes the case report of an asymptomatic 28-year-old patient who presented a 6-cm abdominal cystic mass with mixed density, which was found incidentally by computed tomography. Exploratory laparoscopy was performed followed by conversion to conventional surgery to extract the tumor mass. The anatomical pathology diagnosis was pseudocyst of the mesentery root. Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.

CONCLUSIONS

Mesenteric cysts are rare, and their nonspecific symptoms often lead to diagnosis based on imaging findings. Complete laparoscopic enucleation is the standard treatment.

A gut-secreted peptide suppresses arousability from sleep

Suppressing sensory arousal is critical for sleep, with deeper sleep requiring stronger sensory suppression. The mechanisms that enable sleeping animals to largely ignore their surroundings are not well understood. We show that the responsiveness of sleeping flies and mice to mechanical vibrations is better suppressed when the diet is protein rich. In flies, we describe a signaling pathway through which information about ingested proteins is conveyed from the gut to the brain to help suppress arousability. Higher protein concentration in the gut leads to increased activity of enteroendocrine cells that release the peptide CCHa1. CCHa1 signals to a small group of dopamine neurons in the brain to modulate their activity; the dopaminergic activity regulates the behavioral responsiveness of animals to vibrations. The CCHa1 pathway and dietary proteins do not influence responsiveness to all sensory inputs, showing that during sleep, different information streams can be gated through independent mechanisms.

SARS-CoV-2 infection in adult liver transplantation recipients: a systematic review of risk factors for mortality and immunosuppression role

OBJECTIVE

Data on mortality, immunosuppression, and vaccination role regarding liver transplant (LT) recipients affected by COVID-19 are still under debate. This study aims to identify risk factors for mortality and the role of immunosuppression in COVID-19 LT recipients.

MATERIALS AND METHODS

A systematic review of SARS-CoV-2 infection in LT recipients was performed. The primary outcomes were risk factors for mortality, the role of immunosuppression and vaccination. A meta-analysis was not performed as there was a different metric of the same outcome (mortality) and a lack of a control group in most studies.

RESULTS

Overall, 1,343 LT recipients of 1,810 SOT were included, and data on mortality were available for 1,110 liver transplant recipients with SARS-CoV-2 infection. Mortality ranged between 0-37%. Risk factors of mortality were age >60 years, Mofetil (MMF) use, extra-hepatic solid tumour, Charlson Comorbidity Index, male sex, dyspnoea at diagnosis, higher baseline serum creatinine, congestive heart failure, chronic lung disease, chronic kidney disease, diabetes, BMI >30. Only 51% of 233 LT patients presented a positive response after vaccination, and older age (>65y) and MMF use were associated with lower antibodies. Tacrolimus (TAC) was identified as a protective factor for mortality.

CONCLUSIONS

Liver transplant patients present additional risk factors of mortality related to immunosuppression. Immunosuppression role in the progression to severe infection and mortality may correlate with different drugs. Moreover, fully vaccinated patients have a lower risk of developing severe COVID-19. The present research suggests safely using TAC and reducing MMF use during the COVID-19 pandemic.

Evaluation of colistin consumption in swine and poultry of Marche region during the 2017-2019 period

In Italy, the National Plan against Antimicrobial Resistance (PNCAR 2017-2020) involves both human and veterinary sectors. The last one was requested to reduce colistin consumption, a first choice antibiotic for human health. Indeed, the Plan defines specific limits to reach within 2020. In Marche region, there is a project from 2017, consisting in monitoring antibiotic consumption in livestock, with particular reference to Critically Important Antimicrobials (CIAs), like colistin. The project represents an AMR stewardship, which involves regional Veterinary Services, veterinary professionals and the IZS Umbria e Marche, developing a specific training and education path ad hoc.

In this work, we have considered data coming from swine and poultry prescriptions of Marche region in the 2017-2019 period, using these for the calculation of ADDD (Animal Defined Daily Doses), a method already used in human. In practice, we have first established DDDvet values, as suggested by ESVAC, obtained from the Italian drugs containing colistin made for the considered species.

Colistin prescription in swine reduced of 97% (from 20.60 in 2017 to 0.69 DDD/1000 animals-die in 2019). In poultry, a reduction of 69% was obtained (from 5.07 in 2017 to 1.56 DDD/1000 animals-die in 2019). Then, there was an evidence of reduction more than 70% in colistin consumption, demonstrating the importance of the education and awareness program sponsored by Competent Authorities and the other stakeholders involved. The used method of calculation (ESVAC) is different from the currently applied one, as it consists of standardized unity of measures, using prescription data rather than sales ones.

Monitoring antibiotic consumption both in human and veterinary sector is essential to understand AMR, as well is important the possibility to compare the data to each other. The present work demonstrate that, also in veterinary, is possible to apply the DDD-method to evaluate antibiotic consumption, like colistin.

Key messages

Colistin consumption has reduced in swine and poultry sectors in the 2017-2019 period. A standardized method of calculation of antibiotic consumption in animals is strongly needed.

Sleep Loss Can Cause Death through Accumulation of Reactive Oxygen Species in the Gut

The view that sleep is essential for survival is supported by the ubiquity of this behavior, the apparent existence of sleep-like states in the earliest animals, and the fact that severe sleep loss can be lethal. The cause of this lethality is unknown. Here we show, using flies and mice, that sleep deprivation leads to accumulation of reactive oxygen species (ROS) and consequent oxidative stress, specifically in the gut. ROS are not just correlates of sleep deprivation but drivers of death: their neutralization prevents oxidative stress and allows flies to have a normal lifespan with little to no sleep. The rescue can be achieved with oral antioxidant compounds or with gut-targeted transgenic expression of antioxidant enzymes. We conclude that death upon severe sleep restriction can be caused by oxidative stress, that the gut is central in this process, and that survival without sleep is possible when ROS accumulation is prevented. VIDEO ABSTRACT.

Residential facilities project in Cuba: An original working model

Psychiatry must have among its main aims to reintegrate in their own environment of life people with psychotic disorders, personality disorders and other serious disorder of the psychic sphere. We must be able to operate in places built ad hoc, that is, where time, space and procedures are marked with certainty and, as much as possible, managed firsthand. The environment must be constructed or modified in such a way as to make it unlikely the failure or discomfort. Patients also need to be strengthened in their ability to integrate in their environment and in the ability to cope with various life events. The goal is to transfer a first group of patients from large psychiatric hospital of La Habana to the territory, specifically in 2–3 already identified communities, to realize the rehabilitation projects that in 3–4 years can bring patients selected at their home or, alternatively, at self-managed apartments. The reference model of rehabilitative interventions is multimodal. The model explains the onset, course, prognosis and social functioning of the major mental disorders as a complex and mutually conditioning relation between biological, environmental and behavioural. The results will be evaluated over the next three years and will be the subject of future publications. A good practice cannot disengage from safe theoretical and methodological references. To show clearly and verifiably their work, operators must be trained before and during all phases of work, a job training, continuing education, which has as its primary objective the descriptive clarity and verifiability of results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Drosophila Clock Is Required in Brain Pacemaker Neurons to Prevent Premature Locomotor Aging Independently of Its Circadian Function

Circadian clocks control many self-sustained rhythms in physiology and behavior with approximately 24-hour periodicity. In many organisms, oxidative stress and aging negatively impact the circadian system and sleep. Conversely, loss of the clock decreases resistance to oxidative stress, and may reduce lifespan and speed up brain aging and neurodegeneration. Here we examined the effects of clock disruptions on locomotor aging and longevity in Drosophila. We found that lifespan was similarly reduced in three arrhythmic mutants (ClkAR, cyc0 and tim0) and in wild-type flies under constant light, which stops the clock. In contrast, ClkAR mutants showed significantly faster age-related locomotor deficits (as monitored by startle-induced climbing) than cyc0 and tim0, or than control flies under constant light. Reactive oxygen species accumulated more with age in ClkAR mutant brains, but this did not appear to contribute to the accelerated locomotor decline of the mutant. Clk, but not Cyc, inactivation by RNA interference in the pigment-dispersing factor (PDF)-expressing central pacemaker neurons led to similar loss of climbing performance as ClkAR. Conversely, restoring Clk function in these cells was sufficient to rescue the ClkAR locomotor phenotype, independently of behavioral rhythmicity. Accelerated locomotor decline of the ClkAR mutant required expression of the PDF receptor and correlated to an apparent loss of dopaminergic neurons in the posterior protocerebral lateral 1 (PPL1) clusters. This neuronal loss was rescued when the ClkAR mutation was placed in an apoptosis-deficient background. Impairing dopamine synthesis in a single pair of PPL1 neurons that innervate the mushroom bodies accelerated locomotor decline in otherwise wild-type flies. Our results therefore reveal a novel circadian-independent requirement for Clk in brain circadian neurons to maintain a subset of dopaminergic cells and avoid premature locomotor aging in Drosophila.

Fragile lifespan expansion by dietary mitohormesis in C. elegans

Mitochondrial function is central to longevity and an imbalance in mitonuclear protein homeostasis activates a protective response called the mitochondrial unfolded protein response (UPR^mt). Toxic compounds damaging mitochondria trigger the UPR^mt, but at sublethal doses these insults extend lifespan in simple animals like C. elegans. Mitochondria are the main energy suppliers in eukaryotes, but it is not known if diet influences the UPR^mt. High dietary glucose reduces lifespan in worms, and we show that high dietary glucose activates the UPR^mt to protect against lifespan reduction. While lifelong exposure to glucose reduces lifespan, glucose exposure restricted to developing animals extends lifespan and requires the UPR^mt. However, this lifespan extension is abolished by further mitochondrial stress in adult animals. We demonstrate that dietary conditions regulate mitochondrial homeostasis, where induction of the UPR^mt during development extends lifespan, but prolonged activation into adulthood reduces lifespan.

Neuropsychological rehabilitation training in residential mental health services

The neuropsychological rehabilitation in our mental health service is a central pillar of psychosocial rehabilitation. These interventions are integrated into a more complex program of psychosocial rehabilitation based on cognitive behavioral method.

We devote particular attention to the empowerment of the cognitive functions: attention, memory, language, logical and abstract reasoning.

The aim of this research is to evaluate efficacy of neuropsycological rehabilitation training in cognitive rehabilitation of psychotic patients.

The subjects that took part to the training were psychotics patient, residents in a mental health Community. Patients were both females and males, aged between 18 and 55 years. They were divided in two experimental groups and a control group. The instrument used was a battery of neuropsycological standardized tests. Tests were managed by an eye-tracker specialist.

Preliminary results seem to confirm a certain degree of improvement due to the training. Eye tracking integration during assessment appears to be a powerful tool as well, in order to define more patient-tailored strategies.

The training based on the empowerment of cognitive functions (attention, memory, language, logical and abstract reasoning) seems to change significantly the cognitive functions of the psychotic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Emotional management training in residential mental health services

A core element for the treatment of psychiatric patients in mental health services is the Psychosocial Rehabilitation. In this work we mainly refer to a training whose targets are fundamental components of the Emotional Intelligence (EI), which is, according to the original Salovey and Mayer's definition (1990), “a set of skills hypothesized to contribute to the accurate appraisal and expression of emotion in oneself and in others, the effective regulation of emotion in self and others, and the use of feelings to motivate, plan, and achieve in one's life”.

The purpose of this study is to evaluate the efficacy of Emotional Management Training and to compare our emotional management assessment to standardized emotional intelligence assessment instruments.

Twenty adult inpatients (from 18 to 55 years of age) were enrolled: ten subjects were assigned to a one year lasting emotional management training (clinical target group) and ten subjects were assigned to a clinical control group; furthermore twenty subjects were selected and assigned to a non-clinical control group. Outcome measures were: emotional management assessment, Schutte Emotional Intelligence Scale (SEIS) and Toronto Alexithymia Scale (TAS-20).

Emotional management assessment outcomes confirm the efficacy of emotional management training. Preliminary results also confirm the effectiveness of the assessment compared to standardized emotional intelligence scales.

Emotional management training improves psychiatric patient competence in terms of: emotions definition and acknowledgement, self-emotion identification, self-emotion sharing, management of stressing situation and intense emotions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Highly contaminated areas as sources of pollution for adjoining ecosystems: The case of Augusta Bay (Central Mediterranean)

An assessment of trace element and polycyclic aromatic hydrocarbon (PAH) contamination based on surface sediments collected in summer 2012 was carried out in Priolo Bay adjoining one of the most polluted areas of the Mediterranean Sea, the industrial Augusta harbour (Italy, Central Mediterranean). Inorganic and organic contaminants were generally not remarkable. Occasional elevated concentrations of Hg, Cd, Ni and PAHs exceeding sediment quality guidelines were detected in the northern sector of Priolo Bay, close to Augusta harbour, possibly as a result of water drainage of industrialised and urbanised areas and/or potential direct export of contaminated material from Augusta harbour, whose influence on the adjoining Priolo Bay ecosystem cannot be ruled out. By domino effect, Priolo sediments may therefore become a potential source of pollutants and may represent a threat to the biota.

Perioperative coagulopathy monitoring

Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), "Point-of-care" coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.

Optimal tolerability and high efficacy of a modified schedule of lapatinib-capecitabine in advanced breast cancer patients

PURPOSE

Diarrhea in relation to the lapatinib-capecitabine regimen is a common and debilitating side effect which may interfere with optimal treatment delivery. We performed a post hoc analysis in human epidermal growth factor receptor 2-positive advanced breast cancer patients treated with a modified schedule in its administration, aimed primarily to evaluate grade (G) ≥ 2 diarrhea incidence and, secondarily, treatment efficacy.

PATIENTS AND METHODS

Treatment schedule consisted of lapatinib 1,250 mg daily for the first 10 days, then in combination with capecitabine, 2,000 mg/m(2), starting day 11 for the first cycle, and thereafter from day 8, for 14 days of a 21-day cycle, in 3 daily administrations. Lapatinib was dissolved in water, and cholestyramine was continuously given twice a day.

RESULTS

Among 38 patients treated and analyzed, the incidence of G ≥ 2 diarrhea was 13.2 %. In 28 patients diarrhea was not observed, while G1-2 diarrhea was reported in 9 (23.7 %) patients; a single episode of G3 diarrhea was observed in 1 (2.6 %) patient. Overall response rate was 34.2 %, clinical benefit 55.3 %, and median progression-free survival 10 months.

CONCLUSION

The results of the present post hoc analysis are very encouraging, both in terms of tolerability and treatment efficacy, and all data compare favorably with previous reports of "conventional" administration of the lapatinib-capecitabine regimen.

Pharmacology of levosimendan: inotropic, vasodilatory and cardioprotective effects

WHAT IS KNOWN AND OBJECTIVE

Positive inotropic agents are frequently used in acute decompensated heart failure (ADHF) due to left ventricular systolic dysfunction. These agents are known to improve cardiac performance and peripheral perfusion in the short-term treatment. However, several preclinical and clinical studies emphasized detrimental effects of these drugs on myocardial oxygen demand and on sympathetic tone entailing arrhythmogenesis. Levosimendan is an inotropic agent with an original mechanism of action. This review focuses on major data available for levosimendan.

METHODS

A literature search was conducted in the PubMed database by including studies published in English using combinations of the following key words, levosimendan, inotropic drugs and acute heart failure. Furthermore, bibliographies of selected references were also evaluated for relevant articles. The collection for this review was limited to the most recently available human and animal data.

RESULTS AND DISCUSSION

Levosimendan's vasodilatory and cardioprotective effects are mediated by calcium sensitization of contractile proteins and opening of adenosine triphosphate (ATP)-dependent K+ channels in vascular smooth muscle cells and on mitochondrial ATP-sensitive potassium [mito.K(ATP)] channels. This inotropic agent has mild PDE inhibitory action. Unlike other inotropic agents, levosimendan improves cardiac performance without activating the sympathetic nervous system. Moreover, there are evidences that levosimendan has additional anti-inflammatory and anti-apoptotic properties that prevent cardiac toxicity and contributes to positive hemodynamic response of the drug. Four randomized trials evaluated the effects of levosimendan on mortality in patients with acute decompensated chronic heart failure; nevertheless, a clear benefit has not been demonstrated so far. Although levosimendan is indicated for the treatment of ADHF (class of recommendation IIa, level of evidence B), it is has not been approved in all countries.

WHAT IS NEW AND CONCLUSION

This review summarizes the characteristics and the current knowledge of the literature on levosimendan and its active metabolite OR-1896.

Pharmacological reduction of ER stress protects against TDP-43 neuronal toxicity in vivo

C. elegans and D. rerio expressing mutant TAR DNA Binding Protein 43 (TDP-43) are powerful in vivo animal models for the genetics and pharmacology of amyotrophic lateral sclerosis (ALS). Using these small-animal models of ALS, we previously identified methylene blue (MB) as a potent suppressor of TDP-43 toxicity. Consequently here we investigated how MB might exert its neuroprotective properties and found that it acts through reduction of the endoplasmic reticulum (ER) stress response. We tested other compounds known to be active in the ER unfolded protein response in worms and zebrafish expressing mutant human TDP-43 (mTDP-43). We identified three compounds: salubrinal, guanabenz and a new structurally related compound phenazine, which also reduced paralysis, neurodegeneration and oxidative stress in our mTDP-43 models. Using C. elegans genetics, we showed that all four compounds act as potent suppressors of mTDP-43 toxicity through reduction of the ER stress response. Interestingly, these compounds operate through different branches of the ER unfolded protein pathway to achieve a common neuroprotective action. Our results indicate that protein-folding homeostasis in the ER is an important target for therapeutic development in ALS and other TDP-43-related neurodegenerative diseases.