The long-term effect on surgery-free survival of biological compared to conventional therapy in Crohn's disease in real world-data: a retrospective study

BACKGROUND

The introduction of biological drugs has led to great expectations and growing optimism in the possibility that this new therapeutic strategy could favourably change the natural history of Inflammatory Bowel Disease (IBD) and, in particular, that it could lead to a significant reduction in surgery in the short and long term. This study aims to assess the impact of biological versus conventional therapy on surgery-free survival time (from the diagnosis to the first bowel resection) and on the overall risk of surgery in patients with Crohn's disease (CD) who were never with the surgical option.

METHODS

This is a retrospective, double-arm study including CD patients treated with either biological or conventional therapy (mesalamine, immunomodulators, antibiotics, or steroids). All CD patients admitted at the GI Unit of the S. Salvatore Hospital (L'Aquila. Italy) and treated with biological therapy since 1998 were included in the biological arm. Data concerning the CD patients receiving a conventional therapy were retrospectively collected from our database. These patients were divided into a pre-1998 and post-1998 group. Our primary outcome was the evaluation of the surgery-free survival since CD diagnosis to the first bowel resection. Surgery-free time and event incidence rates were calculated and compared among all groups, both in the original population and in the propensity-matched population.

RESULTS

Two hundred three CD patients (49 biological, 93 conventional post-1998, 61 conventional pre-1998) were included in the study. Kaplan-Meier survivorship estimate shows that patients in the biological arm had a longer surgery-free survival compared to those in the conventional arm (p = 0.03). However, after propensity matching analysis, conducted on 143 patients, no significant difference was found in surgery-free survival (p = 0.3). A sub-group analysis showed shorter surgery-free survival in patients on conventional therapy in the pre-biologic era only (p = 0.02; Hazard Ratio 2.9; CI 1.01-8.54) while no significant difference was found between the biologic and conventional post-biologic groups (p = 0.15; Hazard Ratio 2.1; CI 0.69-6.44).

CONCLUSION

This study shows that the introduction of biological therapy has only a slight impact on the eventual occurrence of surgery in CD patients over a long observation period. Nevertheless, biological therapy appears to delay the first intestinal resection.

The interplay between immune system and microbiota in gynecological diseases: a narrative review

OBJECTIVE

The vaginal microbiome is a dynamic environment, depending on the results of a complex interplay between microbiota and the host. In physiological conditions, Lactobacillus species are the most represented, regulating glycogen metabolism in order to maintain normal pH. Vaginal flora has been divided into five subtypes. Pattern recognition receptors are present on both squamous epithelial cells lining the vagina and columnar cells lining the upper female genital tract. They respond directly to bacterial product expressed by vaginal microbiome. The vagina contains different immune related cells and receptors which can recognize and react with the microbial environment. Altered microbiota and altered interplay between microbiota and immune system underlie several gynecologic diseases.

MATERIALS AND METHODS

In this review, literature data related to vaginal microbiota, vaginal inflammation, immune system and menopause, preterm labor and miscarriage, were summarized. Relevant publications were retrieved from: PubMed, Medline, Scopus and Web of Science.

RESULTS

The vaginal microbiome and the relationship with immune system has been analyzed in different gynecologic conditions. Menopause is associated to estrogen loss which causes vaginal atrophy, reduced abundance of Lactobacilli and increased amount of other bacterial species. Estrogens influence vaginal immunity through known and unknown mechanisms. In bacterial vaginosis (BV), due to many bacterial species, there has been found an inhibition of the chemotaxis and cytokine secretion. A decreased concentration of Lactobacilli seems to be playing a role in preterm labor as well as the increased levels of pro-inflammatory cytokines. Finally, the disequilibrium in the Th1/Th2 immune adaptive response, with a shift from Th2 to Th1, appears to be playing a role in miscarriage.

CONCLUSIONS

The interplay between microbiota and the host closely involves the immune system. In particular, the vaginal microbiota is classically characterized by Lactobacilli even if vaginal microbiome of asymptomatic woman of reproductive age includes multiple aerobic and facultative or obligate anaerobic species. The role of microbiota and immune system in determining gynecological and obstetric events has been studied throughout recent years reaching new advancements. Therefore, additional studies are needed to better comprehend the complexity of the issue.

General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic

OBJECTIVE

Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs.

PATIENTS AND METHODS

This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10.

RESULTS

286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group.

CONCLUSIONS

Rifaximin can be effectively used by GPs in real-life for the management of SUDD.

Occupational exposure for asbestos-related disease groups: geomapping of the last 5 years in Italy

Background

Asbestos-related diseases are a public health challenge in Italy: the country has been a major producer and user of asbestos since World War II until complete ban in 1992. Several contaminated sites and structures across the country have never been decontaminated: incidence peak of asbestos-related diseases is expected somewhen between 2015 and 2020. Study objective is to investigate incidence of asbestos-related diseases in Italy in the last 5 years, from both a chronological and geographical perspective.

Methods

Ascertained diagnoses of asbestos-related diseases among workers were collected from the INAIL public registry from 2014 to 2018. Yearly incidence rate was estimated per province (incident cases per million workers) and mapped by year. Global incidence quota by working sector and sub-sector was also calculated.

Results

8.620 cases have been reported. Incidence rate rapidly increased from 2014, peaking at 7,2 new cases per 100.000 workers in 2015. Afterwards, the number of ascertained cases decreased. There is a clear gradient distribution between northern and southern Italian provinces, with the highest rates in Northern Italy (especially in year 2014) and declining over time. Mesothelioma (all variants) was the most common disease, (2.995 cases, 35% of total), followed by pleural plaques (2.955 cases, 34%), pneumoconiosis (1.327 cases, 15%) and cancer of lungs/respiratory tract (1.298 cases, 14%). Most affected category was that of metal workers, but construction, transportation and electricity workers were also affected.

Conclusions

Detailed surveillance with mapping support is an effective tool for public health servants to locally manage prevention programs targeted on occupational risk. This is especially true for areas with active industries in the most affected sectors.

Key messages

Asbestos does not mean mesothelioma, but also other diseases that impact on workforce health status. Pneumoconiosis and other oral and respiratory cancers are also associated with asbestos exposure. Risk management should be tailored for a wider array of worker types than usually considered, since such exposure happens in sectors that are not traditionally related to asbestos exposure.

Wild rats as urban detectives for latent sources of asbestos contamination

Based on a large body of evidence asbestos minerals have been classified as carcinogens. Despite the Italian ban on asbestos in 1992 and the subsequent remediation activities, latent sources of contamination may still represent a hazard where asbestos were particularly used. Using wild rats as sentinel animals, this study aimed at uncovering sites with the greatest potential for non-occupational exposure to asbestos in the city of Casale Monferrato (Piedmont Region, Italy), where the largest Italian manufacturing plant of asbestos-cement had been active. During the study period (2013-2015) a total of 40 wild rats were captured from 16 sampling capture points. The lungs of wild rats have been investigated by using scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS). The SEM-EDS detected the presence of asbestos fibers (tremolite/actinolite, amosite, and chrysotile) in rats' lungs from 11 sampling points. The hypothetical rats' home-range and the observed site-specific concentration of asbestos fibers per gram of dry lung tissue were used to identify areas to be targeted by additional search of latent sources of asbestos. In conclusion, our results showed that the use of wild rats as sentinel animals may effectively integrate the strategies currently in use to reduce the exposure to asbestos.

A cross-sectional study to identify a set of risk factors for caprine herpesvirus 1 infection

BACKGROUND

Caprine herpesvirus 1 (CpHV-1) causes neonatal mortality and reproductive failure in goats. Despite its impact on herd reproductive performance, few studies have investigated the risk factors associated with CpHV-1 infection. The aim of this cross-sectional study was to identify potential herd- and host-level risk factors associated with CpHV-1 prevalence in a goat population with heterogeneous seropositivity for CpHV-1.

RESULTS

Blood samples and individual data from 4542 goats were collected from 255 herds in Piedmont, Italy. Enzyme-linked immunosorbent assay (ELISA) and serum neutralization tests were carried out to detect antibodies against CpHV-1. A mixed-effects model was applied to identify any statistical association between CpHV-1 seropositivity and a set of putative host-level and herd-level risk factors. A total of 630 samples tested were found positive by ELISA (prevalence = 13.9%; 95% confidence interval (CI) 12.9-14.9). Of the 255 tested herds, 85 were classified as positive for the presence of at least one gB-positive animal (herd prevalence 33.3%, 95% CI 27.5-39.2), with a within-herd prevalence between 0.7 and 100% (Q1 = 17.6%; median = 32.3%; Q3 = 50%) (Q = quartiles). The prevalence ratios showed a statistical association with the following risk factors: breeds other than Saanen, older age, larger herd size, meat and extensive herds, and co-existence of CAEV-infected animals.

CONCLUSIONS

Results from this cross sectional study may help to elucidate the natural history of the infection and inform targeted strategies to control a disease with a potentially important impact on animal health and goat farming economy.

Arthroscopic treatment of osteochondritis dissecans of the shoulder in 126 dogs

Osteochondritis dissecans of the shoulder joint was treated by arthroscopy in 126 dogs. Twenty-four dogs had bilateral surgery, making a total of 150 joints treated. The OCD flaps were removed in small pieces through the cannula or in a single piece through a stab incision. The lameness resolved completely within seven-60 days following arthroscopy in 137 out of 150 affected limbs. Within a subset of 47 dogs with unilateral OCD, it was found that lesions located on the caudo-medial region of the humeral head had a better functional outcome than those lesions located in the caudo-central region of the humeral head.

Prevalence of antibodies against Bubaline herpesvirus (BuHV-1) among Mediterranean water buffalo (Bubalus bubalis) with implications in buffalo trade

BACKGROUND

Both Bovine herpesvirus (BoHV-1) and Bubaline herpesvirus (BuHV-1) have been reported to cross the species barrier. Antibody seroconversion in glycoprotein E (gE) blocking ELISA during BuHV-1 infection has been documented. Recent diagnostic efforts have focused on the development and application of discriminatory tests to distinguish between infections with BoHV-1 and BuHV-1.

OBJECTIVE

To evaluate the impact and distribution of these two infections in water buffalo farms in two regions (Piedmont (n = 3) and Campania (n = 10), Italy) where infectious bovine rhinotracheitis control programs have been implemented.

ANIMALS AND METHODS

Sampling was carried out on 13 buffalo farms comprising 1089 animals using specific gE-indirect ELISA's test able to discriminate among BoHV-1 and BuHV-1 infections.

RESULTS

59.0% of animals reacted positive to ELISA (irrespective of whether BoHV-1 or BuHV-1 antigen was used) and 86.4% of these were reactive to BuHV-1 only, whereas 11.8% showed absorbance values for both antigens and were classified as inconclusive. There was a statistically significant age-related difference in BuHV-1 infection rates but not in overall individual (47% vs. 58%) or herd prevalence (100% vs. 90%) of infection between the two regions.

CONCLUSION

The low percentage of sera reactive to BoHV-1 (1.8%, 12/643) indicates that BuHV-1 may be the main circulating alphaherpesvirus infection in Mediterranean water buffalo in the two study areas. Since Bubalus bubalis is included in Directive 64/432/EEC on animal health problems affecting intra-community trade in bovine animals, diagnostic testing with nonspecific ELISA for BoHV-1 infection in buffalo may yield false-positive reactions. This scenario could lead to economic losses and hamper buffalo trade and movement, particularly for reproduction purposes.

Expression and antigenic characterization of bubaline herpesvirus 1 (BuHV1) glycoprotein E and its potential application in the epidemiology and control of alphaherpesvirus infections in Mediterranean water buffalo

Bubaline herpesvirus 1 (BuHV1) is a member of ruminant alphaherpesviruses antigenically related to bovine herpesvirus 1 (BoHV1). The impact of BuHV1 infection in infectious bovine rhinotracheitis control program is difficult to establish, due to the lack of specific diagnostic test. The ectodomain of glycoprotein E of BuHV1 was expressed as recombinant secreted protein and used in indirect ELISA as well as in a discriminatory test using the BoHV1 counterpart. A panel of monoclonal antibodies was produced against BuHV1; 6 out of 7 anti-gE monoclonal antibodies specifically recognized the BuHV1 gE. Results indicated BuHV1 gE as a sensitive marker of infection compared to seroneutralization (SN) test or blocking ELISA. When BoHV1 and BuHV1 gEs were immobilized in different wells of the same ELISA microplate, bovine and water buffalo sera were more reactive against the respective infecting virus. About one third of seropositive buffaloes with no history of contact with cattle and having higher SN titres, reacted in BoHV1 gE blocking ELISA, possibly because of steric hindrance. Since in two occasions BuHV1 was also isolated from water buffalo scoring gB+/gE+ BoHV1 blocking ELISA, we conclude that the combination of the two blocking ELISAs is not suitable to differentiate between BoHV1 and BuHV1.

Reproducibility study for the detection of Staphylococcal enterotoxins in dairy products between official Italian national laboratories

Staphylococcal food poisoning is a common foodborne disease caused by the ingestion of staphylococcal enterotoxins (SEs) produced mainly by enterotoxigenic strains of Staphylococcus aureus. To date, 21 SEs and/or enterotoxin-like types have been identified, several of which represent a potential hazard for consumers. To protect consumer health and to reduce the amount of SE-contaminated food entering the market, European Union legislation regulating food safety requires testing for SEs. The Italian National Reference Laboratory organized a ring trial to test technical and analytical proficiency in the national network of official food laboratories. Twenty-four laboratories took part, and each received and analyzed 24 blind dairy samples. Reproducibility of the results from the laboratories was assessed by the Cohen k index, and accuracy (sensitivity and specificity) was evaluated according to the International Organization for Standardization definition (ISO 16140:2003). Trial results revealed partially satisfactory agreement: 254 of 276 possible paired participants (92%) reached a k value >0.60, which is conventionally recognized as satisfactory. Accuracy was deemed satisfactory; 100% sensitivity and 100% specificity were achieved by 22 and 18 of the 24 laboratories, respectively.

Histology as a valid and reliable tool to differentiate fresh from frozen-thawed fish

Selling fish products as fresh when they have actually been frozen and thawed is a common fraudulent practice in seafood retailing. Unlike fish products frozen to protect them against degenerative changes during transportation and to extend the product's storage life, fish intended for raw consumption in European countries must be previously frozen at -20° C for at least 24 h to kill parasites. The aim of this study was to use histological analysis to distinguish between fresh and frozen-thawed fish and to evaluate this method for use as a routine screening technique in compliance with the requirements of European Commission Regulation No. 882/2004 on official food and feed controls. Method performance (i.e., accuracy and precision) was evaluated on tissue samples from three common Mediterranean fish species; the evaluation was subsequently extended to include samples from 35 fish species in a second experiment to test for method robustness. Method accuracy was tested by comparing histological results against a "gold standard" obtained from the analysis of frozen and unfrozen fish samples prepared for the study. Method precision was evaluated according to interrater agreement (i.e., three laboratories with expertise in histopathology in the first experiment and three expert analysts in the second experiment) by estimating Cohen's kappa (and corresponding 95 % confidence intervals) for each pair of laboratories and experts and the combined Cohen's kappa for all three experts and laboratories. The observed interrater agreement among the three laboratories and the three experts indicated high levels of method accuracy and precision (high sensitivity and specificity) and method reproducibility. Our results suggest that histology is a rapid, simple, and highly accurate method for distinguishing between fresh and frozen-thawed fish, regardless of the fish species analyzed.

Heat-related mortality in dairy cattle: A case crossover study

The relationship between mortality and stressful weather is not only a complex health, social and environmental issue, but also becomes an economical problem when considering livestock. Future-climate scenarios suggest that higher global mean temperatures could result in marked changes in the frequency of extreme temperatures. The relationship between high temperature and mortality is well known in people living in urban areas, but it has been poorly investigated in livestock such as dairy cows. The aim of this study was to quantify the relationship between heat and mortality from all causes among dairy cows in Italy. We studied 6697 adult (≥24 months) dairy cows that died during the summer in the 5-year period 2002-2006 in three Italian districts (Brescia, Cuneo, Rome) which were selected because of the high livestock production and the availability of weather data for these geographical areas. A case-crossover design was applied using the temperature-humidity index (THI) as exposure of interest. Pooled odds ratio (OR) of mortality at high exposure values versus low exposure values was estimated. An exposure over the THI cut-off increased the risk of mortality by 1.6 times, with a 4% increase in mortality for each THI degree increase above the threshold. We found no effect modification for age-class, herd size or breed, but a certain degree of geographical heterogeneity was identified. The increased dairy cow mortality highlighted in this study should be considered when adopting animal welfare and farm management measures. This phenomenon can be prevented by adopting appropriate interventions to mitigate environmental thermal challenges.

Interlaboratory trial on TSE rapid tests for the control of the Italian scrapie surveillance network

Scrapie, a neurodegenerative disease of sheep and goats and one of several transmissible spongiform encephalopathies (TSEs) has been subject to mandatory active surveillance in EU through rapid testing since 2002. Regulation EC/999/2001 on TSE surveillance requires that each Member State's National Reference Laboratory for TSE periodically verifies diagnostic standards and methods by comparative testing. In 2007 the Italian Reference Centre carried out the first ring trial for classical scrapie on a set of 21 negative and 9 positive homogenated brainstems, the latter consisting of three replicates of an ARQ/ARQ scrapie positive sample diluted 1:10, 1:20 and 1:50. The purpose of the study was to verify the interlaboratory agreement in term of Cohen's kappa (k) of the rapid systems currently used by the 25 national rapid test laboratories (RTLs) [laboratories: Biorad TeSeE (17 laboratories), Enfer TSE version 2.0 (4 laboratories), Idexx Herd chek BSE-scrapie antigen kit (3 laboratories) and Prionics check LIA SR (1 laboratory)]. Our results show that the agreement among the laboratories using the same rapid test varied between 0.84 and 1, while the estimated overall agreement among the 25 laboratories was very good (k-combined=0.87, 95% confidence interval 0.85-0.89). Nevertheless, as regards differences in analytical sensitivity among the rapid tests in use, under-recognition of pre-clinical scrapie cases by lower performing systems must be expected.

Arthroscopic treatment of osteochondritis dissecans of the shoulder in 126 dogs

Osteochondritis dissecans of the shoulder joint was treated by arthroscopy in 126 dogs. Twenty-four dogs had bilateral surgery, making a total of 150 joints treated. The OCD flaps were removed in small pieces through the cannula or in a single piece through a stab incision. The lameness resolved completely within seven-60 days following arthroscopy in 137 out of 150 affected limbs. Within a subset of 47 dogs with unilateral OCD, it was found that lesions located on the caudo-medial region of the humeral head had a better functional outcome than those lesions located in the caudo-central region of the humeral head.