Foreign body ingestion in children: Definition of a nomogram to predict surgical or endoscopic intervention

BACKGROUND AND AIMS

Foreign body ingestion (FBI) in children requires early identification to prevent adverse outcomes and may necessitate endoscopic or surgical intervention. This study aims to develop a nomogram that identifies children who require urgent surgical or endoscopic intervention by using the patient's medical history and clinical parameters collected at admission.

METHODS

This study is a retrospective review (01/2015-12/2020) of a multicenter case series of children admitted for FBI. Data from 5864 records from 24 hospitals in Italy were analyzed. Logistic regression models were used to establish the probability of requiring surgical or endoscopic intervention based on patient history and clinical characteristics. The nomogram representing the results from the multivariable model was reported to examine the propensity for surgery/endoscopy.

RESULTS

The study identified a significant association between intervention and various factors, including type of foreign body (blunt: reference category, disk battery (odds ratio OR:4.89), food bolus (OR:1.88), magnets (OR:2.61), sharp-pointed (OR:1.65), unknown (OR:1.02)), pre-existing diseases or conditions (OR 3.42), drooling (OR 10.91), dysphagia (OR 5.58), vomiting (OR 3.30), retrosternal pain (OR 5.59), abdominal pain (OR 1.58), hematemesis (OR 2.82), food refusal/poor feeding (OR 2.99), and unexplained crying (OR 2.01). The multivariable regression model showed good calibration and discrimination ability, with an area under the ROC curve of 0.77.

CONCLUSIONS

This study developed the first nomogram to predict the probability of the need for surgical or endoscopic intervention in children with FBI, based on the information collected at admission. The nomogram will aid clinicians in identifying children who require early intervention to prevent adverse outcomes.

Cellular and Clinical Pharmacokinetic/Pharmacodynamic Basis for Lack of Efficacy of 21-Day Continuous Topotecan in Patients with Untreated Advanced Adenocarcinoma of the Pancreas

Background

In a phase II study, topotecan was evaluated for response and toxicity in patients with advanced pancreatic carcinoma at the schedule of 0.7 mg/m2/day q 21 days q 28 days.

Methods

Responses were assessed after at least 2 courses using WHO criteria, and toxicity was evaluated after each course according to the CTC-NCI standards. Between December 1995 and September 1997, 15 assessable patients (median age, 55 years; range, 36-74; median ECOG performance, 1; range, 0-3) were included in the study. All had biopsy-proven and measurable disease, a life-expectancy of at least 3 months, and normal bone marrow, liver, and renal function. None of the patients had undergone prior cytotoxic or radiation therapy, and 10 were initially treated by surgery. Twenty-five cycles were assessable for toxicity. Plasma was collected from 7 patients who had received a total of 10 cycles and was, after extraction with methanol at −20°C, analyzed for total topotecan by an HPLC method. The thus determined steady-state concentrations were assessed for their capacity to affect growth and DNA integrity in the BxPC-3 human pancreatic carcinoma cell line after 21 days of continuous exposure. For these purposes, we used a sulforhodamine B staining assay, and agarose gel electrophoresis, respectively.

Results

Grades 3-4 leukopenia, thrombocytopenia, granulocytopenia, and anemia occurred in 8, 6, 8 and 8 cycles, respectively. Other mild to moderate side effects (grades 1-2) included malaise, nausea and vomiting, anorexia, and alopecia. No objective tumor response was documented. HPLC analysis of patients' plasma showed the attainment of constant steady-state levels of 1.0 ± 0.1 ng/mL during the entire infusion period. At such a concentration, topotecan did not significantly affect growth or DNA integrity in the BxPC-3 cells. Fifty percent cell growth inhibition and appreciable oligonucleosomal DNA fragmentation were only evident with 21 days topotecan ≥ 50 ng/mL.

Conclusions

Our data suggest that the lack of clinical activity of 0.7 mg/m2 daily topotecan for 21 days q 28 days in patients with advanced pancreatic carcinoma might be partially attributed to the achievement of non-tumoricidal plasma drug concentrations.

First Results from CUORE: A Search for Lepton Number Violation via 0νββ Decay of ^{130}Te

The CUORE experiment, a ton-scale cryogenic bolometer array, recently began operation at the Laboratori Nazionali del Gran Sasso in Italy. The array represents a significant advancement in this technology, and in this work we apply it for the first time to a high-sensitivity search for a lepton-number-violating process: ^{130}Te neutrinoless double-beta decay. Examining a total TeO_{2} exposure of 86.3 kg yr, characterized by an effective energy resolution of (7.7±0.5)  keV FWHM and a background in the region of interest of (0.014±0.002)  counts/(keV kg yr), we find no evidence for neutrinoless double-beta decay. Including systematic uncertainties, we place a lower limit on the decay half-life of T_{1/2}^{0ν}(^{130}Te)>1.3×10^{25}  yr (90% C.L.); the median statistical sensitivity of this search is 7.0×10^{24}  yr. Combining this result with those of two earlier experiments, Cuoricino and CUORE-0, we find T_{1/2}^{0ν}(^{130}Te)>1.5×10^{25}  yr (90% C.L.), which is the most stringent limit to date on this decay. Interpreting this result as a limit on the effective Majorana neutrino mass, we find m_{ββ}<(110-520)  meV, where the range reflects the nuclear matrix element estimates employed.

Abstract P6-09-40: Her2 and hormonal receptor analysis in breast cancer synchronic node metastases could add therapeutic information

Introduction: Breast cancer is the tumor with highest incidence and mortality in women in Argentina. Hormonal receptors (HR) and HER2 are the most important prognostic and predictive factors. It is suggested that estrogen receptors (ER), progesterone receptors (PR) and HER2 expression can vary during tumor progression and metastases development. Published evidence has reported discordance between primary tumors and its metastases ranging from 15-54% for HR and HER2 overexpression. A similar discordance situation may exist among primary tumor (PT) and its axillary nodal metastases (NM)

Objective: To describe the expression and discordance of ER, PR and HER2 in PT and its synchronic NM

Material and methods: Prospective analysis of surgical breast cancer patients (pts) at Instituto Alexander Fleming (Sept 2013 to Feb 2016). HR were analyzed by immunohistochemistry (IHC) according to CAP protocols; values ≥ 10% were considered positive. HER2 overexpression was defined by 3+ IHC or positive FISH. Paired t test was used to compare mean using Prims 5 software.

Results: In 587 breast cancer surgeries, 190 pts presented NM. HR and HER2 analysis was performed in 101 paired samples. Median age was 51 years (r 25-83). Mean tumor size was 3,3 ± 0,2 cm. 0,99% (1) were stage I, 68,3% (69) stage II and 30,7% (31) stage III. Most frequent histologic subtype was ductal carcinoma (66.3%). 78.2% presented lymphovascular invasion. Median positive nodes were 2 (r 1-21). Paired samples allowed ER analysis in 99 cases, PR in 98 and HER2 in 96; 8 NM were Her2++; FISH analysis was inconclusive in 4 of them due to insufficient tissue. No differences were observed on ER between PT and NM (72% vs 71.1%, OR: 0,91, IC95 -3.2-5.1; p&gt;0,05), nor PR expression (52.1% vs 54,5%, OR: -2.1, IC95 -7.1-3.01; p&gt;0,05). PT were ER+ in 86.1% of the cases; NM were ER+ in 82.2%. Regarding PR, PT were 74.3% PR+ and NM were 76.2% PR+. 28 of the 101 pts (27.7%) were discordant. 5 pts with ER+ PT had ER- NM, and 3 pts had PT ER- but ER+ NM, representing a 7.9% of discordance. 4 of 75 pts with PR+ in PT were PR- in NM, while 8 of 26 pts were PR- in PT but PR+ in NM. Of the 13 HER2+ pts, 2 (15%) did not present overexpression in NM. On the other hand, 6 (7%) of the 83 HER2- PT were HER2+ in NM. 4 of 9 pts had PT RH and Her2- (TN), but NM RH and/or Her2+.

Discussion: Tumor heterogeneity is an important issue that may affect clinical decisions. Axillary nodes are the first metastatic site for breast cancer and different studies have shown discrepancy between PT and NM. We described a discordant expression in ER, PR and HER2 of 8%, 12% and 9% respectively. These differences could be due to technical reasons, intratumor heterogeneity and/or a different cellular phenotype. Although the clinical importance of these changes are not completely understood, NM status could bring important prognostic and therapeutic information defining a particular group of patients in which a specific therapeutic strategy could influence long term results. In fact, in our series 44% of TN tumors presented NM with a therapeutic target, either HR or HER2. We therefore confirm that pathological analysis of NM may bring up additional information that could be useful in a prognostic or therapeutic point of view.

Citation Format: Rizzo MM, Mando P, Perez de la Puente C, Maino M, Ponce C, Fabiano V, Pombo MT, Loza CM, Costanzo MV, Nervo A, Nadal J, Colo F, Chacon RD. Her2 and hormonal receptor analysis in breast cancer synchronic node metastases could add therapeutic information [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-40.

First array of enriched Zn[Formula: see text]Se bolometers to search for double beta decay

The R&D activity performed during the last years proved the potential of ZnSe scintillating bolometers to the search for neutrino-less double beta decay, motivating the realization of the first large-mass experiment based on this technology: CUPID-0. The isotopic enrichment in [Formula: see text]Se, the Zn[Formula: see text]Se crystals growth, as well as the light detectors production have been accomplished, and the experiment is now in construction at Laboratori Nazionali del Gran Sasso (Italy). In this paper we present the results obtained testing the first three Zn[Formula: see text]Se crystals operated as scintillating bolometers, and we prove that their performance in terms of energy resolution, background rejection capability and intrinsic radio-purity complies with the requirements of CUPID-0.

A low noise and high precision linear power supply with thermal foldback protection

A low noise and high precision linear power supply was designed for use in rare event search experiments with macrobolometers. The circuit accepts at the input a "noisy" dual supply voltage up to ±15 V and gives at the output precise, low noise, and stable voltages that can be set between ±3.75 V and ±12.5 V in eight 1.25 V steps. Particular care in circuit design, component selection, and proper filtering results in a noise spectral density of 50nV/Hz at 1 Hz and 20nV/Hz white when the output is set to ±5 V. This corresponds to 125 nV RMS (0.8 μV peak to peak) between 0.1 Hz and 10 Hz, and 240 nV RMS (1.6 μV peak to peak) between 0.1 Hz and 100 Hz. The power supply rejection ratio (PSRR) of the circuit is 100 dB at low frequency, and larger than 40 dB up to high frequency, thanks to a proper compensation design. Calibration allows to reach a precision in the absolute value of the output voltage of ±70 ppm, or ±350 μV at ±5 V, and to reduce thermal drifts below ±1 ppm/(∘)C in the expected operating range. The maximum peak output current is about 6 A from each output. An original foldback protection scheme was developed that dynamically limits the maximum output current to keep the temperature of the output transistors within their safe operating range. An add-on card based on an ARM Cortex-M3 microcontroller is devoted to the monitoring and control of all circuit functionalities and provides remote communication via CAN bus.

Abstract P3-01-07: Second axillary sentinel lymph node biopsy for breast tumor recurrence: Instituto Alexander Fleming experience in Buenos Aires, Argentina

Sentinel Lymph Node Biopsy (SLNB) is the standard technique for axillary staging of patients with operable breast cancer and a clinically negative axilla because it avoids unwarranted axillary dissection and consequently reduces postoperative morbidity.

Purpose: The aim of this study is to determinate the feasibility and accuracy of the second SLNB for patients with ipsilateral breast cancer recurrences with clinically negative axilla, who were treated previously with breast surgery and study of the axilla.

Methods: Retrospective review of the database of the Instituto Alexander Fleming. Between October 2009 and October 2014, 1029 patients with diagnosis of breast cancer required surgery. The study included 26 patients with the diagnosis of operable local breast cancer recurrence, who had previously undergone axillary surgery either as SLNB, sampling or axillary lymph node dissection (ALND). They subsequently underwent additional breast surgery and a second SLNB.

Results: The mean age of the ipsilateral breast cancer recurrences was 59.23 years (range: 32-87) and the most common histologic subtype was invasive ductal carcinoma in 22 patients (84.6%) and 4 patients (15.4%) with invasive lobular carcinoma. 4 patients (15.4%) had previously ALND or sampling and 22 patients (84.6%) SLNB. The identification rate of the second SLNB was 92.31%. Only 2 patients were not identify, one patient with a previous axillary sampling and another one with previous SLNB. In those patients the ALND was performed and the axilla was negative. Lymphoscintigraphy failed to identify any SLN in 6 patients (23%), 2 patients which were not identify and 4 patients only detected with patent blue. The average number of nodes removed at second SLNB was 1.8 (range: 1-5). Second SLNBs were negative in 21 patients (80.8%), and macrometastasis disease was identified in 2 patients and complete ALND was performed.

In 1 patients additional extra-axillary aberrant drainages was observed in the contralateral axilla and interpectoral, and other 3 patients had aberrant drainage in the contralateral axilla (1 patient), internal mammary regions (1 patient), and interpectoral (1 patient). Aberrant drainage pathways were not routinely dissected. Only those accessible during surgery were removed.

The median time between first surgery and ipsilateral breast tumor recurrence was 7.19 years (range: 1-22). The disease free survival (DFS) was 9.16 years (range: 2.25-24).

Conclusion: In the present serie we show a high identification rate of 92.31% in the second SLNB, comparable with other international series published in the literature (range: 51-97%). A second SLNB should be considered for patients with ipsilateral breast tumor recurrence who underwent conservative surgery and have clinically negative axilla. The procedure is technically feasible and accurate for selected patients, and avoids unnecessary ALND. Extra-axillary sentinel lymph node localization rates are higher than for primary SLNB but the clinical significance and management of extra-axillary nodes needs to be clarified.

Citation Format: Maino M, Fabiano V, Ponce C, Loza M, Costanzo V, Nervo A, Nadal J, Mysler D, Amat M, Coló F, Loza J, Chacón R. Second axillary sentinel lymph node biopsy for breast tumor recurrence: Instituto Alexander Fleming experience in Buenos Aires, Argentina. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-07.

Algorithms for Identification of Nearly-Coincident Events in Calorimetric Sensors

For experiments with high arrival rates, reliable identification of nearly-coincident events can be crucial. For calorimetric measurements to directly measure the neutrino mass such as HOLMES, unidentified pulse pile-ups are expected to be a leading source of experimental error. Although Wiener filtering can be used to recognize pile-up, it suffers errors due to pulse-shape variation from detector nonlinearity, readout dependence on sub-sample arrival times, and stability issues from the ill-posed deconvolution problem of recovering Dirac delta-functions from smooth data. Due to these factors, we have developed a processing method that exploits singular value decomposition to (1) separate single-pulse records from piled-up records in training data and (2) construct a model of single-pulse records that accounts for varying pulse shape with amplitude, arrival time, and baseline level, suitable for detecting nearly-coincident events. We show that the resulting processing advances can reduce the required performance specifications of the detectors and readout system or, equivalently, enable larger sensor arrays and better constraints on the neutrino mass.

Double-beta decay investigation with highly pure enriched [Formula: see text]Se for the LUCIFER experiment

The LUCIFER project aims at deploying the first array of enriched scintillating bolometers for the investigation of neutrinoless double-beta decay of [Formula: see text]Se. The matrix which embeds the source is an array of ZnSe crystals, where enriched [Formula: see text]Se is used as decay isotope. The radiopurity of the initial components employed for manufacturing crystals, that can be operated as bolometers, is crucial for achieving a null background level in the region of interest for double-beta decay investigations. In this work, we evaluated the radioactive content in 2.5 kg of 96.3 % enriched [Formula: see text]Se metal, measured with a high-purity germanium detector at the Gran Sasso deep underground laboratory. The limits on internal contaminations of primordial decay chain elements of [Formula: see text]Th, [Formula: see text]U and [Formula: see text]U are respectively: [Formula: see text]61, [Formula: see text]110 and [Formula: see text]74 [Formula: see text]Bq/kg at 90 % C.L. The extremely low-background conditions in which the measurement was carried out and the high radiopurity of the [Formula: see text]Se allowed us to establish the most stringent lower limits on the half-lives of the double-beta decay of [Formula: see text]Se to 0[Formula: see text], 2[Formula: see text] and 2[Formula: see text] excited states of [Formula: see text]Kr of 3.4[Formula: see text]10[Formula: see text], 1.3[Formula: see text]10[Formula: see text] and 1.0[Formula: see text]10[Formula: see text] y, respectively, with a 90 % C.L.

Very low noise AC/DC power supply systems for large detector arrays

In this work, we present the first part of the power supply system for the CUORE and LUCIFER arrays of bolometric detectors. For CUORE, it consists of AC/DC commercial power supplies (0-60 V output) followed by custom DC/DC modules (48 V input, ±5 V to ±13.5 V outputs). Each module has 3 floating and independently configurable output voltages. In LUCIFER, the AC/DC + DC/DC stages are combined into a commercial medium-power AC/DC source. At the outputs of both setups, we introduced filters with the aim of lowering the noise and to protect the following stages from high voltage spikes that can be generated by the energy stored in the cables after the release of accidental short circuits. Output noise is very low, as required: in the 100 MHz bandwidth the RMS level is about 37 μV(RMS) (CUORE setup) and 90 μV(RMS) (LUCIFER setup) at a load of 7 A, with a negligible dependence on the load current. Even more importantly, high frequency switching disturbances are almost completely suppressed. The efficiency of both systems is above 85%. Both systems are completely programmable and monitored via CAN bus (optically coupled).

Search for Neutrinoless Double-Beta Decay of (130)Te with CUORE-0

We report the results of a search for neutrinoless double-beta decay in a 9.8 kg yr exposure of (130)Te using a bolometric detector array, CUORE-0. The characteristic detector energy resolution and background level in the region of interest are 5.1±0.3  keV FWHM and 0.058±0.004(stat)±0.002(syst)counts/(keV kg yr), respectively. The median 90% C.L. lower-limit half-life sensitivity of the experiment is 2.9×10(24)  yr and surpasses the sensitivity of previous searches. We find no evidence for neutrinoless double-beta decay of (130)Te and place a Bayesian lower bound on the decay half-life, T(1/2)(0ν)>2.7×10(24)  yr at 90% C.L. Combining CUORE-0 data with the 19.75 kg yr exposure of (130)Te from the Cuoricino experiment we obtain T(1/2)(0ν)>4.0×10(24)  yr at 90% C.L. (Bayesian), the most stringent limit to date on this half-life. Using a range of nuclear matrix element estimates we interpret this as a limit on the effective Majorana neutrino mass, m(ββ)<270-760  meV.

HOLMES: The electron capture decay of [Formula: see text]Ho to measure the electron neutrino mass with sub-eV sensitivity

The European Research Council has recently funded HOLMES, a new experiment to directly measure the neutrino mass. HOLMES will perform a calorimetric measurement of the energy released in the decay of [Formula: see text]Ho. The calorimetric measurement eliminates systematic uncertainties arising from the use of external beta sources, as in experiments with beta spectrometers. This measurement was proposed in 1982 by A. De Rujula and M. Lusignoli, but only recently the detector technological progress allowed to design a sensitive experiment. HOLMES will deploy a large array of low temperature microcalorimeters with implanted [Formula: see text]Ho nuclei. The resulting mass sensitivity will be as low as 0.4 eV. HOLMES will be an important step forward in the direct neutrino mass measurement with a calorimetric approach as an alternative to spectrometry. It will also establish the potential of this approach to extend the sensitivity down to 0.1 eV. We outline here the project with its technical challenges and perspectives.

The analytic hierarchy process in decisionmaking for caprine health programmes

The purpose of this study was to apply the analytic hierarchy process (AHP) to assist decision-making when planning animal health programmes, by assigning priorities to issues of concern to producers in Chile's main goat production region. This process allows a multi-criteria approach to problems, by analysing and ranking them in a hierarchical structure. Industry experts have highlighted the following animal health and disease control criteria: acceptance by breeders of disease control measures; impact of specific diseases on regional animal trade; the cost and efficacy of control measures; a decrease in flock production; and the impact of caprine diseases on human public health. Using these criteria in the AHP, the study found that the most important impacts were on human public health and on the animal trade. The disease priorities were tuberculosis, brucellosis and echinococcosis/hydatidosis, due mainlyto their zoonotic impact. The analytic hierarchy process proved useful when several criteria were involved in public health issues.

Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study

BACKGROUND

Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study.

METHODS

This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR.

RESULTS

A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79).

CONCLUSIONS

The study showed that EMR can be performed also in LVC.

Performance of the LHCb RICH detector at the LHC

The LHCb experiment has been taking data at the Large Hadron Collider (LHC) at CERN since the end of 2009. One of its key detector components is the Ring-Imaging Cherenkov (RICH) system. This provides charged particle identification over a wide momentum range, from 2-100 GeV/c. The operation and control, software, and online monitoring of the RICH system are described. The particle identification performance is presented, as measured using data from the LHC. Excellent separation of hadronic particle types (π, K, p) is achieved.

First observation of the decay Bs2*(5840)(0)→B*+ K- and studies of excited Bs(0) mesons

The properties of the orbitally excited (L=1) Bs(0) states are studied by using 1.0  fb(-1) of pp collisions at sqrt[s]=7  TeV collected with the LHCb detector. The first observation of the Bs2*(5840)(0) meson decaying to B*+ K- is reported, and the corresponding branching fraction measured relative to the B+ K- decay mode. The Bs1(5830)(0)→B*+ K- decay is observed as well. The width of the Bs2*(5840)(0) state is measured for the first time, and the masses of the two states are determined with the highest precision to date. The observation of the Bs2*(5840)(0)→B*+ K- decay favors the spin-parity assignment J(P)=2+ for the Bs2*(5840)(0) meson. In addition, the most precise measurement of the mass difference m(B*+)-m(B+)=45.01±0.30(stat)±0.23(syst)  MeV/c(2) is obtained.

Observation of D0-D0 oscillations

We report a measurement of the time-dependent ratio of D(0) → K(+) π- to D(0) → K(-) π(+) decay rates in D(*+)-tagged events using 1.0 fb(-1) of integrated luminosity recorded by the LHCb experiment. We measure the mixing parameters x('2) = (-0.9 ± 1.3) × 10(-4), y' = (7.2 ± 2.4) × 10(-3), and the ratio of doubly-Cabibbo-suppressed to Cabibbo-favored decay rates R(D) = (3.52 ± 0.15) × 10^{-3}, where the uncertainties include statistical and systematic sources. The result excludes the no-mixing hypothesis with a probability corresponding to 9.1 standard deviations and represents the first observation of D0-D0 oscillations from a single measurement.

Measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays

A measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays is presented, based on 1.0 fb(-1) of pp collision data recorded by the LHCb experiment during 2011. The measurement is performed in six bins of invariant mass squared of the μ(+)μ(-) pair, excluding the J/ψ and ψ(2S) resonance regions. Production and detection asymmetries are removed using the B(0)→J/ψK(*0) decay as a control mode. The integrated CP asymmetry is found to be -0.072±0.040(stat)±0.005(syst), consistent with the standard model.

First evidence for the decay B(s)(0)→μ+ μ-

A search for the rare decays B(s)(0)→μ+ μ- and B(0)→μ+ μ- is performed with data collected in 2011 and 2012 with the LHCb experiment at the Large Hadron Collider. The data samples comprise 1.1  fb(-1) of proton-proton collisions at sqrt[s]=8  TeV and 1.0  fb(-1) at sqrt[s]=7  TeV. We observe an excess of B(s)(0)→μ+ μ- candidates with respect to the background expectation. The probability that the background could produce such an excess or larger is 5.3×10(-4) corresponding to a signal significance of 3.5 standard deviations. A maximum-likelihood fit gives a branching fraction of B(B(s)(0)→μ+ μ-)=(3.2(-1.2)(+1.5))×10(-9), where the statistical uncertainty is 95% of the total uncertainty. This result is in agreement with the standard model expectation. The observed number of B(0)→μ+ μ- candidates is consistent with the background expectation, giving an upper limit of B(B(0)→μ+ μ-)<9.4×10(-10) at 95% confidence level.

Measurements of B(c)+ production and mass with the B(c)+ → J/ψπ+ decay

Measurements of B(c)(+) production and mass are performed with the decay mode B(c)(+)→J/ψπ(+) using 0.37 fb(-1) of data collected in pp collisions at √[s]=7 TeV by the LHCb experiment. The ratio of the production cross section times branching fraction between the B(c)(+)→J/ψπ(+) and the B(+)→J/ψK(+) decays is measured to be (0.68±0.10(stat)±0.03(syst)±0.05(lifetime))% for B(c)(+) and B(+) mesons with transverse momenta p(T)>4 GeV/c and pseudorapidities 2.5<η<4.5. The B(c)(+) mass is directly measured to be 6273.7±1.3(stat)±1.6(syst) MeV/c(2), and the measured mass difference with respect to the B(+) meson is M(B(c)(+))-M(B(+))=994.6±1.3(stat)±0.6(syst) MeV/c(2).

Can we improve the detection rate and interobserver agreement in capsule endoscopy?

BACKGROUND

Data about strategies for improving the diagnostic ability of capsule endoscopy readers are lacking.

AIM

(1) To evaluate the detection rate and the interobserver agreement among readers with different experience; (2) to verify the impact of a specific training (hands-on training plus expert tutorial) on these parameters.

METHODS

17 readers reviewed 12 videos twice; between the two readings they underwent the training. The identified small bowel findings were described by a simplified version of Structured Terminology and classifies as clinically significant/non-significant. Findings identified by the readers were compared with those identified by three experts (Reference Standard).

RESULTS

The Reference Standard identified 26 clinically significant findings. The mean detection rate of overall readers for significant findings was low (about 50%) and did not change after the training (46.2% and 46.4%, respectively). There was no difference in the detection rate among readers with different experience. The interobserver agreement with the Reference Standard in describing significant findings was moderate (k = 0.44; CI95%: 0.39-0.50) and did not change after the training (k = 0.44; CI95%: 0.38-0.49) or stratifying readers according to their experience.

CONCLUSIONS

Both the interobserver agreement and the detection rate of significant findings are low, regardless of the readers' experience. Our training did not significantly increase the performance of readers with different experience.

Bilio-intestinal bypass for the treatment of obesity

AIM

This study was a retrospective assessment of the results of bilio-intestinal bypass (a variation of the jejuno-ileal bypass, in which the intestinal blind loop is anastomosed to the gallbladder).

METHODS

Seventy-five patients underwent the Eriksson bilio-intestinal bypass since 2003 to January 2009. Mean weight prior to surgery was 115.17 (SD±17.74 kg; range 82-177 kg). Mean preoperative BMI (Body Mass Index) was 41.75 kg/m2 (SD±4.42; range 35-60). Primary criteria taken into consideration have been: weight loss, blood tests, reversal rate and complications.

RESULTS

One year after surgery BMI reported a mean decrease of 28.31% (SD±2.49%) from a mean of 41.75 to a mean 29.72. The mean follow-up is 26.81 months (SD±17.41 months; range 1-72 months). Blood glucose levels at one year follow-up were normalized, shifting from a mean of 138.5 (SD±23.8) to 86.2 (SD±2.6) mg/dL. Diabetic patients were all able to stop hypoglicemic drugs. Serum total cholesterol and triglycerides concentrations decreased of a mean of 31% and 44%. Morbidity was acceptable (two cases of enterorrhage, one biliary leak, one intra-abdominal abscess all treated conservatively). Reversal rate was 2.67%. No mortality was registered.

CONCLUSION

Bilio-intestinal bypass is effective in inducing weight loss and metabolic improvement. This procedure is particularly indicated for the heavily obese who do not accept alimentary restrictions but are willing to submit to long-term monitoring.

Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up

In uncomplicated diverticular disease, treatment is aimed at relieving symptoms. The aim of the present study was to evaluate the efficacy of mesalazine for symptomatic relief of uncomplicated diverticular disease of the colon. Two hundred sixty-eight consecutive eligible outpatients (122 male, 146 female; age, 66.1 years; range, 31-81 years) were enrolled in four treatment schedules in a randomized fashion: Group R1 (66 patients), rifaximin, 200 mg bid; Group R2 (69 patients), rifaximin, 400 mg bid; Group M1 (67 patients), mesalazine, 400 mg bid; and Group M2 (66 patients), mesalazine, 800 mg bid. Treatments were administered for 10 days every month for 12 months. Clinical evaluations were performed at admission and at 3-month intervals for 12 months considering 12 clinical variables (upper and lower abdominal pain/discomfort, tenesmus, diarrhea, abdominal tenderness, fever, bloating, general illness, nausea, emesis, dysuria, bleeding) graded as 0 = no symptoms, 1 = mild, 2 = moderate, and 3 = severe. The Global Symptomatic Score (GSS) was calculated using the sum of each symptom score. Two hundred forty-four patients completed the 12- month study; 24 were discontinued (14 treated with rifaximin and 10 treated with mesalazine) either as voluntary dropouts or because they developed side effects and/or complications. Group M2 demonstrated a lower frequency of many symptoms after 6 and 12 months of treatment; the mean GSS was significantly lower in Group M2 after 6 and 12 months of therapy by both intention-to-treat and per-protocol analyses. Patients treated with mesalazine (Groups M1+M2) had a lower GSS than subjects treated with rifaximin (Groups R1+R2) during the 12-month follow-up period. We conclude that cyclic administration of mesalazine is effective for symptomatic relief of uncomplicated diverticular disease of the colon. Some symptoms showed greater improvement with mesalazine, 800 mg bid, than with the other treatment schedules.

A curcumin-based 1-week triple therapy for eradication of Helicobacter pylori infection: something to learn from failure?

BACKGROUND

Curcumin is the principal element of turmeric powder extracted from the root of Curcuma longa. Studies on curcumin have demonstrated some anti-Helicobacter pylori activity as well as immunomodulating properties. N-acetylcysteine and lactoferrin with their respective mucolytic and antibacterial activities might also be effective in H. pylori eradication therapy.

AIM

To determine if a 7-day non-antibiotic therapy comprised of curcumin, lactoferrin, N-acetylcysteine, and pantoprazole was effective for eradication of H. pylori infection and reduction of gastric inflammation, assessed by serum pepsinogens and relief of symptoms.

SUBJECTS AND METHODS

Twenty-five consecutive H. pylori-positive patients (12 males, mean age 50 +/- 12 years, range 31-76) with functional dyspepsia were enrolled. Patients were administered for 7 days curcumin 30 mg b.i.d., bovine lactoferrin 100 mg b.i.d., N-acetylcysteine 600 mg b.i.d., and pantoprazole 20 mg b.i.d. H. pylori status and upper gastrointestinal symptoms were assessed by (13)C-urea breath test and a scale of upper gastrointestinal symptoms intensity (absent, mild, moderate, and severe), as well as a blood test for serum pepsinogens (sPGI, sPGII), gastrin-17 (G-17), and anti-H. pylori IgG (IgG-Hp) at baseline (T0) and after 2 months (T1).

RESULTS

Three of 25 patients (12%) were cured of H. pylori infection. A significant decrease in the overall severity of symptoms (T0: 6, interquartile range [IQR]: 4.5-8; T1: 2, IQR: 2-3; p < or = .001), and sPGII (T0: 16 microg/L, IQR: 13-22; T1: 10 microg/L, IQR: 8-16; p < or = .001) and sPGI (T0: 82 microg/L, IQR: 67-97; T1: 74 microg/L, IQR: 62-94; p = .02) levels were observed after 2 months of the treatment. IgG and G-17 values did not significantly decrease after 2 months.

CONCLUSIONS

This novel therapy was not effective for H. pylori eradication. However, despite the bacterium persistence, significant improvement of dyspeptic symptoms and reduction of serologic signs of gastric inflammation were observed after 2 months at the end of the 7-day treatment schedule.

Effects of chronic therapy with non-steroideal antinflammatory drugs on gastric permeability of sucrose: A study on 71 patients with rheumatoid arthritis

AIM: To evaluate the gastric permeability after both acute and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and to assess the clinical usefulness of sucrose test in detecting and following NSAIDs- induced gastric damage mainly in asymptomatic patients and the efficacy of a single pantoprazole dose in chronic users.

METHODS: Seventy-one consecutive patients on chronic therapy with NSAIDs were enrolled in the study and divided into groups A and B (group A receiving 40 mg pantoprazole daily, group B only receiving NSAIDs). Sucrose test was performed at baseline and after 2, 4 and 12 wk, respectively. The symptoms in the upper gastrointestinal tract were recorded.

RESULTS: The patients treated with pantoprazole had sucrose excretion under the limit during the entire follow-up period. The patients without gastroprotection had sucrose excretion above the limit after 2 wk, with an increasing trend in the following weeks (P = 0.000). A number of patients in this group revealed a significantly altered gastric permeability although they were asymptomatic during the follow-up period.

CONCLUSION: Sucrose test can be proposed as a valid tool for the clinical evaluation of NSAIDs- induced gastric damage in both acute and chronic therapy. This tecnique helps to identify patients with clinically silent gastric damages. Pantoprazole (40 mg daily) is effective and well tolerated in chronic NSAID users.

Role of gut microflora and probiotic effects in the irritable bowel syndrome

BACKGROUND

Even though the cause of irritable bowel sindrome (IBS) is not yet known, alterations of the intestinal microflora may be important in its pathogenesis.

AIM

To evaluate the efficacy of rifaximine alone or in association with the probiotic strain of Bifidobacterium longum W11 in reducing symptoms in patients with IBS.

METHODS

We performed a monocentric, prospective, randomized open trial including 70 patients randomized in to two groups: Group A (41 patients) receiving rifaximin 200 (2 cp bid for ten days in a month) followed by a formulation of the probiotic strain of Bifidobacterium longum W11(one granulated suspension for 6 days on alternate weeks ) and Group B (29 patients) receiving only rifaximin 200 (2 cp bid for ten days in a month). The clinical evaluation was performed at admission and after 2-months, taking into account the method of visual analogous.

RESULTS

At the 2-month follow-up, Group A patients reported a greater improvement of symptoms compared to patients in group B (p = 0.010) even if the physician's opinion at T1 did not confirm these results (p = 0.07).

CONCLUSION

The increased colonisation by Bifi-dobacterium longum W11, after the cyclic administration of rifaximin, which eradicates the bacterial overgrowth of the small intestine, may reduce symptoms, especially those related to bowel habit and stool frequency in patients with IBS. The abnormalities observed in the colonic flora of IBS suggest, in fact, that a probiotic approach will ultimately be justified.

Does Helicobacter pylori infection eradication modify peptic ulcer prevalence? A 10 years' endoscopical survey

AIM: To compare peptic ulcer prevalence in patients referred for upper gastrointestinal endoscopy in two Italian hospitals in pre-Helicobacter era and ten years after the progressive diffusion of eradication therapy.

METHODS: We checked all the endoscopic examinations consecutively performed in the Gastroenterology Unit of Padova during 1986-1987 and 1995-1996, and in the Gastroenterology Unit of Parma during 1992 and 2002. Chi Square test was used for statistic analysis.

RESULTS: Data from both the endoscopic centers showed a statistically significant decrease in the prevalence of ulcers: from 12.7% to 6.3% (P < 0.001) in Padova and from 15.6% to 12% (P < 0.001) in Parma. The decrease was significant both for duodenal (from 8.8% to 4.8%, P < 0.001) and gastric ulcer (3.9% to 1.5%, P < 0.001) in Padova, and only for duodenal ulcer in Parma (9.2% to 6.1%, P < 0.001; gastric ulcer: 6.3% to 5.8%, NS).

CONCLUSION: Ten years of extensive Helicobacter pylori (H pylori) eradication in symptomatic patients led to a significant reduction in peptic ulcer prevalence. This reduction was particularly evident in Padova, where a project for the sensibilization of H pylori eradication among general practioners was carried out between 1990 and 1992. Should our hypothesis be true, H pylori eradication might in the future lead to peptic ulcer as a rare endoscopic finding.

Bovine lactoferrin for Helicobacter pylori eradication: an open, randomized, multicentre study

BACKGROUND

Cure rates for eradication of Helicobacter pylori appear to be decreasing, thus more effective therapies must be identified.

AIM

To evaluate the efficacy of bovine lactoferrin in the treatment of H. pylori infection.

METHODS

In a multicentered prospective study, 402 (mean age 52.4, range 19-84 years) H. pylori-positive patients were assigned to one of three regimens: group A - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. for 7 days; group B - lactoferrin 200 mg b.d. for 7 days followed by the same schedule of group A; group C - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. plus lactoferrin 200 mg b.d. for 7 days.

RESULTS

Of the 402 patients, 389 completed the study. Six patients were discontinued due to side effects, one patient in group B died and six patients were lost to follow up. The eradication rate (intention-to-treat analysis) was 77% in group A (105/136), 73% in group B (97/132) and 90% in group C (120/134) (chi(2)-test P < 0.01). The incidence of side effects was 9.5% in group A, 9% in group B and 8.2% in group C (chi(2)-test P = 0.1).

CONCLUSION

This study demonstrates that bovine lactoferrin is an effective adjuvant to 7-day triple therapy for eradication of H. pylori infection.

Extended lymphadenectomy (D2) in patients with early gastric cancer

AIMS

To investigate the survival benefit of extended lymphadenectomy (D2) in EGC patients in one European Institution.

METHODS

A review was made of our prospective gastric database from January 1980 to December 2001. Of 527 patients with primary gastric adenocarcinoma, 119 with EGC underwent potentially curative resection (R0) with D2 lymphadenectomy.

RESULTS

There were two post-operative deaths. Of the 117 evaluable cases, 96 were classified as N0 and 21 as N+, with metastases in the perigastric lymph nodes (level 1) in 13, and beyond this site (level 2) in eight. Five-year survival was 85.9 and 83.0% in N0 and N+ patients, respectively. During a median follow-up of 90 months, five of the eight patients with level 2 metastases died of recurrent disease and three were alive. The estimated survival benefit for 119 patients with EGC was 2.5% (3/119 cases).

CONCLUSIONS

In patients with EGC, metastases to level 2 are rare. Our results indicate that D2 lymphadenectomy has a limited survival benefit and that in these cases a less extensive lymphadenectomy (D1) could be performed.

Influence of antisecretory treatment with proton pump inhibitors on serum pepsinogen I levels

It has been reported in literature that serum pepsinogen levels rise during omeprazole and lansoprazole administration. However, the influence of pantoprazole and esomeprazole on serum pepsinogens levels is still to be assessed. The aim of this study was to evaluate the influence of proton pump inhibitor (PPI) therapy on pepsinogen I (PGI) levels. PGI and gastrin (G17) levels (EIA; Biohit, Helsinki, Finland) in 126 consecutive patients (M 57; F 69, mean age 53, range 15-91), with upper gastrointestinal symptoms at baseline condition and after 2 months of PPI treatment, were evaluated. Patients underwent a therapy schedule based on: omeprazole 20 mg b.i.d. (20 patients), pantoprazole 40 mg b.i.d. (27 patients), esomeprazole 40 mg b.i.d. (29 patients), lansoprazole 30 mg b.i.d. (21 patients) and rabeprazole 20 mg b.i.d. (26 patients) for 2 months. A significant increase in serum PGI (sPGI) levels was found after a 2-month treatment for all five different PPIs: omeprazole, pantoprazole, esomeprazole, lansoprazole and rabeprazole (P < 0.05). The effect of rabeprazole on sPGI was less pronounced as compared with other PPIs, whereas esomeprazole achieved superior sPGI levels, with no overall statistically significant difference among the five groups (P > 0.05). However, a comparison within a single group of PPIs showed a statistical significance when the esomeprazole group was compared with the rabeprazole group (P = 0.007). sPGI levels are significantly influenced by antisecretory therapy, rising under PPI treatment. Moreover, a statistically significant difference in sPGI levels between the rabeprazole and esomeprazole groups has been demonstrated.

Efficacy of mesalazine in the treatment of symptomatic diverticular disease

We aimed to improve symptoms by means of mesalazine in symptomatic colonic diverticular disease patients. One hundred seventy outpatients (98 M, 72 F; age, 67.1 years; range, 39-84 years) were assigned to four different schedules: rifaximin, 200 mg bid (Group R1: 39 pts), rifaximin, 400 mg bid (Group R2: 43 pts), mesalazine, 400 mg bid (Group M1: 40 pts), and mesalazine, 800 mg bid (Group M2: 48 pts), for 10 days per month. At baseline and after 3 months we recorded 11 clinical variables (upper/lower abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness, fever, general illness, nausea, emesis, dysuria), scored from 0 = no symptoms to 3 = severe. The global symptomatic score was the sum of all symptom scores. After 3 months in all schedules but Group R1, 3 of the 11 symptoms improved (P < 0.03); the global score decreased in all groups but Group R1 (P < 0.0001). Mesalazine-treated patients had the lowest global score at 3 months (P < 0.001). Mesalazine is as effective as rifaximin (higher dosage schedule) for diminishing some symptoms, but it appears to be better than rifaximin for improving the global score in those patients.

[The minimal bowel resection in Crohn's disease: analysis of prognostic factors on the surgical recurrence]

OBJECTIVE

To assess the effect of disease pattern and involvement of the margins on early and late results of enteric resections with hand-sewn anastomosis for Crohns disease.

BACKGROUND

Bowel sparing is one of the aims of the surgery for CD. When strictureplasties are not possible, "minimal surgery" (the resection just of the grossly involved tract of bowel) is the current choice.

METHODS

One hundred and forty-six cases of resections in 128 patients were performed in the years 1991-2001. We investigated if there is a relationship between disease pattern (perforating and non-perforating) or hystologic involvement of the margins and recurrence (reoperation for recurrent preanastomotic disease). Hand-sewn anastomosis were performed almost in all the cases; we compared the results with the main series of stapled and hand-sewn sutures.

RESULTS

Nine surgical complications occurred (7%), requiring six relaparotomies and three conservative treatments. Overall rate of recurrence (median follow-up 44 months) is 17%: 9% in patients with non perforating disease and 19% in patients with perforating disease. The rate of recurrence is 6% in the group of patients with involved margins and 23% in the group with non involved margins.

CONCLUSIONS

Limited surgery for CD doesn't increase rate of recurrence; the involvement of margins is not a risk factor for early reoperation. Hand-sewn anastomosis seem to be as safe as stapled ones.

Pelvic ultrasound evaluation in patients with Turner syndrome during treatment with growth hormone

OBJECTIVES

Treatment with growth hormone (GH), alone or in combination with oxandrolone, is used in patients affected by Turner syndrome to improve growth velocity and adult height. Since GH interacts with gonadotropins in the stimulation of the human ovary, the aim of our study was to evaluate the possible effects of GH administration on uterine and ovarian characteristics.

METHODS

We performed pelvic ultrasound assessment in 29 patients with Turner syndrome aged 7.5-16.6 years (19 with 45,X karyotype; 10 with variant karyotypes) before and during treatment with GH alone. Uterine volume and ovarian size and morphology were compared to those of 23 age-matched girls with Turner syndrome not treated with GH. Both patients and controls were divided into prepubertal and pubertal groups. Cross-sectional and longitudinal studies (before and every 6 months during GH treatment for 2 years) were performed.

RESULTS

We observed a significantly higher uterine anteroposterior diameter and volume in younger (< or = 11 years) GH-treated Turner syndrome girls than in those who were untreated. Also visualization and heterogeneous echopattern of the ovaries were significantly more frequent in treated than in untreated Turner syndrome patients, particularly before the age of 11 years. The longitudinal study showed a significant increase in uterine volume, more related to treatment than to age. Spontaneous breast development and menarche were found more frequently in GH-treated Turner syndrome girls.

CONCLUSION

Growth hormone therapy can have a co-gonadotropin role in patients with Turner syndrome.