Stereotactic MR-guided adaptive radiotherapy (SMART) for primary rectal cancer: evaluation of early toxicity and pathological response

Background

The purpose of this study is to measure the effects of stereotactic MR-guided adaptive radiotherapy (SMART) for rectal cancer patients in terms of early toxicity and pathological response.

Materials and methods

For this prospective pilot study, patients diagnosed with locally advanced rectal cancer (LARC) with positive lymph node clinical staging underwent SMART on rectal lesion and mesorectum using hybrid MR-Linac (MRIdian ViewRay). Dose prescription at 80% isodose for the rectal lesion and mesorectum was 40 Gy (8 Gy/fr) and 25 Gy (5 Gy/fr), respectively, delivered on 5 days (3 fr/week). Response assessment by MRI was performed 3 weeks after SMART, then patients fit for surgery underwent total mesorectal excision. Primary endpoint was evaluation of adverse effect of radiotherapy. Secondary endpoint was pathological complete response rate. Early toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0).

Results

From October 2020 to January 2022, twenty patients underwent rectal SMART. No grade 3-5 toxicity was recorded. Twelve patients were eligible for total mesorectal excision (TME). Mean interval between the completion of SMART and surgery was 4 weeks. Pathological downstaging occurred in all patients; rate of pathological complete response (pCR) was 17%. pCR occurred with a prolonged time to surgery (> 7 weeks).

Conclusion

To our knowledge, this is the first study to use stereotactic radiotherapy for primary rectal cancer. SMART for rectal cancer is well tolerated and effective in terms of tumor regression, especially if followed by delayed surgery.

Public health risk management during the Covid-19 pandemic, new amendments in the European Maritime and Fisheries Fund to meet fishers' needs

The recent COVID-19 emergency has shaped economic performance across all sectors, and the fisheries and aquaculture sector did not come out unscathed. The need to protect against risks has always been primary for economic operators, but COVID-19 has accentuated the need to obtain coverage for health risks. In this regard, the European Union has moved quickly with an amendment art. 35 of European Maritime and Fisheries Fund (Regulation [EU] No. 508/2014), including "public health crises" among the causes considered valid for compensation in mutual funds. In this paper, we analyze the evolution of Regulation 508, focusing on Article 35 and its most recent amendments, to understand if the new reform is adherent to the needs of the fisheries sector in Italy, one of the only two States that have documented in their Operational Plans the intention to implement mutual funds. The work involved an empirical analysis through the use of multivariate statistics carried out on 61 Italian stakeholders. Several company profiles were identified and then the likelihood of subscribing to a mutual fund was estimated based on their focus on health crises. The work underlines that the amendments meet the demands of the sector for improved mutual fund clauses, but it's not yet an attractive tool for the Italian market.

Comparison of rigid and deformable coregistration between mpMRI and CT images in radiotherapy of prostate bed cancer recurrence

PURPOSE

To evaluate the accuracy of rigid coregistration between multiparametric magnetic resonance (mpMR) and computed tomography (CT) images for radiotherapy of prostate bed cancer recurrence.

MATERIALS AND METHOD

Fifty-three patients (59 nodules) accrued in a prospective study on salvage radiotherapy for prostatic bed recurrence were suitable for the analysis. Patients underwent a pre radiotherapy mpMR exam and a planning CT in the same treatment position and with control of organ filling. The site of recurrence was delineated on mpMR images and contours transferred on planning CT images using both rigid and deformable registrations. Coregistrations were evaluated by mathematical operators that quantify deformation (Jacobian determinant and vector curl) and similarity indices (Dice and Jaccard coefficients). Dose coverage was evaluated.

RESULTS

Deformable registration did not change volumes, (p = 0.92 MW test). The Jacobian coefficient and the vector curl revealed no important image deformations. Dice and Jaccard coefficients indicated dislocation of the nodule volumes. Dislocation magnitude was d = (5.6 ± 3.1) mm. Organ filling was not correlated with deformation or dislocation. Volumes were covered by the 95% isodose in 96% of cases when rigid registration was performed versus 75% of cases when deformed.

CONCLUSIONS

Rigid image coregistration is sufficiently accurate in this setting. The results indicate that the deformable registration tends to shrink the voxels and to dislocate the ROI, the adopted expansion for the recurrence volume adequately accounts for the observed deformation and dislocation, provided that organ filling is controlled.

Radiochromic film dosimetry in synchrotron radiation breast computed tomography: a phantom study

This study relates to the INFN project SYRMA-3D for in vivo phase-contrast breast computed tomography using the SYRMEP synchrotron radiation beamline at the ELETTRA facility in Trieste, Italy. This peculiar imaging technique uses a novel dosimetric approach with respect to the standard clinical procedure. In this study, optimization of the acquisition procedure was evaluated in terms of dose delivered to the breast. An offline dose monitoring method was also investigated using radiochromic film dosimetry. Various irradiation geometries have been investigated for scanning the prone patient's pendant breast, simulated by a 14 cm-diameter polymethylmethacrylate cylindrical phantom containing pieces of calibrated radiochromic film type XR-QA2. Films were inserted mid-plane in the phantom, as well as wrapped around its external surface, and irradiated at 38 keV, with an air kerma value that would produce an estimated mean glandular dose of 5 mGy for a 14 cm-diameter 50% glandular breast. Axial scans were performed over a full rotation or over 180°. The results point out that a scheme adopting a stepped rotation irradiation represents the best geometry to optimize the dose distribution to the breast. The feasibility of using a piece of calibrated radiochromic film wrapped around a suitable holder around the breast to monitor the scan dose offline is demonstrated.

Dose intercomparison at Italian hadrontherapy centers

PURPOSE

To perform the first dosimetric intercomparison for proton beams in Italy using ionization chambers, according to the IAEA TRS-398 code of practice.

METHODS

Measurement sites included: National Center for Oncological Hadron Therapy (CNAO, Pavia), Center for Proton Therapy (CTP, Trento) and Center for Hadron Therapy and for advanced Nuclear Applications (CATANA, Catania). For comparison we also included a 6 MV photon beam produced at Istituti Clinici Scientifici Maugeri (ICSM, Pavia). For proton beams, both single pseudo-monoenergetic layers (in order to obtain a planned dose of 2 Gy at the reference depth of 2 cm in a water phantom) and Spread-out Bragg peaks (SOBP) have been delivered. Measurements were performed with a PTW Farmer 30010-1 and a PTW Advanced Markus type 34,045 ionization chamber.

RESULTS

Data obtained at CATANA, CNAO and CPT in terms of absorbed dose to water depth show good consistency within the experimental uncertainties, with a weighted mean of 1.99 ± 0.01 Gy and a standard error of 0.003 Gy, with reference to a nominal dose of 2 Gy as designed by the treatment planning system.

CONCLUSIONS

The results showed a standard deviation of less than 1% for single layer and SOBP beams, for all chambers and a percent deviation less than 1.5% for single layer measurements. The weighted means of the absorbed doses for clinical proton beams (118.19 MeV and 173.61 MeV) are consistent within less than 1%. These results agree within the 1.5% difference considered acceptable for national dose intercomparison.

A Metastatic Breast Carcinoma Presenting as Autoimmune Hemolytic Anemia

The authors describe the case of a 75-year-old female who was hospitalized for anemia of unknown origin. Physical examination revealed a swelling in the right mammary region, where a mastectomy scar was present from surgery for a breast carcinoma. On admission, laboratory tests disclosed anemia (Hb, 8.5 g/dl), with a reticulocyte count of 65,000/mm3 and slightly increased bilirubin. Immunohematologic study revealed the presence of a red cell autoantibody with anti-D specificity in the serum and in the eluate from the patient's erythrocytes. A biopsy of the swelling was performed and histologic examination showed the presence of metastatic cells of breast carcinoma. The patient was given chemotherapy and radiotherapy. At this writing the anemia was absent, the immunohematologic study was negative, the swelling was greatly reduced, and no other metastatic lesions of breast carcinoma were present.

Femoral Catheters: Safety and Efficacy in Peripheral Blood Stem Cell Collection

Central venous access is necessary in patients candidate for peripheral blood stem cell (PBSC) collection. We report our experience with a dual lumen femoral catheter (Gamcath, 11 french), initially designed for hemodialysis. We studied 147 patients and performed 488 collections after mobilization with either G-CSF alone or chemotherapy + G-CSF, when the white blood cell count exceeded 1 × 109 /L, or when a measurable population of CD34+ cells (20 / μL) was detected in peripheral blood. All patients received systemic anticoagulation with a low weight heparin and ultrasound examination was performed after the removal of the catheter. Seven patients developed thrombosis (4.7%), ten experienced hematomas at the site of catether placement (6.8%) despite prophylactic platelet transfusions, while only one patient (0.6%) had a catheter-related infection. In conclusion, the short-term use of large bore femoral catheters in setting up PBSC collection seems to be associated with minimal risk of infection and low thrombotic incidence.

Extruded Ceramic Microelectrodes for Biomedical Applications

A new process, based on the micro-co-extrusion of preceramic precursors, has been studied for manufacturing ceramic microelectrodes to be used in biomedical applications. Commercially available silicon polymers were applied and proper doping resulted in electrically conductive ceramic filaments. Chemical reticulation and high-temperature pyrolysis were applied to convert the polymeric resins into Si-O-C ceramic materials. Circular microelectrodes were manufactured with diameters between 100 μm and 5 mm with a different number of inner conductive lines (from 1 to 80). The flexural strength of the filaments depended on the outer diameter size; doping with carbon black produced filaments with an average conductivity of approximately 0.4 S/cm for a 50% weight carbon black load. The results achieved by in vitro studies confirmed a good biological performance of Si-O-C ceramic structures with both hard and soft tissue cell models.

In Silico Study of Polymer Sheet Drying Process

In the last decades polymer sheets have been developed and used for various purposes, for example with electronic devices or solar cells. After polymer processing, they present a high residue of polymer solvent that should be reduced. Indeed, a high presence of solvent could affect their electrical properties or cause high levels of pollution. In addition, uncontrolled drying process can cause bubble formation with consequent film breakage. The aim of this work is to simplify the phenomena involved in the drying process in order to develop a mathematical model able to predict the time evolution of the composition and the mass of the polymer sheet. The model proposed here, therefore, is aimed at stimulating the industrial process and the results were verified against experimental data collected with cellulose acetate-based polymeric sheets. In addition, thanks to its simplicity and to the very low system requirements and central processing unit (CPU) time, our model gives immediate views of the system behavior.

Parenteral nutrition admixtures for pediatric patients compounded with highly refined fish oil-based emulsion: assessment of physicochemical stability

Fish oil-based emulsion is increasingly used in pediatric patients receiving Parenteral Nutrition (PN). However, its unique use in children on long-term PN is nutritionally debatable as some patients are better off with a mixture of long-chain (LCT) or long-chain + medium-chain (LCT + MCT) triglycerides along with Fish Oil (FO). Lipid emulsions are safely infused when particle diameter ranges between 0.4 and 1.0 micron (like chylomicra), according to European guidelines. No data exist on Fish Oil stability when added to other PN components typically present in pediatric formulations such as other lipids or micronutrients. Our goal is to evaluate the stability of a highly refined FO-emulsion in PN admixtures containing LCT or LCT + MCT triglycerides and different calcium content. Stability studies were carried out on six PN admixtures having two levels of calcium concentration compounded with olive oil LCT + FO, LCT + MCT + FO emulsion and pure FO alone, respectively. The analyses were performed immediately at time 0 (t = 0) and 24, 48, 72, 96 (t = 96) hours after compounding. Particle diameters were determined by Light Scattering-Reverse Fourier Optics Technique by means of a Laser Granulometer. Every sample was stored at 4 °C and triple tested. Statistical significance was verified by f-test. In all admixtures, physicochemical stability did not change between t = 0 and t = 96 and particle diameters were in the expected range of 0.4-1.0 micron provided calcium concentration remained below 4.5 mmol/L. When calcium exceeded that level, 12% of particle diameters was larger than 1.0 micron and 2% exceeded 5.0 micron immediately after compounding. In particular, admixtures compounded with olive oil LCT + FO emulsion or FO emulsion alone showed lower particle diameters compared to admixture with olive/soybean LCT alone, probably due to a different steric encumbrance of oleic acid and omega-3 fatty acid. In the PN admixtures tested, containing FO-emulsion alone or in combination with olive LCT or LCT + MCT, the fat emulsion appears to be stable and safe for infusion when calcium concentration is maintained below 4.5 mmol/L. If calcium level exceeds 4.5 mmol/L, as often required in premature patients, it is advisable to infuse FO emulsion alone through a second intravenous line.

Evolution of Hypogammaglobulinemia in Premature and Full-Term Infants

There are few data in the literature reporting the evolution of hypogammaglobulinemia in premature and full-term infants during the first years of life. The aim of this study was to assess the clinical and immunological evolution of premature and full-term infants with hypogammaglobulinemia. We included 24 children (11 premature and 13 full-term infants), aged 0–36 months, with hypogammaglobulinemia. Fifteen (62.5%) children had an isolated reduction in IgG, 7 (29.2%) had a decrease in both IgG and IgA and 2 (8.3%) a reduction in IgG and IgM. Normalization of IgG serum levels occurred in the premature infants at a mean age of 7.2 months. Full-term infants were divided into 3 groups based on age at normalization of IgG serum level: A) hypogammaglobulinemia with normalization within 12 months of life; B) with normalization within 36 months of life; C) normalization after 36 months. All the premature infants with hypogammaglobulinemia recovered, even though in the lower limits for age in the first years, while transient hypogammaglobulinemia observed in full-term infants has a different age of recovery.

Coupled-resonator-induced-transparency concept for wavelength routing applications

The presence of coupled resonators induced transparency (CRIT) effects in side-coupled integrated spaced sequence of resonators (SCISSOR) of different radii has been studied. By controlling the rings radii and their center to center distance, it is possible to form transmission channels within the SCISSOR stop-band. Two different methods to exploit the CRIT effect in add/drop filters are proposed. Their performances, e. g. linewidth, crosstalk and losses, are examined also for random variations in the structural parameters. Finally, few examples of high performances mux/demux structures and 2 × 2 routers based on these modified SCISSOR are presented. CRIT based SCISSOR optical devices are particularly promising for ultra-dense wavelength division multiplexing applications.

Robust design of an optical router based on a tapered side-coupled integrated spaced sequence of optical resonators

A novel (to our knowledge) scheme of an optical router/switch element, composed of a tapered side-coupled integrated spaced sequence of optical resonators, is proposed. It is based on a modified design of the ring sequence in which the resonance conditions are set by the single ring resonance and by the coherent feedback of the sequence of rings. This double condition yields robustness against fabrication defects, dense routing capability, and high switching efficiency.

Allergy is not the main trigger of urticaria in children referred to the emergency room

BACKGROUND

Urticaria is the disease that has the highest impact on quality of life and requires the most visits to the emergency room.

OBJECTIVE

To investigate the clinical presentation of acute urticaria in children referred to the paediatric emergency room of our hospital and to define possible related aetiologies.

METHODS

We included 814 children consecutively referred to the emergency room between January 2006 and December 2007 with a diagnosis of acute urticaria, isolated or associated with other clinical symptoms.

RESULTS

Only 2.0% of the cases studied were associated with severe clinical pictures. In 437 cases (53.7%), the cause of urticaria was not determined. The infections of the respiratory tract were the most frequently suspected aetiological factor. The diagnosis of allergic urticaria is more defined, but belongs to a minority group (10.8%). The first level treatment includes the use of non-sedating oral H1-antihistamine.

CONCLUSION

The children with urticaria are frequently referred to the paediatric emergency room, but only in a few cases were associated with severe clinical manifestations or allergy. The evidence of an inverse relationship between the number of accesses and the patients' age may be explained by the higher prevalence of this disease in early childhood and possibly also by a higher concern of the parents of the younger patients.

[Regional programs and opportunities for the occupational health physician]

It is a well known fact that, in amending, Title V of the Italian Constitution, constitutional law no. 3/2001 inserted "Workplace health and safety" in paragraph 3 of article 117 as an issue assigned to the legal competence of regional governments. In this perspective, the role to be played by the regional governments, with due regard for the restrictions of national laws, is both broad and composite. Firstly, it is a active participatory role in the formulation of national legislation through the permanent conference for relations between central, regional and autonomous provincial governments. A second important level is adaptation, via the regional laws passed by the national parliament, to local economic and productive contexts. Thirdly, there is the planning and coordination, via the regional committees set up specifically for this purpose, of all health and safety measures.

Not all children with under-control asthma are controlled

Subclinical lung function alterations can sometimes be discovered in asthmatic patients under clinical control. This study aimed to identify the burden of asthmatic children with subclinical airways abnormalities who may benefit from an adjustment in asthma therapy. 134 6-to-17-year-old asthmatic children were enrolled. Of them, 98 presented apparently under clinical control disease and all performed spirometry before and after bronchodilation: 17 (17.3%) had a positive bronchodilation test, in addition to significantly lower lung function indexes as compared to those with under-control asthma who had a negative bronchodilation test. These patients were randomized and re-evaluated: patients (n=8) receiving an adjustment in their therapy showed an improvement in lung function tests and quality of life indexes as compared to 7 without therapy adjustment. In conclusion, a substantial number of apparently-under-control asthmatic children show airways alterations that can be improved by adjusting their therapy, which also seems to enhance their quality of life.

Engineering injured spinal cord with bone marrow-derived stem cells and hydrogel-based matrices: a glance at the state of the art

Concerning the broad topic of neural tissue engineering, we present a review relating to the state of the art in spinal cord injury repair strategies. Particular attention is given to spinal cord damage causes and effects, in neural and mesenchymal stem cell therapeutic approaches, in the use of hydrogels as cell carriers and in the mathematical modeling of involved phenomena. High importance is given to multidisciplinary strategies applied to spinal cord repair, since new research frontiers are believed to be now on 3D gel/cells and neuroprotective agent constructs for neural reconstruction purposes.

[Prevention in regional policy]

Prevention, safety and health promotion represent fondamental issues in the Regional policy. With this regard, the implementation of the Regional policy has been thought as the promotion of an integrated system which links different fields such as health, work-related information and education, job orientation and work in general. It is recommended that a good standard of prevention is achieved through the synergic actions and the collaborations among all the different actors playing a role in safety and prevention in workplace, including occupational physicians, safety and prevention operators, safety representatives for workers, trade unions, employers associations and public institutions. It is also necessary to adopt a strategy in order to decrease the number of misdiagnosed occupational diseases as well as to promote the "culture of safety in workplaces", increasing the awareness of all figures, with special focus on employers category. All this has to be set in the new scenario of the nowadays work characterized by the progressive increase of atypical job contracts, renewing the emphasis on the necessity of keeping joined "the right to a job with the right to health".

Point of view of Italian regions

The tragic chain of mortal events, that have happened to workers and people who have been exposed to asbestos, proposes clearly an accentuation of the efforts that have been undertaken up to now, even in absence of precise national directives, in order to give an answer to worries and, sometimes, to real consequences of citizens' and workers' asbestos exposure. Region of Tuscany, following the initiatives which have been carried out in national and regional field for the formerly asbestos-exposed or other carcinogenic agents workers, performed a guideline that was just titled "Guidelines on sanitary surveillance of formerly exposed to occupational carcinogens workers". The debate, which had risen around the sanitary surveillance of the formerly-exposed to occupational carcinogenic agents workers, had induced indeed many institutions to take decisions on issues which were not yet explicitly regulated by the national law. For example the guidelines provided suggestions regarding what bodies--either public or private--should be appointed to this task, or the kind of protocols should be adopted with all the related collective and individual consequences.

Two miniaturised TEPCS in a single detector for BNCT microdosimetry

Microdosimetry with tissue-equivalent proportional counters (TEPC) has proven to be an ideal dosimetry technique for mixed radiation fields as those ones used in boron neutron capture therapy (BNCT). A new counter, composed of two twin cylindrical mini TEPCs inserted in a slim titanium sleeve of 2.7 mm external diameter, has been constructed. The detector has been designed to perform dosimetry and microdosimetry in intense radiation fields. The two mini TEPCs work in gas flow mode. They have right cylinder sensitive volumes of 0.9 mm. In spite of gas line tiny sizes, the gas pressure inside the two counters is well established with <1% of uncertainty. The counter has been calibrated in a secondary standard photon fields. The mean of the effective sensitive volume sizes has been measured to be 0.86 mm. The twin TEPC acquisition system processes properly the signals up to about 30 kHz of counting rate. Therefore, twin TEPC can perform dosimetric measurements in photon field with intensities of some tens of Gy h(-1).

Secondary prevention of latex allergy in children: analysis of results

OBJECTIVE

Latex allergy has become an increasing and clinically important problem. Several recommendation for secondary preventive measures have been advised. The aims of the study were to illustrate the results of the latex-safe protocol and to evaluate in allergic patients the role of risk factors for the development of latex allergy.

METHODS

Latex-safe treatment was divided into the following phases: anamnestic identification, allergologic assessment, patient selection, intervention programme, preventive medication, operating room equipment, postoperative management, patient and family training, follow-up.

RESULTS

Between 1998 and 2004, 6.832 patients underwent 7.333 operations. Anamnestic and diagnostic tests showed that 26 patients had latex allergy. 44 secondary perioperative latex-safe management have been accomplished in 26 children. No allergic event or complications linked to the procedure occurred. Atopy, congenital malformations frequently associated with latex allergy and the presence of 5 or more surgical procedures were the major risk factors recognized. Six out of the 26 patients (23%) had only one risk factor (atopy). Twenty out of 26 children (77%) had several associated risk factors: 8 of them had simultaneously 9 of the 10 analysed risk factors. Our data shows that, the higher their number, the higher the gravity of the allergy.

CONCLUSIONS

Although latex allergy is a limited phenomenon, it is nevertheless quite frequent within risk groups. Most patients have simultaneously many risk factors for the development of such an allergy, and the occurrence of several risk factors increases severity of the allergy. Latex-safe perioperative management offers guarantees of safety against latex allergy phenomena.

Anticardiolipin antibodies in children with atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial etiology. Immunological abnormalities (cell-mediated immune hyperactivity, elevated IgE serum levels and eosinophil-derived mediators) have been observed. In a recent issue, Szakos et al. describe, in children with extrinsic type of AD, an association between the occurrence of anticardiolipin (ACL) IgM and specific IgE against mite, and also in relation to the severity of the disease. We studied 51 children (35 males and 16 females, mean age 44 months) with AD, whose diagnosis was made on the basis of Hanifin and Rajka's criteria. The evaluation of the severity of the disease was made using the SCORAD index. Eleven children had intrinsic type AD (group A); 40 children had extrinsic type AD, 14 of them had specific IgE only against food allergens (group B); 26 children had specific IgE also against inhalant allergens (group C). Twelve children without allergy were designated as the control group. Specific IgEs were determined using the CAP-System (Pharmacia, Uppsala, Sweden) for food and inhalant allergens. The measurement of ACL IgG and IgM was carried out by ELISA (Orgentec Diagnostika, Mainz, Germany). An increase in serum levels of ACL was observed in 13 children (25.5%): 1 child (9%) from group A, 7 children (50%) from group B and 5 children (19.2%) from group C with a statistically significant difference (P=0.038). Our study shows the presence of ACL-IgG above all in extrinsic AD, but no association was found between high levels of ACL and increased severity scoring of AD. Increased levels of ACL were observed in younger children (mean age 26.5 months; P=0.025) especially if sensitized against food allergens.

Precocious aging of the immune system in Down syndrome: alteration of B lymphocytes, T-lymphocyte subsets, and cells with natural killer markers

Phenotype and proliferative ability of peripheral blood lymphocytes from 15 noninstitutionalized children affected with Down Syndrome (DS), in apparently good health, were studied and compared with those of 16 healthy control children of the same age. A complex derangement of all the major peripheral blood cell subsets, i.e., B cells, T cells, and natural killer (NK) cells, was present in DS children. A significant decrease of the absolute number of circulating lymphocytes, a marked and significant decrease of B lymphocyte absolute number and percentage, and dramatic modifications of the T-cell subsets were observed. The absolute number of CD4+ cells was significantly decreased, whereas CD8+ cells increased significantly in percentage but not in absolute number. A derangement of cells bearing markers associated with NK activity, such as CD57, CD16, and CD56, was observed. Among the most important alterations, the presence of a high number of CD57+, CD16- cells, of CD57+, CD8+ lymphocytes, and of CD3+, CD56+ lymphocytes was seen. Many of these alterations are similar to those characteristic of chromosomally normal subjects of advanced age. The hypothesis that the reduced thymic endocrine activity and the zinc deficiency characteristic of DS are responsible for the derangement of T and NK subsets is discussed.

Relationship between Bet v 1 and Bet v 2 specific IgE and food allergy in children with grass pollen respiratory allergy

Grass allergy is the most common pollinosis in Northern Italy. Some patients with grass allergy show polysensitization against other pollens and plant-derived foods. In these patients oral allergic syndrome (OAS) is frequently associated. To evaluate the correlation between food allergy or food sensitization and specific IgE against panallergens such as Bet v 1 and Bet v 2, we studied 56 children (mean age: 8 years 5 months) suffering from respiratory allergy due to grass pollens were enrolled. Specific IgE against the most important food, inhalant allergen and Bet v 1, Bet v 2 were performed by ImmunoCAP technology (UniCAP 1000, Pharmacia Diagnostics, Uppsala, Sweden). We found 14 children (25%) sensitized to Bet v 1 and 13 (23%) to Bet v 2; in 24 cases (42.3%) a sensitization to at least one of the 2 panallergens was observed. Five of the 14 cases (36%) sensitized to Bet v 1 showed food allergy and 8 (57%) food sensitization; 6 (46%) of the 13 children sensitized to Bet v 2 showed food allergy and 7 (54%) food sensitization; only one case of Bet v 1 specific IgE without food allergy or sensitization was seen. Sixteen subjects (29%) showed food allergy (group A); 20 children (35.5%) multiple sensitizations to inhalant and at least one plant-derived food (group B); 20 subjects (35.5%) only inhalant allergens (group C). Sensitization to Bet v 1 (P<0.03) and Bet v 2 (P<0.009) is from a statistical point of view significantly higher in groups A and B than in group C. In the 16 patients with food allergy hazelnut was the major triggering food (50%), followed by peanut (38%), kiwi (31%), apple and walnut (19%). Specific IgE for Bet v 1 is more associated with nuts and legumes, while Bet v 2 is more related to fresh fruit and vegetables. In conclusion grass pollinosis is frequently associated with polysensitization to other pollen and food allergens. Bet v 1 and Bet v 2 specific IgE are significantly higher in these patients than in patients with grass monosensitization, and this sensitization may be considered a possible risk factors to evolve later into food allergy. Among the offending foods, legumes and the nut group are mostly related to Bet v 1, while vegetables and fresh fruits to Bet v 2.

[Laparoscopic cholecystectomy for acute cholecystitis: our experience]

Laparoscopic cholecystectomy (LC) is now the gold standard in the treatment of cholelithiasis. LC is safe even in patients with acute cholecystitis. In our 118 cases there was 4 major complications as bile duct injuries (3%) and 13 minor complications (11%); conversion rate was 21% (24 patients), without mortality. Our experience confirms the validity of early LC in the treatment of acute cholecystitis, but laparoscopic procedure is associated with higher conversion rate (21% versus 3%) and complication rates compared to the treatment in non-acute patients.

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis

BACKGROUND

In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors).

OBJECTIVES

To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk) in the treatment of young children affected by AD with acute lesions at the time of examination.

METHODS

Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination.

RESULTS

At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112).

CONCLUSIONS

The use of special silk clothes may be useful in the management of AD in children.