Improvement of Symptoms in Patients Affected by Chronic Atrophic Gastritis Using L-Cysteine (Acetium®).

BACKGROUND: Chronic atrophic gastritis (CAG) alone is a precancerous condition for gastric cancer. Achlorhydria plays an important role in the formation of a class I carcinogen, acetaldehyde. L-cysteine has been claimed to bind acetaldehyde covalently. Symptoms are present in 55% of CAG patients, of whom 70% have upper gastrointestinal complaints. The aim of this study was to investigate the properties of L-cysteine in the modification of symptom patterns in CAG patients. METHODS: Consecutive patients with histological diagnosis of CAG (OLGA ≥1 with gastric corpus involvement) were evaluated with serological determination of gastric function, clinical assessment of symptoms using the visual analog score (VAS) and the global symptomatic score (GSS), and considered for therapy with L-cysteine, 300 mg daily. Data regarding symptoms were collected at enrollment and after 3, 6, 12, 18, and 24 months, with an ultimate follow-up of 2 years. RESULTS: A total of 330 patients with CAG were divided in group 1 (77 patients treated with L-cysteine) and group 2 (50 patients who received no specific treatment - control group). A statistically significant improvement in the VAS score (7.8 at baseline vs. 4.5 after 24 months; p < 0.01) was observed in patients treated with L-cysteine, while no significant changes in symptom pattern/intensity were recorded in the 2-year follow-up of untreated patients with CAG. CONCLUSIONS: Long-term treatment with L-cysteine provides symptom improvement in CAG patients and might be proposed as maintenance therapy in such patients.

Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program.

BACKGROUND AND AIMS: Linked-color imaging (LCI), a new image-enhancing technology emphasizing contrast in mucosal color, has been demonstrated to substantially reduce polyp miss rate as compared with standard white-light imaging (WLI) in tandem colonoscopy studies. Whether LCI increases adenoma detection rate (ADR) remains unclear. METHODS: Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WLI, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR. RESULTS: Of 704 eligible subjects, 649 were included (48.9% men, mean age ± standard deviation, 60.8 ± 7.3 years) and randomized to LCI (n = 326) or WLI (n = 323) colonoscopy. The ADR was higher in the LCI group (51.8%) than in the WLI group (43.7%) (relative risk, 1.19; 95% confidence interval, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions were, respectively, 21.2% and 8.6% in the LCI arm and 18.9% and 5.9% in the WLI arm (not significant for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age, and adequate (Boston Bowel Preparation Scale score ≥6) bowel preparation. At per-polyp analysis, the mean ± standard deviation number of adenomas per colonoscopy was comparable in the LCI and WLI arms, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (.72 ± 1.2 vs .55 ± 1.07, P = .05) CONCLUSIONS: In FIT-positive patients undergoing screening colonoscopy, the routine use of LCI significantly increased the ADR. (Clinical trial registration number: NCT03690297.).

New bismuth-containing quadruple therapy in patients infected with Helicobacter pylori: A first Italian experience in clinical practice.

BACKGROUND: Rising antibiotic resistance requires the evaluation of new and effective therapies. AIMS: To test the efficacy and safety of the new bismuth-containing quadruple therapy in patients infected with Helicobacter pylori. MATERIAL AND METHODS: Consecutive H. pylori-positive dyspeptic patients were enrolled, either naïve or with previous failure treatment. Patients were treated with Pylera® (three-in-one capsules containing bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg) three capsules q.i.d. plus omeprazole 20 mg or esomeprazole 40 mg b.i.d. for 10 days. Eradication was confirmed using an urea breath test (at least 30 days after the end of treatment). Efficacy was assessed by UBT and safety by means of treatment-emergent adverse events. RESULTS: One hundred and thirty-one patients were included in the study: 42% of patients were naïve, and 58%, with previous failure treatment. H. pylori eradication was achieved in 124 patients (94.7%, 95% confidence intervals (CIs) 89.3-97.8) in ITT population. In the PP population, the percentage was 97.6% (95%, CIs 93.3-99.2). No difference in eradication rate was found either between naïve and previously treated patients (92.7% vs 96.0%, P=.383), or smoking and nonsmoking ones, or in patients taking omeprazole or esomeprazole. Treatment-emergent adverse events occurred in 35 patients (26.7%, 95% CIs 19.9-34.9). They were mild in all cases except in four, who discontinued the study due to diarrhea (three patients) and diffuse urticarial rush (one patient). CONCLUSIONS: Pylera® achieved a remarkable eradication rate in clinical practice, irrespective if it was used as first treatment or as a rescue therapy. Treatment-emergent adverse events were uncommon generally mild.

A Primary-Care Interventional Model on the Diverticular Disease: Searching for the Optimal Therapeutic Schedule.

INTRODUCTION: In routine colonoscopy, diverticulosis is the most commonly found feature, but only a minority of these cases show symptoms of diverticular disease.From June 2014 to December 2014, we enrolled prospectively 178 patients affected by symptomatic uncomplicated diverticular disease (Male/Female=0.47, mean age 71.7±11.5 y, range 41 to 95 y) from 15 General Pratictioners patient files. All patients were symptomatic; in all cases, diagnosis was been confirmed by a colonoscopy performed at least 1 year before. Patients with acute diverticulitis were excluded.On the basis of the predominant symptoms (abdominal complaints or constipation), patients were addressed to 4 different therapeutic approaches using mesalamine, rifaximine, probiotics (in a consortium of different species of Lactobacillus and Bifidobacterium), and fibers (Plantago Ovata Husk). All treatments lasted 3 months. RESULTS: Sixty-three patients were enrolled in group A (rifaximine), 43 in group A1 (rifaximine+fibers+probiotics), 23 in group B (mesalamine), and 31 in group B1 (mesalamine+fibers).Analysis of variance suggested a statistically significant difference (P<0.003) among groups at the end of the observation period, with Groups A1 and B1 showing a higher number of bowel movement per week. Global linear measurement confirmed the role of treatment as a significant factor (F=2.858; P=0.039) associated with body mass index (F=6.972; P<0.009). CONCLUSIONS: In accordance with the baseline clinical presentation, the supplementation of fiber and/or probiotics is associated with a statistically significant improvement in the clinical pattern of symptoms in patients with diverticular disease in a primary-care/family physician setting.

Interplay of Quantum Confinement and Strain Effects in Type I to Type II Transition in GeSi Core-Shell Nanocrystals.

The electronic properties of hydrogenated, spherical SiGe and GeSi core-shell nanocrystals, with a diameter ranging from 1.8 to 4.0 nm, are studied within density functional theory. Effects induced by quantum confinement and strain on the near-band-edge state localization, as well as the band-offset properties between Si and Ge regions, are investigated in detail. On the one hand, we prove that SiGe core-shell nanocrystals always show a type II band-offset alignment, with the HOMO mainly localized on the Ge shell region and the LUMO mainly localized on the Si core region. On the other hand, our results point out that a type II offset cannot be observed in small (diameter less than 3 nm) GeSi core-shell nanocrystals. In these systems, quantum confinement and strain drive the near-band-edge states to be mainly localized on Ge atoms, i.e., in the core region. In larger GeSi core-shell nanocrystals, instead, the formation of a type II offset can be engineered by playing with both core and shell thickness. The factors which determine the band-offset character at the Ge/Si interface are discussed in detail.

Evolution of the Electronic and Optical Properties of Meta-Stable Allotropic Forms of 2D Tellurium for Increasing Number of Layers.

In this work, ab initio Density Functional Theory calculations are performed to investigate the evolution of the electronic and optical properties of 2D Tellurium-called Tellurene-for three different allotropic forms (α-, ß- and γ-phase), as a function of the number of layers. We estimate the exciton binding energies and radii of the studied systems, using a 2D analytical model. Our results point out that these quantities are strongly dependent on the allotropic form, as well as on the number of layers. Remarkably, we show that the adopted method is suitable for reliably predicting, also in the case of Tellurene, the exciton binding energy, without the need of computationally demanding calculations, possibly suggesting interesting insights into the features of the system. Finally, we inspect the nature of the mechanisms ruling the interaction of neighbouring Tellurium atoms helical chains (characteristic of the bulk and α-phase crystal structures). We show that the interaction between helical chains is strong and cannot be explained by solely considering the van der Waals interaction.

Fusion radiology in interventional endoscopy (FRIend): a new approach for pancreatic fluid collections.

Background and study aims Fusion imaging consists of overlaying preoperative imaging over live fluoroscopy, providing an augmented live guidance. Since 2017, we have been using a new hybrid operating room (Discovery IGS 740 OR, GE Healthcare) for biliopancreatic endoscopy, combining fusion imaging with traditional endoscopic ultrasound (EUS). This study aimed to assess the advantages that fusion imaging could bring to EUS-guided drainage of post-pancreatitis fluid collections. Patients and methods Thirty-five drainage procedures performed between 2012 and 2019 with traditional guidance and fusion imaging were retrospectively compared, assessing the overall treatment success rate - i. e. symptom improvement with complete PFC emptying - as a primary outcome. Secondary outcomes included technical success rate, time to resolution, hospital stay length, adverse events, recurrence rate, and procedure time. Results Patients treated with standard EUS (n = 17) and with fusion imaging (n = 18) were homogeneous in age, gender, pancreatitis etiology, and indication for drainage; the second group had larger PFCs, more frequently walled-off necrosis than pseudocysts, and were treated more emergently, indicating higher case complexity in this group. During the period when fusion imaging was adopted, procedures had a higher overall treatment success rate than during the period when standard EUS was adopted (83.3 % vs. 52.9 %, P  = 0.075), and complete emptying was reached in less time (61.1 % vs. 23.6 % complete emptying within 90 days, P  = 0.154), differences compatible with random fluctuations. Conclusions This study suggests that fusion imaging in combination with EUS might improve clinical and procedural outcomes of PFC drainage.

Recovery of gastric function in patients affected by chronic atrophic gastritis using l-cysteine (Acetium®): one year survey in comparison with a control group.

BACKGROUND AND AIM: Chronic Atrophic Gastritis (CAG) is a precancerous condition for gastric cancer (GC) as single risk factor, being a consequence of a previous Helicobacter pylori (Hp) infection or based on autoimmune mechanisms. Achlorhydria plays an important role towards the formation of a class I carcinogen, acetaldehyde, after food intake. L-cysteine has been claimed to be able to bind in a covalent way acetaldehyde when administered at means. METHODS: In this study we enrolled two CAG groups of patients, one treated whit 300 mg/daily of L-cysteine for one year, the other one untreated. We assessed gastric function lasting the one year follow-up by using non invasive surrogates, i.e. Pepsinogen I (PGI) and gastrin 17 (G17). RESULTS: In the group of 77 CAG on therapy we found a statistically significative increase in PGI values and a decrease in G17 levels, in comparison with unchanged values in control group. CONCLUSIONS: L-cysteine seems able to provide a recovery in gastric function when administered in CAG patients and could be proposed as a possible therapy in such patients.

Player Session Rating of Perceived Exertion: A More Valid Tool Than Coaches' Ratings to Monitor Internal Training Load in Elite Youth Female Basketball.

PURPOSE: To monitor elite youth female basketball training to verify whether players' and coaches' (3 technical coaches and 1 physical trainer) session rating of perceived exertion (s-RPE) has a relationship with Edwards' method. METHODS: Heart rate of 15 elite youth female basketball players (age 16.7 [0.5] y, height 178 [9] cm, body mass 72 [9] kg, body mass index 22.9 [2.2] kg·m-2) was monitored during 19 team (268 individual) training sessions (102 [15] min). Mixed effect models were applied to evaluate whether s-RPE values were significantly (P ≤ .05) related to Edwards' data, total session duration, maximal intensity (session duration at 90-100% HRmax), type of training (ie, strength, conditioning, and technique), and whether differences emerged between players' and coaches' s-RPE values. RESULTS: The results showed that there is a relationship between s-RPE and Edwards' methods for the players' RPE scores (P = .019) but not for those of the trainers. In addition, as expected, both players' (P = .014) and coaches' (P = .002) s-RPE scores were influenced by total session duration but not by maximal intensity and type of training. In addition, players' and coaches' s-RPE values differed (P < .001)-post hoc differences emerged for conditioning (P = .01) and technique (P < .001) sessions. CONCLUSIONS: Elite youth female basketball players are better able to quantify the internal training load of their sessions than their coaches, strengthening the validity of s-RPE as a tool to monitor training in team sports.

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction after failed ERCP in low performance status patients.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) with the placement of a biliary stent is the treatment of choice for palliation of malignant obstructive jaundice. In 5-10% of cases ERCP fails. In these cases an effective alternative is endoscopic ultrasonography-guided biliary drainage (EUS-BD). AIM: Evaluation of the principal clinical outcomes of direct transluminal EUS-BD. PATIENTS AND METHODS: This study is a retrospective analysis. All consecutive patients with malignant obstructive jaundice, in whom ERCP had failed, were enrolled. The primary outcome was the technical success of EUS-BD defined as the correct placement of the metal or plastic stent across the stomach or duodenum to the biliary tree. The most important secondary outcomes were early and late clinical success, both linked to the decrease of bilirubin haematic level. RESULTS: Between January 2011 and November 2017 thirty-six patients were included. Technical success was obtained in 91.6%. A clinical success, early or late was obtained in 75.8%. The ECOG performance status of less than 3 was correlated with clinical success. Adverse events occurred in 30.3% of patients. CONCLUSIONS: EUS-BD is an effective and safe procedure.

Use, effectiveness and tolerability of budesonide-MMX in ulcerative colitis: A real-life experience.

Background: Budesonide-MMX has an established role in the management of relapsing mild-to-moderate ulcerative colitis. Data regarding effectiveness and tolerability in real-life clinical practice are limited. Aim: The aim of this study was to assess the use of budesonide-MMX in ulcerative colitis, as well as short-term effectiveness and tolerability in real-life practice. Methods: We conducted a retrospective study of adult patients with mild-to-moderate ulcerative colitis treated with budesonide-MMX at four tertiary inflammatory bowel disease centres in Italy from June 2016 to February 2018. Demographic and clinical features of patients, the use of budesonide-MMX, disease course and concomitant therapy were recorded. The primary outcome assessed was clinical remission at 2 months. Results: A total of 82 patients with active mild-to-moderate ulcerative colitis were included in the study with a mean age of 45.9 years and a median partial Mayo Score of 4 (interquartile range 3-5). A total of 41 patients were male. Overall, 36 had extensive colitis, 38 left-sided colitis and eight proctitis. Treatments at the time of inclusion included 10 patients receiving biologic therapy, seven azathioprine and 54 mesalazine or salazopyrin. The main reasons for the addition of budesonide-MMX were clinical relapse (47.5%) or inadequate response to current therapy (39.0%). In total, 50% of patients achieved clinical remission, whereas 9.8% had clinical improvement. No response was noted in 40.2% of subjects. Using multivariate binary logistic regression, a moderate degree of activity was the main independent predictor of non-response. Eight significant adverse effects were reported in six patients with three discontinuing treatment. Conclusion: In real-life clinical practice, budesonide-MMX is commonly used in combination with other therapies, both for acute disease flares and for partial response to therapy.

Does infliximab short infusion have a beneficial impact on the quality of life in patients with inflammatory bowel diseases? A single centre prospective evaluation.

BACKGROUND & AIMS: Infliximab (IFX) is an anti-tumor necrosis factor alpha agent used in inflammatory bowel diseases (IBD) therapy. Usually, it is administered over a 2-hour intravenous infusion. However, shortening the infusion duration to 1 hour has proved to be feasible and safe. In the present study we evaluated whether shortening the IFX infusion could affect the patients' quality of life (QoL) compared to the standard protocol. METHODS: Subjects affected by IBD receiving IFX were prospectively recruited. The main criterion to shorten the infusion was the absence of IFX-related adverse reactions during the previous three 2-h infusions. For each patient, demographic, clinical and anthropometric data were collected. A questionnaire investigating their overall/job/social/sexual QoL was administered. Ordinal regression was performed with odds ratios (OR) for significant independent variables. RESULTS: Eighty-one patients were included (46 with ulcerative colitis - UC, 35 with Crohn's disease - CD). Sixteen received the 2-h infusion due to previous adverse reactions, and the remaining 65 underwent the 1-h schedule. Shortening the infusion to 1 hour determined a better QoL (OR=0.626). However, the QoL was negatively influenced by age (OR=1.023), female sex (OR=2.04) and severe disease activity (OR=7.242). One-hour IFX infusion induced a better outcome on work (OR=0.588) and social (OR=0.643) QoL. Long-standing disease was correlated with a slightly better sexual QoL (OR=0.93). Conversely, older age (OR=1.046), severe clinical score (OR=15.579), use of other immunomodulators (OR=3.693) and perianal CD (OR=3.265) were related to an unsatisfactory sexual life. The total number of infusions (OR=0.891), proctitis (OR=0.062) or pancolitis (OR=0.1) minimized the perception of infusion-related side effects. CONCLUSION: The 1-h short infusion improves overall, social and job QoL, so that, when indicated, it should be recommended.

Infestação por Lynxacarus radovskyi em cães e gatos domésticos na cidade de Niterói (RJ): relato de caso

O Lynxacarus radovskyi é um ácaro da pele do gato que se alimenta da superfície do pêlo. O potencial das manifestaçõesclínicas é proporcional ao número de ácaros fixados no animal e a duração da infestação. Com o objetivo de pesquisar apresença de ectoparasitos em 10 felinos que apresentavam pontos avermelhados nos pêlos foi realizado o tricograma eobservou-se a presença de ovos e exemplares adultos de L. radovskyi aderidos aos pêlos dos animais. Observou-se, ainda,que um canino, macho e adulto, que convivia com estes felinos, também estava parasitado por estes artrópodes, emboraapresentando menor grau de infestação. Em cães, não existem relatos deste parasito na literatura mundial. Concluiu-se que,devido ao pequeno tamanho do parasito e as dificuldades no diagnóstico, é necessário um estudo amplo que avalie aocorrência deste parasito e suas implicações na sanidade dos felinos.

Infestação por Lynxacarus radovskyi em cães e gatos domésticos na cidade de Niterói (RJ): relato de caso / Lynxacarus radovsky infestation in domestic dogs and cats in Niterói city: case reported

O Lynxacarus radovskyi é um ácaro da pele do gato que se alimenta da superfície do pêlo. O potencial das manifestações clínicas é proporcional ao número de ácaros fixados no animal e a duração da infestação. Com o objetivo de pesquisar a presença de ectoparasitos em 10 felinos que apresentavam pontos avermelhados nos pêlos foi realizado o tricograma e observou-se a presença de ovos e exemplares adultos de L. radovskyi aderidos aos pêlos dos animais. Observou-se, ainda, que um canino, macho e adulto, que convivia com estes felinos, também estava parasitado por estes artrópodes, embora apresentando menor grau de infestação. Em cães, não existem relatos deste parasito na literatura mundial. Concluiu-se que, devido ao pequeno tamanho do parasito e as dificuldades no diagnóstico, é necessário um estudo amplo que avalie a ocorrência deste parasito e suas implicações na sanidade dos felinos