Role of gremlin-1 in the pathophysiology of the adipose tissues.

Gremlin-1 is a secreted bone morphogenetic protein (BMP) antagonist playing a pivotal role in the regulation of tissue formation and embryonic development. Since its first identification in 1997, gremlin-1 has been shown to be a multifunctional factor involved in wound healing, inflammation, cancer and tissue fibrosis. Among others, the activity of gremlin-1 is mediated by its interaction with BMPs or with membrane receptors such as the vascular endothelial growth factor receptor 2 (VEGFR2) or heparan sulfate proteoglycans (HSPGs). Growing evidence has highlighted a central role of gremlin-1 in the homeostasis of the adipose tissue (AT). Of note, gremlin-1 is involved in AT dysfunction during type 2 diabetes, obesity and non-alcoholic fatty liver disease (NAFLD) metabolic disorders. In this review we discuss recent findings on gremlin-1 involvement in AT biology, with particular attention to its role in metabolic diseases, to highlight its potential as a prognostic marker and therapeutic target.

Percutaneous lung biopsies: performance of an optical CT-based navigation system with a low-dose protocol.

OBJECTIVES: To compare patients' radiation exposure, technical feasibility, imaging quality and complication rate of percutaneous lung biopsies (PLBs) performed with a low-dose (LD) CT protocol under guidance of an optical navigation system. METHODS: Fifty-two consecutive patients with suspected malignant lung lesions were enrolled and randomised into group 1 (PLBs under the guidance of the navigation system) and group 2 (PLBs under the guidance navigation system with an LD protocol). Patients' demographics, lesion features, procedure-related variables and CT image quality for group 2 were recorded and compared. RESULTS: Technical success was 100 % in both groups. The radiation dose to patients' chest was significantly lower in group 2 than in group 1 (group 1: mean TDLP 206 ± 59 mGy·cm, ~ 3.5 ± 1.0 mSv; group 2: 54.2 ± 46.2 mGy·cm, ~ 0.92 ± 0.78 mSv; P < 0.0001). The PNX rate was 12 % in group 1 and 11.1 % in group 2. The haemoptysis rate was 8.0 % in group 1 and 3.7 % in group 2. CT image quality obtained in group 2 was always rated as adequate and as excellent in 15 cases (56.0 %). CONCLUSIONS: An optical navigation system with LD CT protocol is useful for performing lung biopsies with decreased patient radiation exposure. KEY POINTS: • Navigation systems are useful tools in percutaneous imaging-guided procedures. • For lung biopsies, low-dose (LD) CT protocols may be used. • Combining LD protocols with optical CT navigation results in significantly reduced radiation exposure.

Percutaneous computed tomography-guided lung biopsies: preliminary results using an augmented reality navigation system.

AIMS AND BACKGROUND: "Augmented reality" is a technique to create a composite view by augmenting the real intervention field, visualized by the doctor, with additional information coming from a virtual volume generated using computed tomography (CT), magnetic resonance or ultrasound images previously acquired from the same patient. In the present study we verified the accuracy and validated the clinical use of an augmented reality navigation system produced to perform percutaneous CT-guided lung biopsies. METHODS: One hundred and eighty consecutive patients with solitary parenchymal lung lesions, enrolled using a nonrandom enrollment system, underwent percutaneous CT-guided aspiration and core biopsy using a traditional technique (group C, 90 patients) and navigation system assistance (group S, 90 patients). For each patient we recorded the largest lesion diameter, procedure time, overall number of CT scans, radiation dose, and complications. The entire experimental project was evaluated and approved by the local institutional review board (ethics committee). RESULTS: Each procedure was concluded successfully and a pathological diagnosis was reached in 96% of cases in group S and 90% of cases in group C. Procedure time, overall number of CT scans and incident x-ray radiation dose (CTDIvol) were significantly reduced in navigation system-assisted procedures (P <0.001; z = 5.64) compared with traditional CT-guided procedures. The percentage of procedural complications was 14% in group S and 17% in group C. CONCLUSION: The augmented reality navigation system used in this study was a highly safe, technically reliable and effective support tool in percutaneous CT-guided lung biopsy, allowing to shorten the procedure time and reduce the incident x-ray radiation dose to patients and the rate of insufficient specimens. Furthermore, it has the potential to increase the number of procedures executed in the allocated time without increasing the number of complications.

Neuroendocrine tumor presenting like lymphoma: a case report.

INTRODUCTION: Neuroendocrine tumors are a rare but diverse group of malignancies that arise in a wide range of organ systems, including the mediastinum. Differential diagnosis includes other masses arising in the middle mediastinum such as lymphoma, pericardial, bronchogenic and enteric cysts, metastatic tumors, xanthogranuloma, systemic granuloma, diaphragmatic hernia, meningocele and paravertebral abscess. CASE PRESENTATION: We present a case of 42-year-old Caucasian man with a neuroendocrine tumor of the middle-posterior mediastinum and liver metastases, which resembled a lymphoma on magnetic resonance imaging. CONCLUSION: The differential diagnosis in patients with mediastinal masses and liver lesions should include neuroendocrine tumor.

High prevalence of a screening-detected, HFE-unrelated, mild idiopathic iron overload in Northern Italy.

BACKGROUND AND OBJECTIVES: In Italy, typical HFE mutations account for only 64% of the cases with overt hereditary hemochromatosis (HH), and a common HFE-unrelated disease was hypothesized. DESIGN AND METHODS: One thousand and fifty potential blood donors were screened by iron tests, C282Y and H63D HFE mutation analysis in a region in North Italy. Subjects with repeated fasting transferrin saturation of 45% or more and no secondary iron overload were defined as probands with idiopathic iron overload. To assess the inheritance of iron overload, relatives of probands were screened. RESULTS: The overall frequency of probands with idiopathic iron overload was 3.43% (95% confidence interval, 2.32 to 4.52). Of these, 8.4% had genotypes associated with HH (compound heterozygous for H63D/C282Y or homozygous for H63D HFE mutations), and 91.6% had atypical genotypes: 47.2% were heterozygous for C282Y or H63D HFE mutations, and 44.4% had wild type/wild type genotype. A family history of iron overload was proven in 33.3% of probands with atypical genotypes (1.04% of the overall population). Pedigree analysis excluded linkage of heterozygous HFE mutations with iron overload (cumulative lod score 2.41) and documented a recessive non-HLA-linked locus accounting for iron overload in wild type/wild type genotypes. None of the probands had clinical signs of iron accumulation; in males, serum ferritin positively correlated with age (r=0.63, p<0.01), and the regression model predicted a serum ferritin of 700 ng/mL at the age of 58. INTERPRETATION AND CONCLUSIONS: In Northern Italy an HFE-unrelated, mild idiopathic iron overload is highly prevalent. A recessive locus accounts for iron overload in at least 1.04% of the overall population.

Bioética y derecho / Bioethics and law

Este texto propone una serie de observaciones y argumentos que permiten situar adecuadamente el desafíoplanteado por la bioética al derecho. El modelo de Kelsen, consistente en identificar los desafíos de la bioética como simples problemas de contenido de normas, es postulado como limitado y reduccionista respecto de las temáticas substanciales que la bioética plantea. El camino propuesto por el autor para evitar convertir la ciencia jurídica en una simple técnica, consistiría en lograr que aquella reasuma su específica validez antropológica, lo que la alejaría de toda tentación de estéril formalismo, obligándola a trabajar en la perspectiva de las estructuras que caracterizan el ser delhombre, dado que la bioética plantea problemas antropológicos generales, esto es, de estructura.