Renal involvement in COVID-19: focus on kidney transplant sector.

INTRODUCTION: Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. MATERIALS AND METHODS: The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. CONCLUSION: This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.

Systemic treatment of malignant gastrointestinal neuroectodermal tumour after childhood neuroblastoma: chemotherapy in malignant gastrointestinal neuroectodermal tumour.

Malignant gastrointestinal neuroectodermal tumour is an extremely rare neoplasm that arises in the wall of the small bowel, stomach or large bowel in young-aged and middle-aged adults. Histologically, it is generally characterized by monomorphic cells with clear cytoplasma, S-100 protein expression, and EWSR1 gene translocation. To the best of our knowledge, we describe for the first time, the case of a young woman with a diagnosis of metastatic gastrointestinal neuroectodermal tumour arising from ileum, who had a childhood adrenal neuroblastoma with liver, bone and lymph nodes metastasis, treated with four cycles of chemotherapy with the schedule CADO-CVP (CADO: cyclophosphamide 300 mg/m/day on days 1-5, vincristine 1,5 mg/m/day on days 1 and 5, and doxorubicin 60 mg/m/day on day 5; CVP: cisplatin 40 mg/m/day on days 1-5 and etoposide 100 mg/m/day on days 1-5) followed by right adrenal, kidney, lymph nodes and liver lesion resection, conditioning chemotherapy (melphalan-carmustine-teniposide), stem cells autologous transplantation and consecutively radiotherapy on the spine (T9 to L3) for a total of 30 Gy. For the second diagnosis of gastrointestinal neuroectodermal tumour with liver metastasis, she underwent ileal tumour resection and platinum-anthracycline based chemotherapy with initial shrinkage of liver metastasis. Unfortunately, despite the initial response and the following delivered therapies, she died for rapid progressive disease. Taking into account the late effects of past therapeutic modalities, a long-term surveillance of young child treated for neuroblastoma, is required to appreciate their overall risks of second malignancies.

Can only histological evaluation determine the allocation of ECD kidneys?

INTRODUCTION: There is a recent debate on the "transplantability" of ECD (Expanded Criteria Donors) kidneys and the selection criteria used to allocate them to single or double transplantation. Remuzzi et al. have defined a protocol incorporating pre-transplant donor biopsy to guide the use of older donor organs. They allocated organs as single or double transplants on the basis of histological findings. We aim to show the pros and cons of the only histological evaluation in the allocation of ECD kidneys, to compare the different experiences in United States and Europe and thus to discuss whether this tool should be used alone or included in a comprehensive clinical and histopathological evaluation. DISCUSSION: In the United States many Authors stated that the biopsy actually increases the percentage of kidney discarded and they raised questions about the importance of the biopsy in evaluating ECD kidneys for transplantation. On the other hand, the experiences of the majority of european transplant centers showed that allocating kidneys as single or dual transplant based on biopsy findings may achieve good graft and patient outcomes. Moreover, the experience of some centers as ours showed that kidneys allocated as DKT (Dual Kidney Transplant) on the basis of Remuzzi's score could have been suitable for single transplantation suggesting the need of an adjustment of the Remuzzi Score System. Many Authors, who are in favor of histological evaluation, actually believe that a comprehensive clinical and histopathological assessment before transplantation remains necessary. We lack precise national- or international-based selection criteria to guide clinicians. An adjustment of the Remuzzi Score System could be taken into consideration such as narrowing the indication for DKT from those ECD kidneys with higher scores and including the histological evaluation in a multifactor score.

Ozonated Sunflower Oil Embedded within Spray-Dried Chitosan Microspheres Cross-Linked with Azelaic Acid as a Multicomponent Solid Form for Broad-Spectrum and Long-Lasting Antimicrobial Activity.

Multicomponent solid forms for the combined delivery of antimicrobials can improve formulation performance, especially for poorly soluble drugs, by enabling the modified release of the active ingredients to better meet therapeutic needs. Chitosan microspheres incorporating ozonated sunflower oil were prepared by a spray-drying method and using azelaic acid as a biocompatible cross-linker to improve the long time frame. Two methods were used to incorporate ozonated oil into microspheres during the atomization process: one based on the use of a surfactant to emulsify the oil and another using mesoporous silica as an oil absorbent. The encapsulation efficiency of the ozonated oil was evaluated by measuring the peroxide value in the microspheres, which showed an efficiency of 75.5-82.1%. The morphological aspects; particle size distribution; zeta potential; swelling; degradation time; and thermal, crystallographic and spectroscopic properties of the microspheres were analyzed. Azelaic acid release and peroxide formation over time were followed in in vitro analyses, which showed that ozonated oil embedded within chitosan microspheres cross-linked with azelaic acid is a valid system to obtain a sustained release of antimicrobials. In vitro tests showed that the microspheres exhibit synergistic antimicrobial activity against P. aeruginosa, E. coli, S. aureus, C. albicans and A. brasiliensis. This makes them ideal for use in the development of biomedical devices that require broad-spectrum and prolonged antimicrobial activity.

R0 surgical resection of giant dedifferentiated retroperitoneal liposarcomas in the COVID era with and without nephrectomy: A case report.

Retroperitoneal sarcomas (RPSs) are rare findings that can grow into large masses without eliciting severe symptoms. At present, surgical resection is the only radical therapy, whenever it can be performed with the aim to achieve a complete removal of the tumor. The present report describes two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPSs) and these patients underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic and the latest literature on the topic are discussed and analyzed. The patients, who refused to undergo any medical examination during the prior 2 years due to the COVID pandemic, were admitted to Federico II University Hospital (Naples, Italy) complaining about weight loss and general abdominal discomfort. In the first case, a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney was observed. The second patient had a similar primitive retroperitoneal giant left neoplasm, which did not affect the kidney. Given the characteristics of the masses and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and markedly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, due to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS and both patients benefited from adjuvant chemotherapy. In conclusion, the treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of excision or reconstruction of major organs (including the kidney) could lead to an easier postoperative course and an improved prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. Since the COVID pandemic caused limited medicalization of a number of population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.

The temporal correlation between positive testing and death in Italy: from the first phase to the later evolution of the COVID-19 pandemic.

BACKGROUND AND AIM: After the global spread of the novel coronavirus disease 2019 (COVID-19), research has concentrated its efforts on several aspects of the epidemiological burden of pandemic. In this frame, the presented study follows a previous analysis of the temporal link between cases and deaths during the first epidemic wave (Phase 1) in Italy (March-June 2020). METHODS: We here analyze the COVID-19 epidemic in the time span from March 2020 to June 2021. RESULTS: The elaboration of the curves of cases and deaths allows identifying the temporal shift between the positive testing and the fatal event, which corresponds to one week from W2 to W33, two weeks from W34 to W41, and three weeks from W42 to W67. Based on this finding, we calculate the Weekly Lethality Rate (WLR). The WLR was grossly overestimated (~13.5%) in Phase 1, while a mean value of 2.6% was observed in most of Phase 2 (starting from October 2020), with a drop to 1.4% in the last investigated weeks. CONCLUSIONS: Overall, these findings offer an interesting insight into the magnitude and time evolution of the lethality burden attributable to COVID-19 during the entire pandemic period in Italy. In particular, the analysis highlighted the impact of the effectiveness of public health and social measures, of changes in disease management, and of preventive strategies over time.  (www.actabiomedica.it).

Analysis of the time evolution of COVID-19 lethality during the first epidemic wave in Italy.

BACKGROUND AND AIM: While the entire world is still experiencing the dramatic emergency due to SARS-CoV-2, Italy has a prominent position since it has been the locus of the first major outbreak among Western countries. The aim of this study is the evaluation of temporal connection between SARS-CoV-2 positive tests (cases) and deaths in Italy in the first wave of the epidemic. METHODS: A temporal link between cases and deaths was determined by comparing their daily/weekly trends using surveillance data of the period March 2-June 2020. RESULTS: The monitoring of the cases/deaths evolution during the first wave of the outbreak highlights a striking correlation between infections of a certain week and deaths of the following one. We defined a weekly lethality rate that is virtually unchanged over the entire months of April and May until the first week of June (≈13.6%). Due to the rather low number of cases/deaths, this parameter starts to fluctuate in the following three weeks. CONCLUSIONS: The analysis indicates that the weekly lethality rate is virtually unchanged over the entire first wave of the epidemic, despite the progressive increase of the testing. As observed for the overall lethality, this parameter uniformly presents rather high values. The definition of a temporal link between cases and deaths will likely represent a useful tool for highlighting analogies and differences between the first and the second wave of the pandemic and for evaluating the effectiveness, even if partial, of the strategies applied during the ongoing outbreak. (www.actabiomedica.it).

[Expression of Lewis carbohydrate antigen in human tumors]. / Espressione dell'antigene carboidratico Lewis nei tumori umani.

In this study we show, by immunoblotting, that Mab B3, a newly isolated monoclonal antibody, reacts with a variety of glycoproteins with different molecular weights expressed in gastric, pancreatic and colorectal cancers. The reactivity pattern differed in cancers arising in different tissues, though no correlation was observed with the histopathological characteristics of the lesions analysed. MAb B3 does not react with liver, brain or kidney cancers and has a limited reactivity with lung cancers but reacts very strongly with metastatic lesions. Because of the limited reactivity of this antibody with normal tissues, MAb B3 genetically fused with toxin in the form of a recombinant immunotoxin may be useful in treating certain kinds of cancer such as metastatic lesions. However, until current trials are completed, we will not know whether this immunotoxin will be helpful in cancer treatment.