The potential therapeutic role of Hericium erinaceus extract in pathologic conditions involving the urogenital-gut axis: insights into the involved mechanisms and mediators.

In this review we focused on the putative therapeutic effect of Hericium erinaceus extract in the treatment of pathologic conditions of the lower urinary tract in which intestinal inflammation may play a role. To this aim we reviewed the available evidence on pelvic cross-organ sensitization as a possible mechanism through which intestinal inflammation and dysbiosis may affect the lower urinary tract. Also, we reviewed the clinical and experimental evidence supporting the role of Hericium erinaceus extract as an anti-inflammatory agent highlighting the role of a number of putative mediators and mechanisms which might make this nutraceutical suitable for the management of 'difficult to treat' lower urinary tract disorders.

Semen quality and metabolic profile in people with type 1 diabetes with and without erectile dysfunction: a cross-sectional study.

PURPOSE: The aim of the present study is to evaluate the association of metabolic and glycemic variables with semen parameters in patients with type 1 diabetes (T1D) with and without erectile dysfunction (ED). METHODS: The study population included 88 adults with T1D using a continuous glucose monitoring, of whom 28 with ED (ED group) and 60 without it (NO ED group). All men completed the International Index of Erectile Function (IIEF-5) and underwent body composition analysis (BIA) and semen analysis. RESULTS: ED group showed worse HbA1c levels [median (IQR), 8.4 (7.7, 9.9) vs 7.4 (7, 8.2) %, P < 0.001)], higher insulin dose [60 (51, 65) vs 45 (38, 56) UI/die, P = 0.004)] and a higher total body water and intracellular water as compared with ED group. Men in the ED group presented higher semen volume [2.8 (2.6, 4.2) vs 2.5 (2.2, 2.7) mL, P < 0.001] and sperm concentration [24 (19, 29) vs 20 (12, 23) mil/mL, P = 0.010], but reduced sperm progressive motility [28 (25, 35) vs 35 (25, 36) %, P = 0.011], higher rate of non-progressive motility [15 (10, 15) vs 10 (5, 10) %, P < 0.001] and higher rate of typical morphology [7(5, 8) vs 5 (4, 5) %, P = 0.001]. Based on multivariate logistic regression analysis performed to assess the association between clinical variables and ED, intracellular water (OR 3.829, 95% CI 1.205, 12.163, P = 0.023) resulted as the only independent predictor of ED. CONCLUSION: Men with T1D and ED showed worse metabolic profile which is associated with poor semen quality, as compared with those without ED.

Towards virtual histology with X-ray grating interferometry.

Breast cancer is the most common type of cancer worldwide. Diagnosing breast cancer relies on clinical examination, imaging and biopsy. A core-needle biopsy enables a morphological and biochemical characterization of the cancer and is considered the gold standard for breast cancer diagnosis. A histopathological examination uses high-resolution microscopes with outstanding contrast in the 2D plane, but the spatial resolution in the third, Z-direction, is reduced. In the present paper, we propose two high-resolution table-top systems for phase-contrast X-ray tomography of soft-tissue samples. The first system implements a classical Talbot-Lau interferometer and allows to perform ex-vivo imaging of human breast samples with a voxel size of 5.57 µm. The second system with a comparable voxel size relies on a Sigray MAAST X-ray source with structured anode. For the first time, we demonstrate the applicability of the latter to perform X-ray imaging of human breast specimens with ductal carcinoma in-situ. We assessed image quality of both setups and compared it to histology. We showed that both setups made it possible to target internal features of breast specimens with better resolution and contrast than previously achieved, demonstrating that grating-based phase-contrast X-ray CT could be a complementary tool for clinical histopathology.

Report of terbinafine resistant Trichophyton spp. in Italy: Clinical presentations, molecular identification, antifungal susceptibility testing and mutations in the squalene epoxidase gene.

BACKGROUND: Numerous reports of resistance to terbinafine in Trichophyton spp. from all over the world are arousing justified attention and concern. Point mutations in the gene that encodes the squalene epoxidase (SQLE) enzyme are responsible for these therapeutic resistances. OBJECTIVES: Primary objective of the study was to describe first isolates of Trichophyton spp. resistant to terbinafine among the patients treated between September 2019 and June 2022 at the Dermatology Units of Ospedale Maggiore Policlinico and San Bortolo Hospital. Secondary objective was to study the resistance mechanism. METHODS: Patients with confirmed Trichophyton spp. infection has been treated with systemic and topical terbinafine. Patients were then re-evaluated 12 weeks after the therapy. Patients with incomplete or absent response to terbinafine underwent a new skin scraping for direct mycological examination, new identification of dermatophyte species from culture and MALDI-TOF, molecular species identification, antifungal susceptibility testing and molecular analysis of SQLE gene. RESULTS: We identified five patients without clinical response to treatment with terbinafine. The DNA sequencing of the ITS region identified one Trichophyton rubrum and four Trichophyton indotineae. The T. rubrum strain showed minimum inhibitory concentration (MIC) (90% growth inhibition) of 4 mg/L for terbinafine. The four T. indotineae strains showed a MICs range of 0.25-4 mg/L for terbinafine. The analysis of the SQLE gene in the T. rubrum strain showed a nucleotide substitution generating a missense mutation (L393F). The SQLE gene sequencing in the T. indotineae strains showed a nucleotide substitution generating a missense mutation (F397L) in two strains, a nucleotide substitution L393S in one strain and a nucleotide substitution F415C in another strain. CONCLUSIONS: We report the first cases of terbinafine-resistant Trichophyton isolates in the Italian population. Solid antifungal management programs will be needed to promote more responsible use of antimycotics and preserve their therapeutic efficacy to control antifungal resistance.

Environmental and bioclimatic factors influencing yeasts and molds distribution along European shores.

The present study employed data collected during the Mycosands survey to investigate the environmental factors influencing yeasts and molds distribution along European shores applying a species distribution modelling approach. Occurrence data were compared to climatic datasets (temperature, precipitation, and solar radiation), soil datasets (chemical and physical properties), and water datasets (temperature, salinity, and chlorophyll-a concentration) downloaded from web databases. Analyses were performed by MaxEnt software. Results suggested a different probability of distribution of yeasts and molds along European shores. Yeasts seem to tolerate low temperatures better during winter than molds and this reflects a higher suitability for the Northern European coasts. This difference is more evident considering suitability in waters. Both distributions of molds and yeasts are influenced by basic soil pH, probably because acidic soils are more favorable to bacterial growth. Soils with high nitrogen concentrations are not suitable for fungal growth, which, in contrast, are optimal for plant growth, favored by this environment. Finally, molds show affinity with soil rich in nickel and yeasts with soils rich in cadmium resulting in a distribution mainly at the mouths of European rivers or lagoons, where these metals accumulate in river sediments.

A monocentric retrospective analysis about the effects of COVID-19 pandemic on emergency general surgery consultations.

OBJECTIVE: The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates. PATIENTS AND METHODS: We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded. RESULTS: In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery. CONCLUSIONS: We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.

Are insulin resistance and non-alcoholic fatty liver disease associated with Peyronie's disease? A pilot study.

Risk factors for Peyronie's disease (PD) are serum lipid abnormalities, hypertension and type 2 diabetes mellitus (T2DM). Oxidative stress and inflammation are key-players in the pathogenesis of arterial diseases, leading to insulin resistance (IR), which is a major determinant of non-alcoholic fatty liver disease (NAFLD). We studied the potential relationship between PD, IR, and NAFLD. Forty-nine male patients were enrolled, fulfilling the well-accepted diagnostic criteria of stable PD. Fifty male individuals without PD, well-matched for age and BMI, were selected as the control group. Comorbidities (T2DM and hypertension), as well as the lipid profile and the glucometabolic asset, were evaluated. The triglycerides/HDL ratio (TG/HDL-C ratio) with a cut-off of ≥3 and the triglycerides-glucose index (TyG) with an optimal cut-point of 8.5 were used for diagnosis of IR and NAFLD, respectively. NAFLD diagnosis was confirmed by the presence of bright liver at ultrasonography. Hypertension was found more frequently in PD patients than in no-PD subjects (P=0.017), independently of age (P=0.99). Both IR and NAFLD were significantly associated with the presence of PD in our population of men (P=0.043 and 0.0001, respectively), no matter how old (P=0.11 and 0.74, respectively). At logistic regression, NAFLD was the only predictor of the PD presence (p=0.021). The AUROC of TyG to predict PD was 0.7437 (sensitivity 67.35% and specificity 80%) with a percentage of correctly classified patients of 73.74%. Oxidative stress markers were significantly associated with NAFLD. Testosterone level was significantly low in the subjects with NAFLD in cross-sectional analyses. Both factors, i.e., oxidative stress and hypogonadism, are central to PD pathogenesis. In conclusion, NAFLD and IR are strongly associated with PD. The pathogenic link between these conditions and the underlying mechanisms are only hypothetical and thoroughly summarized in the discussion.

ICU environmental surfaces are a reservoir of fungi: species distribution in northern Italy.

BACKGROUND: Preventing and reducing nosocomial infections is a public health goal. Concern about healthcare-associated fungal infections has increased in recent years due to the emergence and spread of new pathogens, increasing antifungal resistance and outbreaks in hospital settings. AIM: To investigate the presence of medically relevant fungal species on environmental surfaces in 12 intensive care units of eight hospitals in Milan, Italy. METHODS: Environmental samplings, using contact plates on surfaces near bed stations and medical workstations, were conducted between November 2019 and January 2020. Fungi isolated were identified, and some were tested in vitro for antifungal susceptibility. FINDINGS: In total, 401 environmental samples were collected from 61 bed stations and 17 medical workstations. Positive samples were found in all hospitals except one, with positivity rates ranging from 4% to 24.2%. Filamentous fungi were found mainly on infusion pumps (23.2%) and patient tables (21.2%), whereas yeasts were found mainly on computers (25%) and floors (10.9%). Fungi were isolated from 12% of total samples. Filamentous fungi, mainly Aspergillus fumigatus, grew in 70.8% of positive samples, and yeasts grew in 27.1%, mainly Candida parapsilosis (42.8%) and Candida glabrata (28.6%). Fungi were detected near patients' beds and on surfaces at workstations, indicating potential for environment-to-patient, patient-to-patient and healthcare worker-to-patient transmission. CONCLUSIONS: Surveillance in hospital settings through environmental sampling may be an important component of fungal infection prevention.

Intestinal microbiota, intestinal permeability and the urogenital tract: is there a pathophysiological link?

Human gut microbiome is related to different clinical conditions and diseases. Recently several hypotheses have been theorized about a link between gut microbiota and genitourinary disease including urinary tract infections, and benign prostatic hyperplasia. Despite several data, underlying mechanisms still remain unclear. The aim of this review is to report the current state of knowledge in relation to urinary tract infections, benign prostatic hyperplasia and intestinal microbiota with a focus on its role in the development of disease and the underlying pathophysiologic mechanisms.

Design and optimization of an experimental maintenance system for yellow clam broodstock Amarilladesma mactroides (Reeve, 1854) / Desenvolvimento e otimização de um sistema de manutenção experimental para reprodutores de marisco branco Amarilladesma mactroides (Reeve, 1854)

The yellow clam is a sand-burrowing bivalve that inhabits the dissipative beaches from southern Brazil to the north coast of Argentina. In the last decades, populations of this species have been impacted by mass mortality events, overfishing and other anthropogenic activities. The production of juveniles in captivity would allow feasibility studies to be carried out to restore the natural stock as well as the production in aquaculture systems. Given the scarcity of studies on the maintenance of this species in captivity, a culture system and a management protocol were developed and tested. Wild-caught clams (total length ≥50 mm) were used in a series of 14 day-long trials. Survival was higher in clams that were allowed to bury into the sand. A permanent ink marker covered with a thin layer of a quick-hardening adhesive proved to be a reliable method to tag clams. The maintenance of yellow clams in this system resulted in high survival and growth, increases in the condition factor and oocyte diameter, and a relative advancement of gonadal development.

O marisco branco é um bivalve de areia que habita as praias dissipativas do sul do Brasil até a costa norte da Argentina. Nas últimas décadas, as populações desta espécie têm sido afetadas por eventos de mortalidade maciça, sobrepesca e outras atividades antropogênicas. A produção de juvenis em cativeiro permitiria a realização de estudos de viabilidade para restaurar o estoque natural, assim como a produção em sistemas de aquicultura. Dada a escassez de estudos sobre a manutenção desta espécie em cativeiro, um sistema de cultivo e um protocolo de manejo foram desenvolvidos e testados. Mariscos branco selvagens (comprimento total ≥50 mm) foram utilizados em uma série de ensaios de 14 dias de duração. A sobrevivência foi maior nos mariscos que podiam ser enterrados na areia. Um marcador de tinta permanente coberto com uma fina camada de adesivo de endurecimento rápido provou ser um método confiável para marcar os mariscos. A manutenção dos mariscos neste sistema resultou em alta sobrevivência e crescimento, aumento do fator de condição e do diâmetro do ovócito, e um relativo avanço do desenvolvimento gonadal.

Design and optimization of an experimental maintenance system for yellow clam broodstock Amarilladesma mactroides (Reeve, 1854) / Desenvolvimento e otimização de um sistema de manutenção experimental para reprodutores de marisco branco Amarilladesma mactroides (Reeve, 1854)

The yellow clam is a sand-burrowing bivalve that inhabits the dissipative beaches from southern Brazil to the north coast of Argentina. In the last decades, populations of this species have been impacted by mass mortality events, overfishing and other anthropogenic activities. The production of juveniles in captivity would allow feasibility studies to be carried out to restore the natural stock as well as the production in aquaculture systems. Given the scarcity of studies on the maintenance of this species in captivity, a culture system and a management protocol were developed and tested. Wild-caught clams (total length ≥50 mm) were used in a series of 14 day-long trials. Survival was higher in clams that were allowed to bury into the sand. A permanent ink marker covered with a thin layer of a quick-hardening adhesive proved to be a reliable method to tag clams. The maintenance of yellow clams in this system resulted in high survival and growth, increases in the condition factor and oocyte diameter, and a relative advancement of gonadal development.

O marisco branco é um bivalve de areia que habita as praias dissipativas do sul do Brasil até a costa norte da Argentina. Nas últimas décadas, as populações desta espécie têm sido afetadas por eventos de mortalidade maciça, sobrepesca e outras atividades antropogênicas. A produção de juvenis em cativeiro permitiria a realização de estudos de viabilidade para restaurar o estoque natural, assim como a produção em sistemas de aquicultura. Dada a escassez de estudos sobre a manutenção desta espécie em cativeiro, um sistema de cultivo e um protocolo de manejo foram desenvolvidos e testados. Mariscos branco selvagens (comprimento total ≥50 mm) foram utilizados em uma série de ensaios de 14 dias de duração. A sobrevivência foi maior nos mariscos que podiam ser enterrados na areia. Um marcador de tinta permanente coberto com uma fina camada de adesivo de endurecimento rápido provou ser um método confiável para marcar os mariscos. A manutenção dos mariscos neste sistema resultou em alta sobrevivência e crescimento, aumento do fator de condição e do diâmetro do ovócito, e um relativo avanço do desenvolvimento gonadal.

Design and optimization of an experimental maintenance system for yellow clam broodstock Amarilladesma mactroides (Reeve, 1854)

Abstract The yellow clam is a sand-burrowing bivalve that inhabits the dissipative beaches from southern Brazil to the north coast of Argentina. In the last decades, populations of this species have been impacted by mass mortality events, overfishing and other anthropogenic activities. The production of juveniles in captivity would allow feasibility studies to be carried out to restore the natural stock as well as the production in aquaculture systems. Given the scarcity of studies on the maintenance of this species in captivity, a culture system and a management protocol were developed and tested. Wild-caught clams (total length 50 mm) were used in a series of 14 day-long trials. Survival was higher in clams that were allowed to bury into the sand. A permanent ink marker covered with a thin layer of a quick-hardening adhesive proved to be a reliable method to tag clams. The maintenance of yellow clams in this system resulted in high survival and growth, increases in the condition factor and oocyte diameter, and a relative advancement of gonadal development.

Resumo O marisco branco é um bivalve de areia que habita as praias dissipativas do sul do Brasil até a costa norte da Argentina. Nas últimas décadas, as populações desta espécie têm sido afetadas por eventos de mortalidade maciça, sobrepesca e outras atividades antropogênicas. A produção de juvenis em cativeiro permitiria a realização de estudos de viabilidade para restaurar o estoque natural, assim como a produção em sistemas de aquicultura. Dada a escassez de estudos sobre a manutenção desta espécie em cativeiro, um sistema de cultivo e um protocolo de manejo foram desenvolvidos e testados. Mariscos branco selvagens (comprimento total 50 mm) foram utilizados em uma série de ensaios de 14 dias de duração. A sobrevivência foi maior nos mariscos que podiam ser enterrados na areia. Um marcador de tinta permanente coberto com uma fina camada de adesivo de endurecimento rápido provou ser um método confiável para marcar os mariscos. A manutenção dos mariscos neste sistema resultou em alta sobrevivência e crescimento, aumento do fator de condição e do diâmetro do ovócito, e um relativo avanço do desenvolvimento gonadal.

The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score.

OBJECTIVE: Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC. PATIENTS AND METHODS: TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage. RESULTS: In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort. CONCLUSIONS: TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.

Preoperative sarcopenia predicts survival after hepatectomy for colorectal metastases: a prospective observational study.

OBJECTIVE: The surgical approach to colorectal liver metastases has highly improved the survival rates in metastatic colorectal cancer patients. Since sarcopenia estimates the physiologic reserve of an individual patient, it is considered a surrogate marker of patient frailty, and the selection of appropriate candidates for LR could be crucial to maximize the benefits derived from surgery. The present study investigated the impact of sarcopenia as a prognostic factor after LR from CRLM. PATIENTS AND METHODS: The study retrospectively analyzed 74 patients. Skeletal Muscle Mass at the third lumbar vertebra in the inferior direction was quantified using enhanced computed tomography scans. The patients were divided into two subgroups, with and without sarcopenia, based on median Skeletal Muscle Index. RESULTS: The study included 48 Sarcopenic patients and 26 Non Sarcopenic patients. The median follow-up considered for the patients was 32 months. Median SMI was 39.3 and 52.7 cm2/m2, respectively. The OS rate was significantly different between the two groups. Preoperative sarcopenia resulted in worse OS up to 48 months. CONCLUSIONS: Sarcopenia represents a negative prognostic factor as it is associated with poor postoperative OS. Future programs focused on remediating to the preoperative sarcopenic status of colorectal liver metastatic patients should be implemented.

Weight loss after sleeve gastrectomy in patients with diabetes: preliminary study in one year of activity.

OBJECTIVE: The objective of our study is to investigate whether diabetes mellitus could adversely affect post-laparoscopic sleeve gastrectomy (LSG) weight loss. PATIENTS AND METHODS: A retrospectively recorded database of patients who underwent LSG from September 2018 to September 2019 in our Hospital in L'Aquila was analyzed. The post-operative weight loss was evaluated in terms of body mass index (BMI) variation, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL). The association between these parameters and diabetes was analyzed at 3 and 6 months of follow-up. RESULTS: The two groups (patients with and without diabetes) were considered comparable in terms of anthropometric and preoperative parameters. At 3 and 6 months of follow-up, the decrease in BMI resulted to be directly associated with the time and the group. The mean BMI at 3 and 6 months was higher in patients with diabetes. Changes in % EWL and % TWL were similar in both groups. CONCLUSIONS: It is rational to expect a lower weight loss in obese diabetic patients after LSG. This should not be considered as a contraindication to bariatric surgery that, being a metabolic surgery, has as main goal the resolution or improvement of co-morbidities.

A non-relativistic limit of NS-NS gravity.

We discuss a particular non-relativistic limit of NS-NS gravity that can be taken at the level of the action and equations of motion, without imposing any geometric constraints by hand. This relies on the fact that terms that diverge in the limit and that come from the Vielbein in the Einstein-Hilbert term and from the kinetic term of the Kalb-Ramond two-form field cancel against each other. This cancelling of divergences is the target space analogue of a similar cancellation that takes place at the level of the string sigma model between the Vielbein in the kinetic term and the Kalb-Ramond field in the Wess-Zumino term. The limit of the equations of motion leads to one equation more than the limit of the action, due to the emergence of a local target space scale invariance in the limit. Some of the equations of motion can be solved by scale invariant geometric constraints. These constraints define a so-called Dilatation invariant String Newton-Cartan geometry.

Design and optimization of an experimental maintenance system for yellow clam broodstock Amarilladesma mactroides (Reeve, 1854).

The yellow clam is a sand-burrowing bivalve that inhabits the dissipative beaches from southern Brazil to the north coast of Argentina. In the last decades, populations of this species have been impacted by mass mortality events, overfishing and other anthropogenic activities. The production of juveniles in captivity would allow feasibility studies to be carried out to restore the natural stock as well as the production in aquaculture systems. Given the scarcity of studies on the maintenance of this species in captivity, a culture system and a management protocol were developed and tested. Wild-caught clams (total length ≥50 mm) were used in a series of 14 day-long trials. Survival was higher in clams that were allowed to bury into the sand. A permanent ink marker covered with a thin layer of a quick-hardening adhesive proved to be a reliable method to tag clams. The maintenance of yellow clams in this system resulted in high survival and growth, increases in the condition factor and oocyte diameter, and a relative advancement of gonadal development.

The role of sarcopenia in the pancreatic adenocarcinoma.

OBJECTIVE: Pancreaticoduodenectomy is still associated with prolonged hospitalization and with a lot of complications. For these reasons, it is fundamental to improve strategies for preoperative risk stratification, and sarcopenia is one of the new identified markers of frailty. The purpose of our study was to retrospectively detect sarcopenia in patients undergoing pancreaticoduodenectomy and evaluate its importance as a preoperative marker. PATIENTS AND METHODS: We retrospectively identified a total amount of 76 consecutive patients who underwent pancreaticoduodenectomy for pancreatic head adenocarcinoma. Patients' and tumor's characteristics were recorded retrospectively. RESULTS: It appears that sarcopenia might be a useful preoperative prognostic factor for patients undergoing PD for PA. We found that Recurrence Free Survival may be influenced by presence or absence of preoperative sarcopenia, and we can confirm that in sarcopenic patients the average hospital stay is 20% longer than in non sarcopenic ones. CONCLUSIONS: Sarcopenia has a central role because it is a very common condition found in pancreatic cancer patients; there is growing evidence showing that it is associated with worse surgical outcomes. We can state that evaluating sarcopenia in cancer patients could improve the postoperative outcomes, overall survival rates and, nevertheless, the recurrence free survival ones.

Basics for surgeons about the immunohistochemistry role in pancreatic NETs diagnosis.

OBJECTIVE: Pancreatic neuroendocrine tumors (pNETs) are neuroendocrine tumors primarily found in the pancreas and upper small intestine. There are ten different pNETs: nine of these are associated with a specific functional syndrome, while one is not associated with a specific hormonal syndrome, and it is called non-functional. Up to 90% of pNETs are classified as non-functional. Immunohistochemistry is essential to define the diagnosis. However, to have a correct and reliable diagnosis, the pathologist must have adequately collected and treated tissue samples, thus the surgeon himself should be aware of some fundamental notions about tissue collection and fixation. Although several common biomarkers have been described to date, Chromogranin A and synaptophysin are currently considered the most specific immunohistochemical markers for NETs. Nearly 100% of pNETs are positive for both synaptophysin and Chromogranin A. Therefore, CgA and synaptophysin are effective for well-differentiated NETs but are less helpful in the diagnosis of poorly differentiated NECs, due to dedifferentiation, and then, degranulation of tumor cells. The Neuronal Specific Enolase (NSE) results to be an adequate marker in these cases. Considering the specific markers, many studies reported that endocrine pancreatic neoplasms are able to produce many different polypeptides and amines. Through immunohistochemical techniques, it is possible to define the diagnosis of pNET, which allows the clinicians to direct the patient to an effective therapeutic procedure. But to have a correct and reliable diagnosis, the tissue samples have to be adequately collected and treated.

Tobacco and e-cigarette smoking habits among Italian healthcare students.

BACKGROUND: Healthcare professionals might play a significant role in tobacco control. The aims of this study were to investigate tobacco cigarette and electronic cigarette (e-cigarette) consumption among university students enrolled in courses of the healthcare area, and to understand whether training in healthcare could induce to smoking cessation. STUDY DESIGN: Cross-sectional survey using a self-administered, structured questionnaire. METHODS: Tobacco smoking habits of 560 students of four different medical area courses at the University of Milan, enrolled both in the first and in the last course year during the 2017-2018 academic year, were collected. RESULTS: The prevalence of smokers was 34.8%, almost the same for males and females, and higher in Italian students compared to foreigners. Smoking prevalence was higher among employed (46.9%) than unemployed (35.1%) students, without differences between healthcare and non-healthcare workers. The influence of family, and particularly friends, is confirmed to be relevant. About 25% of respondents tried e-cigarettes, mainly smokers (44.6%) and former smokers (38.6%) with the goal of quitting smoking. More than 44% were dual users of both tobacco cigarettes and e-cigarettes. Comparing smoking habits between first-year and final-year students, only students of healthcare assistance course showed a significant drop in smoking during the university studies. CONCLUSIONS: The implementation of specific educational curricula on smoking dangers and on smoking cessation techniques might have the double effect of supporting students in quitting smoking and of properly preparing them for their future task of helping people to quit smoking.