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1. Sarcopenia: A Time for Action. An SCWD Position Paper

Author

Bauer, Juergen, Morley, John E, Schols, Annemie MWJ, Ferrucci, Luigi, Cruz‐Jentoft, Alfonso J, Dent, Elsa, Baracos, Vickie E, Crawford, Jeffrey A, Doehner, Wolfram, Heymsfield, Steven B, Jatoi, Aminah, Kalantar‐Zadeh, Kamyar, Lainscak, Mitja, Landi, Francesco, Laviano, Alessandro, Mancuso, Michelangelo, Muscaritoli, Maurizio, Prado, Carla M, Strasser, Florian, Haehling, Stephan, Coats, Andrew JS, and Anker, Stefan D

Subjects
Nutrition, Biomedical Imaging, Prevention, Aging, Musculoskeletal, Disease Management, Disease Susceptibility, Humans, Practice Guidelines as Topic, Sarcopenia, Cachexia, Geriatric assessment, Muscle, Skeletal, Muscle strength, Physiology, Clinical Sciences, Human Movement and Sports Sciences
Abstract

The term sarcopenia was introduced in 1988. The original definition was a "muscle loss" of the appendicular muscle mass in the older people as measured by dual energy x-ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC-F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease-related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age-related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age-related and disease-related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life-long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.

Published
2019

2. Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis

Author

Molfino, Alessio, Kaysen, George A, Chertow, Glenn M, Doyle, Julie, Delgado, Cynthia, Dwyer, Tjien, Laviano, Alessandro, Fanelli, Filippo Rossi, and Johansen, Kirsten L

Subjects
Biomedical and Clinical Sciences, Nutrition and Dietetics, Bioengineering, Nutrition, Assistive Technology, Clinical Research, Oral and gastrointestinal, Cardiovascular, Metabolic and endocrine, Zero Hunger, Aged, Anorexia, Appetite, Biomarkers, Body Mass Index, C-Reactive Protein, Cachexia, Cross-Sectional Studies, Energy Intake, Female, Humans, Interleukin-6, Leptin, Male, Middle Aged, Nutritional Status, Prealbumin, Prevalence, Renal Dialysis, Serum Albumin, Surveys and Questionnaires, Clinical Sciences, Urology & Nephrology, Clinical sciences, Nutrition and dietetics
Abstract

ObjectiveTo test the performance of appetite assessment tools among patients receiving hemodialysis (HD).DesignCross-sectional.SubjectsTwo hundred twenty-one patients receiving HD enrolled in seven dialysis facilities in Northern California.InterventionWe assessed 5 appetite assessment tools (self-assessment of appetite, subjective assessment of appetite, visual analog scale [VAS], Functional Assessment of Anorexia/Cachexia Therapy [FAACT] score, and the Anorexia Questionnaire [AQ]).Main outcome measuresReported food intake, normalized protein catabolic rate, and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake.ResultsFifty-eight (26%) patients reported food intake ≤ 50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All the tools were significantly associated with food intake ≤ 50% (P < .001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤ 50% (C-statistic 0.80 and 0.76). Patients with food intake ≤ 50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; P = .03). Normalized protein catabolic rate was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, P = .03). Ln interleukin-6 correlated inversely with food intake (P = .03), but neither interleukin-6 nor C-reactive protein correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (P = .02), prealbumin (P = .02) and adiponectin concentrations (P = .03).ConclusionsAlternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in HD. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.

Published
2016

3. The importance of protein sources to support muscle anabolism in cancer: An expert group opinion

Author

Katherine L. Ford, Jann Arends, Philip J. Atherton, Mariëlle P.K.J. Engelen, Thiago J.M. Gonçalves, Alessandro Laviano, Dileep N. Lobo, Stuart M. Phillips, Paula Ravasco, Nicolaas E.P. Deutz, Carla M. Prado, and Veritati - Repositório Institucional da Universidade Católica Portuguesa

Subjects
Nutrition and Dietetics, Protein source, Critical Care and Intensive Care Medicine, Plant Proteins, Dietary, Plant protein, Animal protein, Anabolic Agents, Anabolism, Neoplasms, Animal Proteins, Dietary, Humans, Muscle, Muscle, Skeletal, Expert Testimony, Cancer
Abstract

This opinion paper presents a short review of the potential impact of protein on muscle anabolism in cancer, which is associated with better patient outcomes. Protein source is a topic of interest for patients and clinicians, partly due to recent emphasis on the supposed non-beneficial effect of proteins; therefore, misconceptions involving animal-based (e.g., meat, fish, dairy) and plant-based (e.g., legumes) proteins in cancer are acknowledged and addressed. Although the optimal dietary amino acid composition to support muscle health in cancer is yet to be established, animal-based proteins have a composition that offers superior anabolic potential, compared to plant-derived proteins. Thus, animal-based foods should represent the majority (i.e., ≥65%) of protein intake during active cancer treatment. A diet rich in plant-derived proteins may support muscle anabolism in cancer, albeit requiring a larger quantity of protein to fulfill the optimal amino acid intake. We caution that translating dietary recommendations for cancer prevention to cancer treatment may be inadequate to support the pro-inflammatory and catabolic nature of the disease. We further caution against initiating an exclusively plant-based (i.e., vegan) diet upon a diagnosis of cancer, given the presence of elevated protein requirements and risk of inadequate protein intake to support muscle anabolism. Amino acid combination and the long-term sustainability of a dietary pattern void of animal-based foods requires careful and laborious management of protein intake for patients with cancer. Ultimately, a dietary amino acid composition that promotes muscle anabolism is optimally obtained through combination of animal- and plant-based protein sources.

Published
2022

4. The centenary of the Harris–Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group

Author

Eric Fontaine, Marian A. E. de van der Schueren, Alessandro Laviano, Claude Pichard, Pierre Singer, Michael Hiesmayr, Dileep N. Lobo, Moïse Coëffier, Itai Bendavid, Tommy Cederholm, Rocco Barazzoni, Tel Aviv University [Tel Aviv], Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy., Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden, Theme Ageing, Karolinska University Hospital, Stockholm, Sweden., Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de nutrition [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre d'Investigation Clinique [CHU Rouen] (CIC Rouen), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Nutrition and Dietetics, HAN University of Applied Sciences, School of Allied Health, Nijmegen, the Netherlands., Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria., Department of Translational and Precision Medicine, Sapienza University, Rome, Italy., Clinical Nutrition, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland., Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv, Bendavid, I., Lobo, D. N., Barazzoni, R., Cederholm, T., Coeffier, M., de van der Schueren, M., Fontaine, E., Hiesmayr, M., Laviano, A., Pichard, C., Singer, P., douville, sabine, Tel Aviv University (TAU), Università degli studi di Trieste = University of Trieste, Uppsala University, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], and Normandie Université (NU)-Normandie Université (NU)-CHU Rouen

Subjects
Male, 0301 basic medicine, Critical Illness, Energy (esotericism), Energy requirement, 030209 endocrinology & metabolism, Indirect calorimetry, Energy expenditure, Energy requirements, Nutritional prescriptions, Predictive equations, Critical Care and Intensive Care Medicine, Nutrition Policy, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Neoplasms, Humans, Medicine, Obesity, Medical prescription, Aged, ddc:616, Estimation, Nutritional prescription, 030109 nutrition & dietetics, Nutrition and Dietetics, Actuarial science, business.industry, Harris–Benedict equation, Body Weight, Nutritional Requirements, Calorimetry, Indirect, Expert group, 3. Good health, Variety (cybernetics), [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, Surgical Procedures, Operative, Body Constitution, Female, Basal Metabolism, Energy Intake, Energy Metabolism, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Background & aims: The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure. Methods: Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription. Results: In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice. Conclusions: While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding. (C)2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Published
2021

5. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement

Author

Lorenzo M. Donini, Luca Busetto, Stephan C. Bischoff, Tommy Cederholm, Maria D. Ballesteros-Pomar, John A. Batsis, Juergen M. Bauer, Yves Boirie, Alfonso J. Cruz-Jentoft, Dror Dicker, Stefano Frara, Gema Frühbeck, Laurence Genton, Yftach Gepner, Andrea Giustina, Maria Cristina Gonzalez, Ho-Seong Han, Steven B. Heymsfield, Takashi Higashiguchi, Alessandro Laviano, Andrea Lenzi, Ibolya Nyulasi, Edda Parrinello, Eleonora Poggiogalle, Carla M. Prado, Javier Salvador, Yves Rolland, Ferruccio Santini, Mireille J. Serlie, Hanping Shi, Cornel C. Sieber, Mario Siervo, Roberto Vettor, Dennis T. Villareal, Dorothee Volkert, Jianchun Yu, Mauro Zamboni, Rocco Barazzoni, Unité de Nutrition Humaine (UNH), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), Endocrinology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Donini, L. M., Busetto, L., Bischoff, S. C., Cederholm, T., Ballesteros-Pomar, M. D., Batsis, J. A., Bauer, J. M., Boirie, Y., Cruz-Jentoft, A. J., Dicker, D., Frara, S., Fruhbeck, G., Genton, L., Gepner, Y., Giustina, A., Gonzalez, M. C., Han, H. -S., Heymsfield, S. B., Higashiguchi, T., Laviano, A., Lenzi, A., Nyulasi, I., Parrinello, E., Poggiogalle, E., Prado, C. M., Salvador, J., Rolland, Y., Santini, F., Serlie, M. J., Shi, H., Sieber, C. C., Siervo, M., Vettor, R., Villareal, D. T., Volkert, D., Yu, J., Zamboni, M., and Barazzoni, R.

Subjects
Sarcopenia, Health (social science), Nutrition and Dietetics, Sarcopenic obesity, Skeletal, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Critical Care and Intensive Care Medicine, Body Mass Index, Obesity, Adiposity, Body Composition, Humans, Muscle, Skeletal, Prospective Studies, obesity, sarcopenia, sarcopenic obesity, Physiology (medical), Muscle, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and Methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

Published
2022

6. Energy Expenditure and Treating Obesity

Author

Laviano, Alessandro, Meguid, Michael M., Rossi-Fanelli, Fllippo, Cohen, Paul, Miyazaki, Makoto, Hudgins, Lisa C., Socci, Nicholas D., Ntambi, James M., Hagge-Greenberg, Aaron, Liedtke, Wolfgang, Soukas, Alexander A., Sharma, Ratnendra, and Friedman, Jeffrey M.

Published
2002

7. Association between IGF-1 levels ranges and all-cause mortality: A meta-analysis

Author

Jamal Rahmani, Alberto Montesanto, Edward Giovannucci, Hamid Zand, Meisam Barati, John J. Kopchick, Mario G. Mirisola, Vincenzo Lagani, Hiba Bawadi, Raffaele Vardavas, Alessandro Laviano, Kaare Christensen, Giuseppe Passarino, Valter D. Longo, Rahmani J., Montesanto A., Giovannucci E., Zand H., Barati M., Kopchick J.J., Mirisola M.G., Lagani V., Bawadi H., Vardavas R., Laviano A., Christensen K., Passarino G., and Longo V.D.

Subjects
Adult, Cohort Studies, Aging, IGF-1, Humans, Cell Biology, Prospective Studies, Insulin-Like Growth Factor I, mortality, protein intake, Proportional Hazards Models
Abstract

The association between IGF-1 levels and mortality in humans is complex with low levels being associated with both low and high mortality. The present meta-analysis investigates this complex relationship between IGF-1 and all-cause mortality in prospective cohort studies. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Cochrane Library up to September 2019. Published studies were eligible for the meta-analysis if they had a prospective cohort design, a hazard ratio (HR) and 95% confidence interval (CI) for two or more categories of IGF-1 and were conducted among adults. A random-effects model with a restricted maximum likelihood heterogeneity variance estimator was used to find combined HRs for all-cause mortality. Nineteen studies involving 30,876 participants were included. Meta-analysis of the 19 eligible studies showed that with respect to the low IGF-1 category, higher IGF-1 was not associated with increased risk of all-cause mortality (HR = 0.84, 95% CI = 0.68–1.05). Dose–response analysis revealed a U-shaped relation between IGF-1 and mortality HR. Pooled results comparing low vs. middle IGF-1 showed a significant increase of all-cause mortality (HR = 1.33, 95% CI = 1.14–1.57), as well as comparing high vs. middle IGF-1 categories (HR = 1.23, 95% CI = 1.06–1.44). Finally, we provide data on the association between IGF-1 levels and the intake of proteins, carbohydrates, certain vitamins/minerals, and specific foods. Both high and low levels of IGF-1 increase mortality risk, with a specific 120–160 ng/ml range being associated with the lowest mortality. These findings can explain the apparent controversy related to the association between IGF-1 levels and mortality. Funding was provided by the USC Edna Jones chair fund and NIH P01 AG055369?01 to V.D.L. Scopus

Published
2022

8. Effects of oral immunonutrition on histological changes of inflammatory infiltration of the tumor microenvironment among patients with a new diagnosis of gastric cancer

Author

Alessio Molfino, Alessia Mari, Alessia Paldino, Raffaella Carletti, Giovanni Imbimbo, Maurizio Cardi, Cira R.T. di Gioia, and Alessandro Laviano

Subjects
Nutrition and Dietetics, Stomach Neoplasms, Nutritional Support, Endocrinology, Diabetes and Metabolism, Dietary Supplements, Weight Loss, Tumor Microenvironment, Humans
Abstract

We assessed the effects of oral immunonutrition (OI) on the inflammatory infiltration of the tumor microenvironment (TME) of patients undergoing surgery for gastric cancer.We analyzed patients at the time of their first gastric cancer diagnosis. We collected surgical tissue specimens (stomach), and performed an immunohistochemical analysis to evaluate the inflammatory infiltration of the TME. Patients receiving OI were compared with patients receiving standard oral nutritional supplements and no nutritional support.We enrolled 12 patients with gastric cancer in the study. The median body weight loss was 5.6%. Four patients received OI, five patients received standard nutritional supplement, and three patients received no nutritional supplementation. No difference in age, body mass index (BMI), and body weight loss was observed between the three groups. The OI group showed a tendency of increased number of T-lymphocyte cluster of differentiation (CD) 8+ compared with the other groups, as well as the number of CD83+ and CD68+. The absence of F4/80+ cells was documented only in the TME of the OI group, where a linear positive correlation was present between lymphocytes CD4+ and CD8+ (R = 0.48), and between CD4+ and CD83+ (R = 0.89), although not statistically significant. In the OI group, we observed a positive correlation (not significant) between the number of lymphocytes CD8+ and macrophages CD68+ (R = 0.70; P = 0.30). A strong significant correlation was documented between CD68+ and CD40+ (R = 0.99; P = 0.01), but this correlation did not reach the significance among the patients of the other two groups (R = 0.60; P = 0.116).The administration of OI in patients with gastric cancer might determine changes in inflammatory patterns of the TME.

Published
2022

9. High protein diet in digestive cancers

Author

Alessandro Laviano

Subjects
Nutrition and Dietetics, Neoplasms, Malnutrition, Diet, High-Protein, Medicine (miscellaneous), Animals, Humans, Nutritional Status, Dietary Proteins, Amino Acids, Diet
Abstract

Recent advances in the nutritional management of patients with digestive cancers suggest that modulation of protein intake may significantly contribute to achieve nutritional and clinical benefits. By reviewing the available evidence, a quantitatively and qualitatively optimal protein intake could be derived.High protein diets (i.e., 1-1.5 g/kg body weight/day) appear key to maintain the adequate nutritional status, and may also contribute to achieve clinical benefits. This target appears particularly relevant in patients with digestive cancers at risk or already malnourished, or in older patients. During active cancer treatments, protein intake should be closer to the upper limit of the recommended intake. Also, high protein intake should be maintained beyond the periods of catabolic crisis associated with active treatments. In contrast with general reasoning, animal proteins should represent the majority of the recommended intake. Based on the available evidence, the intake of no specific amino acid can be strongly recommended to enhance anabolic potentials or the immune modulating effects of high protein diets.High protein intake, mostly based on animal proteins, should be recommended to patients with digestive cancers. However, this target should be translated into clinical prescription after considering the clinical and metabolic needs of the patients. The quest for the optimal protein intake of patients with cancer at different time points of their clinical journey is still open.

Published
2022

10. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Author

Benedetto, Ielpo, Mauro, Podda, Gianluca, Pellino, Pata, Francesco, Gianpiero, Gravante, Salomone Di Saverio, Gallo, Gaetano, Rashid, Lui, Adam, Orengia, Aditya, Chowdary, Aditya, Kulkarni, Adnan, Kuvvetli, Adolfo, Navarro, Adolfo, Pisanu, Adrian, Smith, Adriana Cavero Ibiricu, Aeris Jane, D Nacion, Ahmad, Alsaleh, Ahmad, Alhazmi, Ahmad, Elmabri, Ajaz, Wani, Ahmet, Rencuzogullari, Aingeru Sarriugarte Lasarte, Ainhoa Valle Rubio, Akshay, Bavikatte, Akshay, Kumar, Al-Radjid, Jamiri, Alain Michel Alvarado Padilla, Alban, Cacurri, Alberto de San Ildefonso, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Alejandro Paz Yáñez, Alejandro, Becaria, Alejandro, Solís-Peña, Aleksandar, Sretenović, Alex, Urbistondo, Alfonso, Bandin, Alfonso, Najar, Alessandro De Luca, Alex, Boddy, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Amendola, Alfredo Ramirez-Gutierrez de Velasco, Ali Cihat Yildirim, Alice, Frontali, Alpha Oumar Toure, Alvaro, García-Granero, Amaia Martínez Roldan, Amaia Sanz Larrainzar, Amila Sanjiva Ratnayake, Ana María Gonzalez-Ganso, Ana, M Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Andrea, Lucchi, Andrea, Mazzari, Andrea, Musig, Andrea, Peloso, Andrea, Piano, Andrea, Police, Andrei, Mihailescu, Andrés, Pouy, Angela, Romano, Iossa, Angelo, Anna Carmen Leonetti, Anna, Guariniello, Anna, Isaac, Anna Pia Delli Bovi, Antonella, Chessa, Antonella, Tromba, Antonio Álvarez Martínez, Antonio, Brillantino, Antonio, Caira, Antonio, Castaldi, Antonio, Ferronetti, Antonio, Giuliani, Antonio, Prestera, Antonio Ramos-De la Medina, Antonio, Tarasconi, Antonino, Tornambè, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Khan, Arshad, Rashid, Arteaga Luis Eduardo Pérez-Sánchez, Ashok, Mittal, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Asnel, Dorismé, Athanasios, Marinis, Atif, Iqbal, Augusto, Moncada, Bartolomeo, Braccio, Basim, Alkhafaji, Beatriz de Andrés Asenjo, Beatriz, Martin-Perez, Belinda Sánchez Pérez, Ben, Creavin, Benedetto, Calì, Beniamino, Pascotto, Benjamin, Stubbs, Benjamin Zavala Retes, Branislav, Jovanovic, Brian Kp Goh, Bruno, Sensi, Carlo, Biddau, Carlo, Gazia, Carlo, Vallicelli, Carlos Alberto Fagundes, Carlos Cerdán Santacruz, Carlos, Chirico, Carlos Javier Gómez, Carlos, Petrola, Carlos Sánchez Rodriguez, Carlos Yánez Benítez, Carmelisa, Dammaro, Carmelo Lo Faro, Caroline, Reinke, Casandra Dominguez Paez, Catalina, Oliva, Charudutt, Paranjape, Charlotte, Thomas, Chi Fung Chia, Chi Kwan Kong, Chiara De Lucia, Christian Ovalle Chao, Claudio, Arcudi, Claudio, Guerci, Clement, Chia, Cristiano, Parise, Cristina, Folliero, Cristopher, Varela, Dalya, M Ferguson, Daniel, Camacho, Daniel, Popowich, Daniel Souza Lima, Daniela, Rega, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, Dario, Parini, David Alessio Merlini, David DE Zimmerman, David, Moro-Valdezate, Davide, Pertile, Deborah Maria Giusti, Deborah, S Keller, Delko, Tarik, Denis, Kalivaçi, Dennis, Mazingi, Diana Gabriela Maldonado-Pintado, Diego, Sasia, Dimitrios, Linardoutsos, Dixon, Osilli, Domenico, Murrone, Domenico, Russello, Edgar, Rodas, Edisson Alberto Acuña Roa, Edoardo, Ricciardi, Edoardo, Rosso, Edoardo, Saladino, Eduardo, Flores-Villalba, Eduardo Ruiz Ajs, Eduardo, Smith-Singares, Efstratia, Baili, Efstratios, Kouroumpas, Eirini, Bourmpouteli, Eleftheria, Douka, Elena, Martin-Perez, Eleonora, Guaitoli, Elgun, Samadov, Elisa, Francone, Elisa, Vaterlini, Emilio, Morales, Emilio, Peña, Enhao, Zhao, Eneko Del Pozo Andres, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Erman, Aytac, Ernesto, Laterza, Ervis, Agastra, Esteban, Foianini, Esteban, Moscoso, Estefania, Laviano, Ester, Marra, Eugenia, Cardamone, Eugenio, Licardie, Eustratia, Mpaili, Eva, Pinna, Evaristo, Varo, Fabian Martín Navarro, Fabio, Marino, Fabio, Medas, Fabio, Romano, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federica, Mastella, Federico, Gheza, Federico, Luvisetto, Felipe, Alconchel, Felipe Monge Vieira, Felipe, Pareja, Ferdinando, Agresta, Fernanda, Luna, Fernando, Bonilla, Fernando, Cordera, Fernando, Burdió, Fernando, Mendoza-Moreno, Fernando Muñoz Flores, Fernando Pardo Aranda, Fiona, Taylor, Flavia, L Ramos, Flavio, Fernandes, Francesca Paola Tropeano, Francesco, Balestra, Francesco, Bianco, Francesco, Ceci, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Lazzarin, Francesco, Litta, Francesco, Martini, Francesco, Pizza, Francesco, Roscio, Francesco, Virdis, Francisco Blanco Antona, Francisco Cervantes Ramírez, Francisco Miguel Fernandez, Francisco Oliver Llinares, Francisco, Quezada, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabriel, Massaferro, Gabriele, Bislenghi, Gabrielle van Ramshorst, Gaetano, Gallo, Gaetano, Luglio, Georgios, Bointas, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo Arredondo Manrique, Giacomo, Calini, Giacomo, Nastri, Giampaolo, Formisano, Giampaolo, Galiffa, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gilda De Paola, Giorgio, Lisi, Giovanna, Partida, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Giovanni, Sinibaldi, Giovanni, Tebala, Giulia, Bagaglini, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Candilio, Giuseppe Di Grezia, Giuseppe, Esposito, Giuseppe, Faillace, Giuseppe, Frazzetta, Giuseppe La Gumina, Giuseppe, Nigri, Giuseppe, Romeo, Gloria Chocarro Amatriaín, Gloria, Ortega, Gonzalo, Martin-Martin, Gregor, A Stavrou, Gunadi, Gustavo Armand Ugon, Gustavo, Machain, Gustavo, Marcucci, Gustavo, Martínez-Mier, Gustavo Miguel Machain, Gustavo, Nari, Haydée, Calvo, Hamada, Fathy, Hamilto, Hazem, Ahmed, Hazem, Faraj, Hector, Nava, Hector Ordas Macias, Herald, Nikaj, Heriberto, Solano, Huma Ahmed Khan, Humberto Sánchez Alarcón, Husam, Ebied, Iacopo, Giani, Ibabe Villalabeitia Ateca, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki Martinez Rodriguez, Ionut, Negoi, Irene, Ortega, Irina, Bernescu, Iris Shari Russo, Irune Vincente Rodríguez, Irving, Palomares, Isaac, Baltazar, Isabel Jaén Torrejimeno, Isabel María Cornejo Jurado, Isabella, Reccia, Ishtiyaq, Hussain, Ismael Brito Toledo, Ismael, Mora-Guzmán, Iulia, Dogaru, Ivan, Romic, Izaskun, Balciscueta, J Cleo Kenington, Jackison, Sagolsem, Jae, Y Jang, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier Ismael Roldán Villavicencio, Javier, Salinas, Jelena, Pejanovic, Jose Gustavo Parreira, Jovanovic, Jeny Rincón Pérez, Jeryl, Asreyes, Jesus Antonio Medina Luque, Joanna, Mak, Joanne Salas Rodriguez, Johnn Henry Herrera Kok, Jon, Krook, Jose Antonio Diaz-Elizondo, Jose, Castell, José Eduardo García-Flores, José María Jover Navalón, Jose Mauro Silva Rodrigues, José, Pereira, José Tomas Castell Gómez, Juan Bellido Luque, Juan Carlos Martín Del Olmo, Juan Carlos Salamea, Juan Francisco Coronel Olivier, Juan Luis Blas Laina, Juliana Maria Ordoñez, Julieta, Gutierrez, Julio, Abba, Junaid Ahmad Sofi, Kashaf, Sherafgan, Kapil, Sahnan, Katsuhiko, Yanaga, Kevin, Beatson, Laharwal, Asim, Laura, Alvarez, Leandro, Siragusa, Lee, Farber, Lester, Ong, Liarakos, Athanasios, Lorena, García-Bruña, Luca De Martino, Luca, Ferrario, Luca, Giordano, Luca, Gordini, Luca, Pio, Luca, Ponchietti, Lucia, Moletta, Luciano, Curella, Luciano, Poggi, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luigi, Goffredi, Luis Angel Garcia Ruiz, Luis, Barrionuevo, Luis Enrique Fregoso, Luis, F Cabrera, Luis, G Rodriguez, Luis, Grande, Luis Gregorio Osoria, Luis Javier Kantun Gonzalez, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Luis, Tresierra, Luisa, Giavarini, Mahmoud, Hasabelnabi, Maja, Odovic, Mamoru, Uemura, Mansoor, Khan, Manuel, Artiles-Armas, Mara, David, Marcello Di Martino, Marcello Giuseppe Spampinato, Marcelo A, F Ribeiro, Marcelo, Viola, Marco, Angrisani, Marco, Calussi, Marco, Cannistrà, Marco, Catarci, Marco, Cereda, Marco, Conte, Marco, Giordano, Marco, Pellicciaro, Marco Vito Marino, Maria, E Vaterlini, María, F Jiménez, María Giulia Lolli, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Maria, Nicola, Mario, Arrigo, Mario Caneda Mejia, Mario Montes Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mario Zambrano Lara, Marisa, Martínez, Mark, Bagnall, Mark, Peter, Marta Cañón Lara, Marta Jimenez Gomez, Marta, Paniagua-Garcia-Señorans, Marta Perez Gonzalez, Martin, Rutegård, Martin, Salö, Marzia, Franceschilli, Massimiliano, Silveri, Massimiliano, Veroux, Massimo, Pezzulo, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluagua, Maurizio, Cannavò, Maurizio, Cervellera, Maurizio, Iacobone, Mauro, Montuori, Melody García Domínguez, Meltem, Bingol-Kologlu, Mian, Tahir, Michael, Lim, Michael Sj Wilson, Michael, Wilson, Michela, Campanelli, Michele, Bisaccia, Michele De Rosa, Michele, Maruccia, Michele, Paterno, Michele, Pisano, Michele, Torre, Michele, Treviño, Michele, Zuolo, Miguel, A Hernandez Bartolome, Miguel, Farina, Miguel, Pera, Miguel Prieto Calvo, Milagros, Sotelo, Min Myat Thway, Mohamed, Hassan, Mohamed Salah Eldin Hassan, Mohammad, Azfar, Mohammad, Bouhuwaish, Mohammad, Taha, Mohammad, Zaieem, Mohammed, Korkoman, Montserrat, Guraieb, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid Zulfiqar Ali, Nadeem, Quazi, Nagendra, N Dudi-Venkata, Nahar, Alselaim, Natasha, Loria, Nathalie Villan Ramírez, Nay Win Than, Neil, Smart, Nelson, Trelles, Nicanor, Pinto, Niccolò, Allievi, Niccolo, Petrucciani, Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolaescu Diana Cristiana, Nicolás, Nicolás, Nicolò, Falco, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos Andreas Dallas, Nikolaos, Machairas, Noelia, Brito, Nura Ahmed Fieturi, Nuria, Ortega, Octavio, Avilamercado, Oktay, Irkorucu, Omar, Alsherif, Orestes, Valles, Orestis, Ioannidis, Oscar Hernández Palmas, Oscar Isaac Hernandez Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Omelanczuk, Pablo, Ottolino, Pablo, Rodrigues, Pablo, Ruiz, Paola, Campenni, Paola, Chiarade, Paola Prieto Olivares, Paolo, Baroffio, Pascal, Wintringer, Pasquale Di Fronzo, Pasquale, Talento, Pasqualino, Favoriti, Patricia, Sendino, Patrizia, Marsanic, Patricia, Mifsut, Paúl, Andrade, Pawel, Ajawin, Valentina, Ferri, Giuseppe Massimiliano de Luca, Sara, Ingallinella, Eva, Pueyo, Francesco, Palmieri, Jesus, Silva, Ken Min Chin, Nicholas, Syn, Brian K, P Goh, Ye Xin Koh, Valeria, Tonini, Ana, Gonzales-Ganso, Vicente, Simó, Maria Victoria Diago, Pedro, Abadía-Barnó, Pedro Alfonso Najar Castañeda, Pedro Omar Sillas Arevalos, Pedro Palazón Bellver, Peng Soon Koh, Petry, Souza, Piotr, Major, Rajandeep Singh Bali, Rakesh Mohan Khattar, Renato Bessa Melo, Reza, Ebrahiminia, Ricardo, Azar, Ricardo López Murga, Riccardo, Caruso, Riccardo, Pirolo, Richard, Brady, Richard Justin Davies, Rishi, Dholakia, Rishi, Rattan, Rishi, Singhal, Robert, Lim, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Faccincani, Roberto, Peltrini, Rocío, Carrera-Ceron, Rodrigo, Tejos, Rohit, Kashyap, Roosevelt, Fajardo, Rosa, Lozito, Royer Madariaga Pareja, Sabrina, Garbarino, Salvador, Morales-Conde, Sami, Benli, Sami, Mansour, Samir, Flores, Samuel Limon Suarez, Santiago Lopez Ben, Sara, Fuentes, Sara, Napetti, Sara Ortiz de Guzmán, Selmy, Awad, Sergio, A Weckmann Luján, Sergio, Gentilli, Sergio, Grimaldi, Sergio Olivares Pizarro, Serkan, Tayar, Shakeeb, Nabi, Shannon, M Chan, Sheikh, Junaid, Sidney, Rojas, Silvana, Monetti, Silvia, García, Silvia, Salvans, Silvia, Tenconi, Simon, Shaw, Simone, Santoni, Sofia Andrea Parra, Sofía, Cárdenas, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Sophie, Dessureault, Spiros, Delis, Stefano Amore Bonapasta, Stefano, Rausei, Stefano, Scaringi, Sundeep, Keswani, Syed Muhammad Ali, Süleyman, Cetinkunar, Tak Lit Derek Fung, Tariq, Rawashdeh, Tatiana Nicolás López, Tercio De Campos, Teresa Calderon Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Theodoros, Liakakos, Thomas, Barnes, Tijmen, Koëter, Tiku, Zalla, Tomás, E González, Tomás, Elosua, Tommaso, Campagnaro, Tommy, Brown, Topi, Luoto, Touré Alpha Oumar, Ugo, Giustizieri, Ugo, Grossi, Umberto, Bracale, Uriel, Rivas, Valentina, Sosa, Valentina, Testa, Valeria, Andriola, Valerio, Balassone, Valerio, Celentano, Valerio, Progno, Varun, Raju, Vanessa, Carroni, Venera, Cavallaro, Venkateswara Rao Katta, Veronica De Simone, Vicent Primo Romaguera, Victor Hugo García Orozco, Victor, Luraschi, Victor, Rachkov, Victor, Turrado-L, Victor, Visag-Castillo, Victoria, Dowling, Victoria, Graham, Vincenzo, Papagni, Vincenzo, Vigorita, Vinicius Cordeiro Fonseca, Virginia Jimenez Carneros, Vittoria, Bellato, Walyson, Gonçalves, William, F Powers, William, Grigg, Wolf, O Bechstein, Yu Bing Lim, Yuksel, Altinel, Zoran, Golubović, Zutoia, Balciscueta, Ielpo B., Podda M., Pellino G., Pata F., Caruso R., Gravante G., Di Saverio S., Gallo G., Lui R., Orengia A., Chowdary A., Kulkarni A., Kuvvetli A., Navarro A., Pisanu A., Smith A., Ibiricu A.C., Nacion A.J.D., Alsaleh A., Alhazmi A., Elmabri A., Wani A., Rencuzogullari A., Lasarte A.S., Rubio A.V., Bavikatte A., Kumar A., Jamiri A.-R., Padilla A.M.A., Cacurri A., de San Ildefonso A., Porcu A., Sartori A., Rocca A., Yanez A.P., Becaria A., Solis-Pena A., Sretenovic A., Urbistondo A., Bandin A., Najar A., De Luca A., Boddy A., Charalabopoulos A., Tzivanakis A., Amendola A., de Velasco A.R.-G., Yildirim A.C., Frontali A., Toure A.O., Garcia-Granero A., Roldan A.M., Larrainzar A.S., Ratnayake A.S., Gonzalez-Ganso A.M., Minaya-Bravo A.M., Das A., Bondurri A., Costanzi A., Lucchi A., Mazzari A., Musig A., Peloso A., Piano A., Police A., Mihailescu A., Pouy A., Romano A., Iossa A., Leonetti A.C., Guariniello A., Isaac A., Bovi A.P.D., Chessa A., Tromba A., Martinez A.A., Brillantino A., Caira A., Castaldi A., Ferronetti A., Giuliani A., Prestera A., la Medina A.R.-D., Tarasconi A., Tornambe A., Picciariello A., Ioannidis A., Leppaniemi A., Khan A., Rashid A., Perez-Sanchez A.L.E., Mittal A., Mitul A.R., Mehraj A., Laharwal A., Dorisme A., Marinis A., Iqbal A., Moncada A., Braccio B., Alkhafaji B., de Andres Asenjo B., Martin-Perez B., Perez B.S., Creavin B., Cali B., Pascotto B., Stubbs B., Retes B.Z., Jovanovic B., Goh B.K.P., Sensi B., Biddau C., Gazia C., Vallicelli C., Fagundes C.A., Santacruz C.C., Chirico C., Diaz C.J.G., Petrola C., Rodriguez C.S., Benitez C.Y., Dammaro C., Faro C.L., Reinke C., Paez C.D., Oliva C., Paranjape C., Thomas C., Chia C.F., Kong C.K., De Lucia C., Chao C.O., Arcudi C., Guerci C., Chia C., Parise C., Folliero C., Varela C., Ferguson D.M., Camacho D., Popowich D., Lima D.S., Rega D., Delogu D., Zigiotto D., Vinci D., D'Antonio D., Parini D., Merlini D.A., Zimmerman D.D.E., Moro-Valdezate D., Pertile D., Giusti D.M., Keller D.S., Tarik D., Kalivaci D., Mazingi D., Maldonado-Pintado D.G., Sasia D., Linardoutsos D., Osilli D., Murrone D., Russello D., Rodas E., Roa E.A.A., Ricciardi E., Rosso E., Saladino E., Flores-Villalba E., Ajs E.R., Smith-Singares E., Baili E., Kouroumpas E., Bourmpouteli E., Douka E., Martin-Perez E., Guaitoli E., Samadov E., Francone E., Vaterlini E., Morales E., Pena E., Zhao E., Andres E.D.P., Benzoni E., Erdas E., Pinotti E., Colas-Ruiz E., Aytac E., Laterza E., Agastra E., Foianini E., Moscoso E., Laviano E., Marra E., Cardamone E., Licardie E., Mpaili E., Pinna E., Varo E., Navarro F.M., Marino F., Medas F., Romano F., Maraska F., Saliu F., Madrid F., Rosa F., Mastella F., Gheza F., Luvisetto F., Alconchel F., Vieira F.M., Pareja F., Agresta F., Luna F., Bonilla F., Cordera F., Burdio F., Mendoza-Moreno F., Flores F.M., Aranda F.P., Taylor F., Ramos F.L., Fernandes F., Tropeano F.P., Balestra F., Bianco F., Ceci F., Colombo F., Di Marzo F., Ferrara F., Lancellotti F., Lazzarin F., Litta F., Martini F., Pizza F., Roscio F., Virdis F., Antona F.B., Ramirez F.C., Fernandez F.M., Llinares F.O., Quezada F., Schlottmann F., Herrera-Almario G., Massaferro G., Bislenghi G., van Ramshorst G., Luglio G., Bointas G., Kampouroglou G., Papadopoulos G., Manrique G.A., Calini G., Nastri G., Formisano G., Galiffa G., Palini G.M., Colucci G., Pagano G., Vanni G., Pattacini G.C., De Paola G., Lisi G., Partida G., Bellanova G., De Nobili G., Necchi G.S., Sinibaldi G., Tebala G., Bagaglini G., Izzo G., Argenio G., Brisinda G., Candilio G., Di Grezia G., Esposito G., Faillace G., Frazzetta G., La Gumina G., Nigri G., Romeo G., Amatriain G.C., Ortega G., Martin-Martin G., Stavrou G.A., Gunadi, Ugon G.A., Machain G., Marcucci G., Martinez-Mier G., Machain G.M., Nari G., Calvo H., Fathy H., Hamilto, Ahmed H., Faraj H., Nava H., Macias H.O., Nikaj H., Solano H., Khan H.A., Alarcon H.S., Ebied H., Giani I., Ateca I.V., Neri I., Roman I.A.S., Fidoshev I., Rodriguez I.M., Negoi I., Ortega I., Bernescu I., Russo I.S., Rodriguez I.V., Palomares I., Baltazar I., Torrejimeno I.J., Jurado I.M.C., Reccia I., Hussain I., Toledo I.B., Mora-Guzman I., Dogaru I., Romic I., Balciscueta I., Kenington J.C., Sagolsem J., Jang J.Y., Olivier J., Lammel-Lindemann J., Dziakova J., Villavicencio J.I.R., Salinas J., Parreira J.P.J.G., Jovanovic, Perez J.R., Reyes J.A.S., Luque J.A.M., Mak J., Rodriguez J.S., Kok J.H.H., Krook J., Diaz-Elizondo J.A., Castell J., Garcia-Flores J.E., Navalon J.M.J., Rodrigues J.M.S., Pereira J., Gomez J.T.C., Luque J.B., del Olmo J.C.M., Salamea J.C., Olivier J.F.C., Laina J.L.B., Ordonez J.M., Gutierrez J., Abba J., Sofi J.A., Sherafgan K., Sahnan K., Yanaga K., Beatson K., Asim L., Alvarez L., Siragusa L., Farber L., Ong L., Athanasios L., Garcia-Bruna L., De Martino L., Ferrario L., Giordano L., Gordini L., Pio L., Ponchietti L., Moletta L., Curella L., Poggi L., Taglietti L., Bonavina L., Conti L., Goffredi L., Ruiz L.A.G., Barrionuevo L., Fregoso L.E., Cabrera L.F., Rodriguez L.G., Grande L., Osoria L.G., Gonzalez L.J.K., Sanchez-Guillen L., Tallon-Aguilar L., Tresierra L., Giavarini L., Hasabelnabi M., Odovic M., Uemura M., Khan M., Artiles-Armas M., David M., Di Martino M., Spampinato M.G., Ribeiro M.A.F., Viola M., Angrisani M., Calussi M., Cannistra M., Catarci M., Cereda M., Conte M., Giordano M., Pellicciaro M., Marino M.V., Vaterlini M.E., Jimenez M.F., Lolli M.G., Bellini M.I., Lemma M., Chiarello M.M., Nicola M., Arrigo M., Mejia M.C., Manrique M.M., Rodriguez-Lopez M., Serradilla-Martin M., Lara M.Z., Martinez M., Bagnall M., Peter M., Lara M.C., Gomez M.J., Paniagua-Garcia-Senorans M., Gonzalez M.P., Rutegard M., Salo M., Franceschilli M., Silveri M., Veroux M., Pezzulo M., Nardi M., Rottoli M., Tolonen M., Ciro M.P., Zuluagua M., Cannavo M., Cervellera M., Iacobone M., Montuori M., Dominguez M.G., Bingol-Kologlu M., Tahir M., Lim M., Wilson M.S., Wilson M., Campanelli M., Bisaccia M., De Rosa M., Maruccia M., Paterno M., Pisano M., Torre M., Trevino M., Zuolo M., Hernandez Bartolome M.A., Farina M., Pera M., Calvo M.P., Sotelo M., Thway M.M., Hassan M., Hassan M.S.E., Azfar M., Bouhuwaish M., Taha M., Zaieem M., Korkoman M., Guraieb M., Shalaby M., Raza M.A., Younis M.U., Elhadi M., Ali M.Z., Quazi N., Dudi-Venkata N.N., Alselaim N., Loria N., Ramirez N.V., Than N.W., Smart N., Trelles N., Pinto N., Allievi N., Petrucciani N., Antonacci N., Cillara N., Gica N., Cristiana N.D., Krystek N., Falco N., Pecorelli N., Tamini N., Dallas N.A., Machairas N., Brito N., Fieturi N.A., Ortega N., Mercado O.A., Irkorucu O., Alsherif O., Valles O., Ioannidis O., Palmas O.H., Palmas O.I.H., Guadarrama O.S., Bozbiyik O., Omelanczuk P., Ottolino P., Rodrigues P., Ruiz P., Campenni P., Chiarade P., Olivares P.P., Baroffio P., Panaccio P., Wintringer P., Di Fronzo P., Talento P., Favoriti P., Sendino P., Marsanic P., Mifsut P., Andrade P., Ajawin P., Abadia-Barno P., Castaneda P.A.N., Arevalos P.O.S., Bellver P.P., Koh P.S., Souza P., Major P., Bali R.S., Khattar R.M., Melo R.B., Ebrahiminia R., Azar R., Murga R.L., Pirolo R., Brady R., Davies R.J., Dholakia R., Rattan R., Singhal R., Lim R., Angelico R., Isernia R.M., Tutino R., Faccincani R., Peltrini R., Carrera-Ceron R., Tejos R., Kashyap R., Fajardo R., Lozito R., Pareja R.M., Garbarino S., Morales-Conde S., Benli S., Mansour S., Flores S., Suarez S.L., Ben S.L., Fuentes S., Napetti S., de Guzman S.O., Awad S., Weckmann Lujan S.A., Gentilli S., Grimaldi S., Pizarro S.O., Tayar S., Nabi S., Chan S.M., Junaid S., Rojas S., Monetti S., Garcia S., Salvans S., Tenconi S., Shaw S., Santoni S., Parra S.A., Cardenas S., Perez-Bertolez S., Chiappetta S., Dessureault S., Delis S., Bonapasta S.A., Rausei S., Scaringi S., Keswani S., Ali S.M., Cetinkunar S., Fung T.L.D., Rawashdeh T., Lopez T.N., De Campos T., Duque T.C., Perra T., Liakakos T., Daskalakis T., Barnes T., Koeter T., Zalla T., Gonzalez T.E., Elosua T., Campagnaro T., Brown T., Luoto T., Oumar T.A., Giustizieri U., Grossi U., Bracale U., Rivas U., Sosa V., Testa V., Andriola V., Tonini V., Balassone V., Celentano V., Progno V., Raju V., Carroni V., Cavallaro V., Katta V.R., De Simone V., Romaguera V.P., Orozco V.H.G., Luraschi V., Rachkov V., Turrado-L V., Visag-Castillo V., Dowling V., Graham V., Papagni V., Vigorita V., Fonseca V.C., Carneros V.J., Bellato V., Goncalves W., Powers W.F., Grigg W., Bechstein W.O., Lim Y.B., Altinel Y., Golubovic Z., Balciscueta Z., Ielpo, B., Podda, M., Pellino, G., Pata, F., Caruso, R., Gravante, G., Di Saverio, S., Gallo, G., Lui, R., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Pisanu, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Yanez, A. P., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Roldan, A. M., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, A., Prestera, A., la Medina, A. R. -D., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Faro, C. L., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Andres, E. D. P., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., Roman, I. A. S., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Parreira, J. P. J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pereira, J., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Hernandez Bartolome, M. A., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Ali, M. Z., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Than, N. W., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., Gica, N., Cristiana, N. D., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Ben, S. L., Fuentes, S., Napetti, S., de Guzman, S. O., Awad, S., Weckmann Lujan, S. A., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Katta, V. R., De Simone, V., Romaguera, V. P., Orozco, V. H. G., Luraschi, V., Rachkov, V., Turrado-L, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, and Luglio, G

Subjects
medicine.medical_specialty, Anti-Bacterial Agents, Appendectomy, Appendicitis, COVID-19 Testing, Hospital Administration, Humans, Pandemics, Personal Protective Equipment, Practice Patterns, Physicians', Surveys and Questionnaires, Attitude of Health Personnel, COVID-19, Surgeons, Coronavirus disease 2019 (COVID-19), Settore MED/18 - CHIRURGIA GENERALE, COVID-19 pandemic. Acute appendicitis, MEDLINE, Practice Patterns, 030230 surgery, Health administration, 03 medical and health sciences, 0302 clinical medicine, Anti-Bacterial Agent, Pandemic, medicine, Surveys and Questionnaire, Appendiciti, General, Laparoscopy, Personal protective equipment, Physicians', medicine.diagnostic_test, business.industry, General surgery, Original Articles, medicine.disease, Anti-bacterial agents, appendectomy, appendicitis, COVID-19 testing, hospital administration, humans, pandemics, personal protective equipment, practice patterns physicians', surveys and questionnaires, attitude of health personnel, surgeons, appendicitis - COVI-19 - ACIE study - management, Acute appendicitis, Original Article, Surgery, Covid-19, business, Human
Abstract

Background Surgical strategies are being adapted to face the COVID‐19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X‐ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P, The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off

Published
2021

11. ESPEN practical guideline: Clinical Nutrition in cancer

Author

Maurizio Muscaritoli, Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Line Oldervoll, Paula Ravasco, Tora S. Solheim, Florian Strasser, Marian de van der Schueren, Jean-Charles Preiser, Stephan C. Bischoff, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
0301 basic medicine, Societies, Scientific, Cachexia, Nutritional Status, 030209 endocrinology & metabolism, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Chemotherapy, Humans, Cancer, Global Nutrition, Wereldvoeding, 030109 nutrition & dietetics, Nutrition and Dietetics, Radiotherapy, Nutritional Support, Malnutrition, Scientific, Anorexia, Europe, anorexia, cachexia, cancer, chemotherapy, malnutrition, radiotherapy, Societies
Abstract

Background: This practical guideline is based on the current scientific ESPEN guidelines on nutrition in cancer patients. Methods: ESPEN guidelines have been shortened and transformed into flow charts for easier use in clinical practice. The practical guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with cancer. Results: A total of 43 recommendations are presented with short commentaries for the nutritional and metabolic management of patients with neoplastic diseases. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in cancer patients. Conclusion: This practical guideline gives guidance to health care providers involved in the management of cancer patients to offer optimal nutritional care. (c) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Published
2021

12. Nutrition in the spotlight in cachexia, sarcopenia and muscle: avoiding the wildfire

Author

Stefan D. Anker, Andrew J.S. Coats, Carla M. Prado, Stephan von Haehling, and Alessandro Laviano

Subjects
Sarcopenia, medicine.medical_specialty, Cachexia, lcsh:Diseases of the musculoskeletal system, Nutritional Status, Wildfires, lcsh:QM1-695, Physiology (medical), medicine, Humans, Nutrition intervention, Orthopedics and Sports Medicine, Supplements, Intensive care medicine, Nutrition, Muscle loss, business.industry, Muscles, Editorials, lcsh:Human anatomy, medicine.disease, Editorial, Muscle, lcsh:RC925-935, business
Published
2020

13. Mixed-dust pneumoconiosis in a dental technician: a multidisciplinary diagnosis case report

Author

Luigi Di Lorenzo, Francesco Inchingolo, Antonella Pipoli, Filippo Cassano, Maria Elena Maggiore, Angelo Michele Inchingolo, Sabino Ceci, Assunta Patano, Giuseppina Malcangi, Antonio Mancini, Giosi Longo, Rossella Attimonelli, Eugenio Maiorano, Rocco Laviano, Nicola Mariano Manghisi, Antonio Scarano, Felice Lorusso, Antonio Di Lorenzo, Alessio Danilo Inchingolo, and Gianna Dipalma

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Minerals, Humans, Dust, Pneumoconiosis, Dental Technicians, Silicon Dioxide
Abstract

BackgroundIn dental laboratories, exposure to crystalline silica can occur during procedures that generate suspended mineral dusts, e.g. dispersion of mixing powders, removal of castings from molds grinding, polishing of castings and porcelain, and use of silica sand for blasting. There is also a large list of toxic agents (acrylic resins, polymeric materials, etc.) used to produce removable and fixed prostheses, but also impression materials and more. Using personal protective equipment and other aids reduces the exposure to these potentially harmful agents.Case presentationWe report the case of a 42-year-old male dental technician who began to suffer from a dry cough and exertional dyspnea after approximately 15 years of work. The operations he conducted for his job resulted in the generation of crystalline silica, aluminum, chromium and titanium dust. The worker did not regularly wear personal protective equipment and some of the above operations were not carried out in closed circuit systems. The Chest X-ray showed diffused micronodules in the pulmonary interstitium of the upper-middle lobes, bilaterally, and a modest left basal pleural effusion. Simple spirometry showed small airway obstruction in its initial stage. High Resolution Computerized Tomography of the chest showed bilateral micronodulation of a miliariform type, with greater profusion to the upper lobes, also present in the visceral pleura, bilaterally. Histological examination showed aggregates of pigment-laden macrophages forming perivascular macules or arranged in a radial pattern around a core of sclerohyalinosis. Scanning Electron Microscopy and Energy Dispersive Spectrometry revealed several mineral particles, typically characterized by the presence of crystalline silica and metal aggregates. The environmental concentrations of total dust and its respirable fraction were all lower than the relative TLV-TWA—ACGIH, yet not negligible.ConclusionsThe above findings and a multidisciplinary assessment led to the diagnosis of mixed dust pneumoconiosis s/q with 2/2 profusion of occupational origin. This diagnosis in a dental technician was supported for the first time in literature by environmental exposure analysis.

Published
2022

14. Rituximab- and ocrelizumab-induced early- and late-onset neutropenia in a multiple sclerosis patient

Author

Florencia Fornillo, Sofía Oneto, Fabricio M Reino, José Tejada Fernández, Mariano Marrodan, Julia Laviano, Ricardo Delorme, and Jorge Correale

Subjects
medicine.medical_specialty, Pediatrics, Multiple Sclerosis, Neutropenia, Neurology, MEDLINE, Dermatology, Antibodies, Monoclonal, Humanized, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Humans, Immunologic Factors, Medicine, 030212 general & internal medicine, Neuroradiology, business.industry, Multiple sclerosis, General Medicine, medicine.disease, Psychiatry and Mental health, Rituximab, Ocrelizumab, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Fil: Marrodan, Mariano. Fleni. Departamento de Neurologia. Servicio de Neuroinmunologia y Enfermedades Desmielinizantes; Argentina.

Published
2021

15. Surgical site infection in hepatobiliary surgery patients and its relationship with serum vitamin D concentration

Author

María Sanchez, Estefania Laviano, María Teresa González-Nicolás, Pilar Calmarza, Antonio Rezusta, Yolanda Gilaberte, Javier E. López, Alejandro Serrablo, and María Pilar Palacian

Subjects
Male, medicine.medical_specialty, Exploratory laparotomy, Digestive System Diseases, medicine.medical_treatment, 030230 surgery, Logistic regression, Gastroenterology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, medicine, Vitamin D and neurology, Humans, Surgical Wound Infection, Prospective Studies, Vitamin D, Prospective cohort study, Digestive System Surgical Procedures, Aged, Cross Infection, business.industry, Incidence, Incidence (epidemiology), General Engineering, Middle Aged, Protective Factors, Pancreaticoduodenectomy, Logistic Models, Female, Cholecystectomy, Hepatectomy, business
Abstract

Introduction While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. Methods Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. Results Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. Conclusions High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.

Published
2020

16. Nutrition interventions to treat low muscle mass in cancer

Author

Sarah A. Purcell, Alessandro Laviano, and Carla M. Prado

Subjects
0301 basic medicine, Sarcopenia, medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, Anabolism, Psychological intervention, Reviews, Intervention, Context (language use), Review, Body composition, lcsh:QM1-695, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Physiology (medical), medicine, Vitamin D and neurology, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, Intensive care medicine, Cancer, Nutrition, Low muscle mass, 2. Zero hunger, business.industry, Protein, Clinical study design, lcsh:Human anatomy, medicine.disease, Obesity, 3. Good health, Nutrition Assessment, 030104 developmental biology, 030220 oncology & carcinogenesis, Myopenia, lcsh:RC925-935, business
Abstract

Many patients with cancer experience poor nutritional status, which detrimentally impacts clinical outcomes. Poor nutritional status in cancer is primarily manifested by severe muscle mass (MM) depletion, which may occur at any stage (from curative to palliative) and often co‐exists with obesity. The objective of this article was to discuss gaps and opportunities related to the role of nutrition in preventing and reversing low MM in cancer. It also provides a narrative review of relevant nutritional interventions for patients capable of oral intake. The impact of nutrition interventions to prevent/treat low MM in cancer is not well understood, potentially due to the limited number of studies and of clinically viable, accurate body composition assessment tools. Additionally, the type of study designs, inclusion criteria, length of intervention, and choice of nutritional strategies have not been optimal, likely underestimating the anabolic potential of nutrition interventions. Nutrition studies are also often of short duration, and interventions that adapt to the metabolic and behavioural changes during the clinical journey are needed. We discuss energy requirements (25–30 kcal/kg/day) and interventions of protein (1.0–1.5 g/kg/day), branched‐chain amino acids (leucine: 2–4 g/day), β‐hydroxy β‐methylbutyrate (3 g/day), glutamine (0.3 g/kg/day), carnitine (4–6 g/day), creatine (5 g/day), fish oil/eicosapentanoic acid (2.0–2.2 g/day EPA and 1.5 g/day DHA), vitamin/minerals (e.g. vitamin D: 600–800 international units per day), and multimodal approaches (nutrition, exercise, and pharmaceutical) to countermeasure low MM in cancer. Although the evidence is variable by modality type, interventions were generally not specifically studied in the context of cancer. Understanding patients' nutritional requirements could lead to targeted prescriptions to prevent or attenuate low MM in cancer, with the overall aim of minimizing muscle loss during anti‐cancer therapy and maximizing muscle anabolism during recovery. It is anticipated that this will, in turn, improve overall health and prognostication including tolerance to treatment and survival. However, oncology‐specific interventions with more robust study designs are needed to facilitate these goals.

Published
2020

17. Perspective: Role of Micronutrients and Omega-3 Long-Chain Polyunsaturated Fatty Acids for Immune Outcomes of Relevance to Infections in Older Adults-A Narrative Review and Call for Action

Author

Manfred Eggersdorfer, Mette M Berger, Philip C Calder, Adrian F Gombart, Emily Ho, Alessandro Laviano, and Simin N Meydani

Subjects
immunosenescence, eicosapentaenoic acid, Nutrition and Dietetics, vitamin, Medicine (miscellaneous), trace element, COVID-19, Ascorbic Acid, Vitamins, docosahexaenoic acid, Selenium, Zinc, Fatty Acids, Omega-3, Humans, inflammaging, viral infection, Micronutrients, influenza, Pandemics, older adults, Food Science, Aged
Abstract

The immune system is weakened by advancing age, often referred to as immunosenescence, increasing the vulnerability to, and frequently the severity of, infectious diseases in older people. This has become very apparent in the current coronavirus disease 2019 (COVID-19) pandemic for which older people are at higher risk of severe outcomes, even those who are fully vaccinated. Aging affects both the innate and adaptive immune systems and is characterized by an imbalanced inflammatory response. Increasing evidence shows that optimal status of nutrients such as vitamins C, D, and E and selenium and zinc as well as the omega-3 (n-3) fatty acids DHA and EPA can help compensate for these age-related changes. While inadequate intakes of these nutrients are widespread in the general population, this is often more pronounced in older people. Maintaining adequate intakes is a challenge for them due to a range of factors such as physical, physiological, and cognitive changes; altered absorption; and the presence of noncommunicable diseases. While nutritional requirements are ideally covered by a balanced diet, this can be difficult to achieve, particularly for older people. Fortified foods and nutritional complements are effective in achieving adequate micronutrient intakes and should be considered as a safe and cost-effective means for older people to improve their nutritional status and hence support their defense against infections. Complementing the diet with a combination of micronutrients, particularly those playing a key role in the immune system such as vitamins C, D, and E and selenium and zinc as well as DHA and EPA, is recommended for older people. Optimal nutrition to support the immune system in older people will remain essential, particularly in the face of the current COVID-19 pandemic and, thus, developing strategies to ensure adequate nutrition for the growing number of older adults will be an important and cost-effective investment in the future.

Published
2022

18. Mapping ongoing nutrition intervention trials in muscle, sarcopenia, and cachexia: a scoping review of future research

Author

Camila E. Orsso, Montserrat Montes‐Ibarra, Merran Findlay, Barbara S. van der Meij, Marian A. E. de van der Schueren, Francesco Landi, Alessandro Laviano, and Carla M. Prado

Subjects
Adult, Global Nutrition, Sarcopenia, Wereldvoeding, Cachexia, Nutritional Status, Dietary intervention, Clinical trials, Physiology (medical), Humans, Muscle, Nutrition intervention, Orthopedics and Sports Medicine, Muscle Strength, Muscle, Skeletal
Abstract

Muscle loss alone, or in the context of sarcopenia or cachexia, is a prevalent condition and a predictor of negative outcomes in aging and disease. As adequate nutrition is essential for muscle maintenance, a growing number of studies has been conducted to explore the role of specific nutrients on muscle mass or function. Nonetheless, more research is needed to guide evidence-based recommendations. This scoping review aimed to compile and document ongoing clinical trials investigating nutrition interventions as a strategy to prevent or treat low muscle mass or function (strength and physical performance), sarcopenia, or cachexia. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched up to 21 April 2021 for planned and ongoing trials. Randomized controlled trials with ≥20 participants per arm were included based on intent to explore the effects of nutrition interventions on muscle-related outcomes (i.e. muscle mass or strength, physical performance, or muscle synthesis rate) in both clinical and non-clinical conditions (i.e. aging). Two reviewers independently screened records for eligibility, and a descriptive synthesis of trials characteristics was conducted. A total of 113 trials were included in the review. Most trials (69.0%) enroll adults with clinical conditions, such as cancer (19.5%), obesity and metabolic diseases (16.8%), and musculoskeletal diseases (10.7%). The effects of nutrition interventions on age-related muscle loss are explored in 31% of trials. Although nutrition interventions of varied types were identified, food supplements alone (48.7%) or combined with dietary advice (11.5%) are most frequently reported. Protein (17.7%), amino acids (10.6%), and β-hydroxy-β-methylbutyrate (HMB, 6.2%) are the top three food supplements' nutrients under investigation. Primary outcome of most trials (54.9%) consists of measures of muscle mass alone or in combination with muscle strength and/or performance (as either primary or secondary outcomes). Muscle strength and physical performance are primary outcomes of 38% and 31.9% of the trials, respectively. These measurements were obtained using a variety of techniques. Only a few trials evaluate muscle synthesis rate either as a primary or secondary outcome (5.3%). Several nutrition studies focusing on muscle, sarcopenia, and cachexia are underway and can inform future research in this area. Although many trials have similar type of interventions, methodological heterogeneity may challenge study comparisons, and future meta-analyses aiming to provide evidence-based recommendations. Upcoming research in this area may benefit from guidelines for the assessment of therapeutic effects of nutrition interventions.

Published
2022

19. Absence of risk of sarcopenia protects cancer patients from fatigue

Author

Claude Pichard, Alessandro Laviano, Cleidiana S. Barreto, Thaís C. Borges, Tatyanne L.N. Gomes, Nathalia P. Valentino, Gustavo D. Pimentel, Jéssika M. Siqueira, and Jéssika D.P. Soares

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Sarcopenia, Cancer therapy, Medicine (miscellaneous), 030209 endocrinology & metabolism, Lower risk, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Neoplasms, Surveys and Questionnaires, Medicine, Humans, In patient, Geriatric Assessment, Fatigue, Aged, ddc:616, 030109 nutrition & dietetics, Nutrition and Dietetics, Performance status, Hand Strength, business.industry, Cancer type, Cancer, medicine.disease, Cross-Sectional Studies, Female, business, human activities
Abstract

Background: Cancer and its treatments often lead to sarcopenia and fatigue. However, whether these factors are associated remains unproven.Objective: To evaluate whether the risk of sarcopenia predicts the presence of fatigue.Methods: A cross-sectional study was completed and included 198 cancer patients of both sexes, undergoing in- and outpatient treatment. The Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and the Functional Assessment of Cancer Therapy Fatigue (FACT-F) were used to assess the risk of sarcopenia and the presence of fatigue, respectively. The cut-off values used to identify the risk of sarcopenia and the severity of fatigue scale were SARC-F ≥ 4 and Fatigue Results: Out of 198 patients, 35% were at risk of sarcopenia and of these 87% had fatigue. Patients at risk of sarcopenia had lower scores in the FACT-F subscales, lower handgrip strength, lower performance status, were mostly hospitalized and were sedentary. Logistic regression analysis revealed that patients with SARC-F < 4 had a lower risk of fatigue in both models, crude (OR: 0.83; CI 95% [0.79-0.88], p < 0.0001) as well as adjusted for age, gender, BMI, physical activity, current use of alcoholic beverages, smoking, performance status, cancer type, clinical setting and use of supplements (OR: 0.87; CI 95% [0.81-0.92], p < 0.0001).Conclusion: In patients with cancer, 35% presented risk of sarcopenia and of these 87% had fatigue. In addition, the absence of sarcopenia was considered protective against fatigue.

Published
2022

20. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

Author

Rocco Barazzoni, Joao Breda, Cristina Cuerda, Stephane Schneider, Nicolaas E. Deutz, Kremlin Wickramasinghe, Osman Abbasoglu, Judith Beurskens Meijerink, Stephan Bischoff, Rosa Burgos Pelaez, Diana Cardenas, Tommy Cederholm, Emanuele Cereda, Michael Chourdakis, Maria Isabel Toulson Davisson Correia, Marian de van der Schuren, Nathalie Delzenne, Evelyn Frias-Toral, Laurence Genton, Gianluca Gortan Cappellari, Burcu Kelleci Cakir, Stanislaw Klek, Zeljko Krznaric, Alessandro Laviano, Dileep Lobo, Maurizio Muscaritoli, Johann Ockenga, Matthias Pirlich, Mireille JM. Serlie, Han Ping Shi, Pierre Singer, Mattias Soop, Stephane Walrand, Arved Weimann, Barazzoni, Rocco, Breda, Joao, Cuerda, Cristina, Schneider, Stephane, Deutz, Nicolaas E, Wickramasinghe, Kremlin, COVID-19 Call Editorial, Board, Gortan Cappellari, Gianluca, and UCL - SSS/LDRI - Louvain Drug Research Institute

Subjects
Public health, Nutrition and Dietetics, Sars-CoV-2, Malnutrition, Nutritional Status, COVID-19, Nutritional care, World Health Organization, Critical Care and Intensive Care Medicine, Europe, Nutrition Assessment, Post-Acute COVID-19 Syndrome, Communicable Disease Control, Humans, Obesity
Abstract

With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.

Published
2022

22. Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study

Author

Pellino, G., Podda, M., Pata, F., Di Saverio, S., Ielpo, B., Caruso, R., Gravante, G., Orengia, A., Chowdary, A., Kulkarni, A., Kuvvetli, A., Navarro, A., Smith, A., Ibiricu, A. C., Nacion, A. J. D., Alsaleh, A., Alhazmi, A., Elmabri, A., Wani, A., Rencuzogullari, A., Lasarte, A. S., Rubio, A. V., Bavikatte, A., Kumar, A., Jamiri, A. -R., Padilla, A. M. A., Cacurri, A., de San Ildefonso, A., Porcu, A., Sartori, A., Rocca, A., Paz Yanez, A., Becaria, A., Solis-Pena, A., Sretenovic, A., Urbistondo, A., Bandin, A., Najar, A., De Luca, A., Boddy, A., Charalabopoulos, A., Tzivanakis, A., Amendola, A., de Velasco, A. R. -G., Yildirim, A. C., Frontali, A., Toure, A. O., Garcia-Granero, A., Martinez Roldan, A., Larrainzar, A. S., Ratnayake, A. S., Gonzalez-Ganso, A. M., Minaya-Bravo, A. M., Das, A., Bondurri, A., Costanzi, A., Lucchi, A., Mazzari, A., Musig, A., Peloso, A., Piano, A., Police, A., Mihailescu, A., Pouy, A., Romano, A., Iossa, A., Leonetti, A. C., Guariniello, A., Isaac, A., Bovi, A. P. D., Chessa, A., Tromba, A., Martinez, A. A., Brillantino, A., Caira, A., Castaldi, A., Ferronetti, A., Giuliani, A., Prestera, A., Ramos-De la Medina, A., Tarasconi, A., Tornambe, A., Picciariello, A., Ioannidis, A., Leppaniemi, A., Khan, A., Rashid, A., Perez-Sanchez, A. L. E., Mittal, A., Mitul, A. R., Mehraj, A., Laharwal, A., Dorisme, A., Marinis, A., Iqbal, A., Moncada, A., Braccio, B., Alkhafaji, B., de Andres Asenjo, B., Martin-Perez, B., De Simone, B., Perez, B. S., Creavin, B., Cali, B., Pascotto, B., Stubbs, B., Retes, B. Z., Jovanovic, B., Goh, B. K. P., Sensi, B., Biddau, C., Gazia, C., Vallicelli, C., Fagundes, C. A., Santacruz, C. C., Chirico, C., Diaz, C. J. G., Petrola, C., Rodriguez, C. S., Benitez, C. Y., Dammaro, C., Lo Faro, C., Reinke, C., Paez, C. D., Oliva, C., Paranjape, C., Thomas, C., Chia, C. F., Kong, C. K., De Lucia, C., Chao, C. O., Arcudi, C., Guerci, C., Chia, C., Parise, C., Folliero, C., Varela, C., Ferguson, D. M., Camacho, D., Popowich, D., Lima, D. S., Rega, D., Delogu, D., Zigiotto, D., Vinci, D., D'Antonio, D., Parini, D., Merlini, D. A., Zimmerman, D. D. E., Moro-Valdezate, D., Pertile, D., Giusti, D. M., Keller, D. S., Tarik, D., Kalivaci, D., Mazingi, D., Maldonado-Pintado, D. G., Sasia, D., Linardoutsos, D., Osilli, D., Murrone, D., Russello, D., Rodas, E., Roa, E. A. A., Ricciardi, E., Rosso, E., Saladino, E., Flores-Villalba, E., Ajs, E. R., Smith-Singares, E., Baili, E., Kouroumpas, E., Bourmpouteli, E., Douka, E., Martin-Perez, E., Guaitoli, E., Samadov, E., Francone, E., Vaterlini, E., Morales, E., Pena, E., Zhao, E., Del Pozo Andres, E., Benzoni, E., Erdas, E., Pinotti, E., Colas-Ruiz, E., Aytac, E., Laterza, E., Agastra, E., Foianini, E., Moscoso, E., Laviano, E., Marra, E., Cardamone, E., Licardie, E., Mpaili, E., Pinna, E., Varo, E., Navarro, F. M., Marino, F., Medas, F., Romano, F., Maraska, F., Saliu, F., Madrid, F., Rosa, F., Mastella, F., Gheza, F., Luvisetto, F., Alconchel, F., Vieira, F. M., Pareja, F., Agresta, F., Luna, F., Bonilla, F., Cordera, F., Burdio, F., Mendoza-Moreno, F., Flores, F. M., Aranda, F. P., Taylor, F., Ramos, F. L., Fernandes, F., Tropeano, F. P., Balestra, F., Bianco, F., Ceci, F., Colombo, F., Di Marzo, F., Ferrara, F., Lancellotti, F., Lazzarin, F., Litta, F., Martini, F., Pizza, F., Roscio, F., Virdis, F., Antona, F. B., Ramirez, F. C., Fernandez, F. M., Llinares, F. O., Quezada, F., Schlottmann, F., Herrera-Almario, G., Massaferro, G., Bislenghi, G., van Ramshorst, G., Gallo, G., Luglio, G., Bointas, G., Kampouroglou, G., Papadopoulos, G., Manrique, G. A., Calini, G., Nastri, G., Formisano, G., Galiffa, G., Palini, G. M., Colucci, G., Pagano, G., Vanni, G., Pattacini, G. C., De Paola, G., Lisi, G., Partida, G., Bellanova, G., De Nobili, G., Necchi, G. S., Sinibaldi, G., Tebala, G., Bagaglini, G., Izzo, G., Argenio, G., Brisinda, G., Candilio, G., Di Grezia, G., Esposito, G., Faillace, G., Frazzetta, G., La Gumina, G., Nigri, G., Romeo, G., Amatriain, G. C., Ortega, G., Martin-Martin, G., Stavrou, G. A., Gunadi, Ugon, G. A., Machain, G., Marcucci, G., Martinez-Mier, G., Machain, G. M., Nari, G., Calvo, H., Fathy, H., Hamilton, Ahmed, H., Faraj, H., Nava, H., Macias, H. O., Nikaj, H., Solano, H., Khan, H. A., Alarcon, H. S., Ebied, H., Giani, I., Ateca, I. V., Neri, I., San Roman, I. A., Fidoshev, I., Rodriguez, I. M., Negoi, I., Ortega, I., Bernescu, I., Russo, I. S., Rodriguez, I. V., Palomares, I., Baltazar, I., Torrejimeno, I. J., Jurado, I. M. C., Reccia, I., Hussain, I., Toledo, I. B., Mora-Guzman, I., al-Najami, I., Dogaru, I., Romic, I., Balciscueta, I., Kenington, J. C., Sagolsem, J., Jang, J. Y., Olivier, J., Lammel-Lindemann, J., Dziakova, J., Villavicencio, J. I. R., Salinas, J., Pejanovic, J., Parreira, J. G., Perez, J. R., Reyes, J. A. S., Luque, J. A. M., Mak, J., Rodriguez, J. S., Kok, J. H. H., Krook, J., Diaz-Elizondo, J. A., Castell, J., Garcia-Flores, J. E., Navalon, J. M. J., Rodrigues, J. M. S., Pinto, J. P., Gomez, J. T. C., Luque, J. B., del Olmo, J. C. M., Salamea, J. C., Olivier, J. F. C., Laina, J. L. B., Ordonez, J. M., Gutierrez, J., Abba, J., Sofi, J. A., Sherafgan, K., Sahnan, K., Yanaga, K., Beatson, K., Asim, L., Alvarez, L., Siragusa, L., Farber, L., Ong, L., Athanasios, L., Garcia-Bruna, L., De Martino, L., Ferrario, L., Giordano, L., Gordini, L., Pio, L., Ponchietti, L., Moletta, L., Curella, L., Poggi, L., Taglietti, L., Bonavina, L., Conti, L., Goffredi, L., Ruiz, L. A. G., Barrionuevo, L., Fregoso, L. E., Cabrera, L. F., Rodriguez, L. G., Grande, L., Osoria, L. G., Gonzalez, L. J. K., Sanchez-Guillen, L., Tallon-Aguilar, L., Tresierra, L., Giavarini, L., Hasabelnabi, M., Odovic, M., Uemura, M., Khan, M., Artiles-Armas, M., David, M., Di Martino, M., Spampinato, M. G., Ribeiro, M. A. F., Viola, M., Angrisani, M., Calussi, M., Cannistra, M., Catarci, M., Cereda, M., Conte, M., Giordano, M., Pellicciaro, M., Marino, M. V., Vaterlini, M. E., Jimenez, M. F., Lolli, M. G., Bellini, M. I., Lemma, M., Chiarello, M. M., Nicola, M., Arrigo, M., Mejia, M. C., Manrique, M. M., Rodriguez-Lopez, M., Serradilla-Martin, M., Lara, M. Z., Martinez, M., Bagnall, M., Peter, M., Lara, M. C., Gomez, M. J., Paniagua-Garcia-Senorans, M., Gonzalez, M. P., Rutegard, M., Salo, M., Franceschilli, M., Silveri, M., Veroux, M., Pezzulo, M., Nardi, M., Rottoli, M., Tolonen, M., Ciro, M. P., Zuluagua, M., Cannavo, M., Cervellera, M., Iacobone, M., Montuori, M., Dominguez, M. G., Bingol-Kologlu, M., Tahir, M., Lim, M., Wilson, M. S. J., Wilson, M., Campanelli, M., Bisaccia, M., De Rosa, M., Maruccia, M., Paterno, M., Pisano, M., Torre, M., Trevino, M., Zuolo, M., Bartolome, M. A. H., Farina, M., Pera, M., Calvo, M. P., Sotelo, M., Thway, M. M., Hassan, M., Hassan, M. S. E., Azfar, M., Bouhuwaish, M., Taha, M., Zaieem, M., Korkoman, M., Guraieb, M., Shalaby, M., Raza, M. A., Younis, M. U., Elhadi, M., Zulfiqar Ali, M., Quazi, N., Dudi-Venkata, N. N., Alselaim, N., Loria, N., Ramirez, N. V., Win Than, N., Smart, N., Trelles, N., Pinto, N., Allievi, N., Petrucciani, N., Antonacci, N., Cillara, N., De'Angelis, N., Gica, N., Nicolaescu, D. C., Krystek, N., Falco, N., Pecorelli, N., Tamini, N., Dallas, N. A., Machairas, N., Brito, N., Fieturi, N. A., Ortega, N., Mercado, O. A., Irkorucu, O., Alsherif, O., Valles, O., Ioannidis, O., Palmas, O. H., Palmas, O. I. H., Guadarrama, O. S., Bozbiyik, O., Omelanczuk, P., Ottolino, P., Rodrigues, P., Ruiz, P., Campenni, P., Chiarade, P., Olivares, P. P., Baroffio, P., Panaccio, P., Wintringer, P., Di Fronzo, P., Talento, P., Favoriti, P., Sendino, P., Marsanic, P., Mifsut, P., Andrade, P., Ajawin, P., Abadia-Barno, P., Castaneda, P. A. N., Arevalos, P. O. S., Bellver, P. P., Koh, P. S., Souza, P., Major, P., Bali, R. S., Khattar, R. M., Lui, R., Melo, R. B., Ebrahiminia, R., Azar, R., Murga, R. L., Pirolo, R., Brady, R., Davies, R. J., Dholakia, R., Rattan, R., Singhal, R., Lim, R., Angelico, R., Isernia, R. M., Tutino, R., Faccincani, R., Peltrini, R., Carrera-Ceron, R., Tejos, R., Kashyap, R., Fajardo, R., Lozito, R., Pareja, R. M., Garbarino, S., Morales-Conde, S., Benli, S., Mansour, S., Flores, S., Suarez, S. L., Lopez, B. S., Fuentes, S., de las Casas, S. G., Napetti, S., de Guzman, S. O., Awad, S., Lujan, S. A. W., Gentilli, S., Grimaldi, S., Pizarro, S. O., Tayar, S., Nabi, S., Chan, S. M., Junaid, S., Rojas, S., Monetti, S., Garcia, S., Salvans, S., Tenconi, S., Shaw, S., Santoni, S., Parra, S. A., Cardenas, S., Perez-Bertolez, S., Chiappetta, S., Dessureault, S., Delis, S., Bonapasta, S. A., Rausei, S., Scaringi, S., Keswani, S., Ali, S. M., Cetinkunar, S., Fung, T. L. D., Rawashdeh, T., Lopez, T. N., De Campos, T., Duque, T. C., Perra, T., Liakakos, T., Daskalakis, T., Barnes, T., Koeter, T., Zalla, T., Gonzalez, T. E., Elosua, T., Campagnaro, T., Brown, T., Luoto, T., Oumar, T. A., Giustizieri, U., Grossi, U., Bracale, U., Rivas, U., Sosa, V., Testa, V., Andriola, V., Tonini, V., Balassone, V., Celentano, V., Progno, V., Raju, V., Carroni, V., Cavallaro, V., Rao Katta, V., De Simone, V., Primo Romaguera, V., Garcia Orozco, V., Luraschi, V., Rachkov, V., Turrado-Rodriguez, V., Visag-Castillo, V., Dowling, V., Graham, V., Papagni, V., Vigorita, V., Fonseca, V. C., Carneros, V. J., Bellato, V., Goncalves, W., Powers, W. F., Grigg, W., Bechstein, W. O., Lim, Y. B., Altinel, Y., Golubovic, Z., Balciscueta, Z., Ielpo, B, Podda, M, Pellino, G, Pata, F, Caruso, R, Gravante, G, Di Saverio, S, Orengia, A, Chowdary, A, Kulkarni, A, Kuvvetli, A, Navarro, A, Smith, A, Cavero Ibiricu, A, D Nacion, A J, Alsaleh, A, Alhazmi, A, Elmabri, A, Wani, A, Rencuzogullari, A, Sarriugarte Lasarte, A, Valle Rubio, A, Bavikatte, A, Kumar, A, Jamiri, A-R, M Alvarado Padilla, A, Cacurri, A, de San Ildefonso, A, Porcu, A, Sartori, A, Rocca, A, Paz Yáñez, A, Becaria, A, Solís-Peña, A, Sretenović, A, Urbistondo, A, Bandin, A, Najar, A, De Luca, A, Boddy, A, Charalabopoulos, A, Tzivanakis, A, Amendola, A, Ramirez-Gutierrez de Velasco, A, Cihat Yildirim, A, Frontali, A, O Toure, A, García-Granero, A, Martínez Roldan, A, Sanz Larrainzar, A, Sanjiva Ratnayake, A, M Gonzalez-Ganso, A, M Minaya-Bravo, A, Das, A, Bondurri, A, Costanzi, A, Lucchi, A, Mazzari, A, Musig, A, Peloso, A, Piano, A, Police, A, Mihailescu, A, Pouy, A, Romano, A, Iossa, A, C Leonetti, A, Guariniello, A, Isaac, A, P Delli Bovi, A, Chessa, A, Tromba, A, Álvarez Martínez, A, Brillantino, A, Caira, A, Castaldi, A, Ferronetti, A, Giuliani, A, Prestera, A, Ramos-De la Medina, A, Tarasconi, A, Tornambè, A, Picciariello, A, Ioannidis, A, Leppäniemi, A, Khan, A, Rashid, A, E Pérez-Sánchez, A L, Mittal, A, Rahman Mitul, A, Mehraj, A, Laharwal, A, Dorismé, A, Marinis, A, Iqbal, A, Moncada, A, Braccio, B, Alkhafaji, B, de Andrés Asenjo, B, Martin-Perez, B, De Simone, B, Sánchez Pérez, B, Creavin, B, Calì, B, Pascotto, B, Stubbs, B, Zavala Retes, B, Jovanovic, B, P Goh, B K, Sensi, B, Biddau, C, Gazia, C, Vallicelli, C, A Fagundes, C, Cerdán Santacruz, C, Chirico, C, J Gómez Díaz, C, Petrola, C, Sánchez Rodriguez, C, Yánez Benítez, C, Dammaro, C, Lo Faro, C, Reinke, C, Dominguez Paez, C, Oliva, C, Paranjape, C, Thomas, C, Fung Chia, C, Kwan Kong, C, De Lucia, C, Ovalle Chao, C, Arcudi, C, Guerci, C, Chia, C, Parise, C, Folliero, C, Varela, C, M Ferguson, D, Camacho, D, Popowich, D, Souza Lima, D, Rega, D, Delogu, D, Zigiotto, D, Vinci, D, D'Antonio, D, Parini, D, A Merlini, D, E Zimmerman, D D, Moro-Valdezate, D, Pertile, D, M Giusti, D, S Keller, D, Tarik, D, Kalivaçi, D, Mazingi, D, G Maldonado-Pintado, D, Sasia, D, Linardoutsos, D, Osilli, D, Murrone, D, Russello, D, Rodas, E, A Acuña Roa, E, Ricciardi, E, Rosso, E, Saladino, E, Flores-Villalba, E, Ruiz Ajs, E, Smith-Singares, E, Baili, E, Kouroumpas, E, Bourmpouteli, E, Douka, E, Martin-Perez, E, Guaitoli, E, Samadov, E, Francone, E, Vaterlini, E, Morales, E, Peña, E, Zhao, E, Del Pozo Andres, E, Benzoni, E, Erdas, E, Pinotti, E, Colás-Ruiz, E, Aytac, E, Laterza, E, Agastra, E, Foianini, E, Moscoso, E, Laviano, E, Marra, E, Cardamone, E, Licardie, E, Mpaili, E, Pinna, E, Varo, E, M Navarro, F, Marino, F, Medas, F, Romano, F, Maraska, F, Saliu, F, Madrid, F, Rosa, F, Mastella, F, Gheza, F, Luvisetto, F, Alconchel, F, Monge Vieira, F, Pareja, F, Agresta, F, Luna, F, Bonilla, F, Cordera, F, Burdió, F, Mendoza-Moreno, F, Muñoz Flores, F, Pardo Aranda, F, Taylor, F, L Ramos, F, Fernandes, F, P Tropeano, F, Balestra, F, Bianco, F, Ceci, F, Colombo, F, Di Marzo, F, Ferrara, F, Lancellotti, F, Lazzarin, F, Litta, F, Martini, F, Pizza, F, Roscio, F, Virdis, F, Blanco Antona, F, Cervantes Ramírez, F, M Fernandez, F, O Llinares, F, Quezada, F, Schlottmann, F, Herrera-Almario, G, Massaferro, G, Bislenghi, G, van Ramshorst, G, Gallo, G, Luglio, G, Bointas, G, Kampouroglou, G, Papadopoulos, G, Arredondo Manrique, G, Calini, G, Nastri, G, Formisano, G, Galiffa, G, M Palini, G, Colucci, G, Pagano, G, Vanni, G, Casoni Pattacini, G, De Paola, G, Lisi, G, Partida, G, Bellanova, G, De Nobili, G, Sammy Necchi, G, Sinibaldi, G, Tebala, G, Bagaglini, G, Izzo, G, Argenio, G, Brisinda, G, Candilio, G, Di Grezia, G, Esposito, G, Faillace, G, Frazzetta, G, La Gumina, G, Nigri, G, Romeo, G, Chocarro Amatriaín, G, Ortega, G, Martin-Martin, G, A Stavrou, G, Gunadi, G, Armand Ugon, G, Machain, G, Marcucci, G, Martínez-Mier, G, M Machain, G, Nari, G, Calvo, H, Fathy, H, Hamilton, H, Ahmed, H, Faraj, H, Nava, H, Ordas Macias, H, Nikaj, H, Solano, H, Ahmed Khan, H, Sánchez Alarcón, H, Ebied, H, Giani, I, Villalabeitia Ateca, I, Neri, I, A San Roman, I, Fidoshev, I, Martinez Rodriguez, I, Negoi, I, Ortega, I, Bernescu, I, Shari Russo, I, Vincente Rodríguez, I, Palomares, I, Baltazar, I, Jaén Torrejimeno, I, M Cornejo Jurado, I, Reccia, I, Hussain, I, Brito Toledo, I, Mora-Guzmán, I, Al-Najami, I, Dogaru, I, Romic, I, Balciscueta, I, C Kenington, J, Sagolsem, J, Y Jang, J, Olivier, J, Lammel-Lindemann, J, Dziakova, J, I Roldán Villavicencio, J, Salinas, J, Pejanovic Jose Gustavo Parreira, J, Rincón Pérez, J, S Reyes, J A, A Medina Luque, J, Mak, J, Salas Rodriguez, J, H Herrera Kok, J, Krook, J, A Diaz-Elizondo, J, Castell, J, Eduardo García-Flores, J, M Jover Navalón, J, M Silva Rodrigues, J, Pereira Pinto, J, T Castell Gómez, J, Bellido Luque, J, C Martín Del Olmo, J, C Salamea, J, F Coronel Olivier, J, L Blas Laina, J, M Ordoñez, J, Gutierrez, J, Abba, J, Ahmad Sofi, J, Sherafgan, K, Sahnan, K, Yanaga, K, Beatson, K, Asim, L, Alvarez, L, Siragusa, L, Farber, L, Ong, L, Athanasios, L, García-Bruña, L, De Martino, L, Ferrario, L, Giordano, L, Gordini, L, Pio, L, Ponchietti, L, Moletta, L, Curella, L, Poggi, L, Taglietti, L, Bonavina, L, Conti, L, Goffredi, L, A Garcia Ruiz, L, Barrionuevo, L, E Fregoso, L, F Cabrera, L, G Rodriguez, L, Grande, L, G Osoria, L, J Kantun Gonzalez, L, Sánchez-Guillén, L, Tallon-Aguilar, L, Tresierra, L, Giavarini, L, Hasabelnabi, M, Odovic, M, Uemura, M, Khan, M, Artiles-Armas, M, David, M, Di Martino, M, G Spampinato, M, F Ribeiro, M A, Viola, M, Angrisani, M, Calussi, M, Cannistrà, M, Catarci, M, Cereda, M, Conte, M, Giordano, M, Pellicciaro, M, Vito Marino, M, E Vaterlini, M, F Jiménez, M, G Lolli, M, I Bellini, M, Lemma, M, M Chiarello, M, Nicola, M, Arrigo, M, Caneda Mejia, M, Montes Manrique, M, Rodriguez-Lopez, M, Serradilla-Martín, M, Zambrano Lara, M, Martínez, M, Bagnall, M, Peter, M, Cañón Lara, M, Jimenez Gomez, M, Paniagua-Garcia-Señorans, M, Perez Gonzalez, M, Rutegård, M, Salö, M, Franceschilli, M, Silveri, M, Veroux, M, Pezzulo, M, Nardi, M, Rottoli, M, Tolonen, M, Pedraza Ciro, M, Zuluagua, M, Cannavò, M, Cervellera, M, Iacobone, M, Montuori, M, García Domínguez, M, Bingol-Kologlu, M, Tahir, M, Lim, M, J Wilson, M S, Wilson, M, Campanelli, M, Bisaccia, M, De Rosa, M, Maruccia, M, Paterno, M, Pisano, M, Torre, M, Treviño, M, Zuolo, M, A Hernandez Bartolome, M, Farina, M, Pera, M, Prieto Calvo, M, Sotelo, M, Myat Thway, M, Hassan, M, Salah Eldin Hassan, M, Azfar, M, Bouhuwaish, M, Taha, M, Zaieem, M, Korkoman, M, Guraieb, M, Shalaby, M, A Raza, M, U Younis, M, Elhadi, M, Zulfiqar Ali, M, Quazi, N, N Dudi-Venkata, N, Alselaim, N, Loria, N, Villan Ramírez, N, Win Than, N, Smart, N, Trelles, N, Pinto, N, Allievi, N, Petrucciani, N, Antonacci, N, Cillara, N, De'Angelis, N, Gica, N, C Nicolaescu, D, Krystek, N, Falco, N, Pecorelli, N, Tamini, N, A Dallas, N, Machairas, N, Brito, N, Ahmed Fieturi, N, Ortega, N, Avila Mercado, O, Irkorucu, O, Alsherif, O, Valles, O, Ioannidis, O, Hernández Palmas, O, I Hernandez Palmas, O, Sanz Guadarrama, O, Bozbiyik, O, Omelanczuk, P, Ottolino, P, Rodrigues, P, Ruiz, P, Campenni, P, Chiarade, P, Prieto Olivares, P, Baroffio, P, Panaccio, P, Wintringer, P, Di Fronzo, P, Talento, P, Favoriti, P, Sendino, P, Marsanic, P, Mifsut, P, Andrade, P, Ajawin, P, Abadía-Barnó, P, A Najar Castañeda, P, O Sillas Arevalos, P, Palazón Bellver, P, Soon Koh, P, Souza, P, Major, P, Singh Bali, R, Mohan Khattar, R, Lui, R, Bessa Melo, R, Ebrahiminia, R, Azar, R, López Murga, R, Pirolo, R, Brady, R, J Davies, R, Dholakia, R, Rattan, R, Singhal, R, Lim, R, Angelico, R, M Isernia, R, Tutino, R, Faccincani, R, Peltrini, R, Carrera-Ceron, R, Tejos, R, Kashyap, R, Fajardo, R, Lozito, R, Madariaga Pareja, R, Garbarino, S, Morales-Conde, S, Benli, S, Mansour, S, Flores, S, Limon Suarez, S, Santiago Lopez, B, Fuentes, S, Gortazar de Las Casas, S, Napetti, S, Ortiz de Guzmán, S, Awad, S, A Weckmann Luján, S, Gentilli, S, Grimaldi, S, Olivares Pizarro, S, Tayar, S, Nabi, S, M Chan, S, Junaid, S, Rojas, S, Monetti, S, García, S, Salvans, S, Tenconi, S, Shaw, S, Santoni, S, A Parra, S, Cárdenas, S, Pérez-Bertólez, S, Chiappetta, S, Dessureault, S, Delis, S, Amore Bonapasta, S, Rausei, S, Scaringi, S, Keswani, S, M Ali, S, Cetinkunar, S, D Fung, T L, Rawashdeh, T, N López, T, De Campos, T, Calderon Duque, T, Perra, T, Liakakos, T, Daskalakis, T, Barnes, T, Koëter, T, Zalla, T, E González, T, Elosua, T, Campagnaro, T, Brown, T, Luoto, T, Alpha Oumar, T, Giustizieri, U, Grossi, U, Bracale, U, Rivas, U, Sosa, V, Testa, V, Andriola, V, Tonini, V, Balassone, V, Celentano, V, Progno, V, Raju, V, Carroni, V, Cavallaro, V, Rao Katta, V, De Simone, V, Primo Romaguera, V, H García Orozco, V, Luraschi, V, Rachkov, V, Turrado-Rodriguez, V, Visag-Castillo, V, Dowling, V, Graham, V, Papagni, V, Vigorita, V, Cordeiro Fonseca, V, Jimenez Carneros, V, Bellato, V, Gonçalves, W, F Powers, W, Grigg, W, O Bechstein, W, B Lim, Y, Altinel, Y, Golubović, Z, Balciscueta, Z, Pellino G., Podda M., Pata F., Di Saverio S., Ielpo B, Rottoli M., and Tonini V.

Subjects
medicine.medical_specialty, business.industry, COVID-19, Perioperative, Appendicitis, COVID-19 testing, humans, healthcare disparities, mass screening, perioperative care, Perioperative Care, Settore MED/18 - Chirurgia Generale, Healthcare Disparitie, COVID-19 Testing, Pandemic, Acute appendicitis, medicine, Humans, Mass Screening, Surgery, Appendiciti, Healthcare Disparities, Intensive care medicine, business, Human
Abstract

Acute appendicitis remains a common reason for hospital admission. Reports have suggested a reduction in patients attending emergency departments during the acute phase of the SARSCoV- 2 pandemic. Moreover, a global surge in conservative management of acute appendicitis has recently been registered by the Appy Study of the Association of Italian Surgeons in Europe (ACIE)1. This is a treatment option that has been known for some years, although quite seldom used before the pandemic2–4. As most countries are experiencing new waves of the pandemic, the attitude of surgeons towards SARS-CoV-2 screening policies and personal protective equipment (PPE) used during the management of patients with acute appendicitis need to be established. According to a subanalysis of the ACIE Appy Study, half of surgeons globally were testing patients for SARS-CoV-2 only when symptomatic or there was suspicion of infection; approximately 12 per cent did not test patients at all (Fig. 1 and Table S1). There were regional differences. In Europe, respondents tested all patients (50.8 per cent) or those with suspected infection (43.9 per cent), with only 5.3 per cent not being tested at all. In the USA, the majority of participants only tested patients with a suspected infection (65.6 per cent). A similar picture of testing only those with a suspected infection was also reported from Latin America (57.2 per cent), Asia/Middle East (76.8 per cent), and Africa (41.7 per cent). Even more worrisome, 58.3 per cent of respondents from Africa and 27.6 per cent from Latin America were not testing patients at all before appendicectomy. Concerning the screening modality, most respondents used PCR alone or in combination with chest imaging. Serology was rarely used overall and never in Africa (Fig. 1 and Table S2 ). It is now accepted that chest imaging is not routinely required and that PCR is an accurate screening modality. Serology might, however, be useful to shed light on the disease course and previous exposure to the virus, but respondents from some countries still have restricted access to this test. In terms of PPE during appendicectomy, most African respondents did not use different PPE compared with the prepandemic period in patients who tested negative for COVID-19. More concerning is that 58.3 per cent did not use different PPE in untested patients. This differed from other regions where the rate of those not considering a change of PPE in untested patients did not exceed 22 per cent. One in 10 respondents from Latin America also reported that they were not using different PPE compared with the prepandemic phase in patients who tested positive for COVID-19. These data, and taking into account the high prevalence of acute appendicitis, leads to the conclusion that omission of routine patient screening may have contributed to local clusters among patients and threatened the safety of healthcare workers5. In this respect, it is likely that limited access to PPE explains the attitude of surgeons towards patients with unknown SARSCoV- 2 status or those infected, raising ethical concerns about the safety of surgical staff. It is of outmost importance that, even during challenging times and stress on economic stability, industrialized countries make efforts to sustain low-income countries and those with limited resources. This would ensure equal working conditions, safer treatment for patients with acute appendicitis, and better control of the pandemic

Published
2021

24. Current guidelines for nutrition therapy in cancer: The arrival of a long journey or the starting point?

Author

Alessandro Laviano

Subjects
Nutrition and Dietetics, Nutritional Support, Neoplasms, Quality of Life, Humans, Nutritional Status, Medicine (miscellaneous), Nutrition Therapy
Abstract

Large epidemiological data reveal that cancer is progressively becoming a chronic and disabling disease. Implementation in daily practice of early therapies aiming at addressing patients' needs is imperative. Nutrition is a major determinant of patients' quality of life, yet it is frequently neglected. Hopefully, reverting this skeptical clinical approach to nutrition, clinical practice guidelines of nutrition care in patients with cancer have been developed and published by international oncology and nutrition societies. By analyzing the more recent guidelines, it appears that a number of issues may contribute to their insufficient implementation in daily practice. Among them are heterogeneity of recommendations across different guidelines and insufficient robustness of evidence, as well as questionable generalization of recommendations. Future guidelines should aim at providing tumor-specific recommendations for the whole clinical journey of patients with cancer. Also, new, interesting areas should be covered, including fasting metabolism and circadian rhythmicity.

Published
2021

25. Case presentation and panel discussion: Nutrition issues in cancer

Author

Manpreet S. Mundi, Jeffrey I. Mechanick, Jayshil J. Patel, Alessandro Laviano, Robert G. Martindale, and Teresa A. Zimmers

Subjects
Pancreatic Neoplasms, Parenteral Nutrition, Nutrition and Dietetics, SARS-CoV-2, COVID-19, Humans, Medicine (miscellaneous), Aged, Nutrition Disorders
Abstract

Advances in treatment of malignancy including novel pharmacologic therapies and surgical interventions has led to significant improvement in survival. As cancer becomes a chronic disease, nutrition interventions play an increasingly important role in short- and long-term outcomes. The current manuscript presents a case of a 66-year-old male with new diagnosis of pancreatic cancer diagnosed incidentally in the setting of COVID-19. Expert panelists in the field of nutrition discuss optimal strategies for diagnosis of malnutrition along with preoperative, perioperative, and postoperative optimization of nutrition. This discussion focuses on the use of probiotics, immune-modulating nutrition, fish oil, specialized proresolving mediators, and use of enteral and parenteral nutrition support.

Published
2021

26. Dietary choices after a cancer diagnosis: A narrative review

Author

Katherine L. Ford, Camila E. Orsso, Nicole Kiss, Skyler B. Johnson, Sarah A. Purcell, Adele Gagnon, Alessandro Laviano, and Carla M. Prado

Subjects
Nutrition and Dietetics, Fruit, Endocrinology, Diabetes and Metabolism, Vegetables, Humans, Female, Breast Neoplasms, Diet, Nutrition Policy
Abstract

Individuals with cancer may be motivated to make lifestyle changes and informed dietary choices, but are exposed to conflicting and erroneous nutrition information, particularly from online and social media sources. Changes to dietary choices that stem from a diagnosis of cancer are not fully understood. Thus, we conducted a narrative review to summarize the literature focused on dietary choices after a cancer diagnosis, and highlighted influential factors. Postdiagnosis dietary changes have been studied primarily in female patients with breast cancer in European countries. Reported changes typically included decreased red and processed meat intake and increased consumption of fruits and vegetables. These changes align with the recommendations for cancer prevention but were implemented after diagnosis, and may not meet nutrition guidelines for patients with cancer. Age and time since diagnosis were among the influential factors that affected these postdiagnosis changes. Data on dietary changes implemented after a diagnosis of varying cancer types in the North American population are lacking, and would provide practitioners with an enhanced understanding of patient information needs and reasons for dietary choices.

Published
2022

27. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Author

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S., Nepogodiev D, Bhangu A., Matthews, Jh, Morley, Gl, Naumann, Dn, Ball, A, Chauhan, P, Bhanderi, S, Mohamed, I, Glasbey, Jc, Wilkin, R, Drake, Tm, Clements, J, Blencowe, Ns, Herrod, P, Pata, F, Frasson, M, Blanco-Colino, R, Soares, As, Bhangu, A, Nepogodiev, D, Jain, S, Amuthalingam, T, Tyler, R, Griffiths, Ea, Pinkney, Td, Gee, O, Morton, Dg, Beggs, A, Beral, D, Bowley, D, Cruickshank, N, Daniels, I, Griffiths, E, Hornby, St, Lund, Jn, Marriott, P, Singh, P, Smart, Nj, Speake, D, Thompson, C, Torkington, J, Torrance, A, Vohra, R, Warren, O, Winter, Dc, Pellino, G, Sgrò, A, Simioni, A, Farina, V, Podda, M, Di Saverio, S, Birindelli, A, Pasquali, S, Itsurg, Surg, Pt, Bolton, W, Bradshaw, Cj, Chean, Cs, Harris, G, Haddow, Jb, Jamieson, Nb, Mccain, S, Mason, J, Milgrom, D, Nana, Gr, Mohamed, Mn, Brien, Jo, Pearce, J, Rabie, M, Sahnan, K, Sarmah, P, Skerritt, C, Ghazanfar, Ma, Sreedharan, L, Kabwama, S, Gray, Rt, Kamande, Iw, Nazarian, S, Dar, Fa, Misky, At, Arunachalam, S, Twum-Barima, Cs, Mohamed, Im, Connor, Kl, Coe, Po, Kosti, A, Elshaer, M, Colvin, Da, Charalambous, Mp, Yeung, K, Merker, L, Morrison, T, Thaventhiran, Aj, Gilbert, Tm, Clements, Jm, Hicks, G, Afshar, S, Mckinley, Nc, Assaf, N, Hanna, T, Macinnes, E, Thavanesan, N, Dubois, As, Palani-Velu, Lk, Tezas, S, Yow, L, Radwan, Rw, Abdelrahman, M, Lee, Ka, Zarka, Za, Mcdowall, Na, Tan, Cy, Venn, Ml, Ashmore, Dl, Whitehorn, Se, Golder, Am, Reddy, A, Delimpalta, C, Kay, Oh, Shah, Sm, Eiben, I, Doyle, C, Tudyka, V, Issa, E, West, H, Brewer, Hk, Farrow, Ez, Taylor, Ns, Smart, Cj, Griffiths, Np, Halkias, C, Vitish-Sharma, P, Knight, Sr, Mowbray, Ng, Olivier, Jb, Lee, Kj, Clement, Kd, Chrastek, D, Panda, N, Connor, Mj, Fahmy, Se, Bryan, Es, Ngu, Ws, Adegbola, So, Vaughan, Em, Stupalkowska, W, Simmonds, L, Malik, A, Hussein, A, Karim, Mj, Singhal, T, Ormiston, R, Kung, V, Rabie, Ma, Park, Jh, Lal, N, Worku, D, D'Auria, M, Ang, A, Orizu, M, Gammeri, E, Clough, E, Choy, Ch, Lawday, S, Hann, Aj, Robinson, D, Wardle, 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F.M., Abbassi O.A., Divekar G.A., Halmer S., Adams R.E., Davies P.L., Wong S.Y., Amarasinghe R., Tague L.E., Jones E., Singh J., Boza K., Kelly S.D., Morrison F., Chan W.H., Wilson E.J., Awokoya O.O., Griffiths S.N., Kirkham E.N., Cotton A.E., Adimonye A., Leighton P.A., Abdelrahman A., Cartwright H., Gates Z., Miguras M., Khan K., Louw C., Grove T., Badenoch T., Mckeon J., Wood C.S., Leitch R.P., Sgardelis P., Perera M.I., Nagarajan D., Malam Y., Theodoropoulou K., Rajagopal S., Kaptanis S., Popova D., Olagbaiye O., Tayeh S., Rigby S., Harris M.P., Ren K.Z., Liaw G., Zhou S., White F., Marshall C.M., Mitchell J.H., Anderson D.J., Kanakala V., Hollingsworth A., Paramasevon K.R., Milward J., Ahmed S., Fanibi B.F., Ferguson N., Dickson E.A., Shaw A.V., Dixon F., Morrish S., Dandy R., Fooks P., Sharma P., Islam N., Tabain V., Keegan R., Ahel J., Alhammali T., Graveston J., Balai E.J., Rothnie K., Pankin G.P., Eiben I.E., Jackson N.J., Dhar M., Nash D., Dharamavaram S., Seth M., Chowdhury F., Rezacova M., Seneviratne N., Turner E.J., Currow C., Isherwood J.D., Hobson B.M., Lui D.H., Rodger V., Ting N., Photiou D., Taze D., Lodhia S., Earnshaw L., Kumar K., Neale A., Bastianpillai J., Cipparrone M., Barrie A., Nash Z., Anandan L., Tailor K., Vinnicombe Z., Krivan S., Kuo R., Giorga A., Habib H., Malik K., Bogdan M., Mahon-Daly F.P., Athersmith M.J., Strange J.A., Wheeler C., Summerfield L., Khaw R.A., Ashour O., Iosif E., Fadel M., Gopalakrishnan K., Orme N., Williams S., Rashid M., Sultana A., Patel N., Pearson R., Yasin T., Bevan V., Al-Sarireh B., Brown M., Mohd N., Howie E.E., Poudevigne M., Paget C., Rallage H., Chui K., Fawzi F., Layman S., Okorocha E., Jama G.M., Orawiec P., Kouli O., Hassane A., Kilkenny J., Devine A.A., Laurenson M., Slezak I., Barker T., Lau E., Limbada M., O'Brien J., Weaver J., Hajibandeh S., Shah J., Mansour M.M., Malik S.N., Davis S., Trew F., Bandyopadhyay S.K., Dart K., Guru-Naidu S., Callan R., Nair M.K., Alani M., Sezen E., Salim S., Shurlock J., Siddique K., Forouzanfar A., Brews R., Acharya A., Jain A., Tozer P.J., Warusavitarne J., Emslie K.M., Collier-Wakefield O., Sivaloganathan P., Dobson C., Elseedawy M., McNally L., Williams M., Motiwala F.H., Choi S., Asmadi A.A., Burnside D., Everden A., Suriyakumar S., Sandu L., Kent D.A., Bowen J., Long P., Khair A., Shah K., Phelan L., Pierre R., Dhari A.A., Hoff M., Nickson S., Setshwaelo T., Chalk A., Parkola M.J., Harlinska A., Chan T., Dudek J.G., Rolph R., Allen M., Pollard H., Gormely R., Finlayson H., Ljungqvist G., Peponis C., Rahman M., Dhesi S., Arshad F., Faris A.R., Sooriyamoorthy T., Springate E.L., Barnieh W., Patel A.S., Siddiqui Z.A., Chishti I.A., Ayube-Brown J., Rabie M.R., Blake L., Yardimci E., Nagendram S., Neophytou G.I., Henderson L., Farhan-Alanie M., Kong C.Y., Ghazala R., Evans J., Hussain N., Kabir M., Hraishawi I., Cox M., Bailey J.A., Muhibullah N., Yanni F., Stevenson R., Nair A., Murphy C., Mcgucken O., Pandya R., Bowerman H., Lafaurie G., Van Boxel G.I., Shanmugarajah K., Maragouthakis D., Hanif Z., Evans J.D., Yoganathan S., Richardson T.D., Cook V., Clark G.L., Rigney B., O'Neill E., Guliani J., Chan D., Harper F., Sian T., Boereboom C., Blackwell J., Hardy E., Boyd-Carson H., Couch D.G., Barter C.A., Thoukididou S.N., Hatt J.R., Jones C.S., Dean S., Rajaretnam N., Masood M., Thakral N., Griffith D., Doherty C., Longshaw A., Peprah D., Mathew G., Hook A., Vance-Daniel J., Ibrahim Y., Walters K.J., Whewell H.E., Sherif M.A., Mckenna M., O'Sullivan D., Woodrow C., Gill S., Johnstone A., Gentry R., Irwin R., Forgie A., Welsh S., Ivey P., Bullivant J.K., English W.J., Osterberg A., Morowala A., Al-Faham Z., Islam S., Tan E., Sadek S., Sihra N., Shrestha D., Chong B., Nadeem A., Fasuyi J.A., Patel M.M., Daureeawoo R., Okekunle B., Cheruvu M., Mazumdar E., Hussain A., Patel C., Mcquaid M., Banks A., Robinson A., Khan M.S., Riaz W., Verroiotou M., Cohen J.A., Kouroumpas E., Ghaffari I., Moradzadeh J., Kamal M., Gulamhussein M., Gaines E., Ghatorae S., Clark S., Savill A., Hutchinson B., Chapman J., Wu F., Creasy W., Raymond M., Grosvenor S., Odeh A., Malik Y., Bansal H., Grant C., Raofi A., Ahmed B., Mai D., Souter J., Hamelmann R.N., Ikram S., Durbacz M., Gilliland N., Salem A., Chudek D., Ladwa N., Storey R., Fontaine C., Toomey D., Miller B., Oakey M., Smoker H., Chapman S.J., O'Hagan S.C., Tahir W., Wilcox G., Ahmad A., Akram F., Baddams T.S., Boshier P.R., Fehervari M., Easdon S., Ilozue T., Adam M.E., Jokhan S., Foster A., Nambiar K., Bohra P., Janardanan S., Shanmuganathan V., Maqboul F., Ettles C., Wardle S.D., Martinou E., Khasria A., Bagga R., Motter D., Mundkur N., Pan Y., Akbari K., Farrell S.M., Rahim A., Gummaraju A., Mahmoud A., Akinsola O., Smallcombe N., Tarazi M., Hanley C., Campbell U.M., Franklin D., Davidson J.R., Raza S.S., Krishnamoorthy A., Rajjoub Y., Ali M., Seddon T.C., Payne R.E., Das A., Martin L.M., Naismith K.N., Venkata U.P., Manda V.M., Burns K.M., Huang J., Samuel M., Docherty J.A., Cheah W.L., Ooi R., Nyeko-Lacek M., Marsh L., Prideaux A., Li C.H., Poacher A., Lee M., Muzaffar M., Kara A., Walsh E., Sunter H., Roth N., Roy C., Mcmorran D., Turnbull A., Layton G.R., Archer J.E., Yang P., Douka E., Amin V., Borghol K., Blackford O.D., Bond S., Baker B., Mohamed W.O., Williams R., Garnham J., Robb H.D., Allington J., Cloney L., Tamborska A., Kalia K., Fung E., Johnston Z., Lynch L., Christides A., Tan H.L., Cynthia G., Tsang B., Rossi C., Kaubrys M., Al-Khafaji N., Jenkins M., Peiris G.B., Gunning S., Nimako E., Pandya D., Hever P., Amayo A., Bull C., Clements C., Al-Sheikh M., Savioli F., Long M., Horsfield E., Robertson C., Ogboru S., Mcilwrath A.C., Bell J., Limb C., Obeid N., Rich J.E., Balasubramaniam A., Mashar R., Taylor M., Bruce J.S., Dennison G., Curtis N.J., Ezerska E., Ellis B., Wiggill S., Tee A., Ng S., Carder C., Abdelwahed A., Chandler S.B., Tinsley B.J., Finotti E., Occhioni G., Cossu F., Vulcano I., Viscosi F., Michelini M., Compagnoni B., Sepe C., Isolani S.M., Regina G., Alagna V., Martorelli G., Gabbianelli C., Moroni P., Zuin M., Conci S., Lazzari G., Costamagna D., Zurleni T.Z., Altomare M.A., Desiderio J., Di Cintio A., Gemini A., Trastulli S., Viviani E., Tomasoni M., Montori G., Harder G., Argenti F., Malabarba S., Checcacci P., Montanelli P., Guerra F., Skalamera I., Staderini F., Grandi S., Nelli T., Coratti F., Sorrentino L., Maffioli A., Cavallo D., Bondurri A., Groppo G., Curti R., Solaini L., Xidas A., Manias T., Delogu D., Vacca A., Solinas L., Corbellini C., Fiore L., Nigro A., Santurro L., Angrisani M., Sparta C., Lorettu A., Mura F.A., Ruggiu G.V., Pirari P.F., Pau R., Melis M., Piu F., Patti S., Deserra A., Angelieri D., Del Basso C., Rossi D., Iannone I., De Padua C., Giubilo C., Falaschi F., Cirillo B., Gordini L., Podda F., Sanna S., Saba A., Poillucci G., Pinna E., Messina A., Sena G., Cardona R., De Luca E., Sacco R., Vescio G., Ammendola M., Romano R., Bianco A., Bonfante P., D'Ambra L., Feleppa C., Gennai A., Lizzi V., Moggia E., Imperatore M., Bolzon S., Belvedere A., Amaducci E., Ripoli M.C., Segalini E., Cervellera M., Vaccari S., Eretta C.O., O'Neill R., Llewelyn O., Jones N., Clerici F., Ballabio M., Andolfi E., Angelini M., Fontani A., Miranda E., Scricciolo M., Provenza G., Pellicano G.A., Pulighe F., Argenio G., Melis A., Balestra F., Anania M., Cruccu A., Massaiu C., Murru M.L., Martino A., Luzzi A.P., La Valle G., Chillitupa C.Z., Bartoli A., Conti D., Spaziani A., Bellochi R., Listorti C., Salandini M.C., Carlucci M., Tenconi S.M., Cannavo M., Marano A., Giuffrida M.C., Cannata G., Pellegrino L., Giraudo G., Baraghini M., Garzi A., Giudicissi R., Zalla T., Romoli L., Vannucchi A., Giani I., Feroci F., Calussi M., Ribaudo M., Fiorot A., Stecca T., Nistri C., Fornasier C., Valiani S.V., Brunelli D.B., Evoli L.E., Giuliani N.G., Contine A.C., Renzi C.R., Feo C.V., Anania G., Carcoforo P., Aisoni F., Licari L., Tutino R., Cocorullo G., Silvestri V., De Marco P., Fontana T., Orlando G., Falco N., Baseggio M., Napetti S., Mella A., Rossi G.M., Chimetto A., Cosci M., Bonomo M., Scialandrone G., Chetta N., Carvalho L.C., Magalhaes J.S., Pereira A.M., Fernandes C., Fareleira A., Goncalves D., Pais M., Pereira A., Resende F.M., Correia D., Cardoso D., Tojal A., Santos S.C., Barbosa L., Louro H.C., Bairos F., Martins F.M., Messias F.M., Ferreira M.S., Borges F.C., Botelho P., Lima M., Valente P.M., Joao A.A., Guimaraes J.M., Rocha R., Nogueira S.T., Kabir U., Wong C., Rahmani L.S., Tan S., Chng S., Jasinski B., Cheng S.A., Mardhiah S., McGlynn K., Hannan E., Burke J., Haveliwala Z., O'Neill M., Boland M., Hayes C., Fox A., Zaborowski A., Mitru R.M., Mc-Dermott A., Coyle D., Stoica I., McMahon S.V., Laughlin D.M., Kannegieser-Bailey M., Murphy R., Muntean A., Shet S., Thomas L., De Freitas S., Quill S., Aljorfi A., Soh B., Law J.J., Hartnett J., Jansen T., Gilgan J., Jung J., Scanlon K., Szucs A., Ahern D.P., Redmond A.E., Edwards S.E., Manoharan P., Brennan S., Abdelgadir A.M., Mckevitt K.L., Zarog M.A., Ahmed G., Bukhari W., Ahad A., Paniagua M., Samartin C., Primo J.C., Garrido L., Lopez M., Rufo E., Trostchansky I., Rodriguez L., Infante H., Acosta A., Cremades P., Cidoncha A., Olmos V., Oliva I., Santamaria C., Cavero A., Calvo H., Suero C.A., Maderuelo V.M., Galvez P., Hernando A., Eguaras I., Recreo A.C., Garcia-Carrero M., Moreda R., De Andres U., Del Pozo E., Calvo M., Moratalla C.N., Ronda R.N., Contreras R.G., De Burgos C.B., Cortes G.V., Martinez C.C., Agudo A.R., Soriano J.T., Ramos X.H., Echazarreta E., Elia M., Hernaez A., Sanchez L., Vallejo-Bernad C., Oliver J.R., Sanchez-Rubio M., Kalviainen H.K., Genzor S., Gonzalez-Nicolas T., Puerta E., Laviano E., Gimenez T., Ferminan A., Muriel-Alvarez P., Sierra-Granon J.E., Escoll-Rufino J., Cuello-Guzman E., Mestres-Petit N., Merichal-Resina M., Pinillos-Somalo A., Gomez-Carmona Z., Vazquez-Fernandez A.P., Trujillo-Diaz J.J., Couso J.R., Fernandez M.D., Riera E., Espinosa J., Carral-Freire M., Martinez-Almeida R., Santarrufina-Martinez S., Sebastian-Tomas J.C., Gonzalvez-Guardiola P., Fernandez E.C., Mozo A.S., Stoyanov T.I., Santamaria P.C., Grimaldo E.G., Fernandez-Candela A., Curtis-Martinez C., Del-Valle-Ruiz S.R., Sanchez-Cifuentes A., Ramirez-Faraco M., Lopez A.F., Leon C., Kumar S., Fornell-Ariza M., Ayllon-Gamez S., Pena-Barturen C., Ojea-Ruiz-Yherla L., Saavedra-Chacon M., Perez-Calvo J., Gomez-Facundo H., Riba-Combatti L., Manas O.C., De-Soto-Cardenal B., De-La-Herranz-Guerrero P., Dominguez-Sanchez C., Gamero-Huaman J.C., Suarez-Cabrera A., Ramirez-Redondo A.A., Lara-Fernandez Y., Bascuas-Rodrigo B., Lopez-Duran B.L., Pigem A., Gil J., Salvador H., Planellas P., Farres R., Caballero A., Arnau M., Tapiolas I., Ridaura N., Roncero L.S., Collado-Roura F., Fijo L.M., Cormenzana O.B., Vinas N.L., Grifell M.S., Prats M.A., Torrado A.A., Sanz-Navarro S., Contreras-Saiz E., Solar-Garcia L., Moreno-Gijon M., Suarez-Sanchez A., Diaz-Vico T., Rodicio-Miravalles J.L., Garcia-Gutierrez C., Pila U., Melone S., Martin-Prieto L., Rojo J.A., Gonzalez M., Zorrilla L., Garcia-Marin J.A., Baeza-Murcia M., Pellicer-Franco E., Jimenez-Ballester M.A., Asensio-Gomez L., Gortazar-De-Las-Casas S., Guevara-Martinez J., Ramirez L., Verea S., Anguita F., Navarro G., Criado ADC., Lara M.C., Martinez E.T., Sanchez-Martinez A., Hernandez-Gimenez L., Galofre-Recasens M., Ferrer-Vilela I., Perez-Sanchez L.E., Esteves M.B., Menendez-Moreno A., Baz-Figueroa C., Rosat A., Hontoria M.S., Garcia N.A., Gracia-Roman R., Pascua-Sole M., Pino-Perez O., Garcia-Perez J.M., Pineno-Flores C., Ambrona-Zafra D., Sancho-Muriel J., Alvarez E., Jimenez-Rosellon R., Daga O., Alberca-Paramo A., Sanchez-Garcia S., Garcia-Santos E., Pareja-Ciuro F., Olivares-Oliver C., Navarro-Morales L., Tamayo-Lopez M.J., Tinoco-Gonzalez J., Garcia-Rivera C.O., Agua I.A., Moreno-Suero F., Pereira-Mosquera E., Zerpa C., Llacer E., Diaz A., Caro A., Feliu F., Franco M., Escuder J., Abellan M., Padilla E., Mambrilla-Herrero S., Plua-Muniz K.T., Bailon-Cuadrado M., Tejero-Pintor F.J., Choolani-Bhojwani E., Vila-Zarate C., Delgado-Plasencia L.J., Ponchietti L., Cousins L., Busuttil A., Baird C., Drye N., Brown O.D., Mansour S., Anderson O., Mahapatra R., Clements J.A., D'Souza N., Littlehales D.J., Tang A.M., Byrne B.E., Cunha P., Ogbuokiri C., Eiben P., Gravante G., Kho H., Dobbs S., Doulias T., Ng J., Wilson M., Venugopal R., Wolff J., Akhtar K., Walji H.D., Tognarelli J.M., Knight K.A., Ansari A., Hussaini S.A., Wright E., Brewer H., Rinkoff S., Harries R.L., Fairfield C.J., Abbott T., Jackson A., Wright H.L., Walters U., Carney K., Logan P.C., Mughal Z., Strachan E., Chasty B., Ma J., Mazzeo C., Badii B., Armellini A., Grassia M., Perin A., Ruzzenente A., Magnoli M., Depalma N., Longheu A., Papandrea M., Dova L., De Prizio M., Gusai G.P., Di Zitti L., Geretto P., Azabdaftari A., Chianese G., Elbetti C., Ruffolo C., Giaccari S., Devezas V., Ferreira J.S., Peixoto R., Alshafei A., Simo V., Jose H.S., Ugarte-Sierra B., Salva A.B., Gomez N., Marinello F., Medina-Arana V., Vega L., Ballester M.M., Espina B., Prieto-Nieto M.I., Rodriguez E.C., Padilla-Valverde D., and Duran-Munoz-Cruzado V.M.

Subjects
Adult, humanos, Decision Making, Risk Assessment, NO, apendicectomía, apendicitis, evaluación de riesgos, Appendectomy, Humans, hospital, General, collaborative, LS7_4, right iliac fossa, appendicitis, emergency service, Original Articles, adulto, Appendicitis, adult, appendectomy, humans, risk assessment, decision making, Lower GI, Original Article, appendicitis, prediction models, right iliac fossa pain, Emergency Service, Hospital, toma de decisión
Abstract

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P, Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making were identified by identifying UK adults at low risk of appendicitis. An online calculator is available (http://appy-risk.org). WCC, white cell count; CRP, C‐reactive protein; AIRS, Appendicitis Inflammatory Response Score; AAS, Adult Appendicitis Score. Important differences between men and women

Published
2019

28. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic

Author

Darija Vranešić Bender, Željko Krznarić, Matthias Pirlich, Cristina Cuerda, Alessandro Laviano, Rosário Monteiro, Francesco Landi, Rocco Barazzoni, Krznaric, Z., Bender, D. V., Laviano, A., Cuerda, C., Landi, F., Monteiro, R., Pirlich, M., and Barazzoni, R.

Subjects
0301 basic medicine, Telemedicine, Pneumonia, Viral, MEDLINE, Betacoronavirus, COVID-19, Humans, Nutritional Status, Practice Guidelines as Topic, SARS-CoV-2, Coronavirus Infections, Malnutrition, Nutrition Assessment, Pandemics, Remote Consultation, 030209 endocrinology & metabolism, Malnutrition / diagnosis, Critical Care and Intensive Care Medicine, nutrition, primary practice, COVID-19 pandemic, Article, Malnutrition / prevention & control, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Medicine, Viral, Protocol (science), 030109 nutrition & dietetics, Nutrition and Dietetics, Betacoronaviru, SIMPLE (military communications protocol), Coronavirus Infection, business.industry, Social distance, Pneumonia, medicine.disease, Nutritional Statu, Medical emergency, business, Human
Abstract

Summary Challenging periods like the COVID-19 pandemic require fast and efficient adaptations of the healthcare system. It is vital that every patient has access to nutritional care as a part of primary healthcare services, even if social distancing measures are adopted. Therefore, we propose a simple remote nutritional screening tool and practical guidance for nutritional care in primary practice, and their implementation into telemedicine processes and digital platforms suitable for healthcare providers. The acronym for the tool is R-MAPP, as for Remote – Malnutrition APP, while the tool will be available also as an app. This protocol consists of two simple validated clinical tools for identifying nutritional risk and loss of muscle mass and function –Malnutrition Universal Screening Tool (‘MUST’) and SARC-F (5-item questionnaire: Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) - and additional practical guidance on nutritional interventions for family physicians.

Published
2020

29. Clinical characteristics and evolution of hematological patients and COVID-19 in Argentina: a report from the Argentine Society of Hematology

Author

Ana L, Basquiera, Mercedes J, García, Juliana, Martinez Rolón, Julieta, Olmedo, Julia, Laviano, Rubén, Burgos, Gastón, Caeiro, Guillermina, Remaggi, Pablo, Raña, Mariano, Paoletti, Carlos M, González, Isolda, Fernández, Astrid, Pavlovsky, Maria A, Perusini, Andrea, Rodriguez, Luciana, Guanchiale, Analia, Carvani, Laura, Mandrile, Flavia, Figueroa, Angeles, Vicente Reparaz, Patricia N, Fragapane Mathus, Gonzalo, Garate, María E, Fauque, Gustavo, Kantor, Soledad, Cruset, Jacqueline S, Gonzalez Lorch, Milagros, Szelagowski, María P, Giarini, Natalia, Oliveira, María C, García, María V, Ventriglia, Patricio H, Pereyra, Daniel R, Gutierrez, Gustavo, Kusminsky, Josefina, Troccoli, María J, Freitas, Santiago, Cranco, Natalia, Del V Sanchez, Irene, Rey, María E, Funes, Sol, Jarchum, Julian, Freue, Augusto, Miroli, Osvaldo, Guerrero, Lisa, López Ares, Reinaldo, Campestri, Victor, Bove, Graciela N, Salinas, María, Cabrejo, Jorge H, Milone, Soledad, Zabaljauregui, Daniel, Gotta, Juan Carlos, Dupont, and German, Stemmelin

Subjects
COVID-19 Testing, SARS-CoV-2, Argentina, COVID-19, Humans, Hematology, Middle Aged
Abstract

Individuals with malignancies and COVID-19 have a lower survival compared with the general population. However, the information about the impact of COVID-19 on the whole hematological population is scarce. We aimed to describe the 30th day overall survival (OS) after COVID-19 infection in patients with a hematological disease in Argentina. A completely anonymous survey from the Argentine Society of Hematology was delivered to all the hematologists in Argentina; it started in April 2020. A cut-off to analyze the data was performed in December 2020 and, finally, 419 patients were reported and suitable for the analysis (average age: 58 years, 90% with malignant diseases). After the COVID-19 diagnosis, the 30-day OS for the whole population was 80.2%. From the entire group (419), 101 (24.1%) individuals required intensive care unit admission, where the 30-day OS was 46.6%. Among allogeneic stem cell transplant recipients, the 30-day OS was 70.3%. Factors associated with a low OS were two or more comorbidities, an active hematological disease and history of chemotherapy. In individuals with the three factors, the 30-day OS was 49.6% while the 30-day OS in those without those factors was 100%. Patients with hematological diseases have a higher mortality than the general population. This group represents a challenge and requires careful decision-making of the treatment in order not to compromise the chances of cure.El presente estudio tuvo por objetivo primario conocer la mortalidad de pacientes con enfermedad hematológica que presentaron infección por COVID-19 en Argentina. Para ello se difundió una encuesta desde la Sociedad Argentina de Hematología (SAH) entre los hematológos para informar sobre los pacientes con enfermedades hematológicas y diagnóstico de infección por SARS- CoV-2, entre el 19/4/2020, y el 7/12/2020. Se incluyeron individuos de todas las edades con diagnóstico de enfermedad hematológica benigna o maligna e infección por SARS-CoV-2 confirmada por técnica de RTPCR. Se analizaron 419 pacientes (mediana 58 años; 90% enfermedades malignas). La supervivencia al día 30 fue de 80.2%. La supervivencia fue menor en aquellos que requirieron internación (74.2%), cuidados intensivos (46.6%) y asistencia respiratoria mecánica (36.8%). Entre los trasplantados alogénicos la supervivencia fue 70.3%. Los factores vinculados a la supervivencia global fueron las comorbilidades, el estado de la enfermedad al momento de la infección y el antecedente de quimioterapia. Se pudo establecer un score en el que aquellos que tuvieron un puntaje de 4 alcanzaron una supervivencia del 49.6% al día 30, mientras que la de los pacientes con score 0 fue del 100% a 30 días. En comparación con la población general, los pacientes con enfermedades hematológicas presentan una mayor mortalidad vinculada al COVID-19, motivo por el cual es primordial definir pautas destinadas a disminuir la exposición de los mismos sin comprometer las posibilidades de beneficiarse del tratamiento de la enfermedad de base.

Published
2021

30. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care

Author

Carla M, Prado, Alessandro, Laviano, Chelsia, Gillis, Anthony D, Sung, Maureen, Gardner, Suayib, Yalcin, Suzanne, Dixon, Shila M, Newman, Michael D, Bastasch, Abby C, Sauer, Refaat, Hegazi, and Martin R, Chasen

Subjects
Nutrition Assessment, Malnutrition, Quality of Life, Humans, Nutritional Status, Patient Care, Medical Oncology
Abstract

Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies' recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies' recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.

Published
2021

31. Sarcopenia: A Time for Action. An SCWD Position Paper

Author

Annemie M. W. J. Schols, Steven B. Heymsfield, Florian Strasser, Vickie E. Baracos, Wolfram Doehner, Carla M. Prado, Luigi Ferrucci, Andrew J.S. Coats, Elsa Dent, Michelangelo Mancuso, Maurizio Muscaritoli, Alfonso J. Cruz-Jentoft, Stephan von Haehling, Kamyar Kalantar-Zadeh, Francesco Landi, John E. Morley, Aminah Jatoi, Stefan D. Anker, Juergen M. Bauer, Alessandro Laviano, Mitja Lainscak, Jeffrey Crawford, Pulmonologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health

Subjects
0301 basic medicine, Sarcopenia, lcsh:Diseases of the musculoskeletal system, Cachexia, Disease, Geriatric assessment, Muscle, Skeletal, Muscle strength, DOUBLE-BLIND, Grip strength, 0302 clinical medicine, Orthopedics and Sports Medicine, VITAMIN-D, Wasting, ULTRASOUND, PHYSICAL FUNCTION, COPD, education.field_of_study, Disease Management, lcsh:Human anatomy, musculoskeletal system, CANCER, 3. Good health, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Position Paper, Disease Susceptibility, medicine.symptom, medicine.medical_specialty, Population, CACHEXIA SYNDROME, lcsh:QM1-695, SKELETAL-MUSCLE MASS, 03 medical and health sciences, Physical medicine and rehabilitation, Physiology (medical), medicine, Vitamin D and neurology, Humans, OLDER-ADULTS, education, business.industry, Settore MED/09 - MEDICINA INTERNA, medicine.disease, body regions, INTERNATIONAL-CONFERENCE, 030104 developmental biology, CLINICAL-PRACTICE, lcsh:RC925-935, business, human activities
Abstract

The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.

Published
2019

32. Tumour‐derived transforming growth factor‐β signalling contributes to fibrosis in patients with cancer cachexia

Author

Nelson Inácio Pinto, Raquel Galvão Figuerêdo, Fernanda Janku Cabral, Marilia Seelaender, Alessandro Laviano, Paulo S. M. Alcantara, Flavio Tokeshi, Joanna Darck Carola Correia Lima, Aloisio Felipe-Silva, Estefania Simoes, Telma Maria Tenório Zorn, Mychel R. P. T. Morais, Gabriela Salim de Castro, Emidio Marques de Matos-Neto, Michele Joana Alves, José Pinhata Otoch, and Emer S. Ferro

Subjects
0301 basic medicine, lcsh:Diseases of the musculoskeletal system, Colorectal cancer, Angiogenesis, neoplasms, 0302 clinical medicine, Tumour micro‐environment, Fibrosis, Epidermal growth factor, cachexia, epithelial–mesenchymal components, fibrosis, tumour micro-environment, aged, biomarkers, biopsy, body composition, body mass Index, cells cultured, cytokines, female, fibroblasts, gene expression, humans, hypoxia, immunohistochemistry, male, middle aged, oxidative stress, transforming growth factor beta, tumor microenvironment, signal transduction, Orthopedics and Sports Medicine, Cells, Cultured, lcsh:Human anatomy, 030220 oncology & carcinogenesis, Original Article, lcsh:QM1-695, Cachexia, Proinflammatory cytokine, 03 medical and health sciences, Physiology (medical), medicine, business.industry, Cancer, Original Articles, medicine.disease, 030104 developmental biology, Cancer research, lcsh:RC925-935, business, Transforming growth factor
Abstract

Background Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour micro‐environment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour micro‐environment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients. Methods 74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components. Results Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyte–macrophage colony‐stimulating factor, interferon‐α, and interleukin (IL)‐8 was observed in the tumour and serum of cachectic cancer patients in comparison with weight‐stable counterparts. Also, IL‐8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of α‐smooth muscle actin (P

Published
2019

33. Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S

Author

I. Sulz, S. Moick, Kris M. Mogensen, Ainsley Malone, Alessandro Laviano, Abby C. Sauer, Gail Gewirtz, Michael Hiesmayr, and Scott Goates

Subjects
Male, Food intake, 030309 nutrition & dietetics, Prevalence, Nutritional Status, Medicine (miscellaneous), Eating, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Humans, Mass Screening, Medicine, Hospital Mortality, Meals, Aged, 0303 health sciences, Meal, Nutrition and Dietetics, business.industry, Malnutrition, Hazard ratio, Feeding Behavior, Middle Aged, Nutrition Surveys, medicine.disease, Hospitals, United States, Nutrition risk, Hospitalization, Cross-Sectional Studies, Hospital outcomes, Female, 030211 gastroenterology & hepatology, Self Report, Energy Intake, nutritionDay, business
Abstract

BACKGROUND Malnutrition risk estimates vary greatly, and no robust data on the association between food intake and outcomes exist for hospitals in the United States (U.S.). This study aimed to determine the prevalence of malnutrition risk and to evaluate the impact of food intake on mortality using the nutritionDay in the U.S. dataset. METHODS This study analyzed data from 2009 to 2015 for all adult patients from participating hospitals. Prevalence of malnutrition risk was determined by mapping self-reported nutritionDay survey questions to the Malnutrition Screening Tool (MST). Fine and Gray competing-risk analysis with clustering was used to evaluate the impact of nutrition risk and food intake on patients' 30-day in-hospital mortality, while controlling for age, mobility, and other disease-related factors. RESULTS Analysis included data from 9959 adult patients from 601 wards. The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: [1.73, 6.07]; P-value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: [3.03, 11.84]; P-value < 0.0001) for patients eating nothing despite being allowed to eat. CONCLUSION This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.

Published
2019

34. The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition

Author

Kristina Norman, Maria D. Ballesteros, Carla M. Prado, Alessandro Laviano, Alfonso J. Cruz-Jentoft, Ione Ashurst, Francesco Landi, Laurence Genton, Nicolaas E. P. Deutz, and Danielle E. Bear

Subjects
Sarcopenia, medicine.medical_specialty, medicine.medical_treatment, Disease, Muscle mass, Body composition, 03 medical and health sciences, Low muscle mass, 0302 clinical medicine, Health care, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Nutritional supplement, General Nursing, ddc:616, Rehabilitation, Anthropometry, business.industry, Health Policy, Malnutrition, General Medicine, medicine.disease, Institutional repository, Nutrition Assessment, Muscle function, Body Composition, Nutrition Therapy, Geriatrics and Gerontology, medicine.symptom, business, Weight gain, 030217 neurology & neurosurgery
Abstract

Preserving muscle is not only crucial for maintaining proper physical movement, but also for its many metabolic and homeostatic roles. Low muscle mass has been shown to adversely affect health outcomes in a variety of disease states (eg, chronic obstructive pulmonary disease, cancer, cardiovascular disease) and leads to an increased risk for readmission and mortality in hospitalized patients. Low muscle mass is now included in the most recent diagnostic criteria for malnutrition. Current management strategies for malnutrition may not prioritize the maintenance and restoration of muscle mass. This likely reflects the challenge of identifying and measuring this body composition compartment in clinical practice and the lack of awareness by health care professionals of the importance that muscle plays in patient health outcomes. As such, we provide a review of current approaches and make recommendations for managing low muscle mass and preventing muscle loss in clinical practice. Recommendations to assist the clinician in the optimal management of patients at risk of low muscle mass include the following: (1) place muscle mass at the core of nutritional assessment and management strategies; (2) identify and assess low muscle mass; (3) develop a management pathway for patients at risk of low muscle mass; (4) optimize nutrition to focus on muscle mass gain versus weight gain alone; and (5) promote exercise and/or rehabilitation therapy to help maintain and build muscle mass. The need to raise awareness of the importance of screening and managing 'at risk' patients so it becomes routine is imperative for change to occur. Health systems need to drive clinicians to treat patients with this focused approach, and the economic benefits need to be communicated to payers. Lastly, further focused research in the area of managing patients with low muscle mass is warranted.

Published
2019

35. Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial

Author

Filomena Gomes, Philipp Schuetz, Christoph Henzen, Laura Bargetzi, Jaques Donzé, C. Brack, Michael Brändle, Robert Thomann, Sarah Sigrist, Vojtech Pavlicek, Nicolas Rodondi, Stefan Bilz, Mario Bargetzi, Claus Hoess, Drahomir Aujesky, Alessandro Laviano, J. Herrmann, Beat Mueller, Annika Bargetzi, Pascal Tribolet, Jonas Rutishauser, Zeno Stanga, Lara Hersberger, and Nina Kaegi-Braun

Subjects
0301 basic medicine, medicine.medical_specialty, 610 Medicine & health, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, 360 Social problems & social services, Internal medicine, Multicenter trial, medicine, Clinical endpoint, Risk of mortality, Humans, Prospective Studies, business.industry, Nutritional Support, Hazard ratio, Cancer, Hematology, Odds ratio, Length of Stay, medicine.disease, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Hematologic Neoplasms, Quality of Life, business
Abstract

Background Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study. Patients and methods In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. Results We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35-0.94; P = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. Conclusions Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.

Published
2021

36. ESPEN practical guideline: Clinical nutrition in surgery

Author

Pierre Singer, Arved Weimann, Stanislaw Klek, Franco Carli, Martin Hübner, Marco Braga, Robert G. Martindale, Dan Linetzky Waitzberg, Olle Ljungqvist, Stephan C. Bischoff, Dileep N. Lobo, Takashi Higashiguchi, Alessandro Laviano, Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hubner, M, Klek, S, Laviano, A, Ljungqvist, O, Lobo, D, Martindale, R, Waitzberg, D, Bischoff, S, and Singer, P

Subjects
medicine.medical_specialty, Prehabilitation, Clinical nutrition, Critical Care and Intensive Care Medicine, Enteral administration, Perioperative Care, Practical guideline, Nutritional therapy, Perioperative nutrition, Enteral Nutrition, Postoperative Complications, medicine, Humans, Medical physics, ERAS, Postoperative Period, Medical nutrition therapy, Bariatric surgery, Nutrition and Dietetics, Organ transplantation, Nutritional Support, business.industry, Malnutrition, Guideline, medicine.disease, Surgery, Nutrition Therapy, Preoperative fasting, Enhanced Recovery After Surgery, Gastrointestinal function, business
Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.

Published
2021

37. Inflammation reduces the effect of nutritional therapy on clinical outcomes in cancer patients

Author

Zeno Stanga, Philipp Schuetz, Mario Bargetzi, Alessandro Laviano, and Laura Bargetzi

Subjects
Inflammation, Oncology, medicine.medical_specialty, Nutritional Support, business.industry, MEDLINE, Cancer, Hematology, medicine.disease, Neoplasms, Internal medicine, medicine, Humans, Medical nutrition therapy, medicine.symptom, 610 Medicine & health, business
Published
2021

38. [Convalescent plasma as a therapy for severe COVID-19 pneumonia]

Author

Ricardo, Valentini, José, Fernández, Dardo, Riveros, Fernando, Pálizas, Jorge, Solimano, Pablo, Saúl, Juan, Medina, Viviana, Falasco, María Laura, Dupont, Julia, Laviano, Florencia, Fornillo, Daniela, Maymó, Daniel, Gotta, Alfredo, Martínez, Pablo, Bonvehí, and Juan, Dupont

Subjects
Adult, Male, Plasma, SARS-CoV-2, Immunization, Passive, COVID-19, Humans, Female, Middle Aged, Pandemics, COVID-19 Serotherapy, Aged
Abstract

The COVID-19 pandemic presented high mortality from its beginning, without effective treatment for seriously ill patients. Build on the experience in Argentine hemorrhagic fever with convalescent plasma, we incorporated 90 patients with COVID-19, of which 87 were evaluable, into a multicenter study. We collected 397 plasma donations from 278 convalescent donors. Patients received plasma with an IgG concentration of 0.7-0.8 (measured by Abbott chemiluminescence) for every 10 kg of body weight. Survival during the first 28 days was the primary objective; 77% were male, age 54 ± 15.6 y/o (range 27-85), body mass index 29.7 ± 4.4; hypertension 39% and diabetes 20.7%; 19.5% had an immunosuppressive condition, 23% were health workers. Plasma was administered to 55 (63%) on spontaneous breathing with oxygen supplementation (mainly oxygen mask with reservoir bag in 80%), and to 32 patients (37%) on mechanical ventilation. The 28-day survival rate was 80%; 91% in patients infused on spontaneous breathing and 63% in those on mechanical ventilation (p = 0.0002). There was a significant improvement in the WHO pneumonia clinical scale at 7 and 14 days, and in PaO2 / FiO2, ferritin and LDH, in the week post-infusion. We observed an episode of circulatory volume overload and a febrile reaction, both mild. Convalescent plasma infusions are feasible, safe, and potentially effective, especially before requiring mechanical ventilation. They are an attractive clinical option for treating severe forms of COVID-19 until other effective therapies become available.La pandemia de COVID-19, presentó desde su inicio elevada mortalidad, sin tratamiento efectivo para pacientes graves. Basados en experiencia previa con plasma de convaleciente en fiebre hemorrágica Argentina, incorporamos a un estudio multicéntrico 90 pacientes con COVID-19 de los que 87 fueron evaluables. Colectamos 397 donaciones de plasma de 278 convalecientes. El plasma fue suministrado con una concentración de IgG de 0.7-0.8 (medidos por quimioluminiscencia Abbott) por cada 10 kg/ peso. La supervivencia a 28 días fue la variable de resultado primario. El 77% fueron varones, edad 54 ± 15.6 años (rango: 27-85); índice de masa corporal de 29.7 ± 4.4; tenían hipertensión 39%, diabetes 20.7%; 19.5% tenían alguna condición de inmunosupresión, y el 23% era personal de salud. Se administró plasma a 55 (63%) en respiración espontánea con oxígeno (con máscara reservorio en 80%), y a 32 (37%) en ventilación mecánica. La supervivencia global a 28 días fue del 80%; 91% en quienes recibían oxígeno suplementario y 63% en los que permanecían en ventilación mecánica (p = 0.0002). Hubo mejora significativa en la escala clínica de neumonía de la OMS a los 7 y a los 14 días. La ferritina, LDH y PaO2/FiO2, mejoraron en la semana post-infusión. Observamos un episodio de sobrecarga de volumen circulatorio y una reacción febril, leves. Las infusiones de plasma de convaleciente son factibles, seguras y potencialmente efectivas, especialmente antes de requerir ventilación mecánica. Constituyen una opción clínica atractiva para tratar formas graves de COVID-19 hasta que estén disponibles otras terapias eficaces.

Published
2021

39. Low phase angle is associated with the risk for sarcopenia in unselected patients with cancer: Effects of hydration

Author

Gustavo D. Pimentel, Cleidiana S. Barreto, Jéssika D.P. Soares, Alessandro Laviano, Claude Pichard, Thaís C. Borges, Nathalia P. Valentino, and Tatyanne L.N. Gomes

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Sarcopenia, Endocrinology, Diabetes and Metabolism, Hydration, 030209 endocrinology & metabolism, Body composition, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Neoplasms, Surveys and Questionnaires, medicine, Prevalence, Humans, Cancer, ddc:616, 030109 nutrition & dietetics, Nutrition and Dietetics, Performance status, business.industry, Phase angle, Odds ratio, medicine.disease, musculoskeletal system, Confidence interval, Cross-Sectional Studies, Female, business, Body mass index, Bioelectrical impedance analysis, human activities
Abstract

Objective: Individuals with cancer are affected by a loss of cell membrane integrity due to electrolyte imbalance between the intra- and extracellular fluids. Cell membrane integrity and hydration status can be assessed according to the phase angle (PhA) and the risk for sarcopenia, by using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire. To our knowledge, this approach has not been validated in patients with cancer. The aims of this study were to verify the prevalence of the risk for sarcopenia, and to analyze the association between PhA and the risk for sarcopenia with and without adjustment for extracellular water content.Methods: This was a cross-sectional study conducted with 124 male and female cancer patients (77.4% men). PhA and hydration status were assessed using bioelectrical impedance analysis (BIA), and the risk for sarcopenia (cutoff ≥4) was assessed using the SARC-F questionnaire.Results: Of the 124 patients, 28 (22.5%) were at risk for sarcopenia (SARC-F ≥4). There was no association between PhA and the risk for sarcopenia in the crude model, nor in the model adjusted for age, sex, smoking, alcohol consumption, and physical activity, nor after adjusting for use of supplements, body mass index, treatment type, performance status, and type and stage of cancer. However, we found an association between lower PhA values and a higher risk for sarcopenia after adjusting for hydration abnormalities (odds ratio, 1.74; 95% confidence interval, 1.03-2.93; P < 0.035).Conclusion: We found that 22.5% of patients with cancer presented with a risk for sarcopenia. Additionally, an association between lower PhA values and enhanced risk for sarcopenia highlighted the importance of adequate hydration and evaluation of fluid status via BIA as a new recommendation to prevent sarcopenia.

Published
2021

40. Short-term intradialytic NMES targeting muscles of the legs improves the phase angle: A pilot randomized clinical trial

Author

Alessandro Laviano, Gustavo D. Pimentel, João Felipe Mota, Reika D. Motobu, Ana Tvs. Freitas, Claude Pichard, Paula Alves Monteiro, Ana C.B. Marini, Benjamin T. Wall, Universidade Federal de Goiás (UFG), Universidade Estadual Paulista (Unesp), Geneva Univ Hosp, Univ Roma La Sapienza, and Univ Exeter

Subjects
Adult, Male, 0301 basic medicine, NMES, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Pilot Projects, 030209 endocrinology & metabolism, Quadriceps Muscle, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Humans, Medicine, Muscle Strength, ddc:616, Leg, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Phase angle, Middle Aged, Muscle atrophy, Clinical trial, Lean body mass, Anesthesia, Hemodialysis, Female, medicine.symptom, business, Bioelectrical impedance analysis, Muscle Contraction, Muscle contraction
Abstract

Made available in DSpace on 2021-06-25T15:05:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Purpose: Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to attenuate muscle atrophy when physical activity is not possible. Thus, we hypothesized that intradialytic NMES would attenuate the loss leg lean mass and improve the phase angle in patients undergoing hemodialysis (HD). Methods: A randomized controlled trial was performed with twenty-one adult HD patients (n = 8 F, n = 13 M; 45.8 +/- 10.6 y) randomly assigned to usual care (control group, n = 11; 4F/7M) or to the NMES group (n = 10; 4F/6M). NMES was applied bilaterally at the origin and insertion points of the quadriceps or gastrocnemius muscles for 40 min during each HD session (3x/wk for one month). Pre-and post-intervention, we measured leg lean mass using dual-energy x-ray absorptiometry and phase angle using bioelectrical impedance analysis. Results: NMES did not change leg lean mass compared to the control group. Phase angle increased in the NMES compared to the control group (Delta: +0.71 +/- 0.27 degrees vs. -0.46 +/- 0.23 degrees, p = 0.004) with interaction time x treatment (ANOVA p = 0.004). Conclusion: Short-term intradialytic NMES targeting muscles of the legs improved the phase angle but did not change leg lean mass. Brazilian registry of clinical trials under the code: RBR-98wzgn. (C) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Univ Fed Goias, Fac Nutr, Clin & Sports Nutr Res Lab Labince, Goiania, Go, Brazil Sao Paulo State Univ, Dept Phys Educ, Immunometab Res Grp, Presidente Prudente, Brazil Geneva Univ Hosp, Clin Nutr, Geneva, Switzerland Univ Roma La Sapienza, Dept Translat & Precis Med, Rome, Italy Univ Exeter, Coll Life & Environm Sci, Dept Sport & Hlth Sci, Exeter, Devon, England Sao Paulo State Univ, Dept Phys Educ, Immunometab Res Grp, Presidente Prudente, Brazil CNPq: 312252/2019-6

Published
2021

41. High neutrophil to lymphocytes ratio is associated with sarcopenia risk in hospitalized cancer patients

Author

Tatyanne L.N. Gomes, Claude Pichard, Alessandro Laviano, Thaís C. Borges, and Gustavo D. Pimentel

Subjects
Male, 0301 basic medicine, Sarcopenia, Neutrophils, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Logistic regression, Systemic inflammation, 0302 clinical medicine, Reference Values, Neoplasms, Medicine, Lymphocytes, Cancer, ddc:616, Nutrition and Dietetics, Middle Aged, musculoskeletal system, Hospitalization, C-Reactive Protein, Female, medicine.symptom, Blood Platelets, medicine.medical_specialty, 030209 endocrinology & metabolism, Inflammation, Muscle mass, Risk Assessment, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Humans, Karnofsky Performance Status, Aged, Chemotherapy, 030109 nutrition & dietetics, business.industry, fungi, medicine.disease, Blood Cell Count, body regions, Cross-Sectional Studies, Functional Status, Logistic Models, ROC Curve, business, human activities
Abstract

Background & aims: Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients.Methods: A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann-Whitney, or Chi-Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk.Results: ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR Conclusion: In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.

Published
2021

42. ESPEN guideline: Clinical nutrition in surgery

Author

Dan Linetzky Waitzberg, Arved Weimann, Olle Ljungqvist, Stanislaw Klek, Stephan C. Bischoff, Dileep N. Lobo, Marco Braga, Martin Hübner, Takashi Higashiguchi, Pierre Singer, Robert G. Martindale, Alessandro Laviano, Franco Carli, Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hübner, M, Klek, S, Laviano, A, Ljungqvist, O, Lobo, D, Martindale, R, Waitzberg, D, Bischoff, S, and Singer, P

Subjects
medicine.medical_specialty, Gastrointestinal Diseases, Gastrointestinal Disease, Nutritional Status, Clinical nutrition, Critical Care and Intensive Care Medicine, Enteral administration, Perioperative Care, Nutrition Policy, COMPLICAÇÕES PÓS-OPERATÓRIAS, 03 medical and health sciences, Postoperative Complications, Perioperative nutrition, 0302 clinical medicine, Meta-Analysis as Topic, Risk Factors, Nutrition and Dietetic, medicine, Humans, ERAS, Medical nutrition therapy, Intensive care medicine, Digestive System Surgical Procedures, Randomized Controlled Trials as Topic, Nutrition and Dietetics, Nutritional Support, business.industry, Risk Factor, Malnutrition, Digestive System Surgical Procedure, Guideline, Parenteral nutrition, medicine.disease, Surgery, Gastrointestinal Tract, Nutritional Statu, Observational Studies as Topic, 030220 oncology & carcinogenesis, Metabolic control analysis, 030211 gastroenterology & hepatology, Postoperative Complication, Preoperative fasting, Enteral nutrition, Gastrointestinal function, business, Prehabilitation, Human
Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

Published
2017

43. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review

Author

Steven B. Heymsfield, Ferruccio Santini, Yves Rolland, Gema Frühbeck, Maria Cristina Gonzalez, Mario Siervo, Eleonora Poggiogalle, Ho Seong Han, Roberto Vettor, Rocco Barazzoni, Takashi Higashiguchi, Jianchun Yu, Lorenzo M. Donini, Stephan C. Bischoff, Luca Busetto, Carla M. Prado, Andrea Lenzi, Andrea Giustina, Francesco Tecilazich, Edda Parrinello, Dror Dicker, Javier Rodríguez, Tommy Cederholm, Alessandro Laviano, Alfonso J. Cruz-Jentoft, Yves Boirie, Juergen M. Bauer, Mauro Zamboni, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Universitad de Padua, Heidelberg University, University of Hohenheim, Nutrition Clinique, CHU Clermont-Ferrand, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Uppsala University, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Sackler Faculty of Medicine, Tel Aviv University [Tel Aviv], Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Universidad de Navarra (Pamplona), Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición - Biomedical Research Center in Red-Physiopathology of Obesity and Nutrition (CIBEROBN), University Hospital, Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Catholic University of Pelotas (UCPEL), Seoul National University Bundang Hospital (SNUBH), Pennington Biomedical Research Center, Fujita Health University, University of Alberta, University of Navarra, UMR 1027, Centre Hospitalier Universitaire de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, University of Pisa, University of Nottingham, UK (UON), Peking Union Medical College, University of Verona (UNIVR), University of Trieste, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Università degli Studi di Padova = University of Padua (Unipd), Tel Aviv University (TAU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT), University of Pisa - Università di Pisa, Università degli studi di Verona = University of Verona (UNIVR), Università degli studi di Trieste = University of Trieste, Sapienza University Romee, Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), Centre Hospitalier Universitaire de Clermont-Ferrand, Vita-Salute San Raffaele University, Sapienza Univ Rome, Université Toulouse III - Paul Sabatier, University of Verona, Donini, L. M., Busetto, L., Bauer, J. M., Bischoff, S., Boirie, Y., Cederholm, T., Cruz-Jentoft, A. J., Dicker, D., Fruhbeck, G., Giustina, A., Gonzalez, M. C., Han, H. -S., Heymsfield, S. B., Higashiguchi, T., Laviano, A., Lenzi, A., Parrinello, E., Poggiogalle, E., Prado, C. M., Rodriguez, J. S., Rolland, Y., Santini, F., Siervo, M., Tecilazich, F., Vettor, R., Yu, J., Zamboni, M., and Barazzoni, R.

Subjects
0301 basic medicine, Gerontology, Adult, Male, Sarcopenia, Consensus, Cross-sectional study, Population, Nutritional Status, 030209 endocrinology & metabolism, Scientific literature, Clinical nutrition, Critical Care and Intensive Care Medicine, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Prevalence, Medicine, Humans, Sarcopenic obesity, Obesity, education, Muscle, Skeletal, Aged, 2. Zero hunger, Aged, 80 and over, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Middle Aged, medicine.disease, 3. Good health, Critical appraisal, Systematic review, Cross-Sectional Studies, Body Composition, Female, Symptom Assessment, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Summary Background Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. Currently, different definitions of sarcopenic obesity exist and its diagnostic criteria and cut-offs are not universally established. Therefore, the prevalence and sensitivity of this condition for any disease risk prediction is affected significantly. Aim This work was conducted under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). An international expert panel performed a systematic review as an initial step to analyze and summarize the available scientific literature on the definitions and the diagnostic criteria for sarcopenic obesity proposed and/or applied in human studies to date. Methods The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in April 2018 in three databases (PubMed, Scopus, Web of Science). Human studies conducted in both sexes, irrespective of ethnicity, and published from 2007 to 2018 were included; cohorts of individuals with obesity and acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity were excluded from final analyses. The quality of the studies was evaluated using the Newcastle–Ottawa Scale (NOS) adapted for cross sectional studies. Results The electronic search retrieved 2335 papers of which 75 met the eligibility criteria. A marked heterogeneity in definitions and approaches to diagnose sarcopenic obesity was observed. This was mainly due to differences in the definitions of obesity and sarcopenia, in the methodologies used to assess body composition and physical function, and in the reference values for the variables that have been used (different cut-offs, interquartile analysis, diverse statistical stratification methods). This variability may be attributable, at least in part, to the availability of the methodologies in the different settings, to the variability in specialties and backgrounds of the researcher, and to the different settings (general population, clinical settings, etc.) where studies were performed. Conclusion The results of the current work support the need for consensus proposals on: 1) definition of sarcopenic obesity; 2) diagnostic criteria both at the level of potential gold-standards and acceptable surrogates with wide clinical applicability, and with related cut-off values; 3) methodologies to be used in actions 1 and 2. First steps should be aimed at reaching consensus on plausible proposals that would need subsequent validation based on homogeneous studies and databases, possibly based on analyses of existing cohorts, to help define the prevalence of the condition, its clinical and functional relevance as well as most effective prevention and treatment strategies.

Published
2019

44. [Coagulopathy and COVID-19. Recommendations for a changing reality]

Author

Dardo Riveros, Daniela Maymó, Julia Laviano, Florencia Fornillo, José Fernández, Ricardo Benzadon, Jorge Solimano, Roberto Cacchione, Leandro Riera, Patricio Duarte, Nicolás Cazap, Daniel Gotta, Juan García Altuve, Ricardo Valentini, and Juan Dupont

Subjects
lcsh:Immunologic diseases. Allergy, Heparin, SARS-CoV-2, sepsis induced coagulopathy, lcsh:R, Pneumonia, Viral, Argentina, lcsh:Medicine, COVID-19, Blood Coagulation Disorders, Disseminated Intravascular Coagulation, lcsh:Infectious and parasitic diseases, Coronavirus, Betacoronavirus, Sepsis, Thromboembolism, cytokine storm, Cytokines, Humans, lcsh:RC109-216, lcsh:RC581-607, Coronavirus Infections, Pandemics
Abstract

The coronavirus disease 2019 (COVID-19) pandemic requires rapid medical responses. The risk of venous and arterial thromboembolism increases in critically ill patients with SARS-CoV-2 infection. There is a hypercoagulable state that includes elevated levels of D-dimer, with an increased risk of organ failure and increased mortality. The abnormalities described in hemostasis should be considered for therapeutic decision making. We analyzed the available scientific evidence for the therapeutic approach of coagulopathy in the course of the disease with the objective of designing realistic therapeutic recommendations aimed at reducing morbidity and mortality in patients with COVID-19.La pandemia COVID-19 provocada por el betacoronavirus SARS-CoV-2 exige rápidas respuestas desde el campo de la medicina. El riesgo de tromboembolismo venoso y arterial está aumentado durante la infección, especialmente en pacientes críticos. En ese contexto se destaca una coagulopatía caracterizada por niveles elevados de dímero D, con tendencia a la falla multiorgánica, y aumento de la mortalidad. Esas anormalidades de la hemostasia responden a varios mecanismos que deben tenerse en cuenta para la toma de decisiones terapéuticas. Analizamos la evidencia científica disponible en la que se fundamenta el enfoque terapéutico de la coagulopatía descripta y sus complicaciones, con el objetivo de diseñar recomendaciones terapéuticas realistas tendientes a disminuir la morbilidad y la mortalidad en pacientes con COVID-19.

Published
2020

45. Cancer-associated anorexia: Validity and performance overtime of different appetite tools among patients at their first cancer diagnosis

Author

Ioannis Gioulbasanis, Alessandro Laviano, Pilar Milke, Anton Snegovoy, Marian A. E. de van der Schueren, Karla Sánchez-Lara, Alessio Molfino, Giovanni Imbimbo, Giovanni Ronzani, Silvio Cavuto, Luca Di Lazzaro, Maria Ida Amabile, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Food intake, Visual analogue scale, media_common.quotation_subject, Appetite, Anorexia, Critical Care and Intensive Care Medicine, Diet Surveys, Cachexia, Disability Evaluation, Eating, Internal medicine, Neoplasms, Surveys and Questionnaires, Weight Loss, medicine, Prevalence, Humans, media_common, Aged, Nutrition and Dietetics, business.industry, digestive, oral, and skin physiology, Overtime, Cancer, Reproducibility of Results, Middle Aged, medicine.disease, Diet, First cancer diagnosis, Functional Status, Nutrition Assessment, Female, Self Report, medicine.symptom, business
Abstract

Background & aims: Anorexia is a frequent symptom in cancer and we aimed to assess its prevalence among patients at their first cancer diagnosis by different appetite tools and the relationship between each tool with self-reports of food intake. We also tested whether cancer anorexia influences outcomes independently of reduced food intake or body weight loss (BWL) overtime and whether BWL was associated with complications during anticancer-therapy. Methods: Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score, self-assessment of appetite, Anorexia Questionnaire (AQ) and Visual Analog Scale (VAS) were administered. Percent of food intake was used as a criterion measure of anorexia. We registered BWL and anticancer-therapy complications over 3-month-follow-up. Results: 438 cancer patients from 7 cancer-centers worldwide were included. The prevalence of anorexia was 39.9% by FAACT score, 40.2% by VAS, 40.6% by the self-assessment of appetite and 65.4% by AQ. Low food intake (

Published
2020

46. Nutrition Information in Oncology — Extending the Electronic Patient-Record Data Set

Author

Elisa V. Bandera, Conceição Calhau, Ana Margarida Pereira, Federico Bozzetti, Pedro Vieira-Marques, Ricardo Cruz-Correia, Liz Isenring, Alessandro Laviano, Paula Ravasco, Priscila A. Maranhão, and Maureen B. Huhmann

Subjects
Oncology, medicine.medical_specialty, OpenEHR, Computer science, Interoperability, Medicine (miscellaneous), Health Informatics, Context (language use), Health informatics, Patient Facing Systems, Health Information Management, Internal medicine, Health care, medicine, Humans, Electronic health records, Nutrition, Clinical practice guideline, business.industry, Guideline, openEHR, Data Accuracy, Semantics, Data quality, Data set (IBM mainframe), Electronics, business, Delivery of Health Care, Software, Information Systems
Abstract

Electronic health records (EHRs) present extensive patient information and may be used as a tool to improve health care. However, the oncology context presents a complex content that increases the difficulties of EHR application. This study aimed at developing openEHR-archetypes representing clinical concepts in cancer nutrition-care, as well as to develop an openEHR-template including the aforementioned archetypes. The study involved the following stages: 1) a thorough literature review, followed by an expert’s (nutrition guideline authors) survey, aiming to identify the main statements of published clinical guidelines on nutrition in cancer patients that were not included on the Clinical Knowledge Manager (CKM) repository; 2) modelling of the archetypes using the Ocean Archetype Software and submission to the CKM repository; 3) creating an example template with Template Designer; and 4) automatic conversion of the openEHR-template into a readily usable EHR using VCIntegrator. The clinical concepts (among 17 clinical concepts not yet available in the CKM repository) chosen for further development were: body composition, diet plan, dietary nutrients, dietary supplements, dietary intake assessment, and Malnutrition Screening Tool (MST). So far, four archetypes were accepted for review in the CKM repository and a template was created and converted into an EHR. This study designed new openEHR-archetypes for nutrition management in cancer patients. These archetypes can be included in EHR. Future studies are needed to assess their applicability in other areas and their practical impact on data quality, system interoperability and, ultimately, on clinical practice and research. Electronic supplementary material The online version of this article (10.1007/s10916-020-01649-9) contains supplementary material, which is available to authorized users.

Published
2020

47. Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition

Author

Philip C. Calder, Yves Rolland, Ines Warnke, Barbara Troesch, Manfred Eggersdorfer, Alessandro Laviano, Arved Weimann, and A. David Smith

Subjects
Aging, EICOSAPENTAENOIC ACID, DHA and EPA, RESPIRATORY-DISTRESS-SYNDROME, Review, GAMMA-LINOLENIC ACID, 0302 clinical medicine, Health care, Medicine, Nutritional Physiological Phenomena, CANCER CACHEXIA, Cognitive decline, FISH-OIL, chemistry.chemical_classification, Aged, 80 and over, POLYUNSATURATED FATTY-ACIDS, Nutrition and Dietetics, clinical nutrition, oral nutritional supplementation, Alzheimer's disease, Eicosapentaenoic acid, Docosahexaenoic acid, 030220 oncology & carcinogenesis, long-chain omega-3 polyunsaturated fatty acids, Alzheimer’s disease, lcsh:Nutrition. Foods and food supply, Polyunsaturated fatty acid, medicine.medical_specialty, Docosahexaenoic Acids, lcsh:TX341-641, Clinical nutrition, frailty, ACUTE LUNG INJURY, sarcopenia, 03 medical and health sciences, Fatty Acids, Omega-3, Humans, Intensive care medicine, Expert Testimony, immunonutrition, Aged, business.industry, CENTRAL-NERVOUS-SYSTEM, DOCOSAHEXAENOIC ACID, medicine.disease, COGNITIVE IMPAIRMENT, chemistry, inflammation, Sarcopenia, Dietary Supplements, Life expectancy, business, 030217 neurology & neurosurgery, Food Science
Abstract

Life expectancy is increasing and so is the prevalence of age-related non-communicable diseases (NCDs). Consequently, older people and patients present with multi-morbidities and more complex needs, putting significant pressure on healthcare systems. Effective nutrition interventions could be an important tool to address patient needs, improve clinical outcomes and reduce healthcare costs. Inflammation plays a central role in NCDs, so targeting it is relevant to disease prevention and treatment. The long-chain omega-3 polyunsaturated fatty acids (omega-3 LCPUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to reduce inflammation and promote its resolution, suggesting a beneficial role in various therapeutic areas. An expert group reviewed the data on omega-3 LCPUFAs in specific patient populations and medical conditions. Evidence for benefits in cognitive health, age- and disease-related decline in muscle mass, cancer treatment, surgical patients and critical illness was identified. Use of DHA and EPA in some conditions is already included in some relevant guidelines. However, it is important to note that data on the effects of omega-3 LCPUFAs are still inconsistent in many areas (e.g., cognitive decline) due to a range of factors that vary amongst the trials performed to date; these factors include dose, timing and duration; baseline omega-3 LCPUFA status; and intake of other nutrients. Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use.

Published
2020

48. Dietary recommendations during the COVID-19 pandemic

Author

Fabiane La Flor Ziegler Sanches, Christianne de Faria Coelho-Ravagnani, Flávia Campos Corgosinho, Alessandro Laviano, Carla M. Prado, and João Felipe Mota

Subjects
breastfeeding, media_common.quotation_subject, Breastfeeding, Medicine (miscellaneous), Nutritional Status, medicine.disease_cause, Nutrition Policy, hygiene, Nutrient, Hygiene, Environmental health, Pandemic, medicine, Humans, Pandemics, Coronavirus, media_common, Nutrition and Dietetics, Transmission (medicine), business.industry, food, COVID-19, Vitamins, Lead Article, Diet, Food packaging, supplementation, business, Breast feeding
Abstract

Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals. The majority of documents encouraged the consumption of fruits, vegetables, and whole grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system. Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected. There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.

Published
2020

49. Myokines in treatment-naïve patients with cancer-associated cachexia

Author

Anna E. Taranko, Cláudio Campi de Castro, Joanna Correia-Lima, Vera C. Mazurak, Rafael P. de Souza, Alessandro Laviano, Paulo S. M. Alcantara, Ulrike Lenz, Dario Coletti, Jingjie Xiao, Carla M. Prado, José Pinhata Otoch, Katrin Radloff, Marilia Seelaender, Alexandre F. Ramos, Mario Feitoza, Daniela Caetano Gonçalves, Fang Chia Bin, Silvio Pires Gomes, Gabriela Salim de Castro, Leonardo dos Reis Gama, Estefania Simoes, Camila E. Orsso, Raquel Galvão Figueredo Costa, Flavio Tokeshi, Luis H.A. Nucci, Fernanda Belloti Formiga, and Louisie Galantini Lana de Godoy

Subjects
Adult, Male, medicine.medical_specialty, tumor, Cachexia, Follistatin-Related Proteins, myokines, Rectus Abdominis, Adipose tissue, Myostatin, Critical Care and Intensive Care Medicine, Weight loss, Stomach Neoplasms, Internal medicine, Myokine, medicine, cancer, Humans, skeletal muscle, Muscle, Skeletal, Wasting, Aged, Gastrointestinal Neoplasms, Aged, 80 and over, Interleukin-15, Nutrition and Dietetics, biology, PLASMA, business.industry, Rectal Neoplasms, Brain-Derived Neurotrophic Factor, cachexia, Skeletal muscle, Middle Aged, medicine.disease, Fibronectins, Endocrinology, medicine.anatomical_structure, Colonic Neoplasms, biology.protein, Intercellular Signaling Peptides and Proteins, Female, medicine.symptom, Metabolic syndrome, business, Carrier Proteins, Fatty Acid Binding Protein 3
Abstract

Summary Cancer-associated cachexia is a complex metabolic syndrome characterized by weight loss and systemic inflammation. Muscle loss and fatty infiltration into muscle are associated with poor prognosis in cancer patients. Skeletal muscle secretes myokines, factors with autocrine, paracrine and/or endocrine action, which may be modified by or play a role in cachexia. This study examined myokine content in the plasma, skeletal muscle and tumor homogenates from treatment-naive patients with gastric or colorectal stages I-IV cancer with cachexia (CC, N = 62), or not (weight stable cancer, WSC, N = 32). Myostatin, interleukin (IL) 15, follistatin-like protein 1 (FSTL-1), fatty acid binding protein 3 (FABP3), irisin and brain-derived neurotrophic factor (BDNF) protein content in samples was measured with Multiplex technology; body composition and muscle lipid infiltration were evaluated in computed tomography, and quantification of triacylglycerol (TAG) in the skeletal muscle. Cachectic patients presented lower muscle FSTL-1 expression (p = 0.047), higher FABP3 plasma content (p = 0.0301) and higher tumor tissue expression of FABP3 (p = 0.0182), IL-15 (p = 0.007) and irisin (p = 0.0110), compared to WSC. Neither muscle TAG content, nor muscle attenuation were different between weight stable and cachectic patients. Lumbar adipose tissue (AT) index, visceral AT index and subcutaneous AT index were lower in CC (p = 0.0149, p = 0.0455 and p = 0.0087, respectively), who also presented lower muscularity in the cohort (69.2% of patients; p = 0.0301), compared to WSC. The results indicate the myokine profile in skeletal muscle, plasma and tumor is impacted by cachexia. These findings show that myokines eventually affecting muscle wasting may not solely derive from the muscle itself (as the tumor also may contribute to the systemic scenario), and put forward new perspectives on cachexia treatment targeting myokines and associated receptors and pathways.

Published
2020

50. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol

Author

Federica Lobascio, Alessandro Laviano, Alba Muzzi, Elisabetta Montagna, Emanuele Cereda, Antonio Di Sabatino, I Iacona, Mirko Belliato, Giuseppina Grugnetti, Riccardo Caccialanza, Angelo Corsico, Raffaele Bruno, Elisa Bonadeo, Monica Calvi, and Serena Ludovisi

Subjects
0301 basic medicine, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Nutritional Supplementation, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Endocrinology, Diabetes and Metabolism, Critical Illness, MEDLINE, 030209 endocrinology & metabolism, Anorexia, Disease, Article, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Continuous positive airway pressure, Vitamin D, Intensive care medicine, Nutritional support, Protocol (science), 030109 nutrition & dietetics, Nutrition and Dietetics, Critically ill, business.industry, SARS-CoV-2, Malnutrition, Coronavirus disease (COVID-19), COVID-19, medicine.disease, Pragmatic protocol, Pneumonia, Respiratory failure, Oral nutritional supplements, Dietary Supplements, Whey proteins, Feasibility Studies, medicine.symptom, Multivitamin, business
Abstract

Objectives Beginning in December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic that began in Wuhan, China, and is rapidly spreading throughout the whole world. Italy is the hardest hit country after China. Considering the deleterious consequences of malnutrition, which certainly can affect patients with COVID-19, the aim of this article is to present a pragmatic protocol for early nutritional supplementation of non-critically ill patients hospitalized for COVID-19 disease. It is based on the observation that most patients present at admission with severe inflammation and anorexia leading to a drastic reduction of food intake, and that a substantial percentage develops respiratory failure requiring non-invasive ventilation or even continuous positive airway pressure. Methods High-calorie dense diets in a variety of different consistencies with highly digestible foods and snacks are available for all patients. Oral supplementation of whey proteins as well as intravenous infusion of multivitamin, multimineral trace elements solutions are implemented at admission. In the presence of 25-hydroxyvitamin D deficit, cholecalciferol is promptly supplied. If nutritional risk is detected, two to three bottles of protein-calorie oral nutritional supplements (ONS) are provided. If, Highlights • Novel coronavirus disease (COVID-19) is spreading throughout the world and if nutritional care is not promptly implemented, malnutrition will affect also patients with the disease. • Most infected patients present with severe inflammation and anorexia leading to a drastic reduction of food intake; a large percentage develop respiratory failure. • A pragmatic protocol for early nutritional supplementation of patients with COVID-19 not in the intensive care unit was implemented. • Every effort should be made to avoid or limit underfeeding in patients with COVID-19, even if it means struggling against insurmountable difficulties due to the emergency scenario.

Published
2020

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