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Primary small bowel melanoma is a very rare clinical entity with a paucity of publications in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising generally from primary lesion of the skin, eyes, or anus. We present a case of a small bowel intussusception with primary malignant melanoma as lead point and a gluteal melanoma metastasis after four years free from disease.A 77-year-old female has come to our attention with signs and symptoms of intestinal occlusion. She was subjected to a computerized tomography (CT) of the abdomen and pelvis that revealed small bowel intussusception caused by intestinal polypoid lesion. She was treated with a bowel resection. The histological exam has shown the presence of an amelanocytic malignant melanoma. The examination of skin, eyes, esophagus, colon and anus, a tot al body contrast- enhanced CT and a bone scintigraphy were negative for primary melanoma. So, the final diagnosis was primary melanoma of the ileum. After four-years disease-free survival, the patient came back to our attention for a gluteal melanoma metastasis, that was surgically removed. Afterwards she started immunotherapy, that is still ongoing.The diagnosis and the treatment of primary intestinal melanoma is a challenging due to the lack of scientific indications. Our case shows how an early diagnosis, although accidental, can offer a good survival free from disease. Moreover, a careful follow-up of our patients allows us to promptly identify neoplasm recurrence or distant metastasis that can be treated with surgery and systematic therapy.Intussusception, Primary bowel melanoma.Il melanoma intestinale è una patologia estremamente rara e molto spesso difficile da diagnostica a causa della mancanza di manifestazioni sintomatologiche precoci e specifiche. La diagnosi tardiva e la rapidità con cui questa neoformazione diffonde attraverso i vasi sanguigni intestinali sono le due principali cause della sua peggiore prognosi rispetto al melanoma cutaneo. Raramente può presentarsi con sintomi intestinali aspecifici quali dolore addominale cronico, occlusione intestinale, rettorragia e calo ponderale il più delle volte nelle fasi avanzate della malattia. Una presentazione clinica acuta che richiede un intervento chirurgico urgente, come nel nostro caso, può permette una diagnosi precoce, seppure accidentale, e quindi assicurare un trattamento radicale con una buona sopravvivenza dei pazienti. L’esistenza dei melanomi primitivi intestinali è sicuramente oggetto di dibattito, ma l’assenza di lesioni melanocitiche cutanee, oculari e anali permette di escludere la presenza di un melanoma metastatizzato, rinforzando l’ipotesi di una lesione primitiva intestinale confermata dall’esame istologico definitivo. Data la sua bassa incidenza non esistono dei protocolli condivisi di trattamento. Sicuramente la resezione chirurgica ampia della neoformazione, con margini negativi, e l’asportazione dei linfonodi mesenteriali corrispondenti permette una buona sopravvivenza dei pazienti. Un attento follow-up a lungo termine con esame dermatologico, visita oculistica, visita chirurgica, gastroscopia e colonscopia periodiche permettono di individuare precocemente eventuali secondarismi trattabili chirurgicamente e con terapia sistemica, in particolar modo immunoterapia.

The COVID-19 pandemic is an unprecedented global event. Physical distancing and other restrictions imposed by national and local governments all over the world to contain the spread of the virus almost certainly have had a significant impact on young people, who are more sensitive to peer interaction and social stimuli than adults.This article sets out to investigate the lifestyles of young Italians during the first lockdown, with the aim of exploring how leisure becomes the object of a negotiation between social needs, regulatory requirements, and a situation of crisis. To investigate these aspects, we present the results of a quantitative study conducted on a large group of individuals in Italy, focusing on young Italians’ lifestyles and leisure activities, together with an overview of prevailing moods. Our findings indicate that young people activated various adaptation strategies in response to the crisis with possible significant effects on lifestyles and well-being.

The article reports the results of a content analysis of 815 Italian commercials and a qualitative research on some case studies.The study aims to determine the level of sex typing in the Italian advertising and try to find some changes in the gender representations.If the content analysis confirms the perpetuation of old stereotypes in the Italian commercials, the qualitative research reveals a timid transgression of traditional gender roles. Sometimes, women are depicted as professionals and ambitious workers, inserted in different workplaces and not confined at home, and flanked to the men and not only accompanied by them. Occasionally, men are depicted at home, in the role of father or as a sexual object.However, the “new” portrayals do not imply a reduction of the differences between men and women. Rather, they articulate the gender diversity in a more subtle form. On the one hand, the Italian commercials reassure traditional identities, pushing them towards consumptions that destabilize the gender order. On the other hand, they promote a new awareness and attention to the gender complexity, anchoring it to traditional consumptions.Even if the new portrayals are few and do not constitute a trend, they prove that the topic is more complex than it seems, and the issues are much more nuanced than in the past., El artículo presenta los resultados de un análisis de contenido de 815 anuncios publicitarios italianos y una investigación cualitativa sobre algunos estudios de casos. El estudio tiene como objetivo determinar el nivel de asignación del sexo en la publicidad italiana y tratar de encontrar algunos cambios en las representaciones de género. Mientras que el análisis de contenido confirma la perpetuación de los estereotipos de edad en los anuncios italianos, la investigación cualitativa revela una transgresión tímida de los roles de género tradicionales., L'article presenta els resultats d'una anàlisi de contingut de 815 anuncis publicitaris italians i una investigació qualitativa sobre alguns estudis de casos. L'estudi té com a objectiu determinar el nivell d'assignació del sexe en la publicitat italiana i tractar de trobar alguns canvis en les representacions de gènere. Mentre que l'anàlisi de contingut confirma la perpetuació dels estereotips d'edat en els anuncis italians, la investigació qualitativa revela una transgressió tímida dels rols de gènere tradicionals.

Intimal arteritis (v-lesion) is a negative prognostic factor for kidney allograft survival. Early isolated v-lesions do not always represent a pathologic marker of acute T cell- or antibody-mediated rejection. In particular, in the case of transplant negative for C4d and donor-specific antibodies, such a finding can suggest an ischemic-reperfusion injury. There is an intense debate in the literature concerning the origin of this histologic feature. In the present study, we analyze how this argument can have a clinical relevance. Here we report a case of a 61-year-old woman with end-stage renal disease due to autosomal dominant polycystic kidney disease. The patient underwent kidney transplant from expanded criteria donor. Organs from expanded criteria donors are more prone to ischemic-reperfusion injury. Postoperative course was characterized by primary nonfunction of the graft. A first biopsy showed early isolated v-lesion in otherwise normal renal parenchymal. Simultaneously, a computed tomography scan revealed stenosis of the main renal artery. An endovascular stent was placed. Despite improved vascularization of the graft, no clinical response was observed and the patient remained anuric. A second biopsy was performed, showing T-cell mediated rejection (Banff Classification 1A). Despite pulse steroid, the patient lost the graft.

The pathologist is often called to define the origin of tumors through the help of ancillary studies, mainly immunohistochemical stainings. In this setting, the differential diagnosis between intestinal adenocarcinomas, other tumors with intestinal-type morphology, and adenocarcinomas metastatic to the bowel can be particularly difficult. In such cases, an accurate assessment of the disease is required to address the patients to the optimal treatment. Immunohistochemistry offers the use of multiple antibodies: the integrated evaluation of specific stainings can lead to a correct diagnosis. Particularly, the use of cytokeratins, mucins, and β-catenin could be of great help in most cases. In addition, recently, novel specific markers such as SATB2 and AMACR have been introduced, improving the utility of immunohistochemistry in the differential diagnosis of intestinal-type and intestinal adenocarcinomas.

The graft nephrectomy is burdened by immunological and surgical complications. The main surgical complications of graft nephrectomy are hemorrhage, infections, vascular injury and death. The mortality is high, with percentages varying between 1.3 and 38%. Therefore, graft nephrectomy should be recommended only in selected cases. We conducted a retrospective study, comparing the data of 26 patients undergoing an allograft nephrectomy (2009–2013), without embolization of the renal artery (NO EMBO group) with the data of 40 patients undergoing an allograft nephrectomy (2014–2019), with embolization of the renal artery (EMBO group). We included only graft nephrectomies performed at least 6 months after transplantation. The patients included in the study were consecutive because until 2013 we did not perform the embolization of the renal graft artery. Afterwards, from 2014, instead, we routinely carry out embolization to all patients to be subjected to graft nephrectomy. We, therefore, wanted to analyze whether this surgical approach compared to the previous technique can lead to an improvement in morbidity and mortality, reducing the risk of bleeding and operating times. The examination of our data highlights that embolization of renal artery reduces the operating times of the explant, in addition the group subjected to embolization had less changes in hemoglobinemia and less blood loss.

Two cats infected by Dirofilaria immitis and Dirofilaria repens, respectively, were taken to two different private practitioners for a clinical examination. The analyses conducted on the first cat revealed a microfilaraemia due to D. repens of 66 mfs/mL by a modified Knott's test. No clinical signs of D. repens infection were observed in the cat. The animal was euthanised because of a lymphoma condition, and two adult females of D. repens were found in the subcutaneous tissue of the lumbar and left scapular regions at the post-mortem examination. The second cat showed severe abnormalities in the white blood cells, including eosinophil count. Microfilariae of D. immitis were detected in the blood smear, with an average length (n = 2) of 296.2 μm. These clinical cases represent the first reports of feline dirofilarioses in southern Italy and are indicative of a common occurrence of dirofilarial infection in the local canine population.

Purpose: ATTRACTION-2 trial assessed the role of Nivolumab as a new standard treatment for Asian patients with pretreated metastatic gastric cancer (mGC). The aim of this analysis was to evaluate the safety and efficacy of Nivolumab in a real-life Western population, considering the lack of evidence to date. Patients and Methods: Patients progressed after ≥2 chemotherapy regimens and able to receive Nivolumab (3 mg/kg q14) were eligible for the analysis. Results: 16 patients received Nivolumab as third (81.3%) or fourth line (18.7%) from September 2017 to July 2019. The safety was in line with the literature and only one patient discontinued treatment due to persistent hematological toxicity. Overall response rate and disease control rate were 18.7% and 31.2%, respectively. Median duration of response was 5 months. With a median follow-up of 21 months, median OS was 6 months (7, 21 and 22 months in the responders) and median PFS 3 months. PD-L1 and microsatellite status were retrospectively collected in 12 patients. All the major responders were MSI, although no statistically significant difference in OS or PFS was observed according to molecular analysis. Conclusion: Nivolumab is feasible and effective in Western patients with mGC. Further investigation is urgently needed also in non-Asians.

Human epidermal growth factor receptor 2 (HER2) is a transmembrane growth factor receptor with tyrosine kinase activity regulating cell growth and survival. HER2 amplification is responsible for protein overexpression with a negative impact on prognosis, but HER2-overexpressing patients could be treated with anti-HER2 therapy. In gastric cancer HER2 overexpression is observed in approximately 22% of patients, but prognostic significance in this context is not clear. In colon adenocarcinoma, HER2 gene amplification is reported in a wide range from 0% to 83%. The wide range of reported series could be essentially attributable to a difference in scoring systems for HER2 protein expression. The use of testing score, although measuring the same protein, is different from gastric cancer to colorectal cancer. Herein the different scoring models are reported.

Background and Purpose: Diabetic retinopathy, a secondary complication of diabetes mellitus, can lead to irreversible vision loss. Currently, no treatment is approved for early phases of diabetic retinopathy. Modifications of the expression pattern of miRNAs could be involved in the early retinal damage of diabetic subjects. Therefore, we aimed at identification of dysregulated miRNAs–mRNA interactions that might be biomarkers and pharmacological targets for diagnosis and treatment of early diabetic retinopathy. Methods: A focused set of miRNAs was predicted through a bioinformatic analysis accessing to Gene Expression Omnibus dataset and enrichment of information approach (GENEMANIA-Cytoscape). Identification of miRNAs–mRNA interactions was carried out with miRNET analysis. Diabetes was induced in C57BL6J mice by streptozotocin and samples analysed at 5 and 10weeks after diabetes induction. Retinal ultrastructure of diabetic mice was analysed through electron microscopy. We used Real-time PCR, western blot analysis, elisa, and immunohistochemistry to study expression of miRNAs and possible targets of dysregulated miRNAs. Key Results: We found that miR-20a-5p, miR-20a-3p, miR-20b, miR-106a-5p, miR-27a-5p, miR-27b-3p, miR-206-3p, and miR-381-3p were dysregulated in the retina and serum of diabetic mice. VEGF, brain-derived neurotrophic factor (BDNF), PPAR-α, and cAMP response element-binding protein 1 (CREB1) are targets of dysregulated miRNAs, which then modulated protein expression in diabetic retina. We found structural modifications in retinas from diabetic mice. Conclusions and Implications: Serum and retina of diabetic mice express eight dysregulated miRNAs, which modified the expression of VEGF, BDNF, PPAR-α, and CREB1, before vasculopathy in diabetic retinas.

A 23-month-old girl with poor growth and decreased appetite over the past year (figure 1) and increased thirst (including night-time) for the last month was admitted with dehydration and somnolence without vomiting/diarrhoea. She appeared to be miserable and in pain. Capillary refill time was about 2 s. A 1 cm liver edge was palpable. Ear discharge was not evident. Her blood pressure was 75/40 mm Hg and pulse was 115 beats/min. A ‘seborrheic’ dermatitis of the scalp and of the suprapubic region—persisting for 1 year despite topical steroids and antibiotics—was evident (figure 2A–C). On biochemical examinations sodium was 143 mmol/L, glucose 4.1 mmol/L, urea 5.7 mmol/L, total serum proteins 43 g/L, albumin 22 g/L, alanine aminotransferase 227 IU/L, aspartate aminotransferase 181 IU/L, γ-glutamyl transferase 397 IU/L, C-reactive protein 89.3 nmol/L, erythrocyte sedimentation rate 80 mm/hour and creatinine 31.8 µmol/L. Urinalysis was normal, as well as international normalised ratio, prothrombin time and partial thromboplastin time. The abdominal ultrasound revealed a splenic hypoechoic area of about 1 cm. The child’s liquid intake and diuresis …

Background and Aims: Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. Methods: All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. Results: Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were 150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3–93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80–150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). Conclusion: ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.

The demand of innovative solutions to afford healthy and safe lifestyle, for elderly people, are increasing lead by the growth of the ageing population and age-related diseases. Moreover, the availability of smart devices based on IoT technologies for personal environments has evolved the demand for tools to monitor and remotely control the home equipment. A new generation of remote control is available: Electronic Personal Assistants. These devices could be controlled using natural user interfaces, help user to simplify the interaction with home automation and other smart devices. The personal assistants use machine learning strategies to interact with the user. The solutions available in the market are often expensive and, moreover, are limited and legacy since based on proprietary hardware and software. This paper aims to present Alfred, a flexible and modular smart personal assistant based on low-cost hardware and open source machine learning software, in the context of the City4Age, an H2020 Project, to provide Elderly-friendly ambient assisted living.

Quantitative anti-Leishmania antibody titres are critical in the management of dogs with leishmaniosis, from diagnosis to treatment and follow-up, and there is a paucity of data relating changes in antibody titres to sand fly vector seasonality. This study aimed to evaluate seasonal variations in anti-Leishmania infantum antibody titres in dogs from a hyperendemic area for canine leishmaniosis (CanL). Leishmania infantum-seropositive and clinically healthy dogs (n=65) were sampled in June 2019 (sand fly season) and again in February-March 2020 (non-transmission season) to monitor clinical status and serological titres. There was a reduction in anti-L. infantum antibody titres during the non-transmission season in most dogs (n=36; 55.4%), and 44% of those dogs (n=16/36) became seronegative (i.e. below the cut-off value of 1:80). Given the relevance of serology to epidemiological, preventive and clinical studies related to CanL, seasonal variations in antibody titres are important in areas where phlebotomine vectors have seasonal patterns of activity. Sand fly seasonal period must be considered in the interpretation of annual anti-L. infantum antibody screening test results in asymptomatic dogs, to make clinical decisions about staging, treatment and prevention.