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Abstract Background Several GI peptides linked to intestinal barrier function could be involved in the modification of intestinal permeability and the onset of diarrhea during adjuvant chemotherapy. The aim of the study was to evaluate the circulating levels of zonulin, glucagon-like peptide-2 (GLP-2), epidermal growth factor (EGF) and ghrelin and their relationship with intestinal permeability and chemotherapy induced diarrhea (CTD). Methods Sixty breast cancer patients undergoing an FEC60 regimen were enrolled, 37 patients completed the study. CTD(+) patients were discriminated by appropriate questionnaire and criteria. During chemotherapy, intestinal permeability was assessed by lactulose/mannitol urinary test on day 0 and day 14. Zonulin, GLP-2, EGF and ghrelin circulating levels were evaluated by ELISA tests at five time-points (days 0, 3, 10, 14, and 21). Results During FEC60 administration, the lactulose/mannitol ratio was significantly higher on day 14 than at baseline. Zonulin levels were not affected by chemotherapy, whereas GLP-2 and EGF levels decreased significantly. GLP-2 levels on day 14 were significantly lower than those on day 0 and day 3, while EGF values were significantly lower on day 10 than at the baseline. In contrast, the total concentrations of ghrelin increased significantly at day 3 compared to days 0 and 21, respectively. Ten patients (27%) suffered from diarrhea. On day 14 of chemotherapy, a significant increase of the La/Ma ratio occurred in CTD(+) patients compared to CTD(−) patients. With regards to circulating gut peptides, the AUCg of GLP-2 and ghrelin were significantly lower and higher in CTD(+) patients than CTD(−) ones, respectively. Finally in CTD(+) patients a significant and inverse correlation between GLP-2 and La/Ma ratio was found on day 14. Conclusions Breast cancer patients undergoing FEC60 showed alterations in the intestinal permeability, which was associated with modifications in the levels of GLP-2, ghrelin and EGF. In CTD(+) patients, a different GI peptide profile and increased intestinal permeability was found in comparison to CTD(−) patients. This evidence deserves further studies for investigating the potentially different intestinal luminal and microbiota conditions. Trial registration Clinical trial NCT01382667

In recent years we are witnessing the increasingly widespread presence of creative works. As this happens, the situations in which work is increasingly less protected and increasingly poor and precarious increase. The concept of creativity applied to work and public policies therefore seems to bring into play social dynamics linked to the different distribution of power between social parties, between new forms of capital and work. Public policies on their part also promote forms of activation outside a broader dynamic of social emancipation. This type of intervention does not act on the reduction of inequalities and seems to benefit only the strongest. Reference will be made to a case study conducted in the Puglia region in 2016 to analyze the impact of creative policies on the autonomy and welfare paths of young Apulian adults. This typological sample gives the possibility to hypothesize a sociological inference on the rest of the Italian population. [ABSTRACT FROM AUTHOR]

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Purpose. The purpose of this paper is to draw a conceptual analytical framework to help understanding university guidance as a sociologically relevant issue and a matter of educational and active learning strategies, that needs to be redesigned through adequate policy interventions, so as to primarily promote the development of metacognitive skills and eventually positively impact the phenomenon of NEETS and graduates' employability. Design/methodology/approach. The paper analyses the current Italian policies on guidance, and presents a literature review accounting for those teaching experiences and practices already known as effective in terms of students' learning and empowerment, thus focusing on employability and project-based learning, active learning and learning patterns. Findings. The paper advances the proposal of an original, educational model of university guidance, arguing that effective guidance should shift from being extracurricular, as it currently is in Italian universities, to being embedded in curricula, thus becoming part of the learning process. Research limitations/implications. The research proposes an analytical framework and a policy proposal, inviting future empirical investigation. Originality/value. The paper contends that existing models of guidance represent an inadequate, incomplete and ineffective approach, due to the insufficient attention paid to a proper educational dimension, hence develops an original model of university guidance built on the already extant division into entry-progress-exit guidance, but substantially renewing each phase with different activities, meant to be compulsory curricular learning activities, and within an integrated organizational framework. Paper type. Conceptual paper. [ABSTRACT FROM AUTHOR]

Cetuximab improves efficacy when added to chemotherapy for metastatic colorectal cancer ( mCRC). Effective management of skin reactions from cetuximab improves quality of life (QoL), and treatment compliance in clinical trials. No data are available from real-world settings. The ObservEr observational, multicenter, prospective study evaluated QoL, the incidence of skin reactions, and management of chemotherapy plus cetuximab in first-line for mCRC. The primary endpoint was QoL measured with the Dermatology Life Quality Index ( DLQI) and EORTC QLQ-C30. Secondary endpoints were the incidence of skin and serious adverse events, median overall and progression-free survival, tumor response, and resection rates. Between May 2011 and November 2012, 228 patients with KRASwt mCRC were enrolled at 28 Italian centers, 225 evaluable, median age 65 years. QoL did not change during treatment and was not affected by the choice of prophylactic or reactive skin management. The incidence of cetuximab-specific grade ≥3 skin reactions was 14%, with no grade 4/5 events. Skin reactions correlated with survival ( P = 0.016), and their incidence was influenced by chemotherapy regimen (oxaliplatin vs. irinotecan-Incidence rate ratio [ IRR] 1.72, P < 0.0001) and gender (male vs. female- IRR 1.38, P = 0.0008). Compliance at first postbaseline evaluation was 97.75%. Median overall survival was 23.6 months, median progression-free survival 8.3 months. Cetuximab plus chemotherapy did not compromise QoL in the routine clinical setting when patients receive close monitoring plus prophylactic or reactive management of skin reactions. We observed the same correlation between overall survival ( OS) and skin reactions reported in controlled clinical trials, also in this setting. [ABSTRACT FROM AUTHOR]

This article discusses the importance of guidance within university education and proposes a good-practice model for helping students to transition from university to employment. The analysis arises from educational approach to guidance, that over the last few years is providing an alternative to mainly psycho-technical and diagnostic approach, and conceives guidance practice as a process that is cross-functional concerning students' educational path. The educational-guiding practice aims at raising the subject's metacognitive awareness in order to make him/her able to orient him/herself if autonomously. Hence, guidance turns into a choice education/education in choice. The individual, who has to orient him/herself, and the guidance are strictly connected on the one hand to the issue of the overall "growth" of the individual and on the other hand, to the issue of his/her lifelong learning. To the present day, the practices developed within universities, maybe due to an inconsistent national policy, are somehow inadequate or incomplete, mainly for three reasons: they are purely informational (on the working world, on the degree programs, on the professional opportunities); they mainly focus on diagnostic interventions (based on the linear relationship between aptitudes and interests); they are run by clinical specialists (unrelated to university and education). The model proposed in this article seeks to overcome such limitations by promoting practices aimed at: 1) making information preparatory for the whole educational path; 2) making didactics more sensitive to students' educational and learning needs. The relationship with the non academic world (namely, the manufacturing world) is essential to make students responsible for their educational choice. [ABSTRACT FROM AUTHOR]

Aim: The association of motilin, ghrelin, leptin, gastrin, pepsinogen (PG) I and II with cancer chemotherapy-associated dyspepsia syndrome (CADS) was investigated in 35 patients with breast cancer receiving first cycle of 5-fluorouracil, cyclophosphamide, epirubicin (FEC60) chemotherapy., Patients and Methods: The onset of dyspeptic symptoms on days 3 and 10 after chemotherapy identified patients with and without CADS. Gastrointestinal symptoms were scored with the Gastrointestinal Symptom Scoring Rate (GSRS) questionnaire. Gastrointestinal peptides were evaluated by enzyme-linked immunosorbent assay., Results: Twenty-one patients (60%) had CADS. The area under the curve (AUC) of ghrelin was higher, whereas that of PGI, PGII and motilin were lower in patients with CADS compared to those without. In patients with CADS, the AUC of PGI and PGII negatively correlated with the GSRS indigestion cluster., Conclusion: Impairment of gastrointestinal motility suggested by low motilin concentrations and mucosal damage mirrored by an increase of ghrelin seem to be involved in the onset of CADS in patients during chemotherapy for breast cancer.