COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time.Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables.A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36).Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.
Aim: Aim of this study was to analyse clinical correlates of HbA1c, and of overall, nocturnal, and severe hypoglycaemia, through direct‐weighted regressions, as well as the effect of different insulin regimens and insulin analogues, through meta‐analysis. Methods: Appropriate methodology (PRISMA statement) was used. Sixty‐seven randomized studies, published as full papers were analysed to identify predictors of both HbA1c and hypoglycaemia; studies were included in a meta‐analysis to study the effect of different insulin regimens or insulin analogues on HbA1c and hypoglycaemia during the first year of insulin treatment in type 2 diabetes patients. Results: Final HbA1c, change of HbA1c, hypoglycaemia, nocturnal hypoglycaemia and severe hypoglycaemia were associated with intensity of treatment. Final HbA1c was higher with basal than with twice‐a‐day or prandial, and with twice‐a‐day than with prandial regimen, with opposite figures for hypoglycaemia. Within basal regimens, detemir and glargine were similar to NPH insulin on HbA1c, with less hypoglycaemia and nocturnal hypoglycaemia; within prandial regimens, new analogues were more effective than regular insulin on HbA1c, and induced less hypoglycaemia. The effect of glargine on HbA1c and on hypoglycaemia vanished with increasing number of insulin injections. Conclusion: Metabolic control and hypoglycaemia are associated with intensity of treatment. Basal regimens have a reduced effect on metabolic control, but are associated with lower frequency of hypoglycaemia. Newer analogues, short‐ and long‐acting, yield better control and less hypoglycaemia than older analogues.
Introduction: Short bowel syndrome (SBS) is a rare disease characterized by inadequate nutrient absorption caused by severe reduction of the intestinal mucosal surface. The study immunologically characterized the bowel layers’ lymphocyte T infiltrate and evidenced its alterations through a qualitative analysis. Methods: Pediatric SBS patients who underwent bowel surgery between July 2018 and March 2019 were enrolled. Full thickness small bowel samples were taken and processed. The tissue was dissected and the tissue-infiltrating T lymphocytes (TILs) were isolated, cloned and expanded. The phenotypic characterization was performed using flow cytometry and anti-CD4 and CD8. The clones were stimulated and phenotypically characterized through ELISA test, evaluating the production of IFN-γ, IL-4, IL-17, IL-10. Student’s t-test was used for statistical analysis and statistical significance was considered as p<0,05. Results: Twelve patients were enrolled, with a median age of 3 years and 9 months (range: 2 months - 18 years and 5 months) and a median length of the small intestine of 40 cm (range: 19 cm - 67 cm). All patients were parenteral nutrition dependent, 92% received also enteral nutrition and 58% received intestinal decontamination. The intestinal samples of ten of these patients were analyzed and TILs were isolated in 60% of cases. 49 T cell clones were obtained and the phenotypic characterization was made: 30 T helper lymphocytes (61.2%), 17 T cytotoxic (34.7%), 1 T double-positive CD4+CD8+ (2%), 1 T CD4-CD8- defined γδ (2%). We proceeded with the functional characterization: T helper lymphocytes are divided intoTh1 clones (20, 80.0%), T reg (1, 3.3%), Tnull (5, 16.7%), no Th2 clone, no Th0, no Th17. Cytotoxic T lymphocytes are classified into: Tc1 clones (12, 70.6%); Tcnull (5, 29.4%); no Tcreg clone, no Tc2, no Tc0, no Tc17. The correlation between the number of isolated T cell clones and the lack of intestinal decontamination therapy was not statistically significant (p-value=0,27). Conclusion: We hypothesize that the alteration of the immune balance of SBS patients, especially the acquisition of pro-inflammatory characteristics, is caused by the dependence on parenteral nutrition and the deprivation of enteral nutrition or by the intestinal dysbiosis.
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