Early focal electroencephalogram and neuroimaging findings predict epilepsy development after aneurysmal subarachnoid hemorrhage

INTRODUCTION

Seizures are a common complication of subarachnoid hemorrhage (SAH) in both acute and late stages: 10-20 % acute symptomatic seizures, 12-25 % epilepsy rate at five years. Our aim was to identify early electroencephalogram (EEG) and computed tomography (CT) findings that could predict long-term epilepsy after SAH.

MATERIAL AND METHODS

This is a multicenter, retrospective, longitudinal study of adult patients with aneurysmal SAH admitted to two tertiary care hospitals between January 2011 to December 2022. Routine 30-minute EEG recording was performed in all subjects during admission period. Exclusion criteria were the presence of prior structural brain lesions and/or known epilepsy. We documented the presence of SAH-related cortical involvement in brain CT and focal electrographic abnormalities (epileptiform and non-epileptiform). Post-SAH epilepsy was defined as the occurrence of remote unprovoked seizures ≥ 7 days from the bleeding.

RESULTS

We included 278 patients with a median follow-up of 2.4 years. The mean age was 57 (+/-12) years, 188 (68 %) were female and 49 (17.6 %) developed epilepsy with a median latency of 174 days (IQR 49-479). Cortical brain lesions were present in 189 (68 %) and focal EEG abnormalities were detected in 158 patients (39 epileptiform discharges, 119 non-epileptiform abnormalities). The median delay to the first EEG recording was 6 days (IQR 2-12). Multiple Cox regression analysis showed higher risk of long-term epilepsy in those patients with CT cortical involvement (HR 2.6 [1.3-5.2], p 0.009), EEG focal non-epileptiform abnormalities (HR 3.7 [1.6-8.2], p 0.002) and epileptiform discharges (HR 6.7 [2.8-15.8], p < 0.001). Concomitant use of anesthetics and/or antiseizure medication during EEG recording had no influence over its predictive capacity. ROC-curve analysis of the model showed good predictive capability at 5 years (AUC 0.80, 95 %CI 0.74-0.87).

CONCLUSIONS

Focal electrographic abnormalities (both epileptiform and non-epileptiform abnormalities) and cortical involvement in neuroimaging predict the development of long-term epilepsy. In-patient EEG and CT findings could allow an early risk stratification and facilitate a personalized follow-up and management of SAH patients.

HPLC-MS/MS Phenolic Characterization of Olive Pomace Extracts Obtained Using an Innovative Mechanical Approach

Olive pomace results from the production of olive oil. Even if olive pomace represents a potential environmental problem, it contains phenolic compounds, which are widely recognized for their beneficial properties for human health. In this study, an innovative and sustainable technological approach to extract phenolic compounds from fresh olive pomace, based on food-grade solvent instead of those usually adopted, is investigated. Characterization and shelf-life evaluation of the hydroalcoholic extracts obtained from the procedure developed for different industrial purposes were also carried out. The phenolic fractions of the different samples were studied with the Folin-Ciocâlteu method to quantify that the total reducing molecules and HPLC-MS/MS analysis was used to define the profile through the identification and quantification of 42 compounds, belonging to five chemical families. Regarding shelf-life, the hydroalcoholic extract showed no significant reduction in phenolic content, for both instrumental evaluations, retaining most of the phenolic compounds present in the raw material; negative attributes were not perceived by sensory evaluation. Thus, these lab-scale results can be the starting point to develop a procedure that is suitable for a real olive mill, representing a valorization strategy in a circular economy and the perspective of new business models.

Future Perspective and Technological Innovation in Cheese Making Using Artichoke (Cynara scolymus) as Vegetable Rennet: A Review

Milk coagulation is a process used for the formulation of different dairy products such as cheese. In this process, milk undergoes changes in its chemical stability thanks to acidification or enzymatic reactions. Traditionally, milk coagulation has been carried out with rennet of animal origin, but recently, the research of new types of rennet such as microbial rennet and vegetable rennet has increased. This study aims to present an organized review of the most relevant information on lactic coagulation, its relationship with vegetable rennets, and the importance of the botanical genus Cynara in the extraction of vegetable rennets, focusing on the coagulant potential of artichoke (Cynara scolymus). We conducted this literature review and found that lactic coagulation and vegetable rennets are linked through the enzymatic activity of the latter. The results of the main studies demonstrated a strong relationship between vegetable rennets and protease enzymes as well as the presence of these enzymes in extracts of cardoon (Cynara scolymus) and artichoke (Cynara scolymus). In addition, studies highlight the presence of thistle extracts in artisanal cheese preparations in the Iberian Peninsula. Based on the results of the studies, a comparison between cheeses made with vegetable rennet and those made with traditional rennet was also carried out. Although the results show that the use of vegetable rennet in the manufacture of cheese can confer undesirable characteristics, the use of extracts from Cynara plants demonstrates that vegetable rennets have an industrial potential, especially the one obtained from artichoke (Cynara scolymus) due to its high availability. Nevertheless, specific studies are required for a better understanding and application of this rennet.

Lipid Process Markers of Durum Wheat Debranning Fractions

At present, whole grains are usually obtained by adding bran and middlings to refined flours, and this recombination leads to certain variations in the ratio of endosperm, bran and germ, resulting in flours with very different compositional characteristics and rheological properties. Therefore, this study focuses on the identification of specific lipid markers in different debranning fractions of Italian and Canadian durum wheat blends. The by-products obtained from five different debranning levels (3, 6, 9, 12 and 15%) had a high content of monounsaturated fatty acids and a higher concentration of tocopherols and sterols than the corresponding debranned grains. The Italian and Canadian durum wheat samples did not show significant differences in the content of these bioactive lipid compounds. In particular, palmitic acid, oleic acid, tocopherol isomers and total sterols could be useful biomarkers for evaluating the grain-to-tissue ratio in recombined flours.

When Cannabis sativa L. Turns Purple: Biosynthesis and Accumulation of Anthocyanins

Environmental cues elicit anthocyanin synthesis in plant vegetative and reproductive tissues. Their accumulation in different organs accounts for their diverse biological functions, mainly related to their antioxidant properties, and it depends on a temporally and spatially regulated mechanism controlled by the action of a well-known multi-transcription factor complex. Despite the highly recognizable value of Cannabis sativa L. as a natural biorefinery of phytochemicals, very little information is known on anthocyanin pigmentation in this species. In this work, a targeted quantification of anthocyanins via HPLC-MS/MS, combined with the transcriptional profile via RT-qPCR of genes encoding for structural and decorating enzymes and regulatory transcription factors in different C. sativa tissues, help gain insights into the anthocyanin pathway in this species. To the best of our knowledge, this is the first report on the identification of cyanidin-3-rutinoside (keracyanin) as the major anthocyanin in C. sativa vegetative and floral tissues. Keracyanin amounts were higher than in small berries, suggesting that Cannabis biomass is a valuable source of colored antioxidants to be exploited in diverse applications. Furthermore, a gene putatively encoding for an anthocyanin DTX35 type transporter and CsTTG1 were identified in silico and their transcriptional levels were assessed via RT-qPCR. The results allow us to provide the first model of anthocyanin regulation in C. sativa, opening a new research scenario in this species for both breeding purposes and phytochemical exploitation.

Effect of Sprouting on Biomolecular and Antioxidant Features of Common Buckwheat (Fagopyrum esculentum)

Buckwheat is a pseudo-cereal widely grown and consumed throughout the world. Buckwheat is recognized as a good source of nutrients and, in combination with other health-promoting components, is receiving increasing attention as a potential functional food. Despite the high nutritional value of buckwheat, a variety of anti-nutritional features makes it difficult to exploit its full potential. In this framework, sprouting (or germination) may represent a process capable of improving the macromolecular profile, including reducing anti-nutritional factors and/or synthesizing or releasing bioactives. This study addressed changes in the biomolecular profile and composition of buckwheat that was sprouted for 48 and 72 h. Sprouting increased the content of peptides and free-phenolic compounds and the antioxidant activity, caused a marked decline in the concentration of several anti-nutritional components, and affected the metabolomic profile with an overall improvement in the nutritional characteristics. These results further confirm sprouting as a process suitable for improving the compositional traits of cereals and pseudo-cereals, and are further steps towards the exploitation of sprouted buckwheat as a high-quality ingredient in innovative products of industrial interest.

Co-milling process of olives and oleaginous matrices with high nutritional value: a preliminary characterisation of the obtained oils

Extra virgin olive oil (EVOO), grape seeds (GS) and pomegranate seeds (PS) are very popular for human consumption because of their nutraceutical properties. A co-milling of olives with GS or PS was carried out with the aim of a preliminary study of the lipidic and phenolic characteristics of the obtained vegetable oils, also during their shelf life. Results show that the use of GS and PS in the olive co-milling enriches the oil in healthy compounds, such as punicic acid and γ-tocopherol. However, the co-milling process must be re-evaluated, since the compositional profile of the co-milled oils is just slightly different from EVOO. The oxidative state of the oils obtained suggests the use of a protective packaging combined with small containers in order to ensure a rapid consumption. With an appropriate formulation the co-milled oils could bring health-positive compounds and, simultaneously, raw materials could be valorised.

Antioxidant and Antimicrobial Activity of Hydroethanolic Leaf Extracts from Six Mediterranean Olive Cultivars

Phenolic profiles, antioxidant, and antimicrobial activities of hydroethanolic olive leaf extracts from six Mediterranean olive cultivars (Croatian: Lastovka, Levantinka, Oblica; Italian: Moraiolo, Frantoio, Nostrana di Brisighella) were investigated. As expected, various distributions of phenolic levels were observed for each cultivar and the total phenolic content showed high variability (ranging from 4 to 22 mg GAE/g of dry extract), with the highest amount of phenolics found in the Oblica sample, which also provided the highest antiradical (ORAC) and reducing activity (FRAP). The screening of individual compounds was performed by HPLC-PDA-ESI-QTOF-MS and the main detected compounds were oleuropein, hydroxytyrosol, oleoside/secologanoside, verbascoside, rutin, luteolin glucoside, hydroxyoleuropein, and ligstroside. While the antioxidant activity of the samples was relatively high, they showed no bactericidal and bacteriostatic activity against E. coli and S. Typhimurium; weak activity against Staphylococcus aureus, Bacillus cereus, and Listeria innocua; and inhibitory effects against Campylobacter jejuni at 0.5 mg dry extract/mL. The obtained results support the fact that olive leaf extracts, and especially those from the Oblica cultivar, could potentially be applied in various industries as natural preservatives and effective and inexpensive sources of valuable antioxidants.

Influence of different baking powders on physico-chemical, sensory and volatile compounds in biscuits and their impact on textural modifications during soaking

The aim of this study was to investigate the effects of different type of leavening agents (ammonium bicarbonate-A, cream of tartar-B, grape-based leavening agent-C, baking powder-D) on the structural (also after soaking), physico-chemical and other quality characteristics of biscuits made with the same formulation. The major changes observed between samples were related to their textural properties, volatile profile and sensory characteristics. The presence of ammonium bicarbonate in sample A, gave arise to a biscuit with the most homogeneous surface appearance, the less hard structure and highest fracturability and spread, that promoted their greater milk uptake during soaking. The B and C biscuits, made with baking powder having tartaric acid, were characterized by a crisper texture and lower sensory overall acceptability. The presence in formulation of baking powders made with cream of tartar (B) and ammonium bicarbonate (A) mostly influenced the biscuit volatile profiles. Biscuit sample obtained with the most common baking powder (diphosphates powder) showed in general intermediate characteristics between A and B-C samples. Results obtained in this study demonstrate that a lot of final properties of biscuits can be strongly influenced by the type of leavening agents used in formulation.

Olive oil by-product as functional ingredient in bakery products. Influence of processing and evaluation of biological effects

Nowadays, the strong demand for adequate nutrition is accompanied by concern about environmental pollution and there is a considerable emphasis on the recovery and recycling of food by-products and wastes. In this study, we focused on the exploitation of olive pomace as functional ingredient in biscuits and bread. Standard and enriched bakery products were made using different flours and fermentation protocols. After characterization, they were in vitro digested and used for supplementation of intestinal cells (Caco-2), which underwent exogenous inflammation. The enrichment caused a significant increase in the phenolic content in all products, particularly in the sourdough fermented ones. Sourdough fermentation also increased tocol concentration. The increased concentration of bioactive molecules did not reflect the anti-inflammatory effect, which was modulated by the baking procedure. Conventionally fermented bread enriched with 4% pomace and sourdough fermented, not-enriched bread had the greatest anti-inflammatory effect, significantly reducing IL-8 secretion in Caco-2 cells. The cell metabolome was modified only after supplementation with sourdough fermented bread enriched with 4% pomace, probably due to the high concentration of tocopherol that acted synergistically with polyphenols. Our data highlight that changes in chemical composition cannot predict changes in functionality. It is conceivable that matrices (including enrichment) and processing differently modulated bioactive bioaccessibility, and consequently functionality.

Distribution of Free and Bound Phenolic Compounds in Buckwheat Milling Fractions

Buckwheat is a rich source of phenolic compounds that have shown to possess beneficial effect to reduce some diseases due to their antioxidant power. Phenolic compounds are present in the free and in the bound form to the cell wall that are concentrated mainly in the outer layer (hull and bran). Hull is removed before the milling of buckwheat to obtain flours. In order to evaluate the phenolic composition in dehulled buckwheat milling fractions, it was carried out a determination of free and bound phenolic compounds in dehulled whole buckwheat flour, light flour, bran flour, and middling flour by high-performance liquid chromatography-mass spectrometry (HPLC–MS). The most abundant free phenolic compounds were rutin and epiafzelchin–epicatechin-O-dimethylgallate, whereas the most abundant bound phenolic compounds were catechin and epicatechin in all buckwheat flours. Besides, the highest content of free phenolic compounds was obtained in bran flour (1249.49 mg/kg d.w.), whereas the greatest bound phenolic content was in middling (704.47 mg/kg d.w.) and bran flours (689.81 mg/kg d.w.). Thus, middling and bran flours are naturally enriched flours in phenolic compounds that could be used to develop functional foods.

Use of Sieving As a Valuable Technology to Produce Enriched Buckwheat Flours: A Preliminary Study

Fractionation processes based on physical separation are a good strategy to produce enriched cereal flours. Therefore, the aim of this work is to evaluate the suitability of sieving of buckwheat flours to produce protein and phenolic (especially rutin) enriched fractions. Because of that, dehulled whole buckwheat flour (GSTQ) was sieved obtaining fractions with a particle size of 215 µm, 160 µm, 85 µm, and 45 µm (GS215, GS160, GS85, and GS45). For that purpose, the determination of protein, ash, and total starch content and free and bound phenolic compounds was carried out. The highest content of total phenolic compounds was obtained in GS215 (3118.84 mg Kg-1 d.w.), followed by GS160 (2499.11 mg Kg-1 d.w.), GS85 (989.46 mg Kg-1 d.w.), GSTQ (983.15 mg Kg-1 d.w.), and GS45 (481.31 mg Kg-1 d.w.). Therefore, the phenolic content decreased with the particle size decrease from 215 µm to 45 µm. Besides, there were no significant differences between the total phenolic content in GS85 and GSTQ. The fraction with 215 µm reported the highest protein and mineral salt content and presented rutin amounts four times higher than GSTQ.

Optimization of Sonotrode Ultrasonic-Assisted Extraction of Proanthocyanidins from Brewers' Spent Grains

Brewing spent grains (BSGs) are the main by-product from breweries and they are rich of proanthocyanidins, among other phenolic compounds. However, literature on these compounds in BSGs is scarce. Thus, this research focuses on the establishment of ultrasound-assisted extraction of proanthocyanidin compounds in brewing spent grains using a sonotrode. To set the sonotrode extraction up, response surface methodology (RSM) was used to study the effects of three factors, namely, solvent composition, time of extraction, and ultrasound power. Qualitative and quantitative analyses of proanthocyanidin compounds were performed using HPLC coupled to fluorometric and mass spectrometer detectors. The highest content of proanthocyanidins was obtained using 80/20 acetone/water (v/v), 55 min, and 400 W. The established method allows the extraction of 1.01 mg/g dry weight (d.w.) of pronthocyanidins from BSGs; this value is more than two times higher than conventional extraction.

(Ultra) High Pressure Homogenization Potential on the Shelf-Life and Functionality of Kiwifruit Juice

The increasing competition within the food industry sector makes the requisite of innovation in processes and products essential, leading to focus the interest on the application of new processing technologies including high pressure homogenization (HPH) and ultra high pressure homogenization (UHPH). In this context, the present research aimed at evaluating the effects of two UHPH treatments performed at 200 MPa for 2 and 3 cycles on quality and functionality of organic kiwifruit juice stored at three different temperatures, i.e., 5, 15, and 25°C. The results showed that only the treatment performed at 200 MPa for 3 cycles was able to significantly increase the shelf-life of organic kiwifruit juices when stored at refrigeration temperature, avoiding also phase separation that occurred in the sample treated at 0.1 MPa (control) after 20 days of refrigerated storage. The obtained data showed also that the highest applied pressure was able to increase some quality parameters of the juice such as viscosity and luminosity (L^∗) and increased the availability of total phenol content consequently enhancing the juice total antioxidant activity. The application of a treatment at 200 MPa for 3 cycles allowed to obtain a stable kiwifruit juice for more than 40 days under refrigerated storage. A challenge to implement this technology in food process as full alternative to thermal treatment could be represented by the adoption of pressure level up to 400 MPa followed by the packaging in aseptic conditions.

Effect of Fermentation with Different Lactic Acid Bacteria Starter Cultures on Biogenic Amine Content and Ripening Patterns in Dry Fermented Sausages

In the present study, two different diameter (small and large) Milano-type dry fermented sausages were industrially produced to evaluate the effect of two different LAB starter cultures (Lactobacillus sakei and Pediococcus pentosaceus) on biogenic amines (BAs) content, proteolysis, and lipolysis taking place during both fermentation and ripening. With regard to BAs, putrescine and tyramine were mostly found in fermented sausages having large diameter and those inoculated with P. pentosaceus/S. xylosus exhibited significantly higher accumulation of these compounds. Overall, the small size sausages showed a more pronounced proteolysis taking place during processing. In addition, aside from the distinctive electrophoretic bands detected with both starter cultures, a more pronounced proteolysis and a faster protein hydrolysis was observed in salami inoculated with P. pentosaceus/S. xylosus. As for lipolysis, a significantly higher amount of diacylglycerols was observed at the end of ripening in the sausages inoculated with L. sakei/S. xylosus, which concurrently exhibited an increased D32, D34, and D36 series. The results of the present study confirms profound differences in BAs concentration, proteolysis, and lipolysis. These findings are strictly dependent on the starter cultures, which demonstrates that the choice of an appropriate starter optimized for peculiar products and processes should be the key factor to improve safety and quality features of traditional fermented sausages.

Fermented Nut-Based Vegan Food: Characterization of a Home made Product and Scale-Up to an Industrial Pilot-Scale Production

Because of the impossibility to consume food of animal origin, vegan consumers are looking for substitutes that could enrich their diet. Among many substitutes, fermented nut products are made from different nut types and obtained after soaking, grinding, and fermentation. Although other fermented vegetable products have been deeply investigated, there are few data about the fermentative processes of nut-based products and the microbial consortia able to colonize these products are not yet studied. This study characterized a hand-made vegan product obtained from cashew nut. Lactic acid bacteria responsible for fermentation were identified, revealing a succession of hetero- and homo-fermentative species during process. Successively, some lactic acid bacteria isolates from the home-made vegan product were used for a pilot-scale fermentation. The products obtained were characterized and showed features similar to the home-made one, although the microbiological hazards have been prevented through proper and rapid acidification, enhancing their safety features.

PRACTICAL APPLICATION

Spontaneous fermented products are valuable sources of microorganisms that can be used in many food processes as starter cultures. The lactic acid bacteria isolated in this research can be exploited by industries to develop new foods and therefore to enter new markets. The use of selected starter cultures guarantees good organoleptic characteristics and food safety (no growth of pathogens).

Chemical composition and antioxidant activity of the volatile fraction extracted from air-dried fruits of Tunisian Eryngium maritimum L. ecotypes

BACKGROUND

Eryngium maritimum L., also known as 'sea holly', is a typical dune plant species belonging to the Apiaceae family and commonly used in Tunisia for therapeutic purposes in folk medicine. In the present study, the chemical composition and antioxidant activity of the volatile fraction extracted from air-dried fruits of five Tunisian E. maritimum ecotypes were determined.

RESULTS

The total volatile amount ranged from 0.31% to 0.93% (w d.w.^-1 ). Sixty-six volatile components were identified by means of GC-MS and accounted for 77.05-86.65% of the total extracted volatile oil. The majority of the identified metabolites were hydrocarbon sesquiterpenes and oxygenated sesquiterpenes, amounting on average to 46.69% and 30.01% of total volatiles, respectively. The principal individual components were germacrene D (13.62-31.71%), 15-hydroxy-α-muurolene (12.04-18.58%), and germacrene B (6.77-15.04%). Significant differences were noticed among E. maritimum populations. The volatile profile of E. maritimum fruits was consistently different from those of the aerial parts and roots of plants of the same species reported in previous investigations. Average radical scavenging capacity of the volatile fraction, as determined by DPPH and ABTS tests, was twice higher than that of the Trolox control.

CONCLUSION

This study characterised for the first time the fruits of E. maritimum for the composition and radical-scavenging capacity of their volatile fraction. The growth location confirmed as a pivotal factor in influencing the volatile profile of the fruits. © 2017 Society of Chemical Industry.

Monitoring of compositional changes during berry ripening in grape seed extracts of cv. Sangiovese (Vitis vinifera L.)

BACKGROUND

Seed oil and flours have been attracting the interest of researchers and industry, since they contain various bioactive components. We monitored the effects of ripening on lipids, monomeric flavan-3-ols, proanthocyanidins and tocols concentration in seed extracts from organically cultivated cv. Sangiovese vines.

RESULTS

Linoleic acid was the most abundant fatty acid, followed by oleic, palmitic and stearic acids. The tocols detected were α-tocopherol, α-tocotrienol and γ-tocotrienol. The proanthocyanidins degree of polymerisation ranged from dimers to dodecamers; moreover, monomeric flavan-3-ols and polymeric proanthocyanidins were detected. Total flavan-3-ols (monomers, oligomers and polymers) concentration in grape seeds decreased during ripening.

CONCLUSIONS

Fatty acids reached the highest level in post-veraison. The concentration of these compounds varied considerably during ripening. Capric acid has been found for the first time in grape seeds. α-Tocopherol and γ-tocotrienol decreased during ripening, while α-tocotrienol increased. The HPLC analysis with fluorimetric detection, conducted for the first time on cv. Sangiovese, revealed that the concentration of flavan-3-ols monomers, oligomeric proanthocyanidins and polymers greatly changed during ripening. These results suggest that the timing of bunch harvest plays a crucial role in the valorisation of grape seed flour. © 2016 Society of Chemical Industry.

Predictive genetic markers in neoadjuvant chemoradiotherapy for locally advanced esophageal cancer: a long way to go. Review of the literature

The role of genetic molecular markers in neoadjuvant treatment for locally advanced esophageal cancer has been reviewed, focusing strictly on concurrent chemoradiation protocols followed by surgery. Eleven studies evaluated the role of mRNA expression profile; the end point was overall survival (OS) in two studies and different definitions of histological response in nine. Genes reported as significant were involved in cell cycle control (30), apoptosis (7), structural molecules (9), cell metabolism (6) and DNA repair (1). Seven studies reported about 15 microRNA (miRNA) molecules associated with OS (2) or histological response (13), however, defined with different classifications. Their target genes were prevalently involved in cell cycle control (4), apoptosis (1), cell adhesion (1), migration (1) and angiogenesis (1). Gene polymorphisms (single-nucleotide polymorphisms (SNPs)) have been evaluated in 8 studies reporting 10 variants associated with survival or pathological response. OS was the end point in six of these studies. SNPs reported as significant were involved in DNA repair system (4), detoxification (2), folate metabolism (6), drug efflux (2) and others (2). In a study, a panel including histology, pathological response and five SNPs discriminated two subsets of patients with 5-year survival rates of 79.3% and 26.3% (hazard ratio 6.25, P<0.0001). In another study, combination of stage, grade and 4 miRNAs improved prediction of pathological response (P=10^-30). At present, given the great inconsistency of the data and the variability of the end points, definite conclusions are extremely difficult, if not impossible. More consistent data can derive only from analyses obtained from patients included in prospective randomized trials while panels combining genetic and clinical factors may improve prediction.

Psidium guajava L. leaves as source of proanthocyanidins: Optimization of the extraction method by RSM and study of the degree of polymerization by NP-HPLC-FLD-ESI-MS

Due to the importance of the proanthocyanidins (PAs) bioactivity and its relationship with the PAs degree of polymerization (DP), an experimental design was carried out to establish the best extraction conditions in order to evaluate the proanthocyanidins content and their degree of polymerization in Psidium guajava leaves at different oxidation state. Optimal conditions achieved by response surface methodology were 50% acetone/water (v/v), 48°C, 30min, and 0% acetic acid (v/v). The highest DP has been found in the low oxidized state (DP 13 plus the polymers). Medium and high oxidized state leaves reported a DP 11 plus the polymers. The total amounts of proanthocyanidins (sum of PAs by HPLC-FLD-ESI-MS) decreased when oxidation state of leaves increased (15.8±0.4, 12.6±0.4, and 10.5±0.3mg/g leaf dry weight (d.w.) in low, medium and high oxidized state leaves, respectively). Guava leaves present an interesting source of low DP-PAs.

Phase III trial comparing 3-6 months of adjuvant FOLFOX4/XELOX in stage II-III colon cancer: safety and compliance in the TOSCA trial

BACKGROUND

Six months of oxaliplatin-based adjuvant chemotherapy is standard of care for radically resected stage III colon cancer and an accepted option for high-risk stage II. A shorter duration of therapy, if equally efficacious, would be advantageous for patients and Health-Care Systems.

PATIENTS AND METHODS

TOSCA ['Randomized trial investigating the role of FOLFOX-4 or XELOX (3 versus 6 months) regimen duration and bevacizumab as adjuvant therapy for patients with stage II/III colon cancer] is an open-label, phase III, multicenter, noninferiority trial randomizing patients with high-risk stage II or stage III radically resected colon cancer to receive 3 months (arm 3 m) versus 6 months (arm 6 m) of FOLFOX4/XELOX. Primary end-point was relapse-free survival. We present here safety and compliance data.

RESULTS

From June 2007 to March 2013, 3759 patients were accrued from 130 Italian sites, 64% receiving FOLFOX4 and 36% XELOX in either arm. Treatment completion rate without any modification was 35% versus 12% and with delays or dose reduction 52% versus 44% in arm 3 and 6 m. Treatment was permanently discontinued in 8% (arm 3 m) and 33% (arm 6 m). In arm 6 m, 50% of patients discontinuing treatment did so after completing 80% of planned program. Grade 3+ toxicities were higher in arm 6 m than that in 3 m. Grade 2+ neuropathy was 31.2% versus 8.8% (P < 0.0001) while grade 3+ was 8.4 versus 1.3 (P < 0.0001), in arm 3 and 6 m. Seven deaths within 30 days from last treatment administration in arm 6 m and three deaths in arm 3 m were observed (0.3% versus 0.1%, P = 0.34).

CONCLUSIONS

TOSCA is the first trial comparing 3 versus 6 months of adjuvant chemotherapy completing accrual within the international initiative of treatment duration evaluation (International Duration Evaluation of Adjuvant, IDEA). High compliance to treatment in control arm will allow a correct assessment of potential differences between the two treatment durations.

CLINICALTRIALSGOV REGISTRATION NUMBER

NCT00646607.

Genetic prediction of long-term survival after neoadjuvant chemoradiation in locally advanced esophageal cancer

Candidate genes involved in DNA repair, 5-fluorouracil metabolism and drug detoxification were genotyped in 124 patients receiving neoadjuvant chemoradiation treatment for locally advanced esophageal cancer and their predictive role for long-term relapse-free survival (RFS) and cancer-specific survival (CSS) were evaluated. A panel including MTHFR 677TT, MDR1 2677GT, GSTP1 114CC, XPC 499CC and XPC 939AC+CC, defined as high-risk genotypes, discriminated subgroups with significantly different outcomes. When the panel was combined with histology, patients split into two subsets with 5-year RFS and CSS rates of 65% vs 27% (hazard ratio (HR) 3.0, P<0.0001) and 69% vs 31% (HR 2.9, P<0.0001), respectively. Combining the 5-single-nucleotide polymorphism (5-SNP) panel with pathological response defined two major informative risk classes with 5-year PFS and CSS rates of 79.4% vs 17.7% (HR 6.71, P<0.0001) and 79.3% vs 26.3% (HR 6.25, P<0.0001), respectively. This classification achieved a sensitivity of 79%, a specificity of 85.4% and an accuracy of 81.8%.

Predictive markers in elderly patients with estrogen receptor-positive breast cancer treated with aromatase inhibitors: an array-based pharmacogenetic study

So far, no reliable predictive clinicopathological markers of response to aromatase inhibitors (AIs) have been identified, and little is known regarding the role played by host genetics. To identify constitutive predictive markers, an array-based association study was performed in a cohort of 55 elderly hormone-dependent breast cancer (BC) patients treated with third-generation AIs. The array used in this study interrogates variants in 225 drug metabolism and disposition genes with documented functional significance. Six variants emerged as associated with response to AIs: three located in ABCG1, UGT2A1, SLCO3A1 with a good response, two in SLCO3A1 and one in ABCC4 with a poor response. Variants in the AI target CYP19A1 resulted associated with a favourable response only as haplotype; haplotypes with increased response association were also detected for ABCG1 and SLCO3A1. These results highlight the relevance of host genetics in the response to AIs and represent a first step toward precision medicine for elderly BC patients.

[Intramyocardial bridges: anatomo-pathological characteristics, diagnosis, and therapeutic strategies]

Intramyocardial bridge is defined as the segment of a major epicardial coronary artery that runs within the cardiac muscle wall (coronary tunneling). Usually, this kind of anatomic variant is asymptomatic but sometimes it may lead to acute coronary syndrome and/or arrhythmias, and more rarely to sudden cardiac death. Treatment for symptomatic patients is pharmacological, using beta-blockers.

Analysis of oligomer proanthocyanidins in different barley genotypes using high-performance liquid chromatography-fluorescence detection-mass spectrometry and near-infrared methodologies

Proanthocyanidins are a class of polyphenols present in many foodstuffs (i.e., tea, cocoa, berries, etc.) that may reduce the risk of several chronic diseases. Barley, with sorghum, rice, and wheat, are the only cereals that contain these compounds. Because of that, two barley genotypes, named waxy and non-waxy, were analyzed by normal-phase high-performance liquid chromatography-fluorescence detection-mass spectrometry (NP-HPLC-FLD-MS). Total proanthocyanidin content ranged between 293.2 and 652.6 μg/g of flour. Waxy samples reported the highest content (p < 0.05) of proanthocyanidins. Dimer compounds were the principal proanthocyanidin constituents of barley samples. Moreover, the possibility to use near-infrared (NIR) spectroscopy as a rapid method to discriminate between waxy and non-waxy samples and to predict quantitatively proanthocyanidins in barley samples was evaluated. Partial least squares (PLS) models were built to predict the proanthocyanidin constituent, obtaining determination coefficients (R(2)) ranging from 0.92 to 0.97, in test set validation. Because of that, this study highlights that NIR spectroscopy technology with multivariate calibration analysis could be successfully applied as a rapid method to determine proanthocyanidin content in barley.

Buckwheat honeys: screening of composition and properties

The quality of 10 buckwheat honeys, collected from Italian and est European beekeepers declaring to produce monofloral honey, were evaluated by means of their pollen, physicochemical, phenolic and volatile composition data. The results of the traditional analyses and in particular electrical conductivity, optical rotation, pH and sugar composition revealed some poorly pure samples that could not fit in the buckwheat tipology. Honey volatiles, analysed by solid phase microextraction (SPME) and gas chromatography-mass-spectrometry (GC/MS), showed more than 100 volatile compounds, most of them present in all honey samples but with quantitative variation. Besides many furfural derivates, 3-methylbutanoic acid was the main volatile compound found in most of honeys. Also the presence of 2- and 3-methylbutanal and pheynalcetaldehyde confirmed the typical buckwheat aroma of some studied samples, corroborating physicochemical data. The HPLC phenolic profile was similar across the samples and p-hydroxybenzoic and p-coumaric acids proved to be the main components.

Traditional foods for health: screening of the antioxidant capacity and phenolic content of selected Black Sea area local foods

BACKGROUND

The nutritional characteristics of the Black Sea area (BSA) traditional foods are almost unknown, and they could be interesting sources of antioxidant compounds. In this study, carried out within the BaSeFood project, the in vitro total antioxidant capacity (TAC) and phenolic content of 39 BSA traditional foods were determined using different assays.

RESULTS

An ample range of TAC and phenolics content was detected in the examined foods that were ranked according to their scavenging activity expressed per weight unit and per serving size. Based on serving size, the highest TAC was in the order blueberries > nettle soup > sunflower seeds, and the fruits/fruit-based foods group was the one having the highest activity. Correlation analysis evidenced that the TAC is highly dependent on total phenolic content, while hydroxycinnamic acids and compounds having o-diphenolic structure did not show specific prominent effects. Finally, correlations between the two methods used for measuring the TAC suggest that they are both suitable in a wide range of foods.

CONCLUSION

Our data represent the first contribution to further research on the health effects of BSA traditional foods. This could enhance the interest of consumers, with potential benefits to stakeholders at all levels of the production chain.

Neoadjuvant concurrent chemoradiotherapy for locally advanced esophageal cancer in a single high-volume center

BACKGROUND

Neoadjuvant chemoradiotherapy (CRT) is now considered the standard of care by many centers in the treatment of both squamous cell carcinoma (SCC) and adenocarcinoma of the esophagus. This study evaluates the effectiveness of a neoadjuvant CRT protocol, as regards pathological complete response (pCR) rate and long-term survival.

METHODS

From 2003 to 2011, at Upper G.I. Surgery Division of Verona University, 155 consecutive patients with locally advanced esophageal cancers (90 SCC, 65 adenocarcinoma) were treated with a single protocol of neoadjuvant CRT (docetaxel, cisplatin, and 5-fluorouracil with 50.4 Gy of concurrent radiotherapy). Response to CRT was evaluated through percentage of pathological complete response (pCR or ypT0N0), overall (OS) and disease-related survival (DRS), and pattern of relapse.

RESULTS

One hundred thirty-one patients (84.5 %) underwent surgery. Radical resection (R0) was achieved in 123 patients (79.3 %), and pCR in 65 (41.9 %). Postoperative mortality was 0.7 % (one case). Five-year OS and DRS were respectively 43 and 49 % in the entire cohort, 52 and 59 % in R0 cases, and 72 and 81 % in pCR cases. Survival did not significantly differ between SCC and adenocarcinoma, except for pCR cases. Forty-nine patients suffered from relapse, which was mainly systemic in adenocarcinoma. Only three out of 26 pCR patients with previous adenocarcinoma developed relapse, always systemic.

CONCLUSIONS

This study suggests that patients treated with the present protocol achieve good survival and high pCR rate. Further research is necessary to evaluate whether surgery on demand is feasible in selected patients, such as pCR patients with adenocarcinoma.