The immune and microbial homeostasis determines the Candida-mast cells cross-talk in celiac disease

Celiac disease (CD) is an autoimmune enteropathy resulting from an interaction between diet, genome, and immunity. Although many patients respond to a gluten-free diet, in a substantive number of individuals, the intestinal injury persists. Thus, other factors might amplify the ongoing inflammation. Candida albicans is a commensal fungus that is well adapted to the intestinal life. However, specific conditions increase Candida pathogenicity. The hypothesis that Candida may be a trigger in CD has been proposed after the observation of similarity between a fungal wall component and two CD-related gliadin T-cell epitopes. However, despite being implicated in intestinal disorders, Candida may also protect against immune pathologies highlighting a more intriguing role in the gut. Herein, we postulated that a state of chronic inflammation associated with microbial dysbiosis and leaky gut are favorable conditions that promote C. albicans pathogenicity eventually contributing to CD pathology via a mast cells (MC)-IL-9 axis. However, the restoration of immune and microbial homeostasis promotes a beneficial C. albicans-MC cross-talk favoring the attenuation of CD pathology to alleviate CD pathology and symptoms.

A microbially produced AhR ligand promotes a Tph1-driven tolerogenic program in multiple sclerosis

Multiple sclerosis is a debilitating autoimmune disease, characterized by chronic inflammation of the central nervous system. While the significance of the gut microbiome on multiple sclerosis pathogenesis is established, the underlining mechanisms are unknown. We found that serum levels of the microbial postbiotic tryptophan metabolite indole-3-carboxaldehyde (3-IAld) inversely correlated with disease duration in multiple sclerosis patients. Much like the host-derived tryptophan derivative L-Kynurenine, 3-IAld would bind and activate the Aryl hydrocarbon Receptor (AhR), which, in turn, controls endogenous tryptophan catabolic pathways. As a result, in peripheral lymph nodes, microbial 3-IAld, affected mast-cell tryptophan metabolism, forcing mast cells to produce serotonin via Tph1. We thus propose a protective role for AhR-mast-cell activation driven by the microbiome, whereby natural metabolites or postbiotics will have a physiological role in immune homeostasis and may act as therapeutic targets in autoimmune diseases.

Biologics, theranostics, and personalized medicine in drug delivery systems

The progress in human disease treatment can be greatly advanced through the implementation of nanomedicine. This approach involves targeted and cell-specific therapy, controlled drug release, personalized dosage forms, wearable drug delivery, and companion diagnostics. By integrating cutting-edge technologies with drug delivery systems, greater precision can be achieved at the tissue and cellular levels through the use of stimuli-responsive nanoparticles, and the development of electrochemical sensor systems. This precision targeting - by virtue of nanotechnology - allows for therapy to be directed specifically to affected tissues while greatly reducing side effects on healthy tissues. As such, nanomedicine has the potential to transform the treatment of conditions such as cancer, genetic diseases, and chronic illnesses by facilitating precise and cell-specific drug delivery. Additionally, personalized dosage forms and wearable devices offer the ability to tailor treatment to the unique needs of each patient, thereby increasing therapeutic effectiveness and compliance. Companion diagnostics further enable efficient monitoring of treatment response, enabling customized adjustments to the treatment plan. The question of whether all the potential therapeutic approaches outlined here are viable alternatives to current treatments is also discussed. In general, the application of nanotechnology in the field of biomedicine may provide a strong alternative to existing treatments for several reasons. In this review, we aim to present evidence that, although in early stages, fully merging advanced technology with innovative drug delivery shows promise for successful implementation across various disease areas, including cancer and genetic or chronic diseases.

Robot-assisted partial nephrectomy using the novel Hugo™ RAS system: Feasibility, setting and perioperative outcomes of the first off-clamp series

INTRODUCTION

Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System.

METHODS

Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration.

RESULTS

Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4-8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68-115 min). Median estimated blood loss were 200 ml (IQR, 50-400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days.

CONCLUSIONS

We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.

Omics sciences and precision medicine in breast and ovarian cancer

Background

Human breast carcinoma is a complex disease, affecting 1 in 8 women worldwide. The seriousness of the disease increases when the definite cause of the disease remains obscure, thus making prognosis challenging. Researchers are emphasizing on adapting more advanced and targeted therapeutic approaches to address the multifaceted impacts of the disease. Hence, modern multi-omics systems have gained popularity among clinicians, as they offer insights into the genomic, pharmacogenomic, metabolomic, and microbiomic factors, thus allowing researchers to develop targeted and personalized approaches for breast cancer prevention and early detection, and eventually improving patient outcomes.

Aim

The primary focus of this study is to elucidate, through the integration of multi-omics research findings, the inherent molecular origins of diverse subtypes of breast cancer and to evaluate the effectiveness of these findings in reducing breast cancer-related mortalities.

Methods

Thorough investigation was conducted by reviewing reputable and authoritative medical journals, e-books, and online databases dedicated to cancer research. The Mendelian inheritance in man database (OMIM) was used to scrutinize specific genes and their respective loci associated with the development of different types of breast cancer.

Results

Our present research revealed the holistic picture of sundry molecular, genomic, pharmacogenomic, metabolomic, and microbiomic features of breast cancer. Such findings, like genetic alterations in highly penetrant genes, plus metabolomic and microbiomic signatures of breast cancer, unveil valuable insights and show great potential for multi-omics research in breast oncology.

Conclusion

Further research in omics sciences pertaining to breast cancer are at the forefront of shaping precise treatment and bolstering patient survival.

Characterization of somatic mutations in the pathogenesis of lipedema

Background

Lipedema, a complex and enigmatic adipose tissue disorder, remains poorly understood despite its significant impact on the patients' quality of life. Genetic investigations have uncovered potential contributors to its pathogenesis, including somatic mutations, which are nonheritable genetic alterations that can play a pivotal role in the development of this disease.

Aim

This review aims to elucidate the role of somatic mutations in the etiology of lipedema by examining their implications in adipose tissue biology, inflammation, and metabolic dysfunction.

Results

Studies focusing on leukocyte clones, genetic alterations like TET2 and DNMT3A, and the intricate interplay between adipose tissue and other organs have shed light on the underlying mechanisms driving lipedema. From the study of the scientific literature, mutations to genes correlated to three main pathways could be involved in the somatic development of lipedema: genes related to mitochondrial activity, genes related to localized disorders of subcutaneous adipose tissue, and genes of leukocyte clones.

Conclusions

The insights gained from these diverse studies converge to highlight the complex genetic underpinnings of lipedema and offer potential avenues for therapeutic interventions targeting somatic mutations to alleviate the burden of this condition on affected individuals.

The Optimization of Pressure-Assisted Microsyringe (PAM) 3D Printing Parameters for the Development of Sustainable Starch-Based Patches

The aim of this work was to develop sustainable patches for wound application, using the biopolymer starch, created using a low-cost 3D printing PAM device. The composition of a starch gel was optimized for PAM extrusion: corn starch 10% w/w, β-glucan water suspension (filler, 1% w/w), glycerol (plasticizer, 29% w/w), and water 60% w/w. The most suitable 3D printing parameters were optimized as well (nozzle size 0.8 mm, layer height 0.2 mm, infill 100%, volumetric flow rate 3.02 mm3/s, and print speed 15 mm/s). The suitable conditions for post-printing drying were set at 37 °C for 24 h. The obtained patch was homogenous but with low mechanical resistance. To solve this problem, the starch gel was extruded over an alginate support, which, after drying, becomes an integral part of the product, constituting the backing layer of the final formulation. This approach significantly improved the physicochemical and post-printing properties of the final bilayer patch, showing suitable mechanical properties such as elastic modulus (3.80 ± 0.82 MPa), strength (0.92 ± 0.08 MPa), and deformation at break (50 ± 1%). The obtained results suggest the possibility of low-cost production of patches for wound treatment by additive manufacturing technology.

Polymeric Patches Based on Chitosan/Green Clay Composites and Hazelnut Shell Extract as Bio-Sustainable Medication for Wounds

Hazelnut shells, the main waste deriving from hazelnut processing, represent an interesting source of active molecules useful in pharmaceutics, although they have not yet been examined in depth. A hydrosoluble extract (hazelnut shell extract, HSE) was prepared by the maceration method using a hydroalcoholic solution and used as the active ingredient of patches (prepared by casting method) consisting of composites of highly deacetylated chitosan and green clay. In vitro studies showed that the formulation containing HSE is able to stimulate keratinocyte growth, which is useful for healing purposes, and to inhibit the growth of S. aureus (Log CFU/mL 0.95 vs. 8.85 of the control after 48 h); this bacterium is often responsible for wound infections and is difficult to treat by conventional antibiotics due to its antibiotic resistance. The produced patches showed suitable tensile properties that are necessary to withstand mechanical stress during both the removal from the packaging and application. The obtained results suggest that the developed patch could be a suitable product to treat wounds.

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

INTRODUCTION

Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.

AIM

To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.

METHODS

We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.

RESULTS

Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.

CONCLUSIONS

Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

Formulation and characterization of sustainable bioadhesive films for wound treatment based on barley β-glucan extract obtained using the high power ultrasonic technique

β-glucan is a well-known functional and bioactive food ingredient. Recently, some studies highlighted several interesting pharmacological activities, such as hypocholesterolemic, hypoglycemic, immunomodulatory, antitumor, antioxidant and anti-inflammatory. The aim of this study is to evaluate a novel application of β-glucan, obtained from barley, for the development of formulations for skin use. Several water suspensions were obtained from barley flour of different particle sizes treated by high power ultrasonic (HPU) technique. Barley flour fraction in the range of 400-500 μm allowed to obtain a stable suspension, represented both by a water soluble and water insoluble fraction of β-glucans, that showed excellent film forming ability. The plasticizer sorbitol as well as the bioadhesive biopolymer acacia gum were added to this suspension in order to obtain a gel suitable to prepare films by casting. The obtained films demonstrated suitable mechanical properties and ability to stimulate in vitro keratinocytes growth suggesting its possible application in dermatological field as for wound treatment. This study demonstrated the dual use of barley suspension: as excipient and as active ingredient.

Ketorolac Loaded Poly(lactic-co-glycolic acid) Coating of AZ31 in the Treatment of Bone Fracture Pain

Biodegradable metal alloys may be successfully used to support bone repair, avoiding second surgery commonly needed when inert metal alloys are used. Combining a biodegradable metal alloy with a suitable pain relief agent could improve patient quality of life. AZ31 alloy was coated using a poly(lactic-co-glycolic) acid (PLGA) polymer loaded with ketorolac tromethamine using the solvent casting method. The ketorolac release profile from the polymeric film and the coated AZ31 samples, the PLGA mass loss of polymeric film, and the cytotoxicity of the optimized coated alloy were assessed. The coated sample showed a ketorolac release that was prolonged for two weeks, which was slower than that of just the polymeric film, in simulated body fluid. PLGA mass loss was complete after a 45-day immersion in simulated body fluid. The PLGA coating was able to lower AZ31 and ketorolac tromethamine cytotoxicity observed in human osteoblasts. PLGA coating also prevents AZ31 cytotoxicity, which was identified in human fibroblasts. Therefore, PLGA was able to control ketorolac release and protect AZ31 from premature corrosion. These characteristics allow us to hypothesize that the use of ketorolac tromethamine-loaded PLGA coating on AZ31 in the management of bone fractures can favor osteosynthesis and relief pain.

Aryl Hydrocarbon Receptor Agonism Antagonizes the Hypoxia-driven Inflammation in Cystic Fibrosis

Hypoxia contributes to the exaggerated yet ineffective airway inflammation that fails to oppose infections in cystic fibrosis (CF). However, the potential for impairment of essential immune functions by HIF-1α (hypoxia-inducible factor 1α) inhibition demands a better comprehension of downstream hypoxia-dependent pathways that are amenable for manipulation. We assessed here whether hypoxia may interfere with the activity of AhR (aryl hydrocarbon receptor), a versatile environmental sensor highly expressed in the lungs, where it plays a homeostatic role. We used murine models of Aspergillus fumigatus infection in vivo and human cells in vitro to define the functional role of AhR in CF, evaluate the impact of hypoxia on AhR expression and activity, and assess whether AhR agonism may antagonize hypoxia-driven inflammation. We demonstrated that there is an important interferential cross-talk between the AhR and HIF-1α signaling pathways in murine and human CF, in that HIF-1α induction squelched the normal AhR response through an impaired formation of the AhR:ARNT (aryl hydrocarbon receptor nuclear translocator)/HIF-1β heterodimer. However, functional studies and analysis of the AhR genetic variability in patients with CF proved that AhR agonism could prevent hypoxia-driven inflammation, restore immune homeostasis, and improve lung function. This study emphasizes the contribution of environmental factors, such as infections, in CF disease progression and suggests the exploitation of hypoxia:xenobiotic receptor cross-talk for antiinflammatory therapy in CF.

Dataset of night-time emissions of the Earth in the near UV range (290-430 nm), with 6.3 km resolution in the latitude range -51.6<L<+51.6 degrees, acquired on board the International Space Station with the Mini-EUSO detector

The data presented in this article are related to the research paper entitled "Observation of night-time emissions of the Earth in the near UV range from the International Space Station with the Mini-EUSO detector" (Remote Sensing of Environment, Volume 284, January 2023, 113336, https://doi.org/10.1016/j.rse.2022.113336). The data have been acquired with the Mini-EUSO detector, an UV telescope operating in the range 290-430 nm and located inside the International Space Station. The detector was launched in August 2019, and it has started operations from the nadir-facing UV-transparent window in the Russian Zvezda module in October 2019. The data presented here refer to 32 sessions acquired between 2019-11-19 and 2021-05-06. The instrument consists of a Fresnel-lens optical system and a focal surface composed of 36 multi-anode photomultiplier tubes, each with 64 channels, for a total of 2304 channels with single photon counting sensitivity. The telescope, with a square field-of-view of 44°, has a spatial resolution on the Earth surface of 6.3 km and saves triggered transient phenomena with a temporal resolution of 2.5 µs and 320 µs. The telescope also operates in continuous acquisition at a 40.96 ms scale. In this article, large-area night-time UV maps obtained processing the 40.96 ms data, taking averages over regions of some specific geographical areas (e.g., Europe, North America) and over the entire globe, are presented. Data are binned into 0.1° × 0.1° or 0.05° × 0.05° cells (depending on the scale of the map) over the Earth's surface. Raw data are made available in the form of tables (latitude, longitude, counts) and .kmz files (containing the .png images). These are - to the best of our knowledge - the highest sensitivity data in this wavelength range and can be of use to various disciplines.

Effect of Different Drying Treatments and Sieving on Royal Gala Apple Pomace, a Thickening Agent with Antioxidant Properties

Currently, there is an increasing interest in the search of natural derived materials as valuable substitutes for microplastics. One of the categories investigated, represented by thickening agents deriving from agri-food waste and apple pomace (AP), was considered of interest. In this study AP was submitted to three different treatments and drying conditions (oven drying at 55 °C for 12 h; homogenization and oven drying at 55 °C for 12 h; homogenization and freeze-drying), and then grinded and sieved obtaining three different dimensional fractions (>400 µm, 250-400 µm and <250 µm). The hydroalcoholic extracts of these fractions, obtained by ultrasound-assisted extraction, were analyzed to compare their total phenol content (TPC), antioxidant properties, and phenol profile. Correlation studies between the above-indicated parameters were also carried out. The highest values of TPC, antioxidant capacity, and phenol content (determined by liquid chromatography) were found for oven dried AP (250-400 μm) or homogenized and freeze-dried (>400 μm) samples. Both samples were most suitable to form stable hydrogels and the sample obtained after drying at 55 °C showed the best performances in terms of ability to form a stable hydrogel. Among the studied treatments and drying conditions, the oven dried AP was demonstrated to be an interesting stabilizing material with potential applications in many fields (such as food, cosmetics, and nutraceuticals) showing both antioxidant activity and thickening capacity.

Alginate Ag/AgCl Nanoparticles Composite Films for Wound Dressings with Antibiofilm and Antimicrobial Activities

Recently, silver-based nanoparticles have been proposed as components of wound dressings due to their antimicrobial activity. Unfortunately, they are cytotoxic for keratinocytes and fibroblasts, and this limits their use. Less consideration has been given to the use of AgCl nanoparticles in wound dressings. In this paper, a sustainable preparation of alginate AgCl nanoparticles composite films by simultaneous alginate gelation and AgCl nanoparticle formation in the presence of CaCl₂ solution is proposed with the aim of obtaining films with antimicrobial and antibiofilm activities and low cytotoxicity. First, AgNO₃ alginate films were prepared, and then, gelation and nanoparticle formation were induced by film immersion in CaCl₂ solution. Films characterization revealed the presence of both AgCl and metallic silver nanoparticles, which resulted as quite homogeneously distributed, and good hydration properties. Finally, films were tested for their antimicrobial and antibiofilm activities against Staphylococcus epidermidis (ATCC 12228), Staphylococcus aureus (ATCC 29213), Pseudomonas aeruginosa (ATCC 15692), and the yeast Candida albicans. Composite films showed antibacterial and antibiofilm activities against the tested bacteria and resulted as less active towards Candida albicans. Film cytotoxicity was investigated towards human dermis fibroblasts (HuDe) and human skin keratinocytes (NCTC2544). Composite films showed low cytotoxicity, especially towards fibroblasts. Thus, the proposed sustainable approach allows to obtain composite films of Ag/AgCl alginate nanoparticles capable of preventing the onset of infections without showing high cytotoxicity for tissue cells.

Biodrug Delivery Systems: Do mRNA Lipid Nanoparticles Come of Age?

As an appealing alternative to treat and prevent diseases ranging from cancer to COVID-19, mRNA has demonstrated significant clinical effects. Nanotechnology facilitates the successful implementation of the systemic delivery of mRNA for safe human consumption. In this manuscript, we provide an overview of current mRNA therapeutic applications and discuss key biological barriers to delivery and recent advances in the development of nonviral systems. The relevant challenges that LNPs face in achieving cost-effective and widespread clinical implementation when delivering mRNA are likewise discussed.

Pulmonary drug delivery technology enables anakinra repurposing in cystic fibrosis

Inflammation is a key pathological driver in cystic fibrosis (CF). Current therapies are ineffective in treating and preventing the escalation of inflammatory events often exacerbated by superimposed infection. In this work, we propose a novel treatment based on the pulmonary administration of anakinra, a non-glycosylated recombinant form of IL-1Ra. An inhalable dry powder of anakinra was successfully developed to meet the specific needs of lung drug delivery. The new formulation was investigated in vitro for aerodynamic performances and activity and in vivo for its pharmacological profile, including the pharmacokinetics, treatment schedule, antimicrobial and anti-inflammatory activity and systemic toxicity. The protein was structurally preserved inside the formulation and retained its pharmacological activity in vitro immediately after preparation and over time when stored at ambient conditions. Anakinra when delivered to the lungs showed an improved and extended therapeutic efficacy in CF models in vivo as well as higher potency compared to systemic delivery. Peripheral side effects were significantly reduced and correlated with lower serum levels compared to systemic treatment. These findings provide proof-of-concept demonstration for anakinra repurposing in CF through the pulmonary route.

Accuracy of femoral tunnel positioning in medial patellofemoral ligament reconstruction: anatomic insertion leads to better clinical outcome

PURPOSE

The medial patello-femoral ligament (MPFL) is considered the primary restraint against patellar dislocation and its reconstruction is indicated in recurrent patellar instability. An anatomical positioning of MPFL femoral insertion is recommended to achieve satisfactory clinical outcomes and prevent osteoarthritis (OA) due to an altered kinematics. The purpose of the study was first to assess the relationship between correct femoral tunnel position and better clinical outcomes and lower patellofemoral osteoarthritis rate. Second, correlation of outcomes with factors potentially affecting the results, such as the type of graft, patellar height and trochlear dysplasia.

METHODS

Fifty-three patients (58 knees) who underwent MPFL reconstruction between 2009 and 2018 by a senior knee surgeon were retrospectively evaluated. Knee radiographs were performed before surgery, 12 months later and at last follow-up to assess trochlear dysplasia, patellar height and patellofemoral OA. The tibial tuberosity-trochlear groove (TT-TG) value was measured on a CT scan. The accuracy of graft positioning was evaluated on sagittal radiographs according to Schöttle et al. Subjective outcomes were collected before surgery, at 12 months and at last follow-up using several validated scores.

RESULTS

Forty-six patients (51 knees) with a mean age of 24.1 ± 7.4 years were included in the study. Mean follow-up was 8.9 ± 2.1 years. A significant improvement in all clinical scores was observed at 12 months and final follow-up. Anatomic Insertion (AI) of reconstructed MPFL was considered optimal in 33 (64.7%) and sub-optimal in 18 (35.3%) patients. Sub-optimal AI resulted in lower Kujala, IKCD and higher VAS score (p < 0.01); moreover, for every 1 mm distance in any direction from the ideal insertion, a decrease of 0.8 [95% CI (-1.4; -0.2)] in Kujala score and 0.8 [95% CI (-1.3; -0.3)] in IKDC was observed. At final follow-up, 8 patients presented patellofemoral OA Iwano grade 3 (15.7%): although that incidence did not correlate to graft positioning, the use the artificial ligament in all these cases appeared to be significant.

CONCLUSION

The present study confirms the importance of an optimal anatomic femoral insertion in MPFL reconstruction, reporting a significant positive correlation between graft positioning and clinical outcome. No significant correlations were found between anatomic insertion and patello-femoral OA development.

LEVEL OF EVIDENCE

IV.

Designing active breaks in secondary school, results from focus group with teachers: the brave study

Background

Many adolescents are unable to accomplish the daily 60 minutes of moderate to vigorous physical activity (PA) recommended by WHO. Secondary school is a critical period for developing healthy habits and PA interventions have the potential to promote healthy development. Active Breaks (ABs) are a school-based intervention consisting of short bursts (5-15 minutes) of PA made part of the academic routine. Primary school has been ABs main setting, while secondary school interventions received less attention. The aim of the BRAVE Study is to investigate teachers’ opinion about the feasibility of ABs in Italian secondary school.

Methods

In November 2020 20 teachers from two secondary schools located in Bologna province (Italy) were enrolled in two focus groups (FGs). FGs were held online, recorded, and transcribed. Questions were asked about the role of PA in the school routine and related experiences, perceived barriers and facilitators of the intervention, suggestions regarding the intervention design. Final expectations were then discussed.

Results

Despite limited experience with PA interventions, participants felt ABs would improve psycho-physical well-being for both students and teachers. Lack of time and space and a wary attitude towards ABs were listed as barriers. Program flexibility regarding content, administration time frames and implementation mode was listed as a great facilitator: program should be adaptable to participants’ needs, favoring easy and quick exercises. Overall, expectations emphasized improving classroom behavior and promoting healthy habits.

Conclusions

Teachers felt that inclusion of ABs in secondary school was promising and could lead to many health benefits. ABs were deemed feasible given their short duration and adaptability, since the program can be implemented with current personnel resources and space configurations. Co-design is essential to overcome personal barriers and create an effective and sustainable intervention.

Key messages

• According to secondary school teachers, PA interventions have the potential to improve psycho-physical well-being and classroom environment, promoting healthy habits among students.

• ABs are deemed as a feasible and sustainable PA intervention thanks to program flexibility regarding contents, administration time frames and implementation mode.

Potential association between working memory and physical fitness status: the BRAVE study

Introduction

The World Health Organization launched a global action plan targeted to obtain a 15% relative reduction in the global prevalence of physical inactivity in adolescents by 2030 also promoting school-based PA interventions and programs in school. Active Breaks (ABs) are a school-based intervention consisting of short bursts (5-15 minutes) of Pa led by teachers or peer. Many researches investigated the implementation of ABs into primary school setting as a strategy to reduce sedentary behaviour, improve cognitive and physical function. However, this kind of intervention has not extended to secondary school, especially in Italian context. For this reason we started the BRAVE study to evaluate the potential effect of implementing ABs in secondary school. The study is currently in the administration phase of ABs to adolescents The preliminary analysis aims to underline a potential association between working memory performance (WM) and physical fitness status among secondary school students at baseline.

Methods

In March 2022 we conducted baseline assessment in a secondary school in Valsamoggia (Bologna, Italy). Working memory was evaluated using backward digit span while physical fitness status was assessed using three different fitness test: standing long-jump (SLJ), six minute Cooper Test (6MCT) and Shuttle run test (SR).

Results

A total of n = 125 adolescent, mean age 12.79±0.89, were enrolled in the study. After performing a regression analysis we found that WM is significantly associated only with age of student (b = 0.2, 95%CI 0.25, 0.11 p = 0.02). A trend also emerged between WM performance and SLJ but with no statistically significant differences (b = 0.160, 95%CI 0.03, 0.02, p = 0.09). The 6MCT and HT have no relevant associations with WM score.

Conclusions

These preliminary results suggest that age is associated with cognitive performance but no positive association were found between WM score and physical fitness status excepted for a small trend with SLJ test.

Key messages

• Age is related to WM in adolescent students.

• ABs interventions could represent a valid strategy to encourage movement, improve cognitive and physical fitness performance.

The Brave study: promoting active breaks in secondary school from students’ point of view

Background

According to the WHO recommendations, children and adolescents should perform at least 60 minutes per day of moderate to vigorous physical activity (PA). Active Breaks (ABs) interventions, short physical activity breaks of 5-15 minutes during school hours, have been examined in primary school children as a potential strategy to counteract a sedentary lifestyle, with minimal disruption to school learning activities. The aim of the BRAVE STUDY is to investigate the feasibility of ABs in a secondary school setting from the students’ point of view.

Methods

In December 2020, 10 students (age 12-13, 6 females and 4 males) attending the second and third grade of secondary schools located in Bologna province (Italy) were involved in a focus group (FG). The FG was conducted online because of COVID-19 and the answers transcribed for a later analysis. Students’ opinions were probed on the role of PA in school and possible facilitators/barriers to implementation of ABs in the school.

Results

Students reported they wanted to be more active as a consequence of time spent in class sitting at a desk. Students also reported that an organized activity like ABs conducted in the classroom setting provides an excellent opportunity to improve social relations with classmates. Students also highlighted the possible psycho-physical well-being benefits arising from PA. Among the potentially negative aspects reported, students underlined the possible confusion that would be created in classroom and the time subtracted from academic learning activities.

Conclusions

The FG represents an ideal mean to obtain in-depth information on how people feel about a pending program or a change in their routine. The current FG reinforces positive outcomes from exposure to a PA program that can be intertwined with their daily classroom activities. ABs programs can help to reconcile the needs of students that arise during the day with the PA objectives recommended by the WHO.

Key messages

• ABs can be a zero-cost intervention strategy to achieve WHO recommendations and would create conditions for a greater psycho-physical benefits in classrooms.

• A qualitative approach, such as FGs, provides a mean to collect information not obtainable with quantitative methods, that could be useful to co-design interventions for children and adolescents.

The effect of active breaks on cognitive performance and classroom behaviour: the I-move study

Background

Active Breaks (ABs) intervention involves short bouts of moderate to vigorous physical activity (MVPA) conducted during or between curricular lessons by the appropriately trained teachers. The aim of the Imola Active Breaks Study (I-MOVE study) was to evaluate the effect of an ABs intervention on cognitive function and classroom behaviour in primary school children.

Methods

The study was quasi-experimental, and it involved two groups attending a primary school in Imola (Bologna, Italy). The Active Breaks group (ABsG) performed the I-MOVE protocol consisting in 10 minutes of ABs divided in warm up, tone-up with high intensity interval training and cool-down. This is repeated three times a day for one year and half. The control group (CG) continued with regular lessons. The baseline assessment was conducted in October 2019 and the follow-up in May 2021. Cognitive performance was assessed using working memory test and classroom behaviour was monitored using an “ad hoc questionnaire”.

Results

Working memory performance increased significantly more in the ABsG (change: 1.30±1.17) than in CG (0.96±1.20), p &lt; 0.05. Almost the entire sample of the children wanted to continue with this intervention in the next following year. Children reported improvements in their school-life quality, including feeling better in class (75.40%) and in school (82.50%) when using ABs. Improvements were also reported in children time-on-task behaviours: 52.90% said they work easily in class, 52.90% that they could listen more clearly, 58.80% reported they can stay seated easily, and 59.60% that they learned better and were more focused after ABs.

Conclusions

In conclusion the program has proven to be very effective on the children's cognitive improvement and classroom behaviour. Since the ABs intervention demonstrates these positive effects, its implementation in schools can have a beneficial, sustainable and long-term impact on childhood health.

Key messages

• ABs intervention represents a cost-effective strategy to be implemented in the school settings regardless of the age and sex differences, to make the school a more dynamic environment.

• Despite the pandemic difficulties, the ABs intervention proved to be sustainable, and to have a positive effect on classroom behaviour by improving children’s concentration and attention in class.

Starch-based sustainable hydrogel loaded with Crocus sativus petals extract: A new product for wound care

The aim of the present study was to valorize Crocus sativus petals, the main waste deriving from saffron stigma harvesting, as source of bioactive molecules to be used in health field. Three different dry extracts were prepared by eco-friendly methods (maceration and ultrasound bath assisted maceration) using saffron petals as raw material and ethanol 70 % either ethanol 96 % as extraction solvents. A preliminary evaluation of the antioxidant activity (measured by ABTS*⁺, DPPH* and FRAP) highlighted that the most suitable extraction solvent is represented by ethanol 70 %. By in vitro studies on keratinocytes emerged that the extract obtained by maceration (rich in gallic and chlorogenic acids) stimulates their growth in a safe concentration range (0.02-0.4 mg/mL) suggesting a potential application in skin diseases such as superficial wounds. Due to the low manageability, the extract was firstly supported on corn starch powder particles and then formulated as starch gel. The obtained formulation showed both suitable rheological properties and spreadability necessary for an easy and pain free application on damaged skin. Moreover, in vitro microbiological studies of starch gel demonstrated antimicrobial activity toward S. epidermidis and self-preserving capacity.

Low Efficacy of Genetic Tests for the Diagnosis of Primary Lymphedema Prompts Novel Insights into the Underlying Molecular Pathways

Lymphedema is a chronic inflammatory disorder caused by ineffective fluid uptake by the lymphatic system, with effects mainly on the lower limbs. Lymphedema is either primary, when caused by genetic mutations, or secondary, when it follows injury, infection, or surgery. In this study, we aim to assess to what extent the current genetic tests detect genetic variants of lymphedema, and to identify the major molecular pathways that underlie this rather unknown disease. We recruited 147 individuals with a clinical diagnosis of primary lymphedema and used established genetic tests on their blood or saliva specimens. Only 11 of these were positive, while other probands were either negative (63) or inconclusive (73). The low efficacy of such tests calls for greater insight into the underlying mechanisms to increase accuracy. For this purpose, we built a molecular pathways diagram based on a literature analysis (OMIM, Kegg, PubMed, Scopus) of candidate and diagnostic genes. The PI3K/AKT and the RAS/MAPK pathways emerged as primary candidates responsible for lymphedema diagnosis, while the Rho/ROCK pathway appeared less critical. The results of this study suggest the most important pathways involved in the pathogenesis of lymphedema, and outline the most promising diagnostic and candidate genes to diagnose this disease.

MgAl and ZnAl-Hydrotalcites as Materials for Cosmetic and Pharmaceutical Formulations: Study of Their Cytotoxicity on Different Cell Lines

The knowledge about the effect of hydrotalcites (HTlcs), largely used in pharmaceutics, on non-malignant cell lines is limited. The effect of MgAl-HTlc-and ZnAl-HTlc- (NO3−/Cl−/CO32−) on the cell viability of HaCat, fibroblasts and HepG2 was studied by MTT assay. Cells were incubated either with HTlc suspensions in the culture media and with the supernatant obtained from the suspension being centrifuged. MgAl-HTlcs suspensions resulted in being cytotoxic. As SEM and TEM analyses showed the presence of sub-micrometric particles in all the MgAl-HTlc examined, it could be hypothesized that this fraction can be internalized into cells reducing the viability. MgAl-HTlc-NO3 is the most cytotoxic probably due to the additional effect of NO3− anions. ZnAl-HTlcs are cytotoxic, especially for HaCat and HepG2 cells (viability <60% at all the concentrations assayed). The effect is attributable both to the sub-micrometric fraction (identified by TEM) and to the high Zn2+ levels found in the culture medium by ICP-OES analysis, suggesting that ZnAl-HTlcs are less stable than MgAl-HTlc in the used media. The obtained results suggest that it is very important to perform ad hoc studies in order to evaluate HTlc safety before to be introduced in a formulation.

Epidemiological profile of patients with epilepsy attended in an emergency in a psychiatric hospital in 2020

Introduction

According to the Global Burden of Disease study (WHO, 2010), epilepsy is ranked as the second most impacting neurological disorder worldwide, in terms of disability-adjusted life years, and is often associated with psychiatric comorbidities, stigma and high economic costs. This frequent association between epilepsy and mental disorders is a fact, however, they are often underdiagnosed and undertreated in patients with epilepsy, which further reduces the quality of life of this population and induces the demand for psychiatric emergency care.

Objectives

To give the comorbid relevance between epilepsy and mental disorders, this study aims to identify the main psychiatric illnesses associated with patients with epilepsy treated at the emergency of a psychiatric hospital in 2020. In addition to establishing the clinical and epidemiological factors related to this association.

Methods

All patients diagnosed with epilepsy (G40), according to the International Classification of Diseases, who underwent emergency care at the HABM, São José do Rio Preto, São Paulo, in 2020. Epidemiological and clinical data were collected.

Results

There were 7258 consultations, with only 27 as cid G40. 71.4% were male, 55% single and age between 42-49 years old. 47.6% indicated psychiatric comorbidities (cid F06). 23.8% patients with both disorders were attended by psychiatrist.

Conclusions

The concomitant occurrence of psychiatric disorders and epilepsy has significant relevance. However, it is known that the diagnosis of psychiatric disorders in epileptic patients is sometimes late, poorly conducted or even underdiagnosed. Therefore, knowing the profile of patients with epilepsy allows us to identify the factors associated with the concomitant of psychiatric disorders.

Disclosure

No significant relationships.

Pharmaceutically Active Microbial AhR Agonists as Innovative Biodrugs in Inflammation

Alterations of the microbiome occur in inflammatory and autoimmune diseases, a finding consistent with the role of the microbiome in the maintenance of the immune system homeostasis. In this regard, L-tryptophan (Trp) metabolites, of both host and microbial origin, act as important regulators of host–microbial symbiosis by acting as aryl hydrocarbon receptor (AhR) ligands. The intestinal and respiratory barriers are very sensitive to AhR activity, suggesting that AhR modulation could be a therapeutic option to maintain the integrity of the epithelial barrier, which has substantial implications for health even beyond the mucosal site. A number of studies have highlighted the capacity of AhR to respond to indoles and indolyl metabolites, thus positioning AhR as a candidate indole receptor. However, the context-and ligand-dependent activity of AhR requires one to resort to suitable biopharmaceutical formulations to enable site-specific drug delivery in order to achieve therapeutic effectiveness, decrease unwanted toxicities and prevent off-target effects. In this review, we highlight the dual activity of the microbial metabolite indole-3-aldehyde at the host–microbe interface and its ability to orchestrate host pathophysiology and microbial symbiosis and discuss how its proper clinical development may turn into a valuable therapeutic strategy in local and distant inflammatory diseases.

Optimizing therapeutic outcomes of immune checkpoint blockade by a microbial tryptophan metabolite

Background

Despite the great success, the therapeutic benefits of immune checkpoint inhibitors (ICIs) in cancer immunotherapy are limited by either various resistance mechanisms or ICI-associated toxic effects including gastrointestinal toxicity. Thus, novel therapeutic strategies that provide manageable side effects to existing ICIs would enhance and expand their therapeutic efficacy and application. Due to its proven role in cancer development and immune regulation, gut microbiome has gained increasing expectation as a potential armamentarium to optimize immunotherapy with ICI. However, much has to be learned to fully harness gut microbiome for clinical applicability. Here we have assessed whether microbial metabolites working at the interface between microbes and the host immune system may optimize ICI therapy.

Methods

To this purpose, we have tested indole-3-carboxaldehyde (3-IAld), a microbial tryptophan catabolite known to contribute to epithelial barrier function and immune homeostasis in the gut via the aryl hydrocarbon receptor (AhR), in different murine models of ICI-induced colitis. Epithelial barrier integrity, inflammation and changes in gut microbiome composition and function were analyzed. AhR, indoleamine 2,3-dioxygenase 1, interleukin (IL)-10 and IL-22 knockout mice were used to investigate the mechanism of 3-IAld activity. The function of the microbiome changes induced by 3-IAld was evaluated on fecal microbiome transplantation (FMT). Finally, murine tumor models were used to assess the effect of 3-IAld treatment on the antitumor activity of ICI.

Results

On administration to mice with ICI-induced colitis, 3-IAld protected mice from intestinal damage via a dual action on both the host and the microbes. Indeed, paralleling the activation of the host AhR/IL-22-dependent pathway, 3-IAld also affected the composition and function of the microbiota such that FMT from 3-IAld-treated mice protected against ICI-induced colitis with the contribution of butyrate-producing bacteria. Importantly, while preventing intestinal damage, 3-IAld did not impair the antitumor activity of ICI.

Conclusions

This study provides a proof-of-concept demonstration that moving past bacterial phylogeny and focusing on bacterial metabolome may lead to a new class of discrete molecules, and that working at the interface between microbes and the host immune system may optimize ICI therapy.

A135 DO VISCOUS SWALLOWS IMPROVE THE DIAGNOSTIC YIELD OF HIGH-RESOLUTION MANOMETRY?

Background

Esophageal motility disorders are diagnosed using high-resolution esophageal manometry (HR-EMS) using the Chicago Classification (CC V4.0) which is based on a series of 10 normal saline swallows (LS). Viscous swallows (VS; thickened liquid/applesauce) are often performed during esophageal manometry; however, they were not included within the framework of CC V4.0. Previous literature has suggested inconsistency between LS and VS in up to 25% of studies, yet it remains unclear whether routine use of VS offers any benefit to LS alone in diagnosing manometric abnormalities according to the CC V4.0.

Aims

To determine if the routine use of VS improves the diagnostic yield in HR-EMS

Methods

A retrospective analysis of all HR-EMS studies performed between December 2020 and July 2021 at Kingston Health Sciences Centre was completed. Demographic information including age, sex, indication for HR-EMS, surgical history, and chronic narcotic use was documented. Each study (consisting of 10 LS and 10 VS) was reviewed independently by a Gastroenterology Fellow and Neurogastroenterologist. A manometric diagnosis using CC V4.0 was made for both LS and VS. Descriptive statistics were performed.

Results

A total of 101 HR-EMS studies were reviewed (33 male, 68 female, age range 26 to 90 years). The most common indication for HR-EMS was dysphagia (87/101) with 23/101 having 2 indications, 30/101 having 3 indications, and 43/101 patients having >3 indications. Prior upper GI tract surgery and chronic narcotic use was recorded in 9/101 and 8/101 patients, respectively. Two HR-EMS studies were excluded due to incomplete protocol. In total, 38.4% (38/99) had normal HR-EMS for both LS and VS. LS and VS that resulted in a CC V4.0 diagnosis were concordant in 37.4%(37/99) and discordant in 24.2% (24/99). Of the 24 discordant studies, 6 had a CC V4.0 diagnosis for LS (4 esophagogastric outflow obstruction (EGJOO), 1 ineffective esophageal motility (IEM), 1 diffuse esophageal spasm) and normal VS. Ten studies had normal LS and a CC V4.0 diagnosis for VS (9 IEM, 1 EGJOO). Eight had differing CC V4.0 diagnoses for LS and VS.

Conclusions

LS and VS resulted in concordant diagnoses in the majority of cases. However, there were discordant results in approximately 25% of cases. In nearly half of these studies, the LS was within normal limits whereas VS yielded a diagnosis of an esophageal motility disorder which may be of clinical significance to the patient’s management. The addition of VS to HR-EMS protocol may increase diagnostic yield in symptomatic patients.

Funding Agencies

None

A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program

EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.

Can treatment of posterior malleolus fractures with tibio-fibular instability be usefully addressed by Bartonicek classification?

INTRODUCTION

Ankle fractures account for 4% of all fractures and treatment of those involving the Posterior Malleolus remains controversial. Clinical and radiological outcomes in a cohort of patients with Posterior Malleolus fractures conservatively treated were retrospectively evaluated; furthermore, a treatment algorithm was suggested.

METHODS

Patients were divided according to Bartoníček classification. The clinical evaluation was made with OMAS/AOFAS scores; the radiological evaluation with Van Dijk classification for post-traumatic arthritis.

RESULTS

Clinical outcome worsened with the severity of Bartoníček classification, but early degenerative changes were not correlated neither to the clinical outcome nor to the injury pattern. Clinical and radiological outcomes depended on the damage of the syndesmosis as articular step-offs and tibio-fibular notch involvement.

DISCUSSION

We recommend conservative treatment for Bartoníček type I, type II and type III fractures, the latter when undisplaced and without tibial plafond depression. We suggest surgical treatment for type IV and displaced type III fractures.

CDH5, a Possible New Candidate Gene for Genetic Testing of Lymphedema

Background: Expressed by endothelial cells, CDH5 is a cadherin involved in vascular morphogenesis and in the maintenance of vascular integrity and lymphatic function. The main purpose of our study was to identify distinct variants of the CDH5 gene that could be associated with lymphatic malformations and predisposition for lymphedema. Methods and Results: We performed Next Generation Sequencing of the CDH5 gene in 235 Italian patients diagnosed with lymphedema but who tested negative for variants in known lymphedema genes. We detected six different variants in CDH5 five missense and one nonsense. We also tested available family members of the probands. For family members who carried the same variant as the proband, we performed lymphoscintigraphy to detect any lymphatic system abnormalities. Variants were modeled in silico. The results showed that CDH5 variants may contribute to the onset of lymphedema, although further in vitro studies are needed to confirm this hypothesis. Conclusions: Based on our findings, we propose CDH5 as a new gene that could be screened in patients with lymphedema to gather additional evidence.

The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience

A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m², high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.

LIMPRINT in Italy

Background: To define the profile of patients presenting with chronic edema (CE) in three centers in Italy (Lymphoedema IMpact and PRevalence INTernational). Methods and Results: Data were collected in patients referred for CE between September 2016 and July 2017. A total of 1637 were recruited, 86.7% (1419) outpatients and 13.3% (218) inpatients with 80.6% (1319) female and mean age 54 years. Primary lymphedema occurred in 28.2% (461). In the 71.8% (1176) with secondary CE cancer occurred in 72% (846) and 28% (330) due to other causes. Data showed that 84.2% (226) had full upper body mobility, 15.5% (41) had limited mobility and 0.2% (2) had lost all mobility. Lower limb mobility status: 90.4% (1205) complete mobility, 8.4% (112) reduced mobility and 1.2% (21) wheelchair bound. Concurrent leg ulceration occurred in 32.9% (322) with 3.1% (51) having antibiotics. Treatment patterns varied with only 32.4% (530) receiving instructions in skin care, 61.2% (1002) multilayer compression and a further 67.8% (1110) compression garment with 17.6% (288) having sequential pressure therapy. Only 1.4% (23) had received psychological support. Out of the total 481/1637 (29.4%) were not prescribed any treatment. Only 50.4% (825) had access to subsidized treatments within the National and Regional Health Care System, whereas 49.6% (81) had to pay themselves with only half (50.9%) having access to treatment centers that were near their home. Conclusion: Results from this study and active lobbying have led to changes in reimbursement of care for primary and secondary lymphedema in Italy; this has led to a much more optimistic picture for those affected.

SVEP1 IS IMPORTANT FOR MORPHOGENESIS OF LYMPHATIC SYSTEM: POSSIBLE IMPLICATIONS IN LYMPHEDEMA

SVEP1, also known as Polydom, is a large extracellular mosaic protein with functions in protein interactions and adhesion. Since Svep1 knockout animals show severe edema and lymphatic system malformations, the aim of this study is to evaluate the presence of SVEP1 variants in patients with lymphedema. We analyzed DNA from 246 lymphedema patients for variants in known lymphedema genes, 235 of whom tested negative and underwent a second testing for new candidate genes, including SVEP1, as reported here. We found three samples with rare heterozygous missense single-nucleotide variants in the SVEP1 gene. In one family, healthy members were found to carry the same variants and reported some subclinical edema. Based on our findings and a review of the literature, we propose SVEP1 as a candidate gene that should be sequenced in patients with lymphatic malformations, with or without lymphedema, in order to investigate and add evidence on its possible involvement in the development of lymphedema.

Development and in vitro-in vivo performances of an inhalable indole-3-carboxaldehyde dry powder to target pulmonary inflammation and infection

A tryptophan metabolite of microbial origin, indole-3-carboxaldehyde (3-IAld), has been recently identified as a Janus molecule that, acting at the host-pathogen interface and activating the aryl hydrocarbon receptor, can result as a potential candidate to treat infections as well as diseases with an inflammatory and/or immune component. In this work, an inhaled dry powder of 3-IAld was developed and evaluated for its efficacy, compared to oral and intranasal administration using an aspergillosis model of infection and inflammation. The obtained inhalable dry powder was shown to: i) be suitable to be delivered for pulmonary administration, ii) possess good toxicological safety, and iii) be superior to other administration modalities (oral and intranasal) in reducing disease scores by acting on infection and inflammation. This study supports the use of 3-IAld inhalable dry powders as a potential novel therapeutic tool to target inflammation and infection in pulmonary diseases.

Indole-3-Carboxaldehyde Restores Gut Mucosal Integrity and Protects from Liver Fibrosis in Murine Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is a long-term liver disease characterized by a progressive course of cholestasis with liver inflammation and fibrosis. Intestinal barrier dysfunction has been implicated in the pathogenesis of PSC. According to the "leaky gut" hypothesis, gut inflammation alters the permeability of the intestinal mucosa, with the translocation of gut-derived products that enter the enterohepatic circulation and cause hepatic inflammation. Thus, the administration of molecules that preserve epithelial barrier integrity would represent a promising therapeutic strategy. Indole-3-carboxaldehyde (3-IAld) is a microbial-derived product working at the interface between the host and the microbiota and is able to promote mucosal immune homeostasis in a variety of preclinical settings. Herein, by resorting to a murine model of PSC, we found that 3-IAld formulated for localized delivery in the gut alleviates hepatic inflammation and fibrosis by modulating the intestinal microbiota and activating the aryl hydrocarbon receptor-IL-22 axis to restore mucosal integrity. This study points to the therapeutic potential of 3-IAld in liver pathology.

Targeted Drug Delivery Technologies Potentiate the Overall Therapeutic Efficacy of an Indole Derivative in a Mouse Cystic Fibrosis Setting

Inflammation plays a major role in the pathophysiology of cystic fibrosis (CF), a multisystem disease. Anti-inflammatory therapies are, therefore, of interest in CF, provided that the inhibition of inflammation does not compromise the ability to fight pathogens. Here, we assess whether indole-3-aldehyde (3-IAld), a ligand of the aryl hydrocarbon receptor (AhR), may encompass such an activity. We resorted to biopharmaceutical technologies in order to deliver 3-IAld directly into the lung, via dry powder inhalation, or into the gut, via enteric microparticles, in murine models of CF infection and inflammation. We found the site-specific delivery of 3-IAld to be an efficient strategy to restore immune and microbial homeostasis in CF organs, and mitigate lung and gut inflammatory pathology in response to fungal infections, in the relative absence of local and systemic inflammatory toxicity. Thus, enhanced delivery to target organs of AhR agonists, such as 3-IAld, may pave the way for the development of safe and effective anti-inflammatory agents in CF.

Development of sodium carboxymethyl cellulose based polymeric microparticles for in situ hydrogel wound dressing formation

18β-glycyrrhetinic acid (Gly), a natural compound obtained from licorice, is known both for the anti-inflammatory and antioxidant activities and for this reason useful for wound treatment. Due to its poor solubility, Gly is not suitable for formulations used in conventional topical products such as gels, foams and creams. Polymeric bioadhesive microparticles (MP), loaded with Gly, were developed to be introduced in the wound bed and swell, once in contact with the exudate, to form a hydrogel in situ able to close the wound. The MP were prepared by spray drying method from the polymeric solution of polysaccharide sodium carboxymethyl cellulose (CMC) and copolymer Soluplus® (SL). Soluplus® introduction in MP composition, using a 3:1 ratio (CMC/SL wt./wt.), allowed to stabilize Gly in non-crystalline form, favoring the improvement of water solubility, and to obtain a spherical with rugged surface MP morphology. Ex vivo studies showed these MP maintain high swelling capability and are able to form in situ a hydrogel for wound repair. The controlled release of Gly from the hydrogel stimulates keratinocyte growth, potentially supporting the physiological healing processes.

Rojo Duro Red Onion Extract Loaded Spray Thermogel as a Sustainable Platform for the Treatment of Oral Mucosa Lesions

The urgent need for new green and sustainable models is ground for the current demand of innovative renewable resource based pharmaceutical products. We propose a Rojo Duro skin onion extract loaded poloxamer/chitosan spray mucoadhesive thermogel aimed at solving current limitations in oral mucosits treatment. Being among the main side effects of radio- and chemotherapy, effective treatment of buccal lesions still represents an unmet medical need. The obtained thermogel combined optimal gelling capacity, release behavior, sprayability, mucoadhesion properties, while maintaining the extract antioxidant and antimicrobial properties. The product preserved all properties when stored for 1 month as a freeze-dried powder at 4 °C. This potential new product is highly translational, as it combines a recognized safety to administration/application advantages, as well as simplicity and sustainability.

Spectrophotometry and pharmaceutical PAT/RTRT: Practical challenges and regulatory landscape from development to product lifecycle

European Pharmacopoeia includes dedicated chapters for Raman, NIR and Chemometrics, as well as there is a lot of Academia research on the matter. Despite that, the word innovation is often associated to such tools and there is a still slow implementation at industry. The paper is the outcome of the Associazione Farmaceutici dell'Industria (AFI) Study Group on Process Innovation and Product Lifecycle; the aim is to describe some case studies referring to practical approaches in pharmaceutical industry, in order to depict challenges and opportunities for the implementation of spectroscopic techniques. Case studies include: feasibility and pre-screening evaluations, chemometric model development approaches, way for the method maintenance during commercial manufacturing, challenges for implementation on existing equipment and on sterile processes. Case studies refer to oral solid products, liquid products and sterile Active Pharmaceutical Ingradient (API) manufacturing. There are already successful and robust spectroscopic applications in pharmaceutical industry and the technology is mature: this is the outcome of a strong applied research performed at pharmaceutical production departments. It is necessary to acknowledge efforts done by industry as Research for strengthening the cooperation with Academia, so that advantage of process innovation might reach the patients in a fastest way.

Tackling Immune Pathogenesis of COVID-19 through Molecular Pharmaceutics

An increasing number of clinical studies worldwide are investigating the repurposing of antiviral, immune-modulatory, and anti-inflammatory agents to face the coronavirus disease-19 (COVID-19) pandemic. Nevertheless, few effective therapies exist to prevent or treat COVID-19, which demands increased drug discovery and repurposing efforts. In fact, many currently tested drugs show unknown efficacy and unpredictable drug interactions, such that interventions are needed to guarantee access to effective and safe medicines. Anti-inflammatory therapy has proven to be effective in preventing further injury in COVID-19 patients, but the benefit comes at a cost, as targeting inflammatory pathways can imply an increased risk of infection. Thus, optimization of the risk/benefit ratio is required in the anti-inflammatory strategy against COVID-19, which accounts for drug formulations and delivery towards regionalization and personalization of treatment approaches. In this perspective, we discuss how better knowledge of endogenous immunomodulatory pathways may optimize the clinical use of novel and repurposed drugs against COVID-19 in inpatient, outpatient, and home settings through innovative drug discovery, appropriate drug delivery systems and dedicated molecular pharmaceutics.

A106 BENZOCAINE-INDUCED METHEMOGLOBINEMIA: A RARE BUT POTENTIALLY FATAL COMPLICATION OF TOPICAL ANESTHETIC USE IN ESOPHAGOGASTRODUODENOSCOPY

Background

Methemoglobinemia is an uncommon and potentially lethal condition arising when the iron moiety of heme is oxidized from the ferrous (Fe2+) to ferric (Fe3+) state, causing a disruption of O2 binding and impairment of O2 delivery to tissue. There are two forms of methemoglobinemia: inherited and acquired. Acquired methemoglobinemia is caused by medications, including topical anesthetics (TAs) used in esophagogastroduodenoscopy (EGD).

Aims

To raise awareness of this serious complication of TA use.

Methods

A 66-year old woman underwent EGD for dysphagia and globus sensation. Her past medical history included gastroesophageal reflux disease, paraoesophageal hernia, coronary artery disease, and hypertension. Prior to EGD, her oropharynx was anesthetized with benzocaine spray and she was sedated with fentanyl 100 mcg and midazolam 3 mg. EGD was unremarkable. At completion she required no supplemental oxygen (SpO2 96%). In recovery, she became drowsy and cyanotic. Vital signs revealed an SpO2 of 86% that did not improve with 4L supplementary O2 via nasal prongs. Aside from cyanosis, physical examination was normal. ECG, chest X-ray, and CT scan with pulmonary embolism protocol did not identify a cause for hypoxia. Arterial blood gas (ABG) revealed dark brown blood with an PaO2 of 397 mmHg. Methemoglobinemia was suspected and confirmed with a serum methemoglobin (MHg) level of 18% (ref &lt;3%).

Results

Intravenous methylene blue (1g/kg) was administered with complete resolution of symptoms. She was admitted for monitoring and discharged the next day with no sequelae.

Conclusions

Methemoglobinemia is a rare condition (incidence 1/7000 procedures) of increased MHg due to the oxidation of iron in heme, compromising oxygen binding/offloading and delivery to tissues. Normal MHg levels are &lt;3%, which is maintained by NADH-MHg reductase. This enzyme reduces Fe3+ to Fe2+. TAs cause elevated methemoglobinemia by oxidizing iron (Fe2+ to Fe3+) at a rate 100-1000x faster than NADH-MHg reductase can reduce it. Benzocaine has been associated with a 3.7- fold higher risk of methemoglobinemia than other topical anesthetics, and the risk is not dose-dependent. Presentation varies with degree of MHg. Hallmark signs of cyanosis, impaired SpO2 with normal ABG, and “chocolate-colored” blood occur at levels&gt;10%. Death/coma occurs at levels &gt;50%. Incidence is idiosyncratic; however, those with smoking history or underlying cardiac/lung disease are at elevated risk for poor outcomes. The activity of NADH-MHg reductase is increased by methylene blue. When administered at doses of 1-2g/kg, it rapidly reduces MHg, restoring the physiological equilibrium. TAs are used routinely in EGD. Gastroenterologists who use TAs in procedures need to be aware of the association between TAs and methemoglobinemia. Prompt recognition/treatment will prevent morbidity/mortality.

Funding Agencies

None

Abstract PD11-03: Assessing the impact of 12 months lifestyle interventions on breast cancer secondary prevention: A modeling approach

Background Healthy lifestyle, including caloric restriction, balanced diet and physical activity, is important in primary and secondary prevention of breast cancer (BC). It is known that Mediterranean diet reduces metabolic syndrome and insulin resistance that are associated with increased risk of BC onset and recurrence. Physical activity decreases BMI, blood concentrations of testosterone, estrogens, insulin, its resistance and strengthens anti-inflammatory pathways against tumor cells. Since January 2014, at our Institution we promoted a project named “Lifestyle Program” for high risk BC patients underwent to primary surgery. Here we presented the results of 12 months of “Lifestyle Program”. Patients and methods Since January 2014 we have prospectively enrolled all high risk patients between 18 and 70 years treated to our department for invasive early-stage breast cancer (stage I-III). High risk has been defined by one or more of the following inclusion criteria: body mass index (BMI) &gt; 25, diagnosis of metabolic syndrome, increased level of blood testosterone and/or insulin. All high risk patients receive a periodical personalized educational intervention by a physiatrist for physical activity and by a nutritionist for a mediterranean diet low in animals fat and enriched of fibers, fruits and vegetables. All patients underwent to screening for anxiety and depression through HADS questionnaire scores. All data were analyzed by Chi-square test assuming statistical significance at p&lt;0.05. Results 98 BC patients were included; 21.4% of them had a metabolic syndrome. Median age was 56 years old (range 27-75). Most of patients enrolled had ER+ (85.7%), Her2/neu negative (79.6%), stage I (48%) BC. We observed a statistically significant reduction of BMI (BMI&gt;25 in 94.9% of pts at baseline vs 63.2% after 12 months of lifestyle; p=&lt;0.0001), glycemic (&gt;110 mg/dl in 23.5% of pts at baseline vs 10.2% at 12 months; p=&lt;0.0001), insulin levels (&gt;27 uU/ml in 20.6% of pts at baseline vs 2.9% after 12 months; p&lt;0.0001), testosterone (&gt;1,2 ng/ml in 17.6% of pts at baseline vs 4.1% at 12 months; p&lt;0.0001), cholesterol (&gt;200 mg/dl in 46.9% of pts at baseline vs 35.7% at 12 months; p&lt;0.0001), triglycerides (&gt;170 mg/dl in 13.3% of pts at baseline vs 10.2% at 12 months; p&lt;0.0001) and arthralgia (37.7% at baseline vs 17.3% at 12 months; p=0.0008). We also noted a significantly reduction of anxiety and depression after 12 months of lifestyle program (25.4% and 12% respectively at diagnosis vs 13.4% and 4.5% at 12 months respectively; p=0,0064 and p&lt;0.0001). Conclusions Promoting healthy lifestyle can reduce risk factors involved in BC recurrence and ensure psychological benefit and compliance to endocrine therapy. A multidisciplinary approach allows greater adherence to healthy attitudes in BC high risk patients.

Citation Format: Mirco Pistelli, Valentina Natalucci, Lucia Bastianelli, Laura Scortichini, Veronica Agostinelli, Filippo Merloni, Agnese Savini, Marianna Capecci, Maria Gabriella Ceravolo, Roberta Serrani, Maurizio Ricci, Marina Taus, Albano Nicolai, Elena Barbieri, Rossana Berardi. Assessing the impact of 12 months lifestyle interventions on breast cancer secondary prevention: A modeling approach [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-03.

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

INTRODUCTION

Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.

AIM

To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.

METHODS

We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.

RESULTS

Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.

CONCLUSIONS

Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.