The management of the long head of the biceps in rotator cuff repair:A comparative study of high vs.subpectoral tenodesis

Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

Coronavirus disease 2019(COVID-19)has several extrapulmonary symptoms.Gastrointestinal(GI)symptoms are among the most frequent clinical manifestations of COVID-19,with severe consequences reported in elderly patients.Furthermore,the impact of COVID-19 on patients with pre-existing digestive diseases still needs to be fully elucidated,particularly in the older population.This review aimed to investigate the impact of COVID-19 on the GI tract,liver,and pancreas in individuals with and without previous digestive diseases,with a particular focus on the elderly,highlighting the distinctive characteristics observed in this population.Finally,the effectiveness and adverse events of the anti-COVID-19 vaccination in patients with digestive disorders and the peculiarities found in the elderly are discussed.

Gut microbiota in autism and mood disorders

The hypothesis of an important role of gut microbiota in the maintenance of physiological state into the gastrointestinal(GI)system is supported by several studies that have shown a qualitative and quantitative alteration of the intestinal flora in a number of gastrointestinal and extra-gastrointestinal diseases.In the last few years,the importance of gut microbiota impairment in the etiopathogenesis of pathology such as autism,dementia and mood disorder,has been raised.The evidence of the inflammatory state alteration,highlighted in disorders such as schizophrenia,major depressive disorder and bipolar disorder,strongly recalls the microbiota alteration,highly suggesting an important role of the alteration of GI system also in neuropsychiatric disorders.Up to now,available evidences display that the impairment of gut microbiota plays a key role in the development of autism and mood disorders.The application of therapeutic modulators of gut microbiota to autism and mood disorders has been experienced only in experimental settings to date,with few but promising results.A deeper assessment of the role of gut microbiota in the development of autism spectrum disorder(ASD),as well as the advancement of the therapeutic armamentarium for the modulation of gut microbiota is warranted for a better management of ASD and mood disorders.

Role of Helicobacter pylori infection on nutrition and metabolism

Helicobacter pylori (H. pylori) is a gram-negative pathogen that is widespread all over the world, infecting more than 50% of the world’s population. It is etiologically associated with non-atrophic and atrophic gastritis, peptic ulcer and shows a deep association with primary gastric B-cell lymphoma and gastric adenocarcinoma. Recently, the medical research focused on the modification of the gastric environment induced by H. pylori infection, possibly affecting the absorption of nutrients and drugs as well as the production of hormones strongly implicated in the regulation of appetite and growth. Interestingly, the absorption of iron and vitamin B12 is impaired by H. pylori infection, while infected subjects have lower basal and fasting serum levels of ghrelin and higher concentration of leptin compared to controls. Since leptin is an anorexigenic hormone, and ghrelin stimulates powerfully the release of growth hormone in humans, H. pylori infection may finally induce growth retardation if acquired very early in the childhood and in malnourished children. This review is focused on the nutritional effects of H. pylori infection, such as the reduced bioavailability or the malabsorbption of essential nutrients, and of gastrointestinal hormones, as well as on the relationship between H. pylori and the metabolic syndrome.

Propionyl-L-carnitine hydrochloride for treatment of mild to moderate colonic inflammatory bowel diseases

AIM:To assess clinical and endoscopic response to propionyl-L-carnitine hydrochloride(PLC) in colonic inflammatory bowel disease.METHODS:Patients suffering from mild to moderate ulcerative colitis(UC) or Crohn's disease(CD) colitis,with disease activity index(DAI) between 3 and 10 and under stable therapy with oral aminosalicylates,mercaptopurine or azathioprine,for at least 8 wk prior to baseline assessments,were considered suitable for enrollment.Fourteen patients were enrolled to assume PLC 2 g/d(two active tablets twice daily) orally.Clinical-endoscopic and histological activity were assessed by DAI and histological index(HI),respectively,following a colonoscopy performed immediately before and after 4 wk treatment.Clinical response was defined as a lowering of at least 3 points in DAI and clinical remission as a DAI score ≤ 2.Histological response was defined as an improvement of HI of at least 1 point.We used median values for the analysis.Differences pre-and post-treatment were analyzed by Wilcoxon signed rank test.RESULTS:All patients enrolled completed the study.One patient,despite medical advice,took deflazacort 5 d before follow-up colonoscopy examination.No side effects were reported by patients during the trial.After treatment,71%(SE 12%) of patients achieved clinical response,while 64%(SE 13%) obtained remission.Separating UC from CD patients,we observed a clinical response in 60%(SE 16%) and 100%,respectively.Furthermore 60%(SE 16%) of UC patients and 75%(SE 25%) of CD patients were in clinical remission after therapy.The median DAI was 7 [interquartile range(IQR):4-8] before treatment and decreased to 2(IQR:1-3)(P < 0.01) after treatment.Only patients with UC showed a significant reduction of DAI,from a median 6.5(IQR:4-9) before treatment to 2(IQR:1-3) after treatment(P < 0.01).Conversely,in CD patients,although displaying a clear reduction of DAI from 7(IQR:5.5-7.5) before therapy to 1.5(IQR:0.5-2.5) after therapy,differences observed were not significant(P = 0.06).Seventy-nine percent(SE 11%) of patients showed improvement of HI of at least 1 point,while only one CD and two UC patients showed HI stability;none showed HI worsening.Median HI decreased from 1(IQR:1-2),to 0.5(IQR:0-1) at the endoscopic control in the whole population(P < 0.01),while it changed from 1(IQR:1-2) to 0.5(IQR:0-1) in UC patients(P < 0.01) and from 1.5(IQR:1-2) to 0.5(IQR:0-1) in CD patients(P = not significant).The two sample tests of proportions showed no significant differences in clinical and histological response or in clinical remission between UC and CD patients.No side effects were reported during treatment or at 4 wk follow-up visit.CONCLUSION:PLC improves endoscopic and histological activity of mild to moderate UC.Further studies are required to evaluate PLC efficacy in colonic CD patients.

Effects of functional foods, nutraceuticals, and herbal products on pancreas

To the Editor:Today functional foods,nutraceuticals,and herbal products are becoming a part of human daily diet.The patient’s interest and demand for them are rising.Globally,healthcare systems and people have shown an increased desire to prevent some diseases and to improve their performances.Published data about the properties and side effects of these products on the pancreas are still lacking,and more studies are required to provide a definitive opinion on their clinical benefits and safeties.The industry of functional foods,nutraceuticals,and herbal products is gaining popularity.

The role of SARS-COV-2 infection in promoting abnormal immune response and sepsis:A comparison between SARS-COV-2-related sepsis and sepsis from other causes

Background:COVID-19 caused by SARS-CoV-2 virus is characterized by respiratory compromise and immune system involvement,even leading to serious disorders,such as cytokine storm.Methods:We then conducted a literature review on the topic of sepsis and covid-19,and in parallel conducted an experimental study on the histological finding of patients who died from SARS-Covid 19 infection and a control group.Results:Sepsis associated with covid-19 infection has some similarities and differences from that from other causes.Conclusion:In this paper the complex interplay between the 2 disorders was discussed,focusing on the similarities and on the effect that one could have on the other.A preliminary experimental section that demonstrates the multisystemic involvement in subjects who die from SARS-CoV-2 is also proposed.