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Background: The FOLFOXIRI regimen produces a high rate of radiological and histopathological responses. Bevacizumab added to chemotherapy showed an improvement in pathological response and necrosis of colorectal liver metastases (CLMs). FOLFOXIRI plus bevacizumab produced promising early clinical results and is under investigation in several randomised trials, although no data are currently available on its effects on response of CLMs and on liver toxicities. Methods: Starting from 499 patients enrolled in first-line phase II/III trials, we selected on the basis of tissue sample availability 18 patients treated with FOLFOXIRI/XELOXIRI and 24 patients treated with FOLFOXIRI plus bevacizumab who underwent secondary resection of CLMs. The 28 untreated patients who underwent primary resection of CLMs were included as control group. Responses of CLMs and chemotherapy-induced toxicities were assessed. Results: Among the patients, 63% of those treated with FOLFOXIRI plus bevacizumab, as compared with 28% of those treated with only FOLFOXIRI/XELOXIRI, showed a histopathological response ( P= 0.033). In the two groups, 52% and 12.5%, respectively, showed necrosis ⩾50% ( P =0.017). The incidence of liver toxicities was not significantly increased in patients treated with FOLFOXIRI plus bevacizumab. Conclusion: The addition of bevacizumab to FOLFOXIRI produces high rates of pathologic responses and necrosis of CLM without increasing liver toxicity.

Background Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition that commonly affects the clavicle and pelvis. Case presentation We report here a case a 12 years old girl with CRMO arising with recurrent episodes of left supraorbital headache, followed by the appearance of a periorbital dyschromia. Magnetic resonance imaging (MRI) of the skull and orbits revealed an important subacute inflammatory process. Few months after, the child presented a painful swelling of the left clavicle; the histological examination of the related biopsy allowed to establish the diagnosis of CRMO. Conclusion CRMO presenting as acute headache involving neurocranium is rare; to our knowledge this is the first recognized case in the world literature. This pathological condition is frequently misdiagnosed as infection or neoplasm and needs a deep investigation for the differential diagnosis. The physical, laboratoristic and instrumental diagnostic investigations of the patient and the treatment employed are described in detail.

Aim Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak. Materials and Methods Twenty-one patients (8 M, 26–77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at > 48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients. Results Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury ( n  = 10), accessory duct ( n  = 4), or cystic duct stump ( n  = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury ( n  = 8), stone ( n  = 2), or cholangiocarcinoma ( n  = 1) and underwent stenting ( n  = 4), naso-biliary drainage, NBD ( n  = 3), or surgery ( n  = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic. Conclusions Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.

BackgroundThe cause of the breach in immune tolerance in the arthritic joint is not fully understood; many associations between subsets of JIA and HLA and non-HLA molecules have been described.1 An important role is played by T cell population, that is driven also by its specific T cell receptor (TCR) repertoire; it has been previously observed that synovial T cells exhibit oligoclonal TCR repertoires.2 ObjectivesTo examine frequency and distribution of human Collagen261–273-specific T cells and the phenotypes of B and T cells subpopulations and the role of DR alleles in JIA, in order to find new biomarker for management of JIA.MethodsHLA genotyping and CDR3 TRBV-TRBJ spectratyping (TCR repertoire Immunoscope analysis)3 were performed on Peripheral blood mononuclear cells (PBMCs) on a total of 40 Juvenile Idiopathic arthritis (JIA) patients (and in 2 cases also in samples of Synovial fluids) and 6 Healthy Controls. The enrolled patients were mainly affected by polyarticular arthritis (26 out 40) and were free of CS (38 out 40) and cDMARDS (24 out 40) treatments. The mean disease duration was 37 months. All the patients were ACPA and RF negative and the mean ESR and PCR values were respectively 39.5±32.4 mm/h and 17.5±37.4 mg/L. B cells and T cells subpopulations were analysed by flow cytometer assays.ResultsIn our cohort 4 patients were DR4+ (10%) and 8 were DR1+ (20%). In the entire cohort no differences were found in terms of B cells subpopulations, but dividing the cohort on the basis of the age of disease onset it was possible to identify a upregulation of Switched B cells compartment in younger patients more than the JIA with an exordium after 12 years, confirming the data recently published.4 We checked for the presence of collagen specific TRBV25-TRBJ2.2 T cells, whom the expansion were significantly associated with disease activity and modulated by therapy in RA patients, as described in our previous work.3 Our preliminary results in a so small cohort of patients indicate that the same expansion in JIA patients seems to associate with JADAS and DR4/DR1 positivity, independently from any conventional and biological treatment. Moreover our T cells subpopulation analysis allowed to find interesting correlation between Tregs and switched memory, Tregs and double negative (IgDneg/CD27neg) B cells (r=0.476, p=0.04) and Tregs and DR4/1 positivity (0.432 p=0,03) and between CD27high/CD38high cells and Il17a producing cells (r=0.414, p=0.04); these correlations are more significant in JIA patients with a disease onset at a young age (age <6 years).ConclusionsThese preliminary results suggest that the analysis of collagen specific T cells repertoire, T and B cells subpopulations and HLA-DR haplotype can provide useful information to characterise peculiar details of each JIA patientReferences[1] Ravelli, Martini. Lancet2007.[2] Wedderburn LR, et al. Int immunol1999.[3] Di Sante, et al. Ebiomedicine2015.[4] Marasco E, et al. Arth Rheum2018.Disclosure of InterestNone declared