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Background and Objectives: Hemolysis is reported to be present in up to 10% of blood gas specimens in the central lab; however, few data on the incidence of hemolysis using a point-of-care testing (POCT) blood gas analysis are available in the setting of the emergency department. The aims of this study were: (1) to analyze the prevalence of hemolysis in blood gas samples collected in the ED using a POCT device; and (2) to evaluate the impact of hemolysis on blood sample results and its clinical consequences. Materials and Methods: We collected 525 consecutive POCT arterial blood gas samples using syringes with electrolyte-balanced heparin within 3 different EDs in the metropolitan area of Rome. Immediately after the collection, the blood samples were checked for the presence of hemolysis with a POCT instrument (i.e., HEMCHECK, H-10 ®). The samples were then subsequently processed for blood gasses, and an electrolytes analysis by a second operator blinded for the hemolysis results. A venous blood sample was simultaneously collected, analyzed for it’s potassium value, and used as a reference. Results: Of the samples, 472 were considered for the statistics, while 53 were excluded due to the high percentage of hemolysis due to operator fault in carrying out the measurement. The final mean hemolysis per operator was 12% (±13% SD), and the total final hemolysis was 14.4%.Potassium (K+) was significantly higher in the hemolyzed group compared with the non-hemolyzed sample (4.60 ± 0.11 vs. 3.99 ± 0.03 mEq/L; p < 0.001), and there were differences between arterial potassium versus venous potassium (D(a-v) K+, 0.29 ± 0.06 vs.−0.19 ± 0.02 mEq/L, p < 0.01). A Bland–Altman analysis confirmed that hemolysis significantly overestimated blood potassium level. Conclusion: Almost 12% of POCT blood gas analysis samples performed in the ED could be hemolyzed, and the presence of this hemolysis is not routinely detected. This could cause an error in the interpretation of the results, leading to the consideration of potassium concentrations being below the lower limit within the normal limits and also leading to the diagnosis of false hyperkalemia, which would have potential clinical consequences in therapeutic decision-making in the ED. The routine use of a POCT hemolysis detector could help prevent any misdiagnoses.

The tumor, node, metastasis (TNM) system has become the principal method for assessing the extent of disease, determining prognosis in gastric cancer patients, and affecting the therapy strategies. The extent of lymph node metastasis is the most important prognostic factor. The aim of this study was to compare the N-classifications of the 4th and the 5th-6th TNM editions and to evaluate retrospectively the prognostic value of the 2002 TNM edition. We evaluated 344 patients who underwent curative total or subtotal gastrectomy. Nodal involvement was detected in 221 (64%) patients. Median follow-up period was 76 months. Thirty per cent of the old N1 patients were reclassified as pN2 (18.5%) and pN3 (11.3%). Eighty-eight per cent of the old N2 patients were reclassified as pN1 (75%) and pN3 (13.7%). In reclassifying the patients, statistically significant changes were reported between 1987 and 2002 TNM stage grouping, mainly in stage IIIB and IV. The 5-year survival rate per stage group did not statistically differ between the 4th and the 5th–6th editions, although a diminutive trend was registered in the IIIA stage. pTNM stage, nodal numerical stage, nodal topographical stage, and depth of tumor invasion resulted in significantly independent prognostic factors. Our data confirm the simplicity and easy application of the new stadiation and the better prognostic stratification of the N-stage. The pN3 group showed a worse prognosis independent of location. On the other hand, prognostic value of pN1 and pN2 stage is lower, probably depending on lymph node location. In multivariate analysis, the difference between old and new TNM staging is low. Hence, we suggest comparing lymph node location and number in larger series. In our series, in pT1 tumors, neither pN2 nor pN3 involvement was found. Hence, in our opinion, for correct N-staging, 10 lymph nodes in early gastric cancer and at least 16 in the other pT-stages seem sufficient for a real pN0 stadiation.

An esophagogastroscopy was performed and revealed a small ulcerative lesion of 1.5 cm; biopsies of this lesion were negative for neoplastic cells. Because of worsening anemia and signs and symptoms of high intestinal occlusion, the patient underwent laparotomy; the mass was found to originate from the gastric fundus, involving the body and the tail of the pancreas, without any sign of intra-abdominal or liver metastases. [...]oncological outcome was remarkable, because he is disease-free 3 years after surgery. [...]we advocate surgical resection of giant GIST, even in elderly patients with worsening conditions because of the tumor (in our case, anemia for intratumoral bleeding), to obtain complete tumor removal.

Conservative therapy, and endoscopic and radiologic treatment failed to stop the bleeding. [...]the patient underwent exploratory emergency laparotomy, which confirmed the CT finding of a large bleeding tumoral mass; a left upper abdominal exenteration (enbloc total gastrectomy, left nephroadrenalectomy, distal pancreatectomy, splenectomy, and resection of the left colic flexure) was performed. Histological examination of surgical specimen documented squamous cell carcinoma composed of sheets and irregular nests of large pleomorphic tumor cells with abundant cytoplasm, keratinization, with keratin pearl formation, intracellular bridges and multiple atypical mitoses (Fig. 1). Because pancreatic squamous cell carcinoma is an extremely rare subtype of pancreatic cancer, metastatic squamous cell cancer was considered and after the presence of a glandular component had been ruled out with multiple-cut specimen and several histologic techniques.4 No criteria exist for the cytologic distinction of metastatic from primary pancreatic squamous cell carcinoma.

[...]DNA analysis of the MLH1 gene was carried out to exclude the presence of Lynch syndrome.

Gastric cancer remains one of the most common human malignancies with a poor prognosis. Apoptosis is known to be a programmed cell death and its inhibition is involved in the unregulated cellular growth that leads to neoplasms. Microvessel density (MVD) has been investigated as a promoting factor for angiogenesis with conflicting results about its relation to survival. The aim of our study was to search a correlation between these factors and some clinicopathological features and prognosis. Identification of apoptotic cells was performed applying the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling technique and recorded as apoptotic index (A.I.), whereas monoclonal antibodies were used for the study of MVD. A significant correlation was found between low and high A.I. and the subgroup of patients in Stages I and II (P < 0.02); 20 per cent of patients with a low A.I. showed an overall survival longer than 5 years versus 44 per cent of patients with an high A.I. (P = 0.041). High MVD was significantly related to the T stage ( P = 0.036) and to a poorer 5-year overall survival (P < 0.05). Further studies are required to confirm the role of apoptosis and MVD in the development and progression of gastric cancer.

In a series of 4370 patients with gastric cancer, 5 per cent developed liver metastasis (synchronous and metachronous); among this group, only 10 per cent were resectable.2 Hepatic resection has been reported as effective therapy for metastatic colorectal cancer3 with a 5-year survival rate from 30 to 50 per cent.4 On the contrary, in the case of liver metastases for gastric cancer, also in the absence of incurable factors, the effectiveness of hepatic resection is still widely debatable because of the presence of the multiple bilobar metastases with a 5-year survival rate from 0 to 38 per cent.2-4 In the last years, many studies have reported a small select number of cases with long-term survival (3 to 17 years) after surgical treatment of synchronous and metachronous liver metastases from gastric cancer.1-4 The authors that reported cases of gastric cancer with synchronous liver metastases (as we showed in our article) recorded a long survival rate after hepatic curative resection for patients with an early gastric lesion or single liver metastases from 1.5 to 1.7 cm in maximum diameter.1 Moreover, some authors showed a 17-year survival rate after curative gastric and hepatic resection in a patient with single liver metastases 2 to 5 cm in diameter.4 The authors performed limited hepatic resection because of the number (solitary liver metastases) and the dimension of the lesion; they also reported cases with repeated hepatic resection that were disease-free at 5-year follow up.4 A multivariate analysis from Ueada et al. demonstrated that an RO minor liver resection for solitary and small (1.5 to 2.5 cm) repetitive lesions are independent prognostic factors in the surgical treatment for synchronous liver metastases from gastric cancer. 1 In another study, Sakamoto et al. found at multivariate analysis that the number (solitary or multiple) of hepatic lesions and the maximum tumor size (less than 5 cm or larger) were independent prognostic factors.2 In our case, the primitive gastric lesion was not an early tumor (pT2b) with pNO and the two synchronous hepatic lesions were 16 and 20 cm.

Gastroesophageal junction (GEJ) neoplasms have become more common over the past decade. Like mediastinal and abdominal lymph nodes and other gastric tumors, GEJ tumors spread to the retroperitoneal nodes. The TNM staging system does not consider this pattern and does not clinically distinguish GEJ tumors from gastric and esophageal cancers. The aim of the study is to compare the old and new TNM staging systems to assess whether the new TNM classifies lymph node involvement in these tumors as a prognostic factor. From January 1983 to December 1995, 438 patients underwent curative gastric resections for cancer at the Department of Surgery “P. Valdoni” of the University of Rome “La Sapienza.” Sixty-two had GEJ type II and III tumors according to the Siewert classification system. The old pN1 and new pN1 survival rates (P < 0.05) were statistically different; the old pN2 and new pN2 survival rates (P = 0.483) were not. The multivariate analysis of significant statistical prognostic factors showed that the pTNM staging in type II and type III GEJ tumors is the most important prognostic factor (P < 0.001), followed by the old pN and new pN (P < 0.001) and the pT (P < 0.005). Gender, age, Lauren type, and tumor location according to Siewert (II vs III) were not independently significant prognostic factors. This study concludes that the numbers and locations of metastatic lymph nodes are important prognostic factors that should be included in the next TNM edition.

While it is accepted that extracellular vesicles (EVs)-mediated transfer of microRNAs contributes to intercellular communication, the knowledge about molecular mechanisms controlling the selective and dynamic miRNA-loading in EVs is still limited to few specific RNA-binding proteins interacting with sequence determinants. Moreover, although mutagenesis analysis demonstrated the presence/function of specific intracellular retention motifs, the interacting protein/s remained unknown. Here, PCBP2 was identified as a direct interactor of an intracellular retention motif: CLIP coupled to RNA pull-down and proteomic analysis demonstrated that it binds to miRNAs embedding this motif and mutagenesis proved the binding specificity. Notably, PCBP2 binding requires SYNCRIP, a previously characterized miRNA EV-loader as indicated by SYNCRIP knock-down. SYNCRIP and PCBP2 may contemporarily bind to miRNAs as demonstrated by EMSA assays and PCBP2 knock-down causes EV loading of intracellular microRNAs. This evidence highlights that multiple proteins/miRNA interactions govern miRNA compartmentalization and identifies PCBP2 as a dominant inhibitor of SYNCRIP function in murine hepatocytes.