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The aim of this study is to investigate the prognostic role of body mass index (BMI) and survival from head and neck cancer (HNC). We performed a pooled analysis of studies included in the International Head and Neck Cancer Epidemiology consortium in order to investigate the prognostic role of BMI and survival from HNC. We used Cox proportional hazards models to estimate the adjusted hazard ratios (HR) for overall survival and HNC-specific survival, by cancer site. The study included 10,177 patients from 10 studies worldwide. Underweight patients had lower overall survival (HR = 1.69, 95%CI: 1.31–2.19) respect to those having normal weight with consistent results across the HNC sites. Overweight and obese patients with oropharyngeal cancers had a favourable HNC-specific survival (HR = 0.50 (95%CI: 0.33–0.75) and HR = 0.51 (95%CI: 0.36–0.72), respectively). Among ever smokers overweight and obese patients showed a favourable HNC-specific survival (HR = 0.69 (95%CI: 0.56–0.86) and HR = 0.70 (95%CI: 0.61–0.80)). Our findings show that high BMI values at cancer diagnosis predict the survival rates in smoking patients with HNC. This association may be explained by residual confounding, reverse causation, and collider stratification bias, but may also suggest that a nutritional reserve may help patients survive HNC cancer.

Purpose During the early weeks of life optimization of nutrition in extremely preterm infants presents a critical opportunity to attenuate the adverse neurologic consequences of prematurity and potentially improve neurodevelopmental outcome. We hypothesized that the use of multicomponent lipid emulsion (MLE) in PN would be related to larger volume of the cerebellum on brain magnetic resonance at term of equivalent age (TEA) in extremely low birthweight (ELBW) infants. Methods We analyzed the brain Magnetic Resonance Imaging (MRI) at TEA of a cohort of preterm infants with gestational age (GA) ≤28 weeks and/or birthweight (BW) Results MRIs at TEA of 34 infants were then analyzed: 17 in the MLE group and17 in the SLE group. The postmenstrual age (PMA) at which MRIs were performed were comparable between the two study groups. The CeV, as well as the PMA-corrected CeV, were significantly higher in the MLE group than in the SLE group. No difference was found among the other brain volumes considered. Conclusion Our results suggest that the use of MLE in PN could promote CeV growth in ELBW infants, valued with MRI at TEA.

Background Mechanical ventilation is still needed in most preterm newborns, even in the non-invasive ventilation era. Ventilator-induced lung injury is one of the known pathogenetic factors of bronchopulmonary dysplasia (BPD) in preterm newborns. Lung injury has several patterns including surfactant dysfunction. Some recent trials have showed that a late surfactant administration can improve respiratory outcome in preterm babies still on invasive ventilation after the first week of life. Unfortunately, these results are still not conclusive. Moreover, giving surfactant after a recruitment manoeuvre in High Frequency Oscillatory Ventilation (HFOV) was shown to be safe and to reduce mortality in extremely preterm infants in a recent RCT. Our aim is to test the hypothesis that endotracheal administration of poractant-alfa preceded by a recruitment manoeuvre in HFOV in preterm infants still requiring mechanical ventilation at 7-10 days of life could facilitate extubation. Methods/Design: This will be an unblinded monocentric pilot trial that will be conducted in a III level Neonatal Intensive Care Unit at Fondazione Policlinico Agostino Gemelli IRCCS in Rome - Italy. Preterm newborns with a gestational age < 28 weeks still requiring invasive mechanical ventilation at 7-10 days of life with a fraction of inspired oxygen (FiO2) of more than 0.30 and/or an oxygenation index of 8 or more for at least 6 hours will be eligible for the study. Patients will be randomly assigned to intervention or to standard care. Intervention group infants will receive up to 4 doses of Poractant-alfa every 12 hours, each dose preceded by a recruitment manoeuvre in HFOV, until extubation. Primary endpoint will be the first successful extubation. Discussion Surfactant therapy is nowadays recommended in case of RDS in the first days of life but little is known about its effects in ventilator-dependant preterm newborns. Late administration of surfactant could help healing the lung of preterm babies in which RDS is evolving in a chronic pulmonary insufficiency of prematurity. The findings of this pilot trial will permit evaluation of the study design for a full-scale RCT. Trial registration: Clinicaltrials.gov – ID NCT04825197. Registered 12 April 2021, https://clinicaltrials.gov/ct2/home

Background: Nitrous oxide is widely used to induce sedation; however, its use outside of operating rooms – such as in ambulatory rooms – is not properly controlled by norms. In the lack of supervision, there is a chance of workplace exposures for the operators engaged in the outpatient use of nitrous oxide. The aim of this research is to assess nitrous oxide exposure in gastroenterology outpatient settings. Methods: We performed an observational study with a first step marked by nitrous oxide environmental testing in a gastroenterology outpatient care where colonoscopies were practiced; environmental research was supported by biological monitoring with urinary N2O analysis in exposed operators. The research was conducted in the absence and then in the presence of a collective security device (Niki mask). Results: The study was rolled out in 10 sessions of day shift procedures, totaling 4105 samples. The average nitrous oxide concentration in the environment was 27.58 (SD 1.76) and 449.59 (SD 35.29), respectively with and without Niki Mask; the distribution of gases in the environment under investigation was not homogeneous (Anova test p.001). Biological testing revealed a substantial rise in urinary concentration of 8.97 (p.001) between the start and the end of the shift, and the use of the Niki mask was effective (p=.003). Conclusions: The exposure levels reported in environmental sampling exceed the limits of 50 ppm (the value set for operating rooms in Italy) as well as the value of 25 ppm (NIOSH threshold value), indicating a significant issue in the outpatient use of nitrous oxide. It is evident that technical measures are needed to contain the occupational risk from Nitrous oxide exposure outside of operating rooms, and that even the basic use of Niki masks would not be sufficient to minimize professional exposure and protect workers; for the exposure results detected in this research, it is also plain that exposures must be subject to health surveillance.

Background Physical activity (PA) has been recognized as a protective factor against several types of cancer, though robust evidence related to Gastric Cancer (GC) are lacking. This study aimed to establish whether leisure-time PA can prevent GC using data from a large pooled analysis of case-control studies within the Stomach cancer Pooling (StoP) Project.Methods Five case-control studies from StoP project collected data on PA, for a total of 2,415 cases and 9,722 controls. Subjects were classified into three leisure-time PA categories, either none/low, intermediate or high, based on study-specific tertiles. We used a two-stage approach. Firstly, we applied multivariable logistic regression models to obtain study-specific odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Afterwards, we used a random-effect models for estimating pooled effect estimates. Heterogeneity across studies was assessed using Q and I 2 statistics. We performed stratified analyses according to demographic, lifestyle and clinical covariates.Results The pooled ORs for GC risk were 0.90 (95% CI: 0.72, 1.13) for intermediate, and 0.72 (95% CI: 0.57, 0.91) for high levels of leisure-time PA. There was no evidence of significant heterogeneity in outcome estimates ( I 2 = 49.7%; p=0.094 for intermediate; I 2 = 42.9%, p=0.135 for high levels of exposure). GC risk estimates did not differ across strata of selected covariates.Conclusions Our study is the largest pooled analysis that provides insights about protective effects of high levels of recreational PA on GC risk. Although our results should be confirmed from large cohort studies, the implications have relevant public health significance.