Publications by authors named "C Castoro"

141 Publications

MLH1 Deficiency Down-Regulates TLR4 Expression in Sporadic Colorectal Cancer.

Front Mol Biosci 2021 7;8:624873. Epub 2021 May 7.

Clinica Chirurgica I, Azienda Ospedaliera di Padova, Padua, Italy.

Patients with mismatch repair (MMR)-deficient colorectal cancer (CRC) have a more favorable prognosis than patients with tumors with intact MMR. In order to obtain further insights on the reasons for this different outcome, we investigated the interplay between MMR genes and TLR4/MyD88 signaling. The cancer genome atlas (TCGA) databases were selected to predict the differential expression of TLR4 in colon cancer and its correlation with MMR genes. Moreover, the expression of MMR genes and TLR4 was evaluated by immunohistochemistry in 113 CRC samples and a cohort of 63 patients was used to assess mRNA expression and epigenetic silencing status. , the effect of knockdown on expression was quantified by Real Time PCR. TLR4 expression resulted dependent on MMR status and directly correlated to MLH1 expression. , silencing decreased expression. These observations may reflect the better prognosis and the chemoresistance of patients with CRC and MMR defects.
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http://dx.doi.org/10.3389/fmolb.2021.624873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139190PMC
May 2021

Patient-reported outcomes after oesophagectomy in the multicentre LASER study.

Br J Surg 2021 May 11. Epub 2021 May 11.

Oesophago-gastric Centre, Churchill Hospital, University of Oxford, Oxford, UK.

Background: Data on the long-term symptom burden in patients surviving oesophageal cancer surgery are scarce. The aim of this study was to identify the most prevalent symptoms and their interactions with health-related quality of life.

Methods: This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery in 20 European centres between 2010 and 2016. Patients had to be disease-free for at least 1 year. They were asked to complete a 28-symptom questionnaire at a single time point, at least 1 year after surgery. Principal component analysis was used to assess for clustering and association of symptoms. Risk factors associated with the development of severe symptoms were identified by multivariable logistic regression models.

Results: Of 1081 invited patients, 876 (81.0 per cent) responded. Symptoms in the preceding 6 months associated with previous surgery were experienced by 586 patients (66.9 per cent). The most common severe symptoms included reduced energy or activity tolerance (30.7 per cent), feeling of early fullness after eating (30.0 per cent), tiredness (28.7 per cent), and heartburn/acid or bile regurgitation (19.6 per cent). Clustering analysis showed that symptoms clustered into six domains: lethargy, musculoskeletal pain, dumping, lower gastrointestinal symptoms, regurgitation/reflux, and swallowing/conduit problems; the latter two were the most closely associated. Surgical approach, neoadjuvant therapy, patient age, and sex were factors associated with severe symptoms.

Conclusion: A long-term symptom burden is common after oesophageal cancer surgery.
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http://dx.doi.org/10.1093/bjs/znab124DOI Listing
May 2021

Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry.

Surg Endosc 2021 Jan 25. Epub 2021 Jan 25.

Ospedale di Vaio, Fidenza, Italy.

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry.

Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications.

Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not.

Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
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http://dx.doi.org/10.1007/s00464-020-08234-8DOI Listing
January 2021

Identifying medical professionals at risk for in-hospital COVID-19 infection: a snapshot during a "tsunami" highlighting unexpected risks.

Glob Health Med 2020 Aug;2(4):235-239

Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy.

The aim of this study was to profile healthcare professionals (HCPs) who infected with COVID-19 in hospital while working in a COVID-19 hub hospital during the pandemic. A questionnaire was sent to all HCPs from whom nasopharyngeal swabs (NPS) were collected. The type of work, work environment, individual characteristics, and modality of infection were analyzed. Working areas were categorized into COVID-free areas (wards and ICUs for patients without COVID-19, medical offices, and hospitality counters) and COVID+ areas (dedicated wards and the ICU for patients with COVID-19). From March 1 to 20, 2020, 302 HCPs were tested: 251 (83.1%) responded to the questionnaire, but 9 were excluded since infection occurred outside the hospital. The remaining 242 subjects included 53 (21.9%) with positive NPS and 189 (78.1%) with negative NPS, significant differences in NPS results were evident depending on the subject's role ( = 0.028). Pairwise post hoc analysis revealed that surgeons had a significantly increased rate of positive NPS ( = 0.001). Of the 189 subjects with negative NPS, 175 (92.6%) worked in COVID-free areas, and 14 (7.4%) in COVID+ areas. Of the 53 subjects with positive NPS, 44 (83.1%) worked in COVID-free areas and 9 (16.9%) worked in COVID+ areas. Medical offices featuring an open space with adjacent desks were identified as areas of higher risk. An apparent cause of infection could not be identified in 21 (39.6%) subjects with positive NPS. Among a total of 251 subjects, 80 (41.5%) of the 193 subjects with negative NPS and 16 (27.6%) of the 58 subjects with positive NPS had been vaccinated against the common flu. In conclusion, the vast majority of subjects with positive NPS came from COVID-free areas. The source of infection could not be identified in a significant portion of subjects with positive NPS. Personnel need better protection, more testing with NPS needs to be performed, and workplace layouts need to be re-thought. Vaccination against the flu seems to provide some protection.
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http://dx.doi.org/10.35772/ghm.2020.01052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731090PMC
August 2020

Endoscopic ultrasound-guided gastro-enteric anastomosis in the COVID era: May the pandemic emphasize the benefit?

Dig Liver Dis 2021 Jan 7;53(1):8-10. Epub 2020 Oct 7.

Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.dld.2020.09.014DOI Listing
January 2021