Main Recommendations
Patients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk ...stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent
Helicobacter pylori
gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up with a high quality endoscopy every 3 years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high quality endoscopic reassessment with CE is recommended. Patients with an endoscopically visible lesion harboring low or high grade dysplasia or carcinoma should undergo staging and treatment.
H. pylori
eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions, and it is recommended.
H. pylori
eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high risk regions, identification and surveillance of patients with precancerous gastric conditions is cost-effective.
•Chilling injury in zucchini fruit is associated with changes in cell wall metabolism.•Cold storage induces the solubilization and depolymerization of pectin.•Cold storage induces the activity of ...cell wall-modifying proteins.•The lignification process is related with the onset of CI in zucchini fruit.
Postharvest cold storage in zucchini fruit extends the commercial life but causes the appearance of chilling injury (CI), characterized by the development of pits and damaged areas at the surface of the fruit. This physiological disorder has been related to alterations of the cell wall metabolism in several fruit. We have analyzed the relationship between the development of CI and the changes that take place at the cell wall due to cold storage in zucchini fruit, as well as the effect of a preconditioning treatment on these changes. Microscopical observations have shown that the surface depressions detected in chilling injured fruit were caused by cell death and cell collapse. Low temperature induced the solubilization of the more soluble pectins, as evidenced by the highest levels of neutral sugars and uronic acids found in control fruit after the cold storage in water-soluble fraction (WSF) and CDTA-soluble fraction (CSF). The results obtained in Na2CO3-soluble fraction (NSF) for both parameters was opposite; higher levels were detected in preconditioned fruit and lower in more damaged fruit. The same behaviour was found in the base soluble hemicelluloses, 1M KOH- and 4M KOH-soluble fractions (1KSF and 4KSF), and in the insoluble cellulose content. Zucchini fruit stored at low temperature showed an increase of the enzymatic activities pectin methylesterase (PME), polygalacturonase (PG), and cellulase (CEL), and an accumulation of mRNA corresponding to a expansin (EXP) gene. Preconditioned fruit showed the lowest levels of these enzymatic activities. Microscopic analysis of CI fruit correlated with the biochemical changes observed in cell wall. Lignin content was higher in control than preconditioned fruit, suggesting a possible role of the lignification process in CI development in zucchini.
Immature, vegetable-like fruits are produced by crops of great economic importance, including cucumbers, zucchini, eggplants and bell peppers, among others. Because of their high respiration rates, ...associated with high rates of dehydration and metabolism, and their susceptibility to chilling injury (CI), vegetable fruits are highly perishable commodities, requiring particular storage conditions to avoid postharvest losses. This review focuses on the oxidative stress that affects the postharvest quality of vegetable fruits under chilling storage. We define the physiological and biochemical factors that are associated with the oxidative stress and the development of CI symptoms in these commodities, and discuss the different physical, chemical and biotechnological approaches that have been proposed to reduce oxidative stress while enhancing the chilling tolerance of vegetable fruits.
The Cerro del Almirez massif (Spain) represents a unique fragment of serpentinized oceanic lithosphere that has been first equilibrated in the antigorite stability field (Atg-serpentinites) and then ...dehydrated into chlorite–olivine–orthopyroxene (Chl-harzburgites) at eclogite facies conditions during subduction. The massif preserves a dehydration front between Atg-serpentinites and Chl-harzburgites. It constitutes a suitable place to study redox changes in serpentinites and the nature of the released fluids during their dehydration. Relative to abyssal serpentinites, Atg-serpentinites display a low Fe
3+
/Fe
Total(BR)
(=0.55) and magnetite modal content (=2.8–4.3 wt%). Micro-X-ray absorption near-edge structure (μ-XANES) spectroscopy measurements of serpentines at the Fe–K edge show that antigorite has a lower Fe
3+
/Fe
Total
ratio (=0.48) than oceanic lizardite/chrysotile assemblages. The onset of Atg-serpentinites dehydration is marked by the crystallization of a Fe
3+
-rich antigorite (Fe
3+
/Fe
Total
= 0.6–0.75) in equilibrium with secondary olivine and by a decrease in magnetite amount (=1.6–2.2 wt%). This suggests a preferential partitioning of Fe
3+
into serpentine rather than into olivine. The Atg-breakdown is marked by a decrease in Fe
3+
/Fe
Total(BR)
(=0.34–0.41), the crystallization of Fe
2+
-rich phases and the quasi-disappearance of magnetite (=0.6–1.4 wt.%). The observation of Fe
3+
-rich hematite and ilmenite intergrowths suggests that the O
2
released by the crystallization of Fe
2+
-rich phases could promote hematite crystallization and a subsequent increase in
f
o
2
inside the portion of the subducted mantle. Serpentinite dehydration could thus produce highly oxidized fluids in subduction zones and contribute to the oxidization of the sub-arc mantle wedge.
The COVID-19 pandemic is still raging across the world and vaccination is expected to lead us out of this pandemic. Although the efficacy of the vaccines is beyond doubt, safety still remains a ...concern.
We report a case of a 65-year-old woman who experienced acute severe autoimmune hepatitis two weeks after receiving the first dose of Moderna-COVID-19 vaccine. Serum immunoglobulin G was elevated and antinuclear antibody was positive (1:100, speckled pattern). Liver histology showed a marked expansion of the portal tracts, severe interface hepatitis and multiple confluent foci of lobular necrosis. She started treatment with prednisolone, with a favorable clinical and analytical evolution.
Some recent reports have been suggested that COVID-19 vaccination can lead to the development of autoimmune diseases. It is speculated that the vaccine can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Therefore, healthcare providers must remain vigilant during mass COVID-19 vaccination.
•A 65-year-old woman was diagnosed with autoimmune hepatitis after receiving the first dose of SARS-CoV-2 vaccine.•Liver histology showed inflammatory portal infiltrate with interface hepatitis, centrilobular inflammation and necrosis.•The patient showed improvement in liver function tests and normalization of IgG levels under treatment with corticosteroids.•Molecular mimicry is a potential mechanism for COVID-19 vaccine-induced autoimmunity.
(1) Background: This paper outlines the results of a literature review of meta-analyses published on motivation and evaluation in the last five years. (2) Methods: A systematic review of three ...educational databases (WoS, SCOPUS and ERIC) was conducted following the PRISMA and PICO approaches. A total of 54 peer-reviewed meta-analysis papers were selected, analysed and compared. (3) Results: A significant number and variety of meta-analyses have been conducted: motivation meta-analyses focus primarily on contextual variables, self-regulation and students’ academic performance, and evaluation meta-analyses examine the effectiveness of the teaching intervention, the use of teaching methodologies and technological resources for learning. (4) Conclusions: There are two important absences: on the one hand, it is necessary to develop meta-analyses that combine motivation and evaluation, also measuring their interaction, from the perspective of sustainability, and not only of educational improvement, and on the other hand, it is necessary to perform meta-analyses on the effectiveness of the formative and shared evaluation of the sustainability of learning processes.
Truncating pathogenic or likely pathogenic variants of CDH1 cause hereditary diffuse gastric cancer (HDGC), a tumour risk syndrome that predisposes carrier individuals to diffuse gastric and lobular ...breast cancer. Rare CDH1 missense variants are often classified as variants of unknown significance. We conducted a genotype–phenotype analysis in families carrying rare CDH1 variants, comparing cancer spectrum in carriers of pathogenic or likely pathogenic variants (PV/LPV; analysed jointly) or missense variants of unknown significance, assessing the frequency of families with lobular breast cancer among PV/LPV carrier families, and testing the performance of lobular breast cancer-expanded criteria for CDH1 testing.
This genotype-first study used retrospective diagnostic and clinical data from 854 carriers of 398 rare CDH1 variants and 1021 relatives, irrespective of HDGC clinical criteria, from 29 institutions in ten member-countries of the European Reference Network on Tumour Risk Syndromes (ERN GENTURIS). Data were collected from Oct 1, 2018, to Sept 20, 2022. Variants were classified by molecular type and clinical actionability with the American College of Medical Genetics and Association for Molecular Pathology CDH1 guidelines (version 2). Families were categorised by whether they fulfilled the 2015 and 2020 HDGC clinical criteria. Genotype–phenotype associations were analysed by Student's t test, Kruskal-Wallis, χ2, and multivariable logistic regression models. Performance of HDGC clinical criteria sets were assessed with an equivalence test and Youden index, and the areas under the receiver operating characteristic curves were compared by Z test.
From 1971 phenotypes (contributed by 854 probands and 1021 relatives aged 1–93 years), 460 had gastric and breast cancer histology available. CDH1 truncating PV/LPVs occurred in 176 (21%) of 854 families and missense variants of unknown significance in 169 (20%) families. Multivariable logistic regression comparing phenotypes occurring in families carrying PV/LPVs or missense variants of unknown significance showed that lobular breast cancer had the greatest positive association with the presence of PV/LPVs (odds ratio 12·39 95% CI 2·66–57·74, p=0·0014), followed by diffuse gastric cancer (8·00 2·18–29·39, p=0·0017) and gastric cancer (7·81 2·03–29·96, p=0·0027). 136 (77%) of 176 families carrying PV/LPVs fulfilled the 2015 HDGC criteria. Of the remaining 40 (23%) families, who did not fulfil the 2015 criteria, 11 fulfilled the 2020 HDGC criteria, and 18 had lobular breast cancer only or lobular breast cancer and gastric cancer, but did not meet the 2020 criteria. No specific CDH1 variant was found to predispose individuals specifically to lobular breast cancer, although 12 (7%) of 176 PV/LPV carrier families had lobular breast cancer only. Addition of three new lobular breast cancer-centred criteria improved testing sensitivity while retaining high specificity. The probability of finding CDH1 PV/LPVs in patients fulfilling the lobular breast cancer-expanded criteria, compared with the 2020 criteria, increased significantly (AUC 0·92 vs 0·88; Z score 3·54; p=0·0004).
CDH1 PV/LPVs were positively associated with HDGC-related phenotypes (lobular breast cancer, diffuse gastric cancer, and gastric cancer), and no evidence for a positive association with these phenotypes was found for CDH1 missense variants of unknown significance. CDH1 PV/LPVs occurred often in families with lobular breast cancer who did not fulfil the 2020 HDGC criteria, supporting the expansion of lobular breast cancer-centred criteria.
European Reference Network on Genetic Tumour Risk Syndromes, European Regional Development Fund, Fundação para a Ciência e a Tecnologia (Portugal), Cancer Research UK, and European Union's Horizon 2020 research and innovation programme.
What is known and objective
Tocilizumab is an IL‐6 receptor inhibitor agent which has been proposed as a candidate to stop the inflammatory phase of infection by the severe acute respiratory syndrome ...coronavirus‐2 (SARS‐CoV‐2). However, safety data of tocilizumab in pregnant women and their newborn are scarce. We aimed to describe maternal and neonatal safety outcomes associated with tocilizumab treatment in pregnant women with severe COVID‐19.
Methods
This is a retrospective study of severe COVID‐19 pregnant women, treated with tocilizumab in two Spanish hospitals between 1 March and 31 April 2020. Demographics, medical history, clinical and radiologic findings, treatment information and laboratory data of mothers and their newborns were collected from electronic medical records.
Results and discussion
A total of 12 pregnant women were identified to have received tocilizumab during pregnancy in the two hospitals. Median gestational age at admission was 27.7 weeks (interquartile range, 18.0–36.4). Most of them received lopinavir/ritonavir, azithromycin and hydroxychloroquine, two patients received corticosteroids and one received interferon beta 1B. All 12 pregnancies resulted in live births. Somatometric values were normal for all newborns, and evolution at 14 and 28 days was favourable for all of them. Hepatotoxicity was observed in 2 patients, which improved or resolved at discharge. Cytomegalovirus reactivation was detected in another patient who had also received corticosteroids for 15 days, causing a congenital infection in her newborn. Both hepatotoxicity and viral reactivation adverse events were classified as possibly related to tocilizumab administration according to Naranjo's causality algorithm.
What is new and conclusions
It does not appear that tocilizumab has detrimental effects for the mother and newborn. Close monitoring of infections should be considered, especially if other immunosuppressive agents are used.
Evolution of cytomegalovirus viral load and serology tests in one pregnant patient, in which viral reactivation was detected. She received a single dose of tocilizumab and methylprednisolone therapy for 15 days. Baseline IgM antibodies and amniotic fluid polymerase‐chain‐reaction were negative, but they became positive 6 days after tocilizumab infusion and viral load was detected on day 13.
Cuticle composition is an important economic trait in agriculture, as it is the first protective barrier of the plant against environmental conditions. The main goal of this work was to study the ...role of the cuticular wax in maintaining the postharvest quality of zucchini fruit, by comparing two commercial varieties with contrasting behavior against low temperatures; the cold-tolerant variety 'Natura', and the cold-sensitive 'Sinatra', as well as 'Sinatra' fruit with induced-chilling tolerance through a preconditioning treatment (15°C for 48 h). The freshly-harvested 'Natura' fruit had a well-detectable cuticle with a significant lower permeability and a subset of 15 up-regulated cuticle-related genes. SEM showed that zucchini epicuticular waxes mainly consisted of round-shaped crystals and clusters of them, and areas with more dense crystal deposition were found in fruit of 'Natura' and of preconditioned 'Sinatra'. The cuticular wax load per surface was higher in 'Natura' than in 'Sinatra' fruit at harvest and after 14 days at 4°C. In addition, total cuticular wax load only increased in 'Natura' and preconditioned 'Sinatra' fruit with cold storage. With respect to the chemical composition of the waxes, the most abundant components were alkanes, in both 'Natura' and 'Sinatra', with similar values at harvest. The total alkane content only increased in 'Natura' fruit and in the preconditioned 'Sinatra' fruit after cold storage, whereas the amount of total acids decreased, with the lowest values observed in the fruit that showed less chilling injury (CI) and weight loss. Two esters were detected, and their content also decreased with the storage in both varieties, with a greater reduction observed in the cold-tolerant variety in response to low temperature. Gene expression analysis showed significant differences between varieties, especially in
and
genes, involved in alkane production, as well as in the transcription factors
and
, associated with cuticle development and epidermal wax accumulation in other species. These results suggest an important role of the alkane biosynthetic pathway and cuticle morphology in maintaining the postharvest quality of zucchini fruit during the storage at low temperatures.
•GABA shunt participate in the adaptation of zucchini fruit to cold storage.•Putrescine treatment modulates antioxidant system in zucchini fruit.•Putrescine treatment induces accumulation of reducing ...sugars.
Zucchini fruit are marketed at an immature stage. Its subtropical origin makes zucchini fruit susceptible to chilling disorders when stored at low non-freezing temperatures. In this study, we have investigated the implication of treatment with putrescine (1mM), that improves cold storage resistance, on the antioxidant mechanisms and carbohydrate content, and its correlation with the mechanisms that alleviate cold stress in zucchini fruit. Fruit treated with putrescine exhibited higher ascorbate peroxidase, catalase and glutathione reductase activities, and contained higher amounts of ascorbate, FRAP, glucose, fructose and raffinose than control fruit during cold storage. Furthermore, the treatment with putrescine reduced lipoxygenase activity. Our results show that a putrescine treatment, that alleviates chilling injury, also modulates antioxidant system and carbohydrate content in zucchini fruit under cold stress. This response could be due to the degradation of putrescine, and the induction of the γ‐aminobutyric acid (GABA) shunt pathway.
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