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these results may grant the rationale to evaluate this multi-drug combination in randomized phase III trials in advanced gastric cancer.

Macular degeneration is the leading cause of blindness in developed countries. In the treatment of neovascular age-related macular degeneration, vascular endothelial growth factor (VEGF) has emerged as a key target for therapy. The intravitreal injection of anti-VEGF drugs has been widely employed to reduce the disease progression and improve the visual outcomes of the affected patients. However, each intravitreal inoculation poses a risk of several complications as infection, inflammation, endophthalmitis, intraocular inflammation, increase of intraocular pressure and vitreous hemorrhage. This short review evaluates the efficacy and the incidence of adverse drug reactions related to intravitreal administration of the main anti-VEGF drugs actually available: Bevacizumab, ranibizumab and aflibercept.

Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

Purpose This phase II trial assessed the tolerability and eYcacy of a triplet of oxaliplatin, irinotecan, and Xuorouracil/folinic acid in advanced gastric cancer. Methods Patients with unresectable or metastatic gastric cancer, unexposed to palliative chemotherapy, received oxaliplatin 85 mg/m 2 iv and irinotecan 150 mg/m 2 iv on day 1, 6S-folinic acid 250 mg/m 2 iv and Xuorouracil 750 mg/m 2 iv on day 2, every 2 weeks. Response rate (RR) was assessed after a minimum of four cycles, and treatment continued up to 12 cycles. Results Sixty-three patients were treated, with a median of eight (range 1-12) cycles/patient. Two complete and 19 partial responses were registered (RR 33% [95% CI, 22-46%]). Median progression-free survival was 7.5 (95% CI, 5.6-9.4) months, and median overall survival was 12.1 (95% CI, 10.8-13.4) months. Most common grade ¸3 toxicities were neutropenia (59%), febrile neutropenia (7%), vomiting (20%), and diarrhoea (10%). All-grade neurotoxicity aVected 33% of patients. Conclusions Oxaliplatin, irinotecan, and Xuorouracil/folinic acid administered every 2 weeks are safe and active in advanced gastric cancer. Keywords

STARR performed for the treatment of hemorrhoidal disease associated with a large rectal prolapse is a safe and effective procedure. The use of the PPH-03 stapler instead of the PPH-01 guarantees a statistically significant reduction of intraoperative bleeding and a significant decrease of the operative time.

Early switching to de-intensified maintenance regimen is still a matter of debate in metastatic colorectal cancer (mCRC).The MARTHA trial, a S.I.C.O.G. phase III randomized trial, compared FOLOFIRI+bevacizumab (B) for 12 cycles (6 months) followed by B for up to 12 months (FOLFIRI +B*12 arm) vs FOLFIRI+B for 6 cycles (3 months) followed by capecitabine+B for 4 cycles followed by B for up to 12 months (FOLFIRI+B*6 arm). Chemotherapy-naïve mCRC patients were randomized, primary endpoint was progression free survival (PFS), with overall survival (OS) as a secondary endpoint. A novel analysis, the Death Pace Analysis (DPA), was performed to identify patients who benefited from a specific treatment.No PFS difference was seen in 198 enrolled patients (101 in FOLFIRI+B*12, 97 in FOLFIRI+B*6). A non-significant superior OS was observed for FOLFIRI+B*6 (HR 0.74, p 0.098). The DPA demonstrated that 14% of patients were identifiable as FOLFIRI+B*6-benefiting patients. According to a logistic regression analysis including 23 clinicopathological variables, baseline Hb was the only independent predictor of DPA-defined FOLFIRI+B*6-benefit status. Among patients with Hb ≤ 11.1 gr/dL a statistically significant prolonged OS was observed for FOLFIRI+B*6 over FOLFIRI+B*12 (median OS: 20.7 vs 12.6 months, respectively, HR 0.54, p 0.048). No survival difference was observed between arms in patients with Hb > 11.1.mCRC patients with low baseline Hb levels are better treated with FOLFIRI+B*6 first-line strategy. Possible biological explanations for this finding are being investigated.

Background: Suicide in depressed patients is a major health concern and has gained substantial attention in public health fields. However, the role of COPD, with or without lung cancer, in suicide attempts in patients with depression remains unknown. This study aimed to assess whether COPD and lung cancer precipitates suicide attempts. Methods: We identified 1397 depressed adolescents and adults with comorbid COPD alone or alongside lung cancer. Depression types were postpartum depression (n¼145), pre-menstrual dysphoric disorder (n¼196), bipolar disorder (n¼535), or major depression (n¼521). Patients were included from 2001 to 2016 from records in 116 major hospitals in Pakistan and Afghanistan. Patients were matched according to gender (587 males, 810 females) and age (11e72 years) with 6335 (control) patients with COPD without depression. The longitudinal cohort was observed until the end of 2015. Patients with other psychiatric comorbidities were excluded from the study. Findings: Patients with both COPD and lung cancer had a greater incidence of completed suicide than those with COPD alone (2.9% versus 0.9%, p¼0.006). After adjustment for psychiatric comorbidities, a Cox-regression analysis identified lung cancer as an independent risk factor for attempted suicide later in life among depressed COPD patients (hazard ratio 3.12, 95% CI 1.44e4.27). Interpretation: Adolescents and adults who had depression and went to develop COPD and lung cancer had an elevated risk of attempted suicide later in life compared to controls with only COPD. This is the first study to demonstrate an independent influence of COPD with or without lung cancer on attempted suicide. We have not assessed risk of suicide for other psychiatric comorbidities. Funding: None. Conflicts of interest: We declare that we have no conflicts of interest.