The KEAP1/Nrf2 pathway is a master regulator of several redox-sensitive genes implicated in resistance of tumor cells against chemotherapeutic drugs. Recent data suggest that epigenetic mechanisms may play a pivotal role in the regulation of KEAP1 expression. We performed a comprehensive genetic and epigenetic analysis of the KEAP1 gene in 47 non-small cell lung cancer tissues and normal specimens. Promoter methylation analysis was performed using a quantitative methylation specific PCR assay in real time. Methylation at the KEAP1 promoter region was detected in 22 out of the 47 NSCLCs (47%) and in none of the normal tissues analyzed. Somatic mutations were detected in 7 out of the 47 tumors (15%) and loss of heterozygosity (LOH) in 10 out of the 47 (21%) of the cases. Overall, we found at least one molecular alteration in 57% of the cases. Approximately one third of the tumors had two alterations and this feature was associated with higher risk of disease progression in univariate COX regression analysis (HR = 3.62; 95% CI 1.24-10.65, p = 0.02). This result was confirmed by Kaplan-Meier analysis, which demonstrated an association between worst outcome and KEAP1 double alterations (p = 0.01, Log rank test). Our results further suggest that deregulation of the NRF2/KEAP1 system could play a pivotal role in the cancerogenesis of NSCLC. In addition identifying patients with KEAP1 genetic and epigenetic abnormalities may contribute to disease progression prediction and response to therapy in lung cancer patients.

The Enhanced Recovery After Surgery (ERAS) is a model of care introduced in 1997 by a group of general surgeons from Northern Europe led by Henrik Kehlet. The core of this approach is to produce improvements in surgical patient outcomes, especially in the reduction of hospital stay, complications rate, early recovery and reduction of economic burdens. Simply elaborating and establishing a protocol is not enough and much more efforts and changes are needed to achieve the aim to offer a sustainable improvement in the overall quality of patient care, therefore, ERAS is not a single and rigid protocol but is a method, a "modus operandi", a new way of multidisciplinary teamwork with readiness to make changes as knowledge evolves, i.e., a revolution of medical-scientific thought: we have to move from the concept of "management of disease" to that of "health promotion".

We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and leg pain. 33 patients complaining of leg and low back pain underwent percutaneous tests of SCS. 28 patients had failed back surgery syndromes, 1 patient had pain related to an L1 vertebral body fracture, another from Tarlow cysts and the remaining 3 patients had lumbosacral spondyloarthrosis and osteoporosis without radiological signs of root compression. 28 patients showed mono- or pluriradicular deficits. At the end of the test period (5–65 days), 21 patients (63.6%) reported more than 50% of pain relief (mean analgesia 75%) and were submitted to chronic stimulation. The mean follow-up was 45.5 months. At maximum available follow-up, 40% of the patients (13 out of the 33 initial patients) were successfully using the stimulator (mean analgesia 66.6%).

The ectopic or accessory liver lobe is an uncommon congenital anatomic abnormality. It is considered to be the outcome of an abnormal development of liver tissue during embryologic period. In some cases, it may be secondary to a trauma or a surgical operation. Literature reports only anecdotal cases; there are not series. The most common localization is the abdominal cavity, but very rarely it can also be found in the thoracic cavity. In most cases, preoperative correct diagnosis is very difficult because it is unlikely to consider this rare condition in course of differential diagnosis. Most cases are misdiagnosed, and patients undergo surgical intervention with suspect of lung lesion. Some times the intrathoracic accessory lobe is an intraoperative incidental finding. In this report, we present the case of a young female patient who underwent surgical treatment for a suspect pulmonary lesion that at histological examination resulted to be an intrathoracic accessory hepatic lobe.