Incidence, risk factors and clinical implications of venous thromboembolism in cancer patients treated within the context of phase I studies: the 'SENDO experience'

BACKGROUND

To investigate the incidence, risk factors and clinical implications of venous thromboembolism (VTE) in advanced cancer patients treated in phase I studies.

PATIENTS AND METHODS

Patients enrolled and treated in phase I studies conducted by SENDO (Southern Europe New Drugs Organization) Foundation between 2000 and 2010 in 15 experimental centers were considered for the study. Clinical data, including adverse events, were prospectively collected during the studies and retrospectively pooled for VTE analysis.

RESULTS

Data of 1415 patients were considered for analysis. Five hundred and twenty-six (37.2%) patients were males, and median age was 57.3 years (range: 13-85). Eighty-five percent of patients had metastatic disease, while the remaining had locally advanced irresectable disease. For 706 (49.9%) of the patients, the study treatment was with cytotoxic agent(s) only, for 314 with target therapy(ies) only, while the remaining patients received a target therapy in combination with a cytotoxic drug. Fifty-six (3.96%) patients who developed a VTE, almost all (89.3%) during the course of treatment, the remaining during the follow-up. At univariate analysis, the Khorana score, the combination of an antiangiogenic agent with a cytotoxic drug, and the time from first cancer diagnosis to study entry (as continuous variable) were associated with a statistically significant increase of VTE occurrence. The multivariate analysis confirmed only a statistically significant association for the Khorana score. The hazard ratio of VTE occurrence was 7.88 [95% confidence interval (CI) 2.86-21.70) and 2.74 (95% CI 1.27-5.92) times higher for the highest (≥3) and intermediate (1-2) scores as compared with score = 0.

CONCLUSIONS

VTE is a relatively common complication among patients treated in the context of phase I studies. The Khorana score predicts VTE development and can be used to identify patients at high of VTE.

Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country

Screening scales can be useful in searching for common mental disorders in primary care and in tracking relevant prevalence and correlates in community surveys. However, it is important to document their validity, before using them. We developed Italian versions of the widely-used K10 and K6 screening scales following the WHO forward-translation and back-translation protocol. To evaluate their effectiveness as screens for DSM-IV 12-month mood or anxiety disorders and "serious mental illness" (SMI), the scales were validated in a two-stage clinical reappraisal survey. In the first-phase, the scales were administered to 605 people. In the second-phase, a sub-sample of 147 first-phase respondents over-sampling screened positives was administered the 12-month version of the Structured Clinical Interview for DSM-IV Axis I Disorders as a clinical gold standard. Performance of the scales in screening for chosen disorders was assessed by calculating area under the receiver operating characteristic curve and stratum-specific likelihood ratios. Both the K10 and K6 performed well in detecting DSM-IV mood disorders, anxiety disorders, and serious mental illness (SMI), with areas under the curve (AUCs) (95% CIs) between 0.82 (0.75-0.89) and 0.91 (0.85-0.96). The Italian versions of the K6 and K10 scales have good psychometric properties, making them attractive inexpensive screens for mood disorders, anxiety disorders, and SMI.

[General practitioners and colorectal cancer screening: experience in the Trentino region]

The aims of this longitudinal study are to investigate general practitioners' opinions and knowledge about colorectal cancer screening in Trentino region, to identify their role and level of participation within the screening program and to find out their formative needs. 174 general practitioners answered the postal self-filled questionnaire: 82% of them asserted their main role in colorectal screening is patient counselling, but many physicians also showed availability to collaborate with the Centre for Health Services of Trento in organizing patients recruitment list and in recovering patients who didn't accept screening invitation. 78% thinks the Health Services of Trento should allocate incentives, especially push money, to promote physicians participation in screening program. Moreover 68% needs a basic formative course about screening programme. Female general practitioners are more prepared to collaborate in organizing patients recruitment list and in handing over the kit for fecal occult blood test than their male colleagues. Instead men prefer to take an active role in counselling and are more interested in economic incentives. The study has found considerable general practitioners support for the introduction of the new screening programme. The info-formative line to improve in Trentino could create a better interface between general practitioners and Centre for Health Services, keeping into account the organizing features of physicians. It seems to be important the definition of shared procedures for the counselling and the requirement of formative courses by general practitioners; the Centre for Health Services of Trento has already undertaken these courses disguised as seminars addressed all health operators.

Hawking radiation from ultrashort laser pulse filaments

Event horizons of astrophysical black holes and gravitational analogues have been predicted to excite the quantum vacuum and give rise to the emission of quanta, known as Hawking radiation. We experimentally create such a gravitational analogue using ultrashort laser pulse filaments and our measurements demonstrate a spontaneous emission of photons that confirms theoretical predictions.

[Violence in psychiatric inpatients]

AIM

To evaluate knowledges about violence acted by psychiatric in-patients.

METHODS

We selected inherent articles classified as useful to our purpose encoded in PubMed in the last 5 years, not neglecting previous but equally valid for a more precise and complete reasoning EBM Literature.

RESULTS

Risk factors for violent acts are: previous acts history, male sex and young age, alcohol and drug abuse/dependence, lack of insight, anger management problems, impulsivity discontrol and ostility at admission. Most of the acts are classified as impulsive and so schizophrenic spectrum whether in presence of productive symptoms, personality disorders and manic episodes are the most involved psychiatric pathology. Clinical experience evaluating behaviour at risk as threatening or provoking acts towards patients or clinical staff and the identification of personal history features (in particular if detected at admission) should lead to the classification of patients into risk groups for acting violence during hospitalization.

CONCLUSIONS

Good clinical practice aimed at violent acts reduction and possible prevention into clinical environment couldn't leave aside a precise known risk factors identification and the observation and constant monitorization of patients behaviour predictive of a possible act.

Space-time focusing of Bessel-like pulses

We report on a space-time compression technique allowing for complete and independent control of the longitudinal dynamics and of the transverse pulse localization by means of spatial beam shaping. We experimentally observe both strong temporal compression and high transverse localization, of the order of a few wavelengths, along free-space propagation.

Long-term balancing selection maintains trans-specific polymorphisms in the human TRIM5 gene

The human TRIM5 genes encodes a retroviral restriction factor (TRIM5α). Evolutionary analyses of this gene in mammals have revealed a complex and multifaceted scenario, suggesting that TRIM5 has been the target of exceptionally strong selective pressures, possibly exerted by recurrent waves of retroviral infections. TRIM5 displays inter-individual expression variability in humans and high levels of TRIM5 mRNA have been associated with a reduced risk of HIV-1 infection. We resequenced TRIM5 in chimpanzees and identified two polymorphisms in intron 1 that are shared with humans. Analysis of the gene region encompassing the two trans-specific variants in human populations identified exceptional nucleotide diversity levels and an excess of polymorphism compared to fixed divergence. Most tests rejected the null hypothesis of neutral evolution for this region and haplotype analysis revealed the presence of two deeply separated clades. Calculation of the time to the most recent common ancestor (TMRCA) for TRIM5 haplotypes yielded estimates ranging between 4 and 7 million years. Overall, these data indicate that long-term balancing selection, an extremely rare process outside MHC genes, has maintained trans-specific polymorphisms in the first intron of TRIM5. Bioinformatic analyses indicated that variants in intron 1 may affect transcription factor-binding sites and, therefore, TRIM5 transcriptional activity. Data herein confirm an extremely complex evolutionary history of TRIM5 genes in primates and open the possibility that regulatory variants in the gene modulate the susceptibility to HIV-1.

Severe hemophilia with mild bleeding phenotype: molecular characterization and global coagulation profile

BACKGROUND

Patients with severe hemophilia may show very varied bleeding tendencies, and the reasons for this heterogeneous clinical expression are unclear. The factor VIII/FIX genotype is the main determinant of the residual factor activity; however, different bleeding phenotypes have also been reported in patients sharing the same mutation. Such global coagulation tests as thrombin generation assays are tools with which to investigate different coagulation profiles among severe hemophiliacs.

OBJECTIVES, PATIENTS AND METHODS

This case-control study was aimed at comprehensively evaluating the role of genotype and endogenous thrombin potential (ETP) as predictors of the clinical phenotype in severe hemophiliacs with an extremely mild bleeding tendency (cases, n = 22), in comparison with those showing a typical bleeding tendency (controls, n = 50).

RESULTS

Cases were more frequently affected by hemophilia B than by hemophilia A, and showed a lower incidence of severe FVIII/FIX gene defects (referred to as null mutations), higher FVIII and FIX antigen levels and higher ETP values in platelet-rich plasma than controls (P < 0.05). By multivariate logistic regression, only non-null mutations were confirmed as an independent predictor of a mild clinical phenotype.

CONCLUSIONS

These results indicate that non-null mutations represent the main determinant of the bleeding tendency, and that ETP measurement in platelet-rich plasma is able to identify severe hemophiliacs with a mild clinical phenotype.

HLA-A*01 is associated with late onset of Alzheimer's disease in Italian patients

In this study, the distribution of HLA-A alleles was analyzed in Italian Alzheimer's Disease (AD)patients. Interaction between HLA alleles, APOE genotypes, age of onset, and gender were also analyzed. The results were compared to those obtained in healthy controls (HC). One hundred-seventy-three AD patients and 258 age-and-sex-matched healthy controls were enrolled in the study. AD patients were classified according to age at the onset of disease using quartiles of the distribution. HLA-A genotyping was performed by PCR-SSP; APOE genotyping was performed by RFLP. A correlation between late disease onset and HLA-A*01 was observed. Thus, HLA-A*01, calculated as number of alleles, was significantly more present in patients with age of onset > 74.0 years than in HC (20% vs 10.5%; p=0.014); the distribution of this allele was skewed also in patients 68.1-74 years of age (16.3%), even if the difference did not reach statistical significance. The relative risk ratio (RRR) of AD onset calculated by a multinomial logistic regression adjusted for sex and presence of APOE-4 confirmed a significant association of HLA-A*01 with AD onset > 74.0 years of age (RRR=2.2; 95%CI: 1.1-4.6; p=0.033). A high RRR (2.04) was also present in patients 68.1-74 years (p=0.064). Lower age of disease onset did not correlate with HLA-A*01. Data herein suggest that the presence of HLA-A*01 results in delayed AD development, even in patients carrying APOE-4. These results could offer new insights into the etiopathogenesis of Alzheimer's disease.

Relationship between psychoncology and psychoneuroendocrinoimmunology (PNEI): enhanced T-regulatory lymphocyte activity in cancer patients with self-punishement, evaluated by Rorschach test

BACKGROUND

Psychological studies have documented the presence of a self-punishment profile in cancer patients. Recent immuno-oncological studies have shown that within the group of CD4(+) cells, which play a fundamental role in the generation of anticancer immunity, there is a subtype of cells that in contrast mediates the suppression of the anticancer immunity, the so-called T-regulatory cells (T-reg), which may be identified as CD4(+)CD25(+) cells.

PATIENTS AND METHODS

On this basis, we performed a psychoncological study to evaluate CD4(+)CD25(+) cell numbers in relation to the response to Rorschach's test in a group of 30 cancer patients suffering from the most frequent tumor histotypes.

RESULTS

Normal values obtained in our laboratory (95% confidence limits) of T-reg lymphocytes and CD4(+)/CD4(+)CD25(+) were <240/mm(3) and >4mm(3), respectively. The psychological profile of self-punishment was found in 18/30 patients (60%). The percentage of patients with abnormally high CD4(+)CD25(+) values observed in the group with self-punishment was significantly higher than that found in patients without self punishment (11/18 vs. 3/12 (25%), p<0.05). In the same way, the percentage of patients with abnormally low CD4(+)/CD4(+)CD25(+) ratios was significantly higher in the group with self-punishment (16/18 vs. 4/12, p<0.01). The mean numbers of T-reg lymphocytes observed in the group with self-punishment was significantly higher than that found in patients who had no self-punishment (314+/-39 vs. 173+/-27, p<0.05). In addition, the mean CD4(+)/ CD4(+)CD25(+) ratio was significantly lower in patients with self-punishment than in the other group (2.6+/-0.2 vs. 5.2+/-0.8, p<0.025). On the contrary, no significant difference was seen in the mean number of CD4(+) lymphocytes.

CONCLUSION

The study suggests that self-punishment may inhibit the generation of an effective anticancer immune response by stimulating the activation and proliferation of T-reg lymphocytes, which in turn stimulate tumor dissemination by suppressing anticancer immunity. The abnormally high number of T-reg lymphocytes in patients with self-punishment would suggest a specific immune alteration, as suggested by the evidence of a normal profile for other immune parameters, such as total CD4(+) lymphocytes.

BDNF Val66Met polymorphism is associated with cognitive impairment in Italian patients with Parkinson's disease

BACKGROUND AND PURPOSE

A possible association between Parkinson's disease (PD) and the polymorphism of Brain Derived Neurotrophic Factor (BDNF) G196A (Val66Met) has been suggested by different studies that nevertheless yielded-contrasting result. The purpose of this study was to analyze such possible association in a cohort of Italian PD patients.

METHODS

The BDNF polymorphisms were analyzed in 294 Italian patients with PD; results were compared to those obtained in 233 age- and sex-matched healthy controls (HC) enrolled from two tertiary centres in Italy. Polymorphisms were determined by Restriction Fragment Length Polymorphism (RFLP) analysis; correlations between BDNF G196A polymorphism, and cognitive function were established by sub analyzing the results upon dividing PD patients based on their Mini Mental State Examination (MMSE) score.

RESULTS

Univariate analysis showed a highly significant correlation between the BDNF(AA) genotype and a MMSE score < or =24. Hence, the distribution of this genotype in PD individuals with a MMSE score < or =24 was significantly increased compared to PD patients with an MMSE score >24 and HC (P < 0.001 in both cases). Multivariate analyses showed that BDNF (AA) genotype was associated to a sixfold risk of cognitive impairment.

CONCLUSIONS

The BDNF(AA) homozygote genotype is over-represented in PD patients compared with normal individuals; this genotype was significantly correlated to cognitive impairment, age and disease severity. These results, although preliminary, could be important in establishing novel diagnostic and therapeutic approaches to PD.

Spatiotemporal amplitude and phase retrieval of Bessel-X pulses using a Hartmann-Shack sensor

We propose a new experimental technique, which allows for a complete characterization of ultrashort optical pulses both in space and in time. Combining the well-known Frequency-Resolved-Optical-Gating technique for the retrieval of the temporal profile of the pulse with a measurement of the near-field made with an Hartmann-Shack sensor, we are able to retrieve the spatiotemporal amplitude and phase profile of a Bessel-X pulse. By following the pulse evolution along the propagation direction we highlight the superluminal propagation of the pulse peak.

Immunomodulatory effects of 1,25-dihydroxyvitamin D3 on TH1/TH2 cytokines in inflammatory bowel disease: an in vitro study

Crohn's disease (CD) is associated with a higher type-1-helper T cell (Th1) cytokine expression, whereas ulcerative colitis (UC) appears to express a modified Th2 response. In addition to its classic role in calcium homeostasis, calcitriol, the hormonal active form of vitamin D, exerts immunoregulatory effects such as modulation of Th1/Th2 cytokines. Therefore, calcitriol administration could modify immune dysfunction in CD and UC. Nine patients with UC (M/F: 5/4; mean age 47 years, remission(R)/active(A) disease: 7/2), 8 patients with CD (M/F: 2/6; mean age 36, R/A 5/3) and 6 healthy controls (HC) (M/F: 3/3, mean age 4) were enrolled. Peripheral blood was collected after a drug-washout of 15 days and peripheral blood mononuclear cells were stimulated with mitogens alone or in the presence of physiological concentrations of calcitriol (100 pg/ml). Type 1 (IL-2, TNF-alpha, IFN-gamma) and type 2 (IL-10) cytokine production was assayed on supernatants by ELISA. Compared to HC, TNF-alpha production was significantly higher both in UC (p=0.0002) and CD (p=0.0001) patients, at baseline and after incubation with calcitriol (UC p=0.0003, CD p=0.0009). The effects of calcitriol incubation were: 1) reduced IFN-gamma (p=0.024) and increased IL-10 (p=0.06) production in UC patients; 2) reduced TNF-alpha production in CD (p=0.032); 3) no significant effects in HC. Calcitriol increased, albeit not significantly, IL-10 production in UC compared to CD patients (p=0.09). These results suggest an important modulatory role of vitamin D in the Th1/Th2 immune response. The observation that the effect of this modulation was different in CD compared to UC patients provides an interesting area of research into the pathogenesis and treatment of these inflammatory conditions.

Immune modulation by lactoferrin and curcumin in children with recurrent respiratory infections

The clinical and immunologic effects of lactoferrin and curcumin (LC) oral supplementation were examined in healthy children with recurrent respiratory tract infections. Infections were reduced in children receiving LC. Immunologic analyses showed that LC supplementation resulted in a significant skewing of CD8+T lymphocytes maturation. Additionally: 1) CD14+, toll like receptor (TLR) 2-expressing cells augmented (p= 0.005) whereas CD14+/TLR4+ diminished (p= 0.004); and 2) IL10 production by CD14+ cells was reduced in children receiving LC. LC supplementation results in immune modulation and could be clinically beneficial.