Gender oncology: recommendations and consensus of the Italian Association of Medical Oncology (AIOM)

BACKGROUND

Following the development of gender medicine in the past 20 years, more recently in the field of oncology an increasing amount of evidence suggests gender differences in the epidemiology of cancers, as well as in the response and toxicity associated with therapies. In a gender approach, critical issues related to sexual and gender minority (SGM) populations must also be considered.

MATERIALS AND METHODS

A working group of opinion leaders approved by the Italian Association of Medical Oncology (AIOM) has been set up with the aim of drafting a shared document on gender oncology. Through the 'consensus conference' method of the RAND/University of California Los Angeles (UCLA) variant, the members of the group evaluated statements partly from the scientific literature and partly produced by the experts themselves [good practice points (GPPs)], on the following topics: (i) Healthcare organisation, (ii) Therapy, (iii) Host factors, (iv) Cancer biology, and (v) Communication and social interventions. Finally, in support of each specific topic, they considered it appropriate to present some successful case studies.

RESULTS

A total of 42 articles met the inclusion criteria, from which 50 recommendations were extracted. Panel participants were given the opportunity to propose additional evidence from studies not included in the research results, from which 32 statements were extracted, and to make recommendations not derived from literature such as GPPs, four of which have been developed. After an evaluation of relevance by the panel, it was found that 81 recommendations scored >7, while 3 scored between 4 and 6.9, and 2 scored below 4.

CONCLUSIONS

This consensus and the document compiled thereafter represent an attempt to evaluate the available scientific evidence on the theme of gender oncology and to suggest standard criteria both for scientific research and for the care of patients in clinical practice that should take gender into account.

Etiology, presentation and management of urinary tract infections in multiple sclerosis patients: A review of the current literature

Urinary tract infections (UTIs) present a formidable challenge in the care of individuals affected by multiple sclerosis (MS). Lower urinary tract dysfunction is a prevalent issue among MS patients, predisposing them to an elevated risk of UTIs. When left untreated, UTIs can further exacerbate the already compromised quality of life in individuals with MS. The diagnosis and management of UTIs in MS patients necessitate a careful clinical evaluation. The objective of this review is to delineate preventive strategies and current and developing therapeutic approaches for preventing and treating UTIs associated with urinary dysfunction, catheterization, and upper urinary tract infections in patients with MS. Effectively addressing UTIs and urinary tract dysfunction in individuals with multiple sclerosis calls for a comprehensive, interdisciplinary approach.

Robustness analysis of surface-guided DIBH left breast radiotherapy: personalized dosimetric effect of real intrafractional motion within the beam gating thresholds

PURPOSE

The robustness of surface-guided (SG) deep-inspiration breath-hold (DIBH) radiotherapy (RT) for left breast cancer was evaluated by investigating any potential dosimetric effects due to the residual intrafractional motion allowed by the selected beam gating thresholds. The potential reduction of DIBH benefits in terms of organs at risk (OARs) sparing and target coverage was evaluated for conformational (3DCRT) and intensity-modulated radiation therapy (IMRT) techniques.

METHODS

A total of 192 fractions of SGRT DIBH left breast 3DCRT treatment for 12 patients were analyzed. For each fraction, the average of the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift") during beam-on was evaluated and applied to the original plan isocenter. The dose distribution for the treatment beams with the new isocenter point was then calculated and the total plan dose distribution was obtained by summing the estimated perturbed dose for each fraction. Then, for each patient, the original plan and the perturbed one were compared by means of Wilcoxon test for target coverage and OAR dose-volume histogram (DVH) metrics. A global plan quality score was calculated to assess the overall plan robustness against intrafractional motion of both 3DCRT and IMRT techniques.

RESULTS

Target coverage and OAR DVH metrics did not show significant variations between the original and the perturbed plan for the IMRT techniques. 3DCRT plans showed significant variations for the left descending coronary artery (LAD) and the humerus only. However, none of the dose metrics exceeded the mandatory dose constraints for any of the analyzed plans. The global plan quality analysis indicated that both 3DCRT and IMRT techniques were affected by the isocenter shifts in the same way and, generally, the residual isocenter shifts more likely tend to worsen the plan in all cases.

CONCLUSION

The DIBH technique proved to be robust against residual intrafractional isocenter shifts allowed by the selected SGRT beam-hold thresholds. Small-volume OARs located near high dose gradients showed significant marginal deteriorations in the perturbed plans with the 3DCRT technique only. Global plan quality was mainly influenced by patient anatomy and treatment beam geometry rather than the technique adopted.

Temporal Structures in Positron Spectra and Charge-Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic positron fluxes in the rigidity range from 1.00 to 41.9 GV based on 3.4×10^{6} positrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The positron fluxes show distinctly different time variations from the electron fluxes at short and long timescales. A hysteresis between the electron fluxes and the positron fluxes is observed with a significance greater than 5σ at rigidities below 8.5 GV. On the contrary, the positron fluxes and the proton fluxes show similar time variation. Remarkably, we found that positron fluxes are modulated more than proton fluxes with a significance greater than 5σ for rigidities below 7 GV. These continuous daily positron fluxes, together with AMS daily electron, proton, and helium fluxes over an 11-year solar cycle, provide unique input to the understanding of both the charge-sign and mass dependencies of cosmic rays in the heliosphere.

EURADOS ISO/IEC 17025 guidance for IMS: suggestions on how to interpret and implement the requirements including examples from accredited laboratories

Individual monitoring of external radiation is an activity usually regulated by national regulatory bodies in most countries. Regulations generally contain technical requirements to be met by the individual monitoring services (IMS), in order to ensure that the measurements are correct and therefore the dosimetry results are reliable. In some countries, the requirements include or even consist of the accreditation of the service according to the standard ISO/IEC 17025: 'General requirements for the competence of testing and calibration laboratories.' It is a fact that accreditation is a growing trend among European IMS as a way to guarantee confidence in their technical competence. The acceptance of the dosimetry results between countries and their indentation in the respective National Dose Registries is facilitated if laboratories conform to the ISO/IEC 17025 standard. In the framework of the activities of EURADOS (European Radiation Dosimetry Group) working group 2 'Harmonization of Individual Monitoring in Europe' and attending to the concern of many European IMS in the process of accreditation, a guide has been prepared. The purpose was to assist and encourage IMS to apply for accreditation and to share the authors' own experience with the process. The guide intends to be a practical reference for IMS on how to interpret and implement the ISO/IEC 17025 requirements to the specific activity of a personal dosimetry service for external radiation, emphasizing those aspects of special interest. It includes examples from dosimetry laboratories already accredited. The major novelties from a new edition of ISO/IEC 17025: 2017 are also identified in the guide. Finally, the guide aims to assist the auditing process, giving examples of auditor's questions and how to show evidence of compliance. The main findings are presented.

Built-in tensile strain dependence on the lateral size of monolayer MoS2 synthesized by liquid precursor chemical vapor deposition

Strain engineering is an efficient tool to tune and tailor the electrical and optical properties of 2D materials. The built-in strain can be tuned during the synthesis process of a two-dimensional semiconductor, such as molybdenum disulfide, by employing different growth substrates with peculiar thermal properties. In this work, we demonstrate that the built-in strain of MoS2 monolayers, grown on a SiO2/Si substrate by liquid precursor chemical vapor deposition, is mainly dependent on the size of the monolayer. In fact, we identify a critical size equal to 20 μm, from which the built-in strain increases drastically. The built-in strain is the maximum for a 60 μm sized monolayer, leading to 1.2% tensile strain with a partial release of strain close to the monolayer triangular vertexes due to the formation of nanocracks. These findings also imply that the standard method for evaluation of the number of layers based on the Raman mode separation can become unreliable for highly strained monolayers with a lateral size above 20 μm.

A retrospective study on bone metastasis in dogs with advanced-stage solid cancer

OBJECTIVES

To review clinical characteristics, treatment, outcome and prognostic factors in dogs with solid cancer-bearing bone metastases.

MATERIALS AND METHODS

Records were reviewed from dogs with histologically-proven solid cancer and bone metastases. Clinicopathologic variables, bone metastases characteristics and skeletal-related events were recorded. Endpoints were time to bone metastases and survival.

RESULTS

Fifty dogs were included, 20 of them with synchronous and 30 of them with metachronous bone metastases. In the latter group, median time to diagnosis of bone metastases was 210 days (range, 30 to 1835). Most common primary cancer locations included mammary gland (n=6), spleen (n=5) and tonsil (n=5). Most common histotypes were carcinoma (n=32) and hemangiosarcoma (n=10). Nineteen dogs had multiple bones involvement, with humeri and vertebrae more commonly affected. Twenty-four dogs received antitumoural therapy, five symptomatic treatment and 21 were not treated. Overall median survival after bone metastases diagnosis was 30 days (range, 11 to 49); 83% of dogs died because of skeletal-related events. Lack of antitumoural therapy was significantly associated with shorter survival (hazard ratio: 2.7; 95% confidence interval: 1.3 to 5.6) and with increased risk of skeletal-related death (hazard ratio: 3.3; 95% confidence interval: 1.4 to 7.4). Dogs with endocrine/neuroendocrine tumours (odds ratio: 8.8; 95% confidence interval: 1.2 to 63.9), without appendicular metastases (odds ratio: 5.1; 95% confidence interval: 1.0 to 25.8), without extra-skeletal metastases (odds ratio: 5.2; 95% confidence interval: 1.1 to 24.5) and receiving antitumoural therapy (odds ratio: 14.8; 95% confidence interval: 1.7 to 131.4) had an increased chance of surviving more than 100 days.

CLINICAL SIGNIFICANCE

Bone metastases in dogs with solid cancers are associated with poor prognosis and a high risk of skeletal-related events. Treatment appears to have an impact on survival.

CT features of gastrointestinal spindle cell, epithelial, and round cell tumors in 41 dogs

There is sparse published information on computed tomographic (CT) characteristics of canine gastrointestinal tumors. The purposes of this multi-center, retrospective, descriptive study were to describe the CT features of histologically-confirmed canine gastrointestinal spindle cell, epithelial, and round cell tumors and, when available, describe the corresponding ultrasound findings. The inclusion criteria were as follows: availability of pre-and post-contrast CT study, and a histopathological diagnosis of the lesions. Recorded parameters were tumor size, location, gastrointestinal wall layers involvement, lesion's growth and enhancement patterns, tumor margination, presence of stenosis, mineralization, ulcerations, lymphadenopathy, or other lesions in the abdomen/thorax. When available, ultrasound images were evaluated. Forty-one dogs met the inclusion criteria and had the following histological diagnoses: 21/41 (51%) spindle cells (7 leiomyomas, 14 leiomyosarcomas/gastrointestinal stromal tumors (GISTs)), 13/41 (32%) epithelial (adenocarcinoma), and 7/41 (17%) round cell (lymphoma) tumors. The growth pattern was concentric, eccentric, and mixed in epithelial, spindle cell, and round cell tumors, respectively. Spindle cell tumors had the largest main volume and involved the outer gastrointestinal layer with an unaffected inner layer. Leiomyosarcomas/GISTs showed irregular margins compared to leiomyomas. Only lymphomas showed multifocal gastrointestinal involvement. Nine carcinomas and six spindle cell tumors caused partial stenosis with secondary sub-obstruction. Mineralizations were more frequent in spindle cell tumors (10/21) and absent in lymphomas. Lymphadenomegaly was widespread in lymphomas, regional in leiomyosarcomas-GISTs and adenocarcinomas, and absent in leiomyomas. The reported CT features may be useful in prioritizing the differential diagnosis between spindle cell, epithelial, and round cell tumors, similar to those reported on ultrasound.

Atrial fibrillation: Epigenetic aspects and role of sodium-glucose cotransporter 2 inhibitors

Atrial fibrillation (AF) is the most frequent arrhythmia and is associated with substantial morbidity and mortality. Pathophysiological aspects consist in the activation of pro-fibrotic signaling and Ca²⁺ handling abnormalities at atrial level. Structural and electrical remodeling creates a substrate for AF by triggering conduction abnormalities and cardiac arrhythmias. The care of AF patients focuses predominantly on anticoagulation, symptoms control and the management of risk factors and comorbidities. The goal of AF therapy points to restore sinus rhythm, re-establish atrioventricular synchrony and improve atrial contribution to the stroke volume. New layer of information to better comprehend AF pathophysiology, and identify targets for novel pharmacological interventions consists of the epigenetic phenomena including, among others, DNA methylation, histone modifications and noncoding RNAs. Moreover, the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in diabetic and non-diabetic patients at cardiovascular risk as well as emerging evidence on the ability of SGLT2i to modify epigenetic signature in cardiovascular diseases provide a solid background to investigate a possible role of this drug class in the onset and progression of AF. In this review, following a summary of pathophysiology and management, epigenetic mechanisms in AF and the potential of sodium-glucose SGLT2i in AF patients are discussed.

Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability

PURPOSE

To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold - DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability.

METHODS

An SGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift"). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. A total of 24 patients, 12 treated with a tangential technique and 12 with a locoregional technique, were evaluated for a total number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated.

RESULTS

Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with a null shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample.

CONCLUSION

Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.

Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures

PURPOSE

This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures.

METHODS

The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear.

RESULTS

The surgeon most exposed eye lens median H_p(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy.

CONCLUSIONS

In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.

Interaction of methyl-jasmonate and Fusarium poae in bread wheat

Fusarium Head Blight (FHB) is a devastating disease that affects the grain yield and quality of essential crops such as wheat. In the last years, some Fusarium species have acquired particular importance as Fusarium poae. However, studies to evaluate F. poae-wheat interaction are still scarce. The interaction between F. poae and two bread wheat cultivars with different resistance levels against FHB was evaluated. Moreover, the application of methyl-jasmonate (MeJA) was evaluated as a possible tool to reduce the fungal presence. Our results showed that the MeJA treatment is isolate-dependent, reducing F. poae fungal growth. A decrease in fungal biomass was observed in the susceptible cultivar after MeJA application; however, no differences between inoculated and inoculated-MeJA treatments were observed in the resistant cultivar. Finally, the F. poae inoculation induces the expression of PR1-1 and PDF 1.2, being early in the resistant cultivar compared to the susceptible ones. The application of MeJA combined with the F. poae inoculation increased PR1-1 and PDF1.2 expressions in resistant cultivars. To our knowledge, this is the first study that evaluates the interaction between F. poae and wheat and the MeJA treatment as a possible management strategy against this important pathogen.

Integrated monitoring of AMR and enterotoxins genes of S. aureus isolated in Lombardy

Background

S. aureus is a widespread pathogen responsible for mild to severe human and animals’ infections. The abuse of antimicrobials provides the potential for selection of resistant strains in livestock, which represents a public health concern. S. aureus can carry several virulence factors of which staphylococcal enterotoxins (SEs) play a key role during food poisoning in human populations. The aim of this study is to monitor the prevalence of antimicrobial resistance factors in S. aureus isolates and their ability to produce enterotoxins.

Methods

Within an ongoing monitoring plan for the assessment of antimicrobial resistance in S. aureus strains, a total of 83 isolates collected from food, and swine and dairy farms, between 2020-2022, were characterized using MLST and then screened for the presence of methicillin resistance and SEs genes. The isolates were tested for susceptibility to a panel of 14 antimicrobial agents using the disc agar diffusion method on Mueller-Hinton agar.

Results

Among 83 S. aureus isolates, 53% carried at least one SEs gene. Eighteen isolates were methicillin-resistant of which 17 were no-enterotoxigenic strains belonging to ST398, and one was a food origin ST8 strain and harbored SEs genes. Among the ST398 isolates, only one was a food origin strain, while the others were from swine farms. The antibiogram showed that a few isolates were susceptible to nalidixic acid, and 42% resulted multidrug-resistant.

Conclusions

Our results showed that more than half of S. aureus isolates were enterotoxigenic, the majority belonging to food industries. Numerous tested isolates resulted multidrug-resistant, confirming that antimicrobial resistance is a critical public health threat in a food safety perspective.

Key messages

• The antimicrobial resistance profiles of S. aureus isolates underlines the importance of monitoring plans with a One Health perspective.

• The prevalence of enterotoxins genes in S. aureus strains in Lombardy confirms the relevance of the microorganism as a foodborne pathogen.

Stranded pellets in Fildes Peninsula (King George Island, Antarctica): New evidence of Southern Ocean connectivity

Plastic and microplastic debris is transported by ocean currents over long distances, reaching remote areas, far from its original source. In Polar Regions, microplastics (MPs) can come from local activities or be transported from lower latitudes, with the former being the likely and major source. Although historically Antarctica was considered isolated from the global ocean, there is recent evidence of materials and organisms being transported in and out of the Southern Ocean, despite its multi-front structure. During the austral summer of 2019, beach surveys were conducted on the NW coast of the Fildes Peninsula (King George Island). The beach was characterised, and the first 2 cm of sediment from 5 quadrants (50 × 50 cm) along 100 m of the highest strandline were collected. Large microplastics (LMPs) and mesoplastics (MesoPs) were isolated, counted, measured, weighed and classified by shape. Polymer composition was analysed by FTIR and ageing estimated by Carbonyl Index. We found 293 items of LMPs (188 items) and MesoPs (105 items), with a total average density (±SD) of 234.4 ± 166 items m^-2. Foams (130.4 ± 76.3), fragments (58.4 ± 56.0) and pellets (44.0 ± 50.5) were the most abundant shapes. The main polymers found were polystyrene, polypropylene, and polyethylene. We found pellets among the MesoPs, being the first record for beaches in Antarctica. The presence of these primary MPs south of 62°S not only alerts about their possible direct consequences on Antarctic ecosystems, but also gives empirical evidence for the passive entry of plastic debris from lower latitudes through cross-frontal exchanges, providing new evidence of a global connectivity of the Southern Ocean. Despite increasing research, knowledge of plastics dynamics and their impact in the Southern Ocean and Antarctica is still limited but certainly necessary.

Impact of new operational dosimetric quantities on individual monitoring services

The new operational dosimetric quantities framework, proposed in the ICRU95 report, has stimulated the scientific community to start investigations that aim to assess its impact on radiation protection practices. As part of this effort, the present study describes an inter-comparison exercise among individual monitoring services (IMSs) on passive whole-body dosimetry. The inter-comparison is performed in terms of both the existing operational dose quantityHp(10)and its proposed replacementHp, to allow an evaluation of the actions that may be necessary to adapt dosimetry systems to the proposed quantity. For two of the tested IMSs, simple modifications to the detector response function, or the dose calculation algorithm, were sufficient to obtain results within acceptable limits. However, these approaches are not sufficient to give a level of performance comparable to that achieved in terms ofHp(10). This may require a modification to dosemeter design.

Molecular detection of HEV in domestic pigs in Italy from Abruzzo and Molise regions

Background

Hepatitis E virus (HEV) is a zoonotic pathogen transmitted through the faecal-oral route and it is responsible of disease in humans with more than 21.000 cases reported in the European Union (EU) over the last decade. It is a non-enveloped single stranded RNA virus that includes 8 genotypes; among these, genotypes 3 and 4 (HEV-3 and HEV-4) are the most prevalent in developed countries and infect both humans and some animal species such as domestic pigs. In this study, we investigated the prevalence of HEV in domestic pigs bred in Italy, in Abruzzo and Molise regions.

Methods

During the period October 2020-March 2021, 327 liver samples from individual pigs were analysed. In particular, 211 were collected in 1 slaughterhouse and originated from animals bred in Abruzzo in 8 different farms and 116 were collected in 7 slaughterhouses and originated from animals bred in Molise in 47 farms. The real time retro-transcriptase (RT)-polymerase chain reaction (PCR) technique was used to detect HEV by targeting the open reading frame (ORF) 3 region of the viral ribonucleic acid (RNA).

Results

None of the samples deriving from pigs bred in Abruzzo tested positive for the detection of HEV RNA. Instead, 4 samples from pigs bred in 2 different farms in Molise tested positive, showing a prevalence of 3.45%.

Conclusions

Pigs are considered important reservoirs for HEV virus. For this reason, it is opportune to investigate the role of these animals for better understanding their involvement in the human infection through the consumption of contaminated raw or undercooked pork-meat products. These findings need to be further investigated with in depth genomic characterization of positive RNA samples to highlight the role of the specific strains circulating in this region and to draw conclusions about connections between animals, potential contaminated food and human disease.

Key messages

The study paved the way for defining the role of pigs in the transmission of HEV virus to humans through the consumption of pork meat products. This study reports the prevalence of HEV in domestic pigs of Abruzzo and Molise regions, two Italian regions.

Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study

BACKGROUND

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality.

AIM

To analyse an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward.

METHODS

A case-control study was conducted. Cases were identified through routine surveillance culture and real-time polymerase chain reaction for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization.

FINDINGS

CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which seven (46.7%) were in the urinary tract; among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, retransplantation, urological surgical reintervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months.

CONCLUSION

KT recipients remain colonized by CRPA for long periods and could be a source of nosocomial outbreaks. In addition, a high proportion of such patients develop infection. During an outbreak, urine culture should be added to the screening protocol for KT recipients.

Effectiveness and safety of 1L PEG-ASC preparation for colonoscopy in patients with inflammatory bowel diseases

INTRODUCTION

The effectiveness of bowel cleansing is a key element for high-quality colonoscopy. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced, but effectiveness and safety of this preparation have not been assessed in IBD patients. This study aims to evaluate effectiveness and safety of 1 L PEG-ASC solution in patients with IBD compared to controls.

METHODS

We retrospectively analysed prospectively collected data on a cohort of 411 patients performing a colonoscopy after preparation with 1 L PEG-ASC, consecutively enrolled in 5 Italian centres.

RESULTS

Overall, 185/411 (45%) were patients with IBD and 226/411 (55%) served as controls. A significantly higher cleansing success was achieved in IBD patients (92.9% vs 85.4%, p = 0.02). The multiple regression model showed that presence of IBD (OR=2.514, 95%CI=1.165-5.426; P = 0.019), lower age (OR=0.981, 95%CI=0.967-0.996; P = 0.014), split preparation (OR=2.430, 95%CI=1.076-5.492; P = 0.033), absence of diabetes (OR=2.848, 95%CI=1.228-6.605; P = 0.015), and of chronic constipation (OR=3.350, 95%CI=1.429-7.852; P = 0.005), were independently associated with cleansing success. The number of treatment-emergent adverse events (TEAEs) (51 vs 62%, p = 0.821), and of patients with TEAEs (22.2% vs 21.2%, p = 0.821), were similar in IBD patients and in controls, respectively.

CONCLUSIONS

Results from this study support the effectiveness and safety of 1 L PEG-ASC solution in IBD patients, which may improve the definition of endoscopic outcomes both in Crohn's disease and ulcerative colitis.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students

INTRODUCTION

Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students.

METHODS

A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded.

RESULTS

Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest.

CONCLUSIONS

The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

Gold nanoparticle assisted synthesis of MoS2 monolayers by chemical vapor deposition

The use of metal nanoparticles is an established paradigm for the synthesis of semiconducting one-dimensional nanostructures. In this work we study their effect on the synthesis of two-dimensional semiconducting materials, by using gold nanoparticles for chemical vapor deposition growth of two-dimensional molybdenum disulfide (MoS₂). In comparison with the standard method, the employment of gold nanoparticles allows us to obtain large monolayer MoS₂ flakes, up to 20 μm in lateral size, even if they are affected by the localized overgrowth of MoS₂ bilayer and trilayer islands. Important modifications of the optical and electronic properties of MoS₂ triangular domains are reported, where the photoluminescence intensity of the A exciton is strongly quenched and a shift to a positive threshold voltage in back-gated field effect transistors is observed. These results indicate that the use of gold nanoparticles influences the flake growth and properties, indicating a method for possible localized synthesis of two-dimensional materials, improving the lateral size of monolayers and modifying their properties.

Ocrelizumab in a case of refractory chronic inflammatory demyelinating polyneuropathy with anti-rituximab antibodies

Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has demonstrated good efficacy as treatment in patients with resistant chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but it is highly immunogenic due to its structure. Ocrelizumab (OCR) is a humanized anti-CD20 antibody, with higher tolerability and a lower immunogenic profile compared to RTX. We present a case of refractory CIDP effectively treated with OCR, switched from RTX after the development of anti-drug antibodies. A 25-year-old man was admitted to our clinic for the onset of distal upper and lower limb weakness and numbness, with electrodiagnostic criteria of CIDP. After several attempted standard CIDP treatments, RTX was introduced due to poor control of clinical relapses. Unfortunately, the patient developed a high anti-drug antibody titer after RTX infusion, with no control of disease. OCR was started as an off-label treatment, resulting in partial recovery from the last recurrence and achieving good prevention of new relapses with no adverse events. We suggest that OCR should be considered as another therapeutic option in refractory CIDP. In the literature, this is the first case of CIDP treated with OCR, demonstrating good efficacy for its anti-CD20 effect and better tolerability because of its lower immunogenicity.

Acute toxic exposures in children: analysis of a three year registry managed by a Pediatric poison control Center in Italy

Introduction

Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry.

Methods

This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group “P”), or who presented to the Emergency Department (group “ED”), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for “P”, and hospital admission for “ED”group).

Results

We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission.

Conclusions

Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.

Pain distraction during awake low anterior resection and Cuddle Delivery initiative for inpatient: frugal procedural options to support surgery in the COVID-19 era

OBJECTIVE

Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients.

PATIENTS AND METHODS

A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital.

RESULTS

Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life.

CONCLUSIONS

During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach.

Improved experimental evaluation and model validation of a 252Cf irradiator for delayed gamma-ray spectrometry applications

We present experimental and MCNP modeled results of neutron flux monitoring in an irradiator, which consists of a²⁵²Cf sealed source housed in the center of a cubic block of high-density polyethylene. This work is contributing to our development in the delayed gamma-ray spectroscopy non-destructive assay technique for nuclear safeguards and security applications. We evaluated the thermal and resonance flux values using the Westcott foil activation method for two measurement position count rates of ¹⁹⁷Au and ¹¹⁵In. Comparisons between the calculated thermal fluxes from measurements and those from MCNP models show deviations of ~20%. However, both the measured and modeled thermal fluxes are two orders of magnitude higher than the fluxes at the resonance peak energies at both measurement positions, demonstrating that the irradiator is sufficient. Furthermore, this work showed that with a²⁵²Cf sealed source of a strength of 4.4 × 10⁶ n.s^-1, a thermal flux in the range 2-5 × 10⁴ n.s^-1.cm^-2 is achievable in our compact irradiator making it suitable for active analysis techniques such as DGS.

Deterministic synthesis of Cu9S5 flakes assisted by single-layer graphene arrays

The employment of two-dimensional materials, as growth substrates or buffer layers, enables the epitaxial growth of layered materials with different crystalline symmetries with a preferential crystalline orientation and the synthesis of heterostructures with a large lattice constant mismatch. In this work, we employ single crystalline graphene to modify the sulfurization dynamics of copper foil for the deterministic synthesis of large-area Cu₉S₅ crystals. Molecular dynamics simulations using the Reax force-field are used to mimic the sulfurization process of a series of different atomistic systems specifically built to understand the role of graphene during the sulphur atom attack over the Cu(111) surface. Cu₉S₅ flakes show a flat morphology with an average lateral size of hundreds of micrometers. Cu₉S₅ presents a direct band-gap of 2.5 eV evaluated with light absorption and light emission spectroscopies. Electrical characterization shows that the Cu₉S₅ crystals present high p-type doping with a hole mobility of 2 cm² V^-1 s^-1.

Evaluating the plasmon-exciton interaction in ZnO tetrapods coupled with gold nanostructures by nanoscale cathodoluminescence

Plasmon-exciton coupling is gaining increasing interest for enhancing the performance of optoelectronic, photonic and photo-catalytic devices. Herein we evaluate the interaction of excitons in zinc oxide tetrapods with surface plasmons of gold nanostructures with different morphologies. The gold nanostructures are grown in situ on ZnO tetrapods by means of a photochemical process, resulting in clean interfaces. The modification of the synthesis parameters results in different morphologies, as isolated nanoparticles, nano-domes or nanoparticles aggregates. Plasmon-exciton interaction is evaluated by means of cathodoluminescence spectroscopy and mapping at the nanoscale. The ZnO excitonic emission is strongly blue-shifted and broadened in close proximity of the gold nanostructures. This effect is explained by the formation of a Schottky barrier that is strongly mediated by the morphology of metal nanostructures.

Fluoroquinolone treatment as a protective factor for 10-day mortality in Streptococcus pneumoniae bacteremia in cancer patients

To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains. We evaluated the episodes in patients admitted to a cancer hospital between 2009 and 2015. The outcomes were defined as 48 h mortality and mortality within 10 days after the episode. The variables evaluated were: age, sex, ethnicity, ECOG, Karnofsky score, SOFA, cancer type, metastasis, chemotherapy, radiotherapy, neutropenia, previous antibiotic therapy, community or healthcare-acquired infection, comorbidities, smoking, pneumococcal vaccination, infection site, presence of fever, polymicrobial infection, antimicrobial susceptibility, serotype and treatment. 165 episodes were detected in 161 patients. The mean age was 61.3 years; solid tumors were the most prevalent (75%). 48 h and 10-day mortality were 21% (34/161) and 43% (70/161) respectively. The 48 h mortality- associated risk factors were SOFA and polymicrobial bacteremia; 10-day mortality-associated risk factors were fever, neutropenia, ECOG 3/4, SOFA and fluoroquinolones as a protective factor. Pneumococcal bacteremia presented high mortality in cancer patients, with prognosis related to intrinsic host factors and infection episodes features. Fluoroquinolone treatment, a protective factor in 10-day mortality, has potential use for IPDs and severe community-acquired pneumonia in cancer patients.

Methylation of the hippo signalling effector YAP by SETD7 drives myocardial ischemic injury

Introduction

Myocardial ischemia/reperfusion (I/R) injury is one of the most deleterious cardiovascular conditions and a leading cause of mortality. The Hippo pathway effector YAP critically regulates cardiomyocyte proliferation and survival during myocardial I/R injury. However, the mechanisms regulating YAP activation in this setting remain poorly understood. Post-translational modifications of proteins, namely methylation, modulate pathways implicated in myocardial I/R injury. The methyltransferase SETD7 is emerging as a regulator of cell survival via methylation of histone and non-histone proteins. Whether SETD7 participates to myocardial I/R injury remains elusive.

Purpose

To investigate the role of SETD7 in regulating Hippo signaling during myocardial I/R injury.

Methods

Neonatal rat ventricular myocytes (NRVM) were exposed to normal glucose levels or glucose deprivation (GD) for 15 h, in the presence of the selective SETD7 inhibitor [(R)-PFI-2] or its inactive enantiomer [(S)-PFI-2]. Western blot and real time PCR were employed to investigate the effects of energy stress on SETD7 and the Hippo pathway, while apoptosis was assessed by Caspase-3 activity assay. YAP activity was assessed through chromatin immunoprecipitation assay (ChIP), its localization was examined by confocal microscopy while mono-methylation was assessed by immunoblotting. SETD7 knockout (SETD7−/−) mice and wild-type (WT) littermates (male, 8–12 weeks old) underwent 1 h of left anterior descending (LAD) coronary artery ligation followed by 24 h of reperfusion. Infarct size was assessed by TTC staining and shown as infarct size per ventricle surface (I/V). Cardiac function was investigated at 24h by conventional and Tissue Doppler Imaging (TDI) echocardiography.

Results

GD in NRVMs led to upregulation of SETD7 and physical interaction with the pro-survival transcriptional cofactor YAP, resulting in its direct mono-methylation. Furthermore SETD7-dependent methylation of YAP led to its cytosolic retention and subsequent reduction of YAP binding to the promoter of pro-survival genes. Of note, pharmacological inhibition of SETD7 by (R)-PFI-2 blunted YAP mono-methylation while restoring its nuclear retention. Mechanistically, SETD7 inhibition promoted YAP binding to catalase and superoxide dismutase (SOD) gene promoters, thus preventing GD-induced mitochondrial oxidative stress and apoptosis. In line with our in vitro findings, SETD7−/− mice showed decreased infarct size as compared to WT littermates and preserved cardiac systolic (ejection fraction, fractional shortening) and diastolic function, as assessed by both conventional and TDI echocardiography.

Conclusions

We show that SETD7-dependent methylation of YAP is required for its inactivation, thus leading to myocyte oxidative stress and apoptosis. Pharmacological modulation of SETD7 by (R)-PFI-2 may represent a new therapeutic approach to prevent myocardial ischemic damage through modulation of the Hippo pathway.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation

Effects of marine noise pollution on Mediterranean fishes and invertebrates: A review

Marine noise pollution (MNP) can cause a multitude of impacts on many organisms, but information is often scattered and general outcomes difficult to assess. We have reviewed the literature on MNP impacts on Mediterranean fish and invertebrates. Both chronic and acute MNP produced by various human activities - e.g. maritime traffic, pile driving, air guns - were found to cause detectable effects on intra-specific communication, vital processes, physiology, behavioral patterns, health status and survival. These effects on individuals can extend to inducing population- and ecosystem-wide alterations, especially when MNP impacts functionally important species, such as keystone predators and habitat forming species. Curbing the threats of MNP in the Mediterranean Sea is a challenging task, but a variety of measures could be adopted to mitigate MNP impacts. Successful measures will require more accurate information on impacts and that effective management of MNP really becomes a priority in the policy makers' agenda.

Awake laparotomy: is locoregional anesthesia a functional option for major abdominal surgeries in the COVID-19 era?

OBJECTIVE

Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency.

PATIENTS AND METHODS

In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed.

RESULTS

None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed.

CONCLUSIONS

Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.

Hormonal and metabolic gender differences in a cohort of myotonic dystrophy type 1 subjects: a retrospective, case-control study

PURPOSE

Myotonic dystrophy type 1 (DM1) is a genetic disorder caused by CTG expansion in the DMPK gene. The aim was to investigate the endocrine and metabolic aspects of DM1.

PATIENTS AND METHODS

Retrospective, case-control study. We compared pituitary, thyroid, adrenal, gonadal and liver function and glycolipid metabolism of 63 DM1 patients against 100 control subjects. Given age-related differences, 2 further subgroups were created to investigate the pituitary-gonadal axis: < 41 (1a) and ≥ 41 (1b) years old for male subjects and < 46 (2a) and ≥ 46 (2b) years old for female subjects. Testicular and thyroid ultrasounds were also performed in the DM1 group.

RESULTS

FT3 and FT4 were significantly lower in DM1 men than controls, while for both males and females, thyroglobulin, ACTH and cortisol were significantly higher in the DM1 group. Gonadotropin levels were significantly higher and inhibin B and DHEA-S levels significantly lower in DM1 patients than controls for both male subgroups. Testosterone and SHBG were significantly higher in controls than in patients for subgroup 1a. Prolactin was significantly higher in patients in subgroups 1b, while testosterone was lower in subgroup 2a than in age-matched female controls. A correlation between the number of CTG repeats and the percentage of male hypogonadal subjects was found. Finally, there was a worse glucose and lipid pattern and significantly higher transaminase and gamma-GT levels in both male and female patients.

CONCLUSIONS

The high frequency of endocrine and metabolic abnormalities in DM1 highlights the importance of endocrine monitoring to enable the prompt initiation of a suitable therapy.

VISÃO ARTIFICIAL PARA A DIAGNOSE NUTRICIONAL DO MILHO CULTIVADO COM SILICATO DE CÁLCIO E MAGNÉSIO EM DOSES PONDERAIS E ALTAS DILUIÇÕES

A hipótese do presente trabalho foi que um sistema de visão artificial fosse capaz de caracterizar a deficiência nutricional na folha do milho, sob preparados homeopáticos, com a utilização das propriedades espectrais da cultura. O trabalho, realizado na Faculdade de Zootecnia e Engenharia de Alimentos (FZEA) – Universidade de São Paulo (USP), em Pirassununga/SP/Brasil estudou o comportamento nutricional da cultura do milho (Zea mays L.), hibrido Biogene 7049H. O delineamento experimental utilizado foi o blocos ao acaso com 6 tratamentos: silicato de cálcio e magnésio, nas seguintes dinamizações CH6 (diluição a 10- 12), CH9 (diluição a 10-18), CH12 (diluição a 10-24) e CH15 (diluição a 10-30), um tratamento controle sem aplicação de silício e um tratamento com silicato de cálcio e magnésio na dose de 1 t ha-1, com 10 repetições. As folhas de milho foram digitalizadas por "scanner" e o processamento das imagens foi realizado pelo programa MATLAB®. Três diferentes tamanhos de blocos de imagem foram testados 9 x 9; 20 x 20 e 40 x 40 “pixels”. Os melhores resultados foram alcançados pelos blocos de 40 x 40 “pixels”.

Novel EM Guided Endovascular Instrumentation for In Situ Endograft Fenestration

Objective: This work aims at providing novel endovascular instrumentation to overcome current technical limitations of in situ endograft fenestration including challenges in targeting the fenestration site under fluoroscopic control and supplying mechanical support during endograft perforation. Technology: Novel electromagnetically trackable instruments were developed to facilitate the navigation of the fenestration device and its stabilization at the target site. In vitro trials were performed to preliminary evaluate the proposed instrumentation for the antegrade in situ fenestration of an aortic endograft, using a laser guidewire designed ad hoc and the sharp end of a commercial endovascular guidewire. Results: In situ fenestration was successfully performed in 22 trials. A total of two laser tools were employed since an over bending of laser guidewire tip, due to its manufacturing, caused the damage of the sensor in the first device used. Conclusions: Preliminary in vitro trials demonstrate the feasibility of the proposed instrumentation which could widespread the procedure for in situ fenestration. The results obtained should be validated performing animal studies. Clinical Impact: The proposed instrumentation has the potential to expand indications for standard endovascular aneurysm repair to cases of acute syndromes.

Targeted healthy compounds in small and large-scale brewed beers

The determination of targeted healthy compounds in the most popular small and large-scale brewed beer sold in Italy was carried out. Nitrogen compounds, fermentable sugars, total phenolic content and antioxidant capacity, β-glucans, pyridoxine, folates and silicon were quantified. Further, amine content was determined since raw materials and brewing technology can affect their level. Significantly higher values for total phenolic content, antioxidant activity, nitrogen, folate and putrescine content were found for small scale beers. However, the statistical results were affected by the different beer styles in the small scale and large scale brewed beer groups, since the content of these components can vary between beer styles. Positive Pearson correlation was found between total phenolic content and EBC colour. Wide variations in pyridoxine, β-glucans and fermentable sugars levels were observed both for small and large scale beers, while average silicon content of two groups was similar.