An Integrated Care Approach to Improve Well-Being in Breast Cancer Patients

BACKGROUND

Breast cancer (BC) treatment has recently been revolutionized by the introduction of newer targeted agents, that helped tailoring therapies around the single patient. Along with increased survival rates, a careful evaluation of diet, lifestyle habits, physical activity, emotional and psychological experiences linked to the treatment journey, is now mandatory. However, a true proposal for an omnicomprehensive and "integrative" approach is still lacking in literature.

METHODS

A scientific board of internationally recognized specialists throughout different disciplines designed a shared proposal of holistic approach for BC patients.

RESULTS

A narrative review, containing information on BC treatment, endocrinological and diet aspects, physical activity, rehabilitation, integrative medicine, and digital narrative medicine, was developed.

CONCLUSIONS

In the context of a patient-centered care, BC treatment cannot be separated from a patient's long-term follow-up and care, and an organized interdisciplinary collaboration is the future in this disease's cure, to make sure that our patients will live longer and better.

TRIAL REGISTRATION

NCT05893368: New Model for Integrating Person-based Care (PbC) in the Treatment of Advanced HER2-negative Breast Cancer (PERGIQUAL). Registration date: 29th May 2023.

Influence of training status on cardiac and vascular functioning in young recreational and competitive male rowers

Introduction

The aim of the study was to investigate the influence of training status on cardiovascular function in young male recreational and competitive rowers.

Methods

Ejection duration in percentage to the heart rate period (ED%), subendocardial viability ratio (SEVR), augmentation index at 75 bpm (AIx75) and carotid to femoral pulse wave velocity (cf-PWV) of competitive rowers (CR) (age 17.6 ± 4.1 years), recreational rowers (RR) (age 16.7 ± 2.70 years) and athletes practicing other recreational sports (ORS) (age 15.3 ± 1.4 years) were assessed.

Results

ED% was lower in CR compared to ORS (31.9 ± 3.9% vs. 38.4 ± 4.8%; p = 0.026) and cf-PWV was higher in CR compared to ORS (5.5 ± 1.0 m/s vs. 4.7 ± 0.5 m/s; p = 0.032). SEVR was higher in CR compared to RR and ORS (165.8 ± 33.7% vs. 127.4 ± 30.4% and 128.3 ± 27.8%; p = 0.022) and AIx75 was lower in CR compared to RR and ORS (-15.7 ± 8.6% vs. 1.2 ± 9.9% and 1.5 ± 9.1; p = 0.001).

Discussion

Healthy, young competitive male rowers reported higher myocardial performance and better cardiovascular health than recreational athletes. Interpretations of cf-PWV in competitive rowers should be performed alongside other cardiovascular indicators.

Live Streaming vs. Pre-Recorded Training during the COVID-19 Pandemic in Italian Rhythmic Gymnastics

The SARS-CoV-2 outbreak led to an inevitable and drastic transition to online training systems. This study aimed to analyze the differences between live-streaming and pre-recorded training modalities in rhythmic gymnastics (RG) with coaches and gymnasts of different technical levels. A total of 238 coaches and 277 athletes affiliated with the Italian Gymnastics Federation (FGI) participated in the study. The data collection tool was a self-collected questionnaire structured in three sections: participant's information, characteristics of live-streaming training, and characteristics of pre-recorded training. A 2 × 2 ANOVA was used for each numeric variable. A Pearson's chi-squared test was used for each categorical variable. For the athletes, training frequency, motivation, and efficacy were significantly higher (p < 0.05) with live streaming (3.7 ± 1.5 day/week, 3.8 ± 0.9 score and 3.8 ± 0.8 score, respectively) than with a pre-recorded modality (2.2 ± 1.7 day/week, 3.1 ± 1.2 score and 3.7 ± 0.9 score, respectively), while for coaches, significant differences (p < 0.005) were found between the two modalities only for training frequency (live streaming, 3.6 ± 1.8 days/week vs. pre-recorded, 2.1 ± 1.7 days/week). The adherence (number of No:Yes) was significantly higher (p < 0.05) for the live-streaming modality than for the pre-recorded modality in gold athletes (1:74 vs. 14:61, respectively), silver athletes (12:190 vs. 28:174, respectively), and gold coaches (3:63 vs. 11:55, respectively), but it was not for silver coaches. Physical preparation was performed significantly (p < 0.005) more often (number of No:Yes) for live streaming than for the pre-recorded modality by gold athletes (9:66 vs. 34:41, respectively), silver athletes (25:177 vs. 77:125, respectively), gold coaches (8:58 vs. 37:29), and silver coaches (33:139 vs. 85:87, respectively). Free body technical preparation was performed significantly (p < 0.005) more often (number of No:Yes) for live streaming than for the pre-recorded modality by gold athletes (15:60 vs. 39:36, respectively), silver athletes (84:118 vs. 121:81, respectively), gold coaches (10:56 vs. 38:28), and silver coaches (60:112 vs. 105:67, respectively), while no differences were found for silver athletes' and coaches' technical preparations for apparatus training between the two modalities. In conclusion, live streaming had greater positive effects on RG training during home confinement. However, pre-recorded training could be more effective for some types of training, depending on the technical level of the athletes.

A Countermovement Jump for the Midterm Assessment of Force and Power Exertion After Anterior Cruciate Ligament Reconstruction

OBJECTIVE

The aim of this study was to assess force and power exertion during a countermovement jump after anterior cruciate ligament reconstruction using either semitendinosus and gracilis or bone-patellar tendon-bone graft.

DESIGN

One hundred-nineteen semitendinosus and gracilis and 146 bone-patellar tendon-bone participants performed a countermovement jump on two force platforms after 3 (T1) and 6-9 mos (T2) from surgery. Twenty-four healthy participants served as control group. Peak force of eccentric and concentric phases and peak power were obtained from the analysis of vertical components of the ground reaction forces. Asymmetry was quantified by means of limb symmetry index.

RESULTS

Eccentric peak force was significantly ( P < 0.05) lower than concentric peak force in both bone-patellar tendon-bone and semitendinosus and gracilis at T1 and T2. At T1, bone-patellar tendon-bone showed higher peak power, but lower limb symmetry index in eccentric and concentric compared with semitendinosus and gracilis. At T2, bone-patellar tendon-bone showed higher peak power than semitendinosus and gracilis, although there were no differences in limb symmetry index between the two groups, which however was significantly ( P < 0.05) lower in both groups when compared with control group.

CONCLUSIONS

Bone-patellar tendon-bone and semitendinosus and gracilis participants showed asymmetries in eccentric and concentric force during a countermovement jump. Bone-patellar tendon-bone showed greater asymmetries and a higher peak power respect to semitendinosus and gracilis participants.

Are there sex differences in physiological parameters and reaction time responses to overload in firefighters?

Male and female firefighters work side-by-side in the same in strenuous and risky conditions. Anthropometrics, physiological, and reaction time (mean of reaction time -MRT-, and errors made -E) parameters of 12 Female and 13 Male firefighters were compared. Effect of overload (step test with and without equipment) on the MRT and E were analyzed on 3 trials (T1 = 1-1s, T2 = 0.5-1s, T3 = 0.5–0.5s), compared with a pre-test condition (basal). T-test between males and females was applied to assess differences (p<0.05) in all parameters. ANOVA with repeated measures and Bonferroni on 3 conditions of step test between males and females was applied in reaction time variables. Between MRT and E, in T1, T2 and T3 trials and the 3 test conditions, ANCOVA models with interactions were used. Differences (p<0.05) in anthropometric, physiological and reaction time data emerged across groups, and on the 3rd trials (T3 vs T1 and T2) in reaction time parameters of each group. ANCOVA showed differences (p<0.001) in E among trials. Post hoc showed significant differences in T1vsT3 and T1vsT2. MRT x trial interaction was extremely significant (P<0.001). Implementing fitness and reaction time exercise programs is important to decrease the injury risk and increase work capacity in firefighters with reference to female workers.

Initial validation of the Italian version of the Volition in Exercise Questionnaire (VEQ-I)

The purpose of this study was to validate the Volition in Exercise Questionnaire in Italian language (VEQ-I). The translation and cultural adaptation of the VEQ-I was conducted using the forward-backward translation method. VEQ-I eighteen items correspond to the six-factors structure of the original version. The construct validity was verified by the confirmatory factor analysis (CFA) (CFI = 0.960; TLI = 0.943; RMSEA = 0.039; and SRMR = 0.040). The eighteen items were well distributed in six subscales and the six-factors structure of the questionnaire was supported. Internal Consistency value of the questionnaire was investigated for each subscale of the VEQ-I. Cronbach’s alpha and Omega values of the Reasons, Postponing Training, Unrelated Thoughts, Self-Confidence, Approval from Others and Coping with Failure subscales were 0.76 (α) and 0.76 (ω), 0.76 (α) and 0.76 (ω), 0.87 (α) and 0.88 (ω), 0.85 (α) and 0.85 (ω), 0.70 (α) and 0.72 (ω) and 0.74 (α) and 0.74 (ω), respectively. They were acceptable in all the six subscales. The concurrent validity was assessed using the correlation among the subscales of VEQ-I measures and those contained in two questionnaires: Psychobiosocial States in Physical Education (PBS-SPE) and Exercise Motivations Inventory (EMI-2).

Somatosensory-guided tool use modifies arm representation for action

Tool-use changes both peripersonal space and body representations, with several effects being nowadays termed tool embodiment. Since somatosensation was typically accompanied by vision in most previous tool use studies, whether somatosensation alone is sufficient for tool embodiment remains unknown. Here we address this question via a task assessing arm length representation at an implicit level. Namely, we compared movement’s kinematics in blindfolded healthy participants when grasping an object before and after tool-use. Results showed longer latencies and smaller peaks in the arm transport component after tool-use, consistent with an increased length of arm representation. No changes were found in the hand grip component and correlations revealed similar kinematic signatures in naturally long-armed participants. Kinematics changes did not interact with target object position, further corroborating the finding that somatosensory-guided tool use may increase the represented size of the participants’ arm. Control experiments ruled out alternative interpretations based upon altered hand position sense. In addition, our findings indicate that tool-use effects are specific for the implicit level of arm representation, as no effect was observed on the explicit estimate of the forearm length. These findings demonstrate for the first time that somatosensation is sufficient for incorporating a tool that has never been seen, nor used before.

Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms

BACKGROUND

The incidence of asymptomatic, sporadic, small non-functioning pancreatic neuroendocrine neoplasms (NF-PNENs) has increased in recent decades. Conservative treatment has been advocated for these tumours. The aim of this study was systematically to evaluate the literature on active surveillance and to compare this with surgical management for asymptomatic sporadic small NF-PNENs.

METHODS

PubMed, Embase and the Cochrane Library were searched systematically for studies that compared the active surveillance of asymptomatic, sporadic, small NF-PNENs with surgical management. PRISMA guidelines for systematic reviews were followed.

RESULTS

After screening 3915 records, five retrospective studies with a total of 540 patients were included. Of these, 327 patients (60·6 per cent) underwent active surveillance and 213 (39·4 per cent) had surgery. There was wide variation in the tumour diameter threshold considered as inclusion criterion (2 cm to any size). The median length of follow-up ranged from 28 to 45 months. Measurable tumour growth was observed in 0-51·0 per cent of patients. Overall, 46 patients (14·1 per cent) underwent pancreatic resection after initial conservative treatment. In most patients the reason was an increase in tumour size (19 of 46). There were no disease-related deaths in the active surveillance group in any of the studies.

CONCLUSION

This systematic review suggests that active surveillance of patients affected by sporadic, small, asymptomatic NF-PNENs may be a good alternative to surgical treatment.

Addition of different concentrations of prostasome-like vesicles at neutral or slightly alkaline pH decreases canine sperm motility

Prostasome-like vesicles (PV) are components of the canine prostatic fluid during ejaculation and despite some enzymatic activities have been identified recently, their functions in the reproductive events in this species are still poorly understood. In this study, we evaluated at neutral or slightly alkaline pH, the effects of different concentrations of purified PV on sperm cell motility characteristics and the impact on the short- and long-term preservation of preserved semen maintained at room temperature. Two different experiments were performed. In the first experiment, purified PV were added at increasing concentration (1.25, 2.5, 5, 10, and 20 μL equivalent to 1, 2, 4, 8, and 16 μg of protein, respectively) to aliquots of 100 μL of preserved semen maintained at 22 °C at the following time points: 0, 30, 60, 120, 240, and 480 min. Computer-assisted sperm motility characteristics and pH were assessed three times at each time points, for each sample and for every concentrations. In the second experiment, the purified PV were added with the same methods as described above but only at time 0. Sperm motility characteristics and pH were assessed over the time. This study showed how the addition of purified PV to preserved semen affects negatively (p < 0.05) at neutral and alkaline pH, both total and progressive motility in a concentration depending manner. Furthermore, prostasome addition was demonstrated to change the quality of sperm movement which may represent a mechanism facilitating sperm cells attachment to the uterine epithelium and facilitating energy preservation before fertilization.

Evaluation of testicular artery blood flow by Doppler ultrasonography as a predictor of spermatogenesis in the dog

The present study examines the relationship between reproductive and seminal characteristic with blood flow supply of the testis in male dogs by means of Doppler ultrasonography. Five male dogs were subject to a clinical examination, blood sampling, B-Mode and Doppler ultrasonography of the testis, semen evaluation at collections and after storage at 4°C for 24, 48 and 72 h in three replicates 30 days apart. Peak Systolic Velocity was positively correlated with testicular volume and negatively with live sperm at collections and after 24h. A negative correlation existed between Resistive Index and Pulsatility Index with total and progressive motility at collections and also after 24, 48 and 72 h. Resistive Index and Pulsatility Index were also negatively correlated with the percentage of membrane intact sperms with curled tails at collections while the latter was positively correlated with End Diastolic Velocity. Moreover, positive linear correlations of weight with bilateral testicular volume and total sperm concentration and also between age and abnormal sperm at collections and after 24h were established. The results suggest that the Resistive Index and Pulsatility Index seem to be potential markers of seminal quality in dogs.

Apolipoprotein-E genotype in normal aging, age-associated memory impairment, Alzheimer's disease and vascular dementia patients

Apolipoprotein-E (Apo-E) genotype and allele frequencies were evaluated in patients with late-onset probable Alzheimer's disease (LOAD; n = 64), early-onset probable Alzheimer's disease (EOAD; n = 32), possible Alzheimer's disease (pAD; n = 44), vascular dementia (VD; n = 12), age-associated memory impairment (AAMI; n = 15) and 40 healthy age-matched controls. APO-E was performed by polymerase chain reaction products digested by the restriction enzyme HhaI. A statistically significant increase of epsilon4 frequency was found in LOAD as compared to the other groups, and in pAD with respect to controls, while VD and AAMI groups did not disclose any difference as regards to control subjects. Multivariate analysis showed a significant association of epsilon4 with female gender. Our results confirm the increased frequency of epsilon4 in both probable and possible LOAD, failing to show a similar trend in VD and AAMI.

Dexamethasone suppression test in elderly patients with dementia of Alzheimer type, vascular dementia and stroke: a re-evaluation of its applicability

In order to evaluate the prevalence of non-suppression after dexamethasone in psychogeriatrics and to further verify the reliability of the neurobiological information obtained, dexamethasone suppression test was carried out in a geriatric population composed of patients with dementia of Alzheimer type, vascular dementia, stroke and age and sex-matched controls. Basal cortisol levels did not differ among groups and was positively correlated to age. Prevalence of non-suppression, defined according to Carroll's criterion was high in the pathological groups studied, and relatively high in controls, showing no diagnostic value. Unlikely suppressors, the time course of mean plasma corticol levels of non-suppressors was highly heterogeneous in each group considered, especially in the pathological groups. More restrictive criteria for the definition of non-suppressors are proposed, in order to increase the specificity of the test when applied to psychogeriatrics.

[Arrhythmogenic right ventricular dysplasia. Report of a familial case]

Arrhythmogenic right ventricular dysplasia is a pathologic condition of unknown origin that primarily affects the right ventricle free wall characterized by progressive atrophy with fibrous-fatty substitution of the myocardium. The patient affected may present in childhood or as an adult with cardiomegaly or/and ventricular arrhythmias with a left bundle branch block configuration. The reports of familial occurrence suggest the etiologic role of a genetic defect with autosomal dominance and variable expression and penetrance, an alternative, myocarditis (toxic or infectious) is a possible cause. The aim of the present study is an non-invasive instrumental evaluation of the family of a young patient affected by arrhythmogenic right ventricle dysplasia. The authors evaluated 10 patients, 7 women and 3 men, all asymptomatic, with electrocardiography, exercise stress test on a bicycle ergometer, 24-hour Holter monitoring and two-dimensional echocardiography. A patient had certain ARVD diagnosis, while in the other 9 patients all the instrumental investigations were normal. This observation seem to confirm that ARVD may be familial and justify a systematic in-depth familial study in all demonstrated cases of ARVD and the follow-up of all patients identified who had arrhythmias or isolated right ventricular morphologic anomalies.

Cerebrospinal fluid neuron-specific enolase in Alzheimer's disease and vascular dementia

Levels of neuron-specific enolase (NSE), a glycolytic enzyme localized in neurons, were measured in serum and cerebrospinal fluid (CSF) of patients with early-onset (e-AD) and late-onset (l-AD) Alzheimer's disease, vascular dementia (VD) and controls. Mean CSF NSE levels in patients with Alzheimer's disease did not significantly differ from those in controls, although in the AD group a correlation was found between NSE levels and severity of cognitive deficits. In VD patients, CSF NSE was lower than in controls or in AD patients. These findings are of physiopathological interest but suggest that CSF NSE is not a useful biological marker in dementia disorders.

[Atrial fibrillation induced by massage of the carotid sinus in patients with orthodromic reciprocal supraventricular tachycardia and Wolff-Parkinson-White syndrome]

A 46 years old man with WPW syndrome, due to a posteroseptal accessory pathway, was admitted because of orthodromic reciprocating tachycardia, 210/m'in frequency. At the end of the carotid sinus massage, for accomplish the conversion of tachycardia to sinus rhythm, the orthodromic reciprocating supraventricular tachycardia degenerated into atrial fibrillation associated with high ventricular rate and the presence of hemodynamic instability, reverted to sinus rhythm by intravenous propafenone. Vagal stimulation, induced by carotid sinus massage, probably caused dispersion of atrial refractorines and intraatrial reentry, converting the orthodromic tachycardia into atrial fibrillation. The transesophageal electrophysiologic study, executed in treatment with propafenone, not documented the accessory connection and atrial fibrillation or reciprocating tachycardia were not inducible.

Effect of interleukin-4 on interleukin-2-dependent generation of natural killer cells

We have previously shown that interleukin-2 (IL-2) is able to induce the generation of natural killer (NK) activity in bone marrow (BM) cells from mice pretreated with 5-fluorouracil. IL-2 alone could dose-dependently induce NK activity in marrow cells and interleukin-4 (IL-4) has dual effect on the NK activity in that, depending on the concentration of IL-2, IL-4 inhibits or stimulates development of NK cells. The inhibitory effect was in part antagonized by interleukin-1 alpha. These effects were not obtained when NK-reactive spleen cells were cultured with the same concentrations of IL-2 or IL-2 plus IL-4 with or without irradiated BM cells as feeders. The effects of IL-4 were also obtained by preincubation for 6-24 hr before culturing with IL-2 alone and correlated with the expression of interleukin-2 receptor (IL-2/r), suggesting that IL-4 might play a regulatory role in the IL-2-dependent generation of NK cells in BM.

[Post-menopausal metrorrhagia. Use of danazol in endometrial hyperplasia]

The Authors, after a careful examination of the literature on endometrial hyperplasias, review the results of a preliminary study on 15 patients affected with postmenopausal metrorrhagia, cured by Danazol (200 mg/die) through 90 consecutive days. Also recognizing the best tolerance to the drug and the low incidence of the side effects, they think the results obtained by Danazol need further confirmation by more protracted controls.