Liquid biopsy for the management of NSCLC patients under osimertinib treatment

Therapeutic management of NSCLC patients is quite challenging as they are mainly diagnosed at a late stage of disease, and they present a high heterogeneous molecular profile. Osimertinib changed the paradigm shift in treatment of EGFR mutant NSCLC patients achieving significantly better clinical outcomes. To date, osimertinib is successfully administered not only as first- or second-line treatment, but also as adjuvant treatment while its efficacy is currently investigated during neoadjuvant treatment or in stage III, unresectable EGFR mutant NSCLC patients. However, resistance to osimertinib may occur due to clonal evolution, under the pressure of the targeted therapy. The utilization of liquid biopsy as a minimally invasive tool provides insight into molecular heterogeneity of tumor clonal evolution and potent resistance mechanisms which may help to develop more suitable therapeutic approaches. Longitudinal monitoring of NSCLC patients through ctDNA or CTC analysis could reveal valuable information about clinical outcomes during osimertinib treatment. Therefore, several guidelines suggest that liquid biopsy in addition to tissue biopsy should be considered as a standard of care in the advanced NSCLC setting. This practice could significantly increase the number of NSCLC patients that will eventually benefit from targeted therapies, such as EGFR TKIs.

Changes in the cellular fatty acid profile drive the proteasomal degradation of α-synuclein and enhance neuronal survival

Parkinson's disease is biochemically characterized by the deposition of aberrant aggregated α-synuclein in the affected neurons. The aggregation properties of α-synuclein greatly depend on its affinity to bind cellular membranes via a dynamic interaction with specific lipid moieties. In particular, α-synuclein can interact with arachidonic acid (AA), a polyunsaturated fatty acid, in a manner that promotes the formation of α-helix enriched assemblies. In a cellular context, AA is released from membrane phospholipids by phospholipase A₂ (PLA₂ ). To investigate the impact of PLA₂ activity on α-synuclein aggregation, we have applied selective PLA₂ inhibitors to a SH-SY5Y cellular model where the expression of human wild-type α-synuclein is correlated with a gradual accumulation of soluble oligomers and subsequent cell death. We have found that pharmacological and genetic inhibition of GIVA cPLA₂ resulted in a dramatic decrease of intracellular oligomeric and monomeric α-synuclein significantly promoting cell survival. Our data suggest that alterations in the levels of free fatty acids, and especially AA and adrenic acid, promote the formation of α-synuclein conformers which are more susceptible to proteasomal degradation. This mechanism is active only in living cells and is generic since it does not depend on the absolute quantity of α-synuclein, the presence of disease-linked point mutations, the expression system or the type of cells. Our findings indicate that the α-synuclein-fatty acid interaction can be a critical determinant of the conformation and fate of α-synuclein in the cell interior and, as such, cPLA₂ inhibitors could serve to alleviate the intracellular, potentially pathological, α-synuclein burden.

[Biomechanical risk in two dairy industries with different levels of mechanization]

Risks of biomechanical overload of the upper limbs and of altered posture are not well investigated in dairy industry. This study carries out an evaluation of ergonomic and postural risk in two cheese factories in North Sardinia, characterized by a different level of automation, in order to point out at the more dangerous activities for biomechanical overload and to check possible improvements determined by mechanization. Ergonomic analysis has been performed by using NIOSH and OSHA check-lists, and then using the Strain Index method for repetitive movements. Results show that mechanization has a great importance in reducting ergonomic risk, mainly in the salting phase, where SI was lowered from 40.5 to 4.5, and in the cheese shaping (SI 9 vs. 36). Some simple ergonomic solutions and preventive measures have been suggested.

[Progress of studies promoted by the MODS collaborative group]

In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.

Utility of routine chest radiographs in a medical-surgical intensive care unit: a quality assurance survey

OBJECTIVE

To determine the utility of routine chest radiographs (CXRs) in clinical decision-making in the intensive care unit (ICU).

DESIGN

A prospective evaluation of CXRs performed in the ICU for a period of 6 months. A questionnaire was completed for each CXR performed, addressing the indication for the radiograph, whether it changed the patient's management, and how it did so.

SETTING

A 14-bed medical-surgical ICU in a university-affiliated, tertiary care hospital.

PATIENTS

A total of 645 CXRs were analyzed in 97 medical patients and 205 CXRs were analyzed in 101 surgical patients.

RESULTS

Of the 645 CXRs performed in the medical patients, 127 (19.7%) led to one or more management changes. In the 66 surgical patients with an ICU stay <48 hours, 15.4% of routine CXRs changed management. In 35 surgical patients with an ICU stay > or = 48 hours, 26% of the 100 routine films changed management. In both the medical and surgical patients, the majority of changes were related to an adjustment of a medical device.

CONCLUSIONS

Routine CXRs have some value in guiding management decisions in the ICU. Daily CXRs may not, however, be necessary for all patients.

Perinatal management of nasopharyngeal teratoma

Nasopharyngeal teratoma is a rare benign entity, with most of the published literature represented by sporadic case reports. We present a recent case of a 23-year-old woman found to have elevated maternal serum alpha-fetoprotein and ultrasound findings of a fetal cystic mass in the mandibular region. The infant had a large nasopharyngeal teratoma protruding from the oral cavity making airway access extremely difficult. The presence of severe coexisting cardiac anomalies and respiratory disease led to death in the neonatal period. This report and the review of the literature stress the importance of recognizing suggestive prenatal data and preparing for perinatal management including maintenance of fetal oxygenation and aggressive early provision of an adequate airway.