A multicenter LArge retrospectIve daTabase on the personalization of Stereotactic ABlative Radiotherapy use in lung metastases from colon-rectal cancer: the LaIT-SABR study

INTRODUCTION

stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD).

MATERIAL AND METHODS

the study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC).

RESULTS

Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED <100 Gy, 100-124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p=0.000). Two-year FLP for lesion measuring ≤10 mm, 10-20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p=0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11-0.51; p=0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2-3 or 4-5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p=0.035).

CONCLUSION

The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.

Effects of melatonin in perimenopausal and menopausal women: our personal experience

The purpose of this clinical trial on possible effects of nocturnal MEL administration in perimenopausal women was to find if MEL by itself modifies levels of hormones and produces changes of any kind, independently of age (42-62 years of age) and the stage of the menstrual cycle. It is accepted that a close link exists between the pineal gland, MEL, and human reproduction and that a relationship exists between adenohypophyseal and steroid hormones and MEL during the ovarian cycle, perimenopause, and menopause. Subjects took a daily dose of 3 mg synthetic melatonin or a placebo for 6 months. Levels of melatonin were determined from five daily saliva samples taken at fixed times. Hormone levels were determined from blood samples three times over the 6-month period. Our results indicate that a cause-effect relationship between the decline of nocturnal levels of MEL and onset of menopause may exist. The follow up controls show that MEL abrogates hormonal, menopause-related neurovegetative disturbances and restores menstrual cyclicity and fertility in perimenopausal or menopausal women. At present we assert that the six-month treatment with MEL produced a remarkable and highly significant improvement of thyroid function, positive changes of gonadotropins towards more juvenile levels, and abrogation of menopause-related depression.

Anxiety, depression, hunger and body composition: III. Their relationships in obese patients

The present paper explores the relationships between anxiety, depression, hunger sensation and body composition in obese patients (OP). The aim is to detect whether or not there are abnormalities in these relationships in OP as compared to clinically healthy subjects (CHS). The study was performed on 22 CHS (2 M, 20 W; mean age = 24 +/- 2 years; mean body mass index = 21 +/- 2 kg/m2) and 48 OP (4 M, 44 W; mean age = 40 +/- 17 years; mean body mass index = 32 +/- 7 kg/m2). Anxiety and depression were found to be correlated, negatively, with the relative lean body mass, and, positively, with the fat body mass in OP but not in CHS. These findings corroborate the idea that anxiety and depression can reach an abnormal expression when obesity shows its worst loss in lean body mass and its highest expansion in adipocyte mass. As hunger sensation was found not to correlate with either anxiety or depression in OP, the opinion is expressed that the impairment of anxio-depressive integrity is a corollary of obesity rather than a primary affective disorder leading to obesity via an enhanced food intake.

Daily hunger sensation and body compartments: II. Their relationships in obese patients

Hunger sensation (HS) is a signal whose levels change during the 24-h day. The daily mean level of HS was correlated with the human body compartments, as investigated by bioelectrical impedance analysis, to detect the relationship between the orectic perception and both the free fat mass (FFM) and the fat body mass (FBM) in 22 clinically healthy subjects (CHS) (2 M, 20 W, BMI: 18.5-24.0 kg/m2) and 48 obese patients (OP) (4 M, 44 W, BMI: 25.2-54.7 kg/m2). In CHS, the daily mean level of HS correlated positively with the FFM and negatively with the FBM. These correlations were not present in OP. This lack of relationships between HS and the body compartments where energy is maximally consumed (i.e., the FFM) and maximally stored (i.e., the FBM) indicates that the orectic response to energy expenditure and the orectic inhibition to fat accumulation are feedback mechanisms which are impaired in obesity.

Hunger sensation in Graves' disease before and after pharmacological therapy

PURPOSE

Hunger sensation (HS) provides information about the need of eating in order to counterbalance the energy expenditure (EE). HS was, thus, investigated in patients affected by Graves' disease (PAGD), a clinical condition characterized by excessive EE.

MATERIALS AND METHODS

Ten newly diagnosed PAGD were investigated before and after therapy. Thirty clinically healthy subjects (CHS) were investigated as controls. The investigated subjects were asked to provide the 24-h profile of their HS by subjectively self-rating (from 1 to 10 hunger units) their orectic perception (OP) at regular intervals of 30 minutes (orexigram). The orexigrams were investigated via the conventional descriptive statistics as well as the Single-Cosinor method.

RESULTS

PAGD were found to show a very consistent increase of their HS (hyperorexia), whose day-night variability was, still, the expression of a circadian rhythm, characterized by an elevation in its oscillatory level and extent. Interestingly, the pre-treatment hyperorexia was seen to show a normalization (eurexia) after pharmacological therapy.

CONCLUSIONS

According to these results, it can be affirmed that hyperorexia is a clinical sign of Graves' disease, which is obtained via mechanisms of tonic and amplitude modulation of the HS circadian rhythm. Because of the eurexia after remission, it can be argued that the hyperorexia is a theleological response really aimed at increasing food intake in order to counterbalance the excessive EE which characterizes the thyrotoxicosis.

Daily hunger sensation and body composition: I. Their relationships in clinically healthy subjects

The human hunger sensation (HS) is a perceptive signal characterized by day-night variability (DNV). This pattern was investigated with respect to its relations with the body compartments in 22 clinically healthy subjects (CHS, 11 males and 11 females, mean age: 24 +/- 2.5 years, mean BMI: 21 +/- 1.7). The DNV was investigated by means of conventional descriptive statistics and the single cosinor method (SCM). Both procedures were applied to the orexigram, i.e., the 24-h profile of the orectic stimulus (OS) provided by each subject, who self-rated his/her HS (from 1 to 10 hunger units) every half hour. Body composition was investigated by Bioelectrical Impedance Analysis (BIA) on the day when the orexigrams were compiled. It was found that the daily HS level correlates positively with the Free Fat Body Mass (FFBM) and negatively with the Fat Body Mass (FBM). These opposite relations indicate that HS is stimulated by the needs of the FFBM, and inhibited by expansion of the FBM, and provide further evidence of the existence of an "adipostat" anorectic mechanism.

Who are the non-dippers? A better definition via the blood pressure circadian rhythm

OBJECTIVE

The non-dipping phenomenon (NDP) can be better interpreted when considering that blood pressure (BP) shows a within-day variability which is the expression of a circadian rhythm (CR).

PATIENTS AND METHODS

The NDP was investigated at the light of the BP CR by analysing the ambulatory BP monitoring of 298 essential hypertensive patients (EHP), 84 secondary hypertensive patients (SHP), as well as 93 normotensive subjects (NS). According to the rhythmometric validation, the investigated subjects were defined "rhythmic" (R) or "non-rhythmic" (NR).

RESULTS

The non-dippers (ND) were found among not only the EHP (14%) and SHP (27%) but also the NS (16%). The percentages of R ND were 9%, 4% and 20%, respectively in EHP, SHP and NS. The R ND were characterized by a nocturnal phase-shift (100% in NS), associated with an amplitude increase (50% in EHP) or a mesor increase (50% in EHP; 100% in SHP) in BP CR. The NR ND were characterized by an amplitude almost negligible (100% in NS) associated with a mesor increase (100% in EHP; 100% in SHP).

CONCLUSIONS

The detection of a NDP associated with a rhythmicity suggests that the criterion with which the ND are identified cannot be used for making inferences on the BP CR in HP or NS. The rhythmic characteristics in ND suggest that the rhythmometric analysis is fundamental for identifying the abnormal time structure of BP 24-h values in the presence of the NDP.

Hunger sensation: a chronobiometric approach to its within-day and intra-day recursivity in anorexia nervosa restricting type

Hunger sensation (HS) is a perception with a daily (circadian) and within-day (ultradian) recursive pattern. In human beings, circadian repeatability was investigated by means of the Single Cosinor method, while the ultradian recursivity was investigated by means of the spectral analysis, both applied to the 24-h HS profile (orexigram). Orexigrams were provided by each subject investigated, who self-rated her subjective orectic stimulus (OS) (from 1 to 10 hunger units) every half hour. The study was performed in 19 female patients aged 13-52 newly diagnosed as in the first episode of Anorexia Nervosa Restricting Type, with a BMI below 18.7. The control group consisted of 10 clinically healthy women aged 21 to 52 years with a BMI from 23 to 25. Two types of orexigrams were found. The first was characterized by a low profile with negligible ultradian variability, in which the HS circadian rhythm (CR) was still detectable, but the power spectrum (PS) was composed of unusual ultradian components associated with a very diminished amplitude for the circadian harmonics. The second was characterized by an almost regular profile, in which the ultradian variability was clearly detectable, the CR regularly fluctuated, and the PS was almost regularly composed. These findings indicate that anorectic patients (AP) can be recognized by their orexigram as "hyporectic", or "eurectic". Therefore, the term "anorexia" seems to be appropriate for AP who exhibit the first type of orexigram (anorectic aphagia nervosa), whereas the second identifying those who could be defined as suffering from "eurectic aphagia nervosa".

[Acute gangrenous appendicitis in incarcerated inguinal hernia. A case report]

A case of acute gangrenous appendicitis in the sac of right inguinal hernia in a 77 year-old man is described. This condition is extremely uncommon; it is very difficult to establish a correct diagnosis preoperatively; a high mortality rate is due to extensive peritoneal contamination; primary hernia repair is indicated.

[Respiratory rehabilitation of the elderly patient: results and prospects]

The epidemiology and the principal indications of the pulmonary rehabilitation are firstly summarized, along with its peculiar aspects in the aged people. Then the outcomes of some significant studies are described, taking into consideration three areas of objectives aimed by the authors: improving quality of life, increasing survival, and assessing some physiological parameters. Finally, a few guidelines in the field of the pulmonary rehabilitation research are highlighted particularly emphasizing the singly-used therapeutic techniques and the control group.

[Respiratory inductive plethysmography in the functional evaluation of patients undergoing coronary by-pass surgery]

The functional respiratory changes following coronary by-pass surgery were previously evaluated with the traditional spirometric method. Aim of this work is to introduce the respiratory inductive plethismography (RIP), a well known non-invasive technique, into the study of those volumetric and ventilatory modifications. Eight cardioischemic patients were selected: all but one were free from pulmonary disorders. The tidal volume, the respiratory rate, the minute ventilation, the vital capacity and the relation between the abdominal and the thoracic part of the ventilatory act, were measured in the pre-intervention session and in the 1st, 3rd and 7th day after the operation of coronary by-pass. In the same sessions, except the 1st day after surgery, the maximal respiratory pressures were evaluated with traditional manometers. The functional changes of the examined parameters, statistically studied with the variance analysis, closely resemble the spirometric modifications registered by other authors. Furthermore the relative contributions of the thoracic and abdominal compartments of the pulmonary ventilation were evaluated, thanks to the non-invasive plethysmographic method. Rip makes it possible to measure the ventilatory pattern and some pulmonary volumes in the very early phases after thoracic surgery, without any trouble for the patient and in a non-collaborative state of consciousness, too.