Oncofertility: the importance of counseling for fertility preservation in cancer patients

Scientific and technological advances in the diagnosis of neoplastic disease and the introduction of increasingly accurate and personalized anti-cancer treatments have significantly improved the chances of survival of most cancer patients, particularly at a young age. Since the interest of the research community in the life prospects of young cancer survivors has been growing, a new branch of medicine has emerged in recent years that reconciles the potentially gonadotoxic treatments of cancer with the preservation of fertility: oncofertility. The possibility of preserving one's fertility can be of great benefit for the psychological well-being of cancer patients, whose mental health is already severely tested by the cancer diagnosis. Although national and international guidelines urge doctors to start early a discussion on fertility conservation issues (reproductive counseling), still little is known as to the awareness of oncofertility by young cancer survivors and the information they receive about it.

OS2.3 Relevance of Neurofibromatosistype 1 and schwannomotosis in extramedullary spine tumors

BACKGROUND

Extramedullary spine tumors represent two-thirds of all primary spine neoplasms. Approximately half of these are peripheral nerve sheath tumors, mainly neurofibromas and schwannomas and neurofibromatosis or schwannomatosis can be suspected. Given the rarity of this condition the clinical genetic and radiological features remains to be better define. The aim of this study was to characterize the clinical, radiologic presentation of patients with widespread spinal disease and to identify gene mutation.

MATERIAL AND METHODS

We selected patient with a at least: intradural extramedullary, or extradural intraspinal (tumor within the spinal canal), or extradural paraspinal (tumor at the neural foramenor extending outward into adjacent tissues) neoplasms and no other tumors such as meningiomas in the spine at spine MRI. Patients’ DNA were analyzed by Targeted NGS by means a custom gene panel including NF1, NF2, LZTR1, SMARCB1 genes.

RESULTS

63 patients were identified31 had few isolated tumors, involving spinal roots (Multiple Neurofibromas Few Spinal Root, MNFSR), 18 had bilateral neurofibromas involving all spinal roots. 14 had a single lesion; 10 cases were familiar and 53 sporadic. Genetic analysis showed NF1 gene mutations (in prevalence splicing or missense) in 49 cases LZTR1 mutations in 3 and in the others 11 no mutation or deletion was detected. Pain was the hallmark symptom in patients with LZTR1 mutations, while all familial cases all had NF1 diagnosis. About 50% of them had few cutaneous manifestations.

CONCLUSION

In patients with extramedullary spine tumors is important to look for signs of neurofibromatosis or schawannomatosis and if there are present genetic testing should be performed.

Early effect of dalfampridine in patients with MS: A multi-instrumental approach to better investigate responsiveness

BACKGROUND

4-aminopyridine (4-AP) is a potassium-channel blocker able to enhance walking speed in MS improving the action potentials of demyelinated axons on which internodal potassium channels are exposed.

OBJECTIVE

to study early 4-AP effect with clinical, subjective, neurophysiological and neuroradiological tools.

METHODS

Clinical (Timed 25-Foot Walk - T25FW, Timed Up-And-Go - TUG), subjective (MS Walking Scale-12 - MSWS-12), neurophysiological (Motor Evoked Potentials - MEPs) and imaging (Diffusion Tensor Imaging - DTI) evaluations were performed before (T0) and after (T1) 14days of 4-AP treatment. MEPs were recorded from Abductor Hallucis of both legs. A Tract-Based-Spatial-Statistics (TBSS) was performed on DTI.

RESULTS

We found a significant difference between T0 and T1 for T25FW, TUG, MSWS-12 (p≤0.001) in the whole patients' sample (23 subjects, median EDSS 6.0) and decrease of Central Motor Conduction Time and increase of mean Amplitude (Amp) at T1 (p=0.008 and p=0.006). We also recorded a significant difference of T25FW, TUG, MSWS-12 and Amp in clinical responder (CR) patients (CR: amelioration >20% at T25FW). TBSS showed a significant Mean and Radial Diffusivity reduction in the corticospinal tracts (p<0.05) of the whole group of patients; this reduction was also found in the CR subgroup.

CONCLUSION

Neurophysiological and neuroradiological parameters were modified in MS patients treated with 4-AP, and most of them reported a subjective improvement of their motor performances after treatment. The use of clinical, subjective, neurophysiological and neuroradiological tools could help to better explore MS patients responsiveness to 4-AP.

Development and validation of the multiple sclerosis questionnaire for the evaluation of job difficulties (MSQ-Job)

OBJECTIVE

Multiple sclerosis (MS) affects young adults of working age. Difficulties in work-related activities are usually ascribed to MS symptoms, while the impact of workplace features is underestimated. This article presents the Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job), designed to assess working difficulties due to MS symptoms and workplace features.

METHODS

A sample of employed MS patients completed the MSQ-Job, the WHO-Disability Assessment Schedule (WHODAS 2.0) and the 54-items MS Quality of Life Questionnaires (MSQOL-54); the expanded disability status scale (EDSS) was used to define MS severity. Factor structure was evaluated using principal component extraction and Oblimin rotation; internal consistency was assessed with Cronbach's alpha; construct and discriminant validity using t-test (EDSS 0-2 vs >2; patients self-reporting need for support vs patients reporting no needs; full-time vs part-time employees); and Pearson's correlation with WHODAS 2.0 and MSQOL-54.

RESULTS

The MSQ-Job is a 42-item questionnaire with six scales and an overall factor. Scores range on a 0-100 scale (higher scores indicate more and more severe difficulties); patients with EDSS>2 and self-reporting support needs had worse scores than those with EDSS 0-2 and without needs. Correlations with WHODAS 2.0 and MSQOL-54 were generally significant (P < 0.0007) and below 0.70.

CONCLUSIONS

The MSQ-Job jointly measures the impact of respondents' symptoms and workplace features on work activities and enables to assess the effects of clinical and occupational interventions and better describe the impact of MS indirect costs.

Neuropsychological Findings in Idiopathic Occipital Lobe Epilepsies

PURPOSE

We reviewed the clinical charts of 22 patients (mean age 12 years) with idiopathic occipital lobe epilepsies (IOLE) to verify the presence of visuoperceptual difficulties.

METHODS

All 22 patients underwent a standard neuropsychiatric examination and had a sleep electroencephalogram (EEG). Eleven had normal development and adequate scholastic achievements, so no formal testing was performed. Psychological assessment was carried out in the remaining 11 patients who had been referred because of learning and behavioral difficulties.

RESULTS AND CONCLUSIONS

IQ was in the average/low-average range in most patients, with a cognitive profile characterized by relatively better verbal than performance abilities (8/11). There was a high incidence of scholastic disabilities (7/11); psychiatric disorders in the form of anxiety and depressive disorders were also frequent (6/11). In the six patients who had neuropsychological assessment with specific visuoperceptual testing, a deficit in facial discrimination was found in four patients, associated with a line orientation deficit in three. Although preliminary, and based on a tertiary-care clinical sample, these data suggest that children with IOLE, are at risk for lower intellectual performance, poor scholastic achievement and psychiatric disorders, as well as for specific deficits in the visuoperceptual domain, probably due to dysfunction of the occipitotemporal circuitries most often involved in seizure spread in epilepsies originating in the posterior brain.

Structural, mechanical and wear resistance assessment of UHMWPE orthopedic components

The long-term survival of total joint prostheses is influenced by many factors. Among these factors, the most critical one is the presence of wear debris, particularly from the joint articulating surfaces. While ultra high molecular weight polyethylene (UHMWPE) has shown to be extremely promising in vitro and short-term clinical results, shelf-aged, oxidized components have been extremely unsuccessful clinically. Although shelf-aged components have been frequently tested in the laboratory, few studies have compared the properties of clinical retrievals to shelf-aged UHMWPE components. In this study, a thorough analysis method was developed and applied to both UHMWPE components retrieved at the time of revision, and non-implanted, shelf-aged UHMWPE components with the aim to understand better the significance of the in vivo factors on the material properties of the retrievals. The UHMWPE components were analyzed and characterized by visual observation of the surfaces, mechanical properties were assessed by small punch tests, wear resistance was analyzed by a multidirectional pin-on-disk test, and the oxidation level was detected by the Fourier transformed infrared (FT-IR) technique. The results indicated a strong correlation between the UHMWPE oxidation level, mechanical properties and wear resistance.

[Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace]

BACKGROUND

The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon.

OBJECTIVES

The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto".

MATERIALS AND METHODS

The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions.

RESULTS

The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing.

CONCLUSIONS

The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.

Influence of heat treatment on structural, mechanical and wear properties of crosslinked UHMWPE

New crosslinked ultra high molecular weight polyethylenes (UHMWPEs) have recently been developed, characterized and introduced in clinical applications. UHMWPE cross-linking treatments are very promising for reducing osteolysis induced by wear debris. The irradiation type, gamma or beta, the dosage and the thermal treatment performed during or following the irradiation process are all factors affecting polyethylene wear resistance. Thermal stabilization treatments performed after or during the irradiation process at a temperature above melting point (i.e. >130 degrees C) have been proven to effectively remove the free radicals generated during irradiation from UHMWPE, but their effect on the mechanical properties of UHMWPE are not completely clear. In addition to wear rate reduction, maintaining good mechanical properties is fundamental aspect in designing the new generation of crosslinked UHMWPE for artificial load bearing materials, especially considering the application in total knee replacements. In this study, we investigated the influence of different stabilization treatments, performed after gamma irradiation, on structural, wear and mechanical properties of UHMWPE. We performed four different stabilization treatments, with different temperatures and cooling rates, on 100 kGy gamma irradiated UHMWPE. Structural properties of UHMWPE were assessed by differential scanning calorimetry (DSC). To assess the mechanical performance of the materials, uni-axial tensile tests were performed according to the ASTM D638 standard, bi-axial tension performance was evaluated by small punch tests (ASTM F2183-02), toughness resistance was evaluated by the Izod method (ASTM F648), and cold flow resistance was analysed by a dynamic compressive test. Evaluation of wear resistance was by a multidirectional pin-on-disk screening machine. Materials considered were in ""aged"" and ""non-aged"" conditions. Results confirmed that cross-linking greatly enhances UHMWPE wear resistance, but introduces some detrimental effects on the mechanical properties. In this study, we found that the negative ef-fects on the mechanical properties of crosslinked UHMWPE can be modulated, to some extent, by choosing a thermal stabiliza-tion treatment at a correct temperature and cooling rate. (Journal of Applied Biomaterials & Biomechanics 2004; 2: 20-8).

Characterization of Penicillium Isolates Associated with Blue Mold on Apple in Uruguay

Blue mold caused by Penicillium spp. is the most important postharvest disease of apple in Uruguay. Fourteen isolates of Penicillium were recovered from rotten apple and pear fruit with blue mold symptoms, and from water from flotation tanks in commercial apple juice facilities. Phenotypic identification to species level was performed, and the isolates were tested for sensitivity to commonly used postharvest fungicides. Genetic characterization of the isolates was performed with restriction fragment length polymorphism of the region including the internal transcribed spacer (ITS) ITS1 and ITS2 and the 5.8SrRNA gene (ITS1-5.8SrRNA gene-ITS2) ribosomal DNA region and with random amplified polymorphic DNA (RAPD) primers. Both techniques were able to differentiate these isolates at the species level. RAPD analysis proved to be an objective, rapid, and reliable tool to identify Penicillium spp. involved in blue mold of apple. In all, 11 isolates were identified as Penicillium expansum and 3 as P. solitum. This is the first report of P. solitum as an apple pathogen in Uruguay.

Mercury, zinc, and copper accumulation in mangrove sediments surrounding a large landfill in southeast Brazil

The accumulation of Hg, Zn, and Cu was evaluated in mangrove sediments located between a large, 20-years-old landfill and waters of Guanabara Bay (southeast Brazil). The contamination history of the area provides substantial evidence that metal accumulation in the study site is influenced by past metal emissions from multiple sources (e.g. contaminated rivers and the landfill surrounding the site). At the southern part of the site, metal levels are up to 890 ng g(-1) Hg, 850 microg g(-1) Zn, and 58 microg g(-1) Cu. Enrichment factors and excess (background-deducted) concentration inventories show a high spatial variability of metal contamination and storage in the site, with differences often by a factor higher than two within a sampling station and higher than five between sampling stations. These contrasts are attributable to a coupling between spatial variability of anthropogenic metal input and metal behavior and retention within the sediments. Results indicate that during the last few decades mangrove sediments retained a substantial part of metal emissions to the site, probably reducing the metal transport to Guanabara Bay waters, and suggest the suitability of mangrove ecosystems as physical and biogeochemical barriers to metal contaminant transport.

Enhanced wear performance of highly crosslinked UHMWPE for artificial joints

It is well known that osteolysis induced by polyethylene wear debris is the main cause of long-term failure of hip and knee prostheses. We developed a treatment of medical-grade ultra-high molecular-weight polyethylene (UHMWPE) in order to improve its tribologic properties and reduce its wear. Medical-grade UHMWPE was irradiated with a 200 kGy dose of radiation, thermally stabilized at a temperature close to the melting point, and then sterilized with ethylene oxide. The irradiation treatment was performed to crosslink the UHMWPE. The thermal stabilization treatment, contributing to the reaction between the free radicals generated by the irradiation process, was chosen to enhance crosslinking and to prevent oxidation and the shortening of chains. The non-invasive sterilization process with ethylene oxide was chosen to prevent the re-formation of free radicals. The wear performance of this material was compared to UHMWPE, untreated or treated with different sterilization techniques, using gamma and beta irradiation. Insoluble crosslinked constituents were measured with an extraction method. Wear was evaluated using a flat-on-ring wear test machine. While small differences were found among the different sterilization processes, 200 kGy-irradiated UHMWPE followed by thermal treatment and sterilization with ethylene oxide had the least wear and the greatest amount of crosslinking.

Risk factors of hepatitis C virus infection in patients on hemodialysis: a multivariate analysis based on a dialysis register in Central Italy

A seroprevalence survey of antibodies to HCV was carried out among 2788 hemodialysis (HD) patients in a region of central Italy. Anti-HCV seroprevalence was 28.6%. A multivariate analysis of risk factors showed a significant association with time on HD, history of blood transfusion and metropolitan area of residence. Our study clearly showed that HCV infection is common among HD patients and is partially associated with preventable factors.