Endometrial cancer (EC) is the most common malignancy of the female genital tract in Western and emerging countries. In 2012, new cancer cases numbered 319,605, and 76,160 cancer deaths were ...diagnosed worldwide. ECs are usually diagnosed after menopause; 70% of ECs are diagnosed at an early stage with a favorable prognosis and a 5-year overall survival rate of 77%. On the contrary, women with advanced or recurrent disease have extremely poor outcomes because they show a low response rate to conventional chemotherapy. EC is generally considered easy to treat, although it presents a 5-year mortality of 25%. Though the guidelines (GLs) recommend treatment in specialized centers by physicians specializing in gynecologic oncology, most women are managed by general gynecologists, resulting in differences and discrepancies in clinical management. In this paper we reviewed the literature with the aim of highlighting where the treatment of EC patients requires gynecologic oncologists, as suggested by the GLs. Moreover, we sought to identify the causes of the lack of GL adherence, suggesting useful changes to ensure adequate treatment for all EC patients.
The aim of this narrative review is to summarize the available evidence on the use of minimal invasive surgery (MIS) in the management of epithelial ovarian cancer (EOC).
MIS is currently performed ...to stage and treat EOC at different stage of presentation. We will evaluate risks and benefits of minimally invasive surgery for early stage EOC treatment, then potential advantages provided by staging laparoscopy in identifying patients suitable for primary cytoreductive surgery (PDS) will be discussed. Finally we will investigate the growing role of MIS in the treatment of advanced EOC after neoadjuvant chemotherapy (NACT) and in the treatment of EOC recurrence.
An electronic database search was performed on PubMed, Medline, and Google Scholar for relevant studies up to December 2022.
LPS represents a feasible surgical procedure for the staging and treatment in early, advanced and EOC relapse in selected patients treated in high-volume oncological centers by surgeons with adequate experience in advanced surgical procedures. Despite the increasing use of MIS over the last few years, randomized clinical trials are still needed to prove its effectiveness.
Abstract Elevation of homocysteine is associated with an increased risk for bone fractures. Whether the risk is due to homocysteine or to the reduced levels of cofactors necessary for its ...metabolisation, such as folates or vitamin B12, is not completely clear. In this study we wanted to determine whether in postmenopausal women, levels of folates, homocysteine or vitamin B12 are predictive of the rate of vertebral bone mineral density (BMD) change. The study was conducted at the centre for the menopause of our university hospital. Between September 2001 and March 2002, 161 healthy postmenopausal women volunteered for a cross-sectional evaluation of BMD and levels of serum folates, homocysteine and vitamin B12. Women were recalled for a second evaluation of vertebral BMD after about 5 years. Women having used anti-resorptive therapies for more than 1 year were excluded. The analysis was possible in 117 postmenopausal women. The annual rate of vertebral BMD change was independently related to levels of folates (coefficient of regression (CR): 2.040; 95%CI: 0.483, 3.596; p = 0.011), and initial BMD values (CR: − 0.060; 95%CI: − 0.117, − 0.003; p = 0.040). No significant relation was found between the change of vertebral BMD and homocysteine or vitamin B12. BMD values at the first ( r = 0.225; p = 0.016) and the second ( r = 0.206; p = 0.027) evaluation were related to levels of folates, but not of homocysteine or of vitamin B12. These data suggest an important role for folates deficiency in the vertebral BMD decline of postmenopausal women.
Objective To evaluate modification in body weight and anthropometric indexes in women at the time of menopause. Design Prospective longitudinal study. Setting Menopause Center at the University ...Hospital of Modena. Patient(s) Women in perimenopause (n = 87), ovariectomized (n = 60), and in postmenopause (n = 182) without and with treatment. Intervention(s) Data were retrieved from the electronic database of the Menopause Center. Main Outcome Measure(s) Modification of weight, body mass index (BMI), waist, hip, and waist-to-hip ratio in 12 months. Result(s) Body weight increased in perimenopausal (0.6 ± 0.1 kg) women, did not vary in postmenopausal (0.2 ± 0.1 kg) women, and decreased in ovariectomized (−0.5 ± 0.3 kg) women. Waist increased significantly in perimenopausal (2.3 ± 0.4 cm) and in postmenopausal (2.0 ± 0.4 cm) women. In comparison to no treatment, progestin administration (n = 29) decreased body weight (−0.2 ± 0.5 kg) and hip (−1.1 ± 0.9 cm) in perimenopausal women, estrogen (E) administration (n = 38) increased body weight (0.8 ± 0.3 kg) in ovariectomized women, whereas E plus progestin administration (n = 89) did not induce any modification in postmenopausal women. Conclusion(s) Present preliminary data indicate that body weight increases in perimenopausal women, decreases in ovariectomized women, and does not increase significantly in naturally postmenopausal women. Estrogens and progestins influence body weight differently, increasing and decreasing it, respectively.
To assess compliance with the 2019 regional recommendation to centralize epithelial ovarian cancer (EOC) patients and to assess whether the COVID-19 pandemic has affected the quality of care for EOC ...patients.
We compared data from EOC patients treated before the introduction of the 2019 regional recommendation (2018-2019) with data obtained from EOC patients treated after the regional recommendation was adopted during the first 2 years of the COVID-19 pandemic (2020-2021). Data were retrieved from the Optimal Ovarian Cancer Pathway records. R software version 4.1.2 (the R Foundation for Statistical Computing, Vienna, Austria) was used for the statistical analysis.
251 EOC patients were centralized. The number of EOC patients centralized increased from 2% to 49% despite the COVID-19 pandemic. During the COVID-19 pandemic, there was an increase in the use of neoadjuvant chemotherapy and interval debulking surgery. There was an improvement in the percentage of Stage III patients without gross residual disease following both primary and interval debulking surgery. The percentage of EOC cases discussed by the multidisciplinary tumor board (MTB) increased from 66% to 89% of cases.
Despite the COVID-19 pandemic, centralization has increased and the quality of care has been preserved thanks to the MTB.
Since their introduction in 1959, development of hormonal contraceptives has been ongoing, with the ultimate aim of creating not only an effective and safe contraceptive method, but also a drug able ...to meet the need for treatment of other conditions, such as acne, seborrhea, and hirsutism, with few or no side effects. With this objective, a new progestin, chlormadinone acetate (CMA), has been developed as a derivative of progesterone for contraception. This new molecule has been introduced in combination with ethinylestradiol (EE) 30 µg as a safe contraceptive with antiandrogenic properties. Many clinical studies have investigated this new oral combination and found it to be safe, with a Pearl Index similar to that of other combined hormonal contraceptives. CMA, because of its antiandrogenic properties, has been also considered effective for resolution of acne, seborrhea, and hirsutism. The data show it to be a safe molecule in terms of glucose and lipid metabolism. No major weight changes have been linked with its use, and it seems to be the only progestin able to reduce fat mass during use. The CMA-EE combination is well tolerated and acceptable to women. Adverse events related to its use are similar to those reported with other third-generation contraceptives. We can conclude that CMA-EE is an effective, safe, and well tolerated antiandrogenic hormonal contraceptive.
PC4HC: Personalized communication for health care Generali, Matteo; Gazzano, Monia; Dolla, Matteo
2017 IEEE 3rd International Forum on Research and Technologies for Society and Industry (RTSI),
2017-Sept.
Conference Proceeding
PC4HC (Personalized Communication for Health Care) intends to create a communication platform tailored to people with multimorbidity and healthcare facilities that manage the care process. The ...project aims at: (1) Providing patients and healthcare facilities with a concise, clear and communicative interpretation of data from heterogeneous sources such as anamnestic, anthropometric, clinical and instrumental data (in particular, data obtainable from wearable sensors and so-called personal health systems). For this purpose, we plan to set up an infrastructure with high computational capabilities that is able to process large amounts of data (Big Data) and identify new associations (Data Mining) between variables that can enrich communication and generate new knowledge. (2) Promoting a patient empowerment approach aimed at making the patient fully aware of the significance of a specific piece of information and the implications that it entails for the patient's state of health and wellbeing. To this end, we applied the principles of persuasive computing technology, i.e. technologies developed in order to influence and possibly modify habits and lifestyle choices through persuasion and awareness. (3) Implementing effective strategies to maintain health and a healthy lifestyle, as well as to provide integrated and optimized management of acute and chronic pathologies with an economic and social benefit for both individuals and the healthcare system. The platform, designed and developed to address multimorbidity, identifies as a validation scope an innovative model of personalized communication for people in dialysis treatment.
Breast Cancer (BC) is the second most common type of cancer worldwide and displays the highest cancer-related mortality among women worldwide. Targeted therapies have revolutionized the way BC has ...been treated in recent decades, improving the life expectancies of millions of women. Among the different molecular pathways that have been of interest for the development of targeted therapies are the Cyclin-Dependent Kinases (CDK). CDK inhibitors are a class of molecules that already exist in nature and those belonging to the Cyclin dependent kinase inhibitors family INK4 that specifically inhibit CDK4/6 proteins. CDK4/6 inhibitors specifically block the transition from the G1 to the S phase of the cell cycle by dephosphorylation of the retinoblastoma tumor suppressor protein. In the past four years, the CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib, received their first FDA approval for the treatment of Hormone Receptor (HR)-positive and Human Epidermal growth factor Receptor 2 (HER2)-negative breast cancer after showing significant improvements in progression-free survival in the PALOMA-1, MONALEESA-2 and the MONARCH-2 randomized clinical trials, respectively. After the encouraging results from these clinical trials, CDK4/6 inhibitors have also been investigated in other BC subtypes. In HER2-positive BC, a combination of CDK4/6 inhibitors with HER2-targeted therapies showed promise in preclinical studies and their clinical evaluation is ongoing. Moreover, in triple-negative BC, the efficacy of CDK4/6 inhibitors has been investigated in combination with other targeted therapies or immunotherapies. This review summarizes the molecular background and clinical efficacy of CDK4/6 inhibitors as single agents or in combination with other targeted therapies for the treatment of BC. Future directions for ongoing clinical trials and predictive biomarkers will be further debated.
•Canakinumab is an IL-1β antibody that neutralises the activity of IL-1β.•The effects of canakinumab in patients with COVID-19-related pneumonia were studied.•33 patients received canakinumab and 15 ...received institutional standard of care.•Treatment with canakinumab rapidly restored normal oxygen status.•Canakinumab was also associated with favorable prognosis versus standard of care.
Canakinumab is an IL-1β antibody that neutralises the activity of IL-1β. This study examined the efficacy and safety of canakinumab in patients with moderate COVID-19-related pneumonia.
This study aimed to evaluate the reduction in duration of hospitalisation with adequate oxygen status. Forty-eight patients with moderate COVID-19-related pneumonia were asked to participate in the prospective case-control study: 33 patients (cases) signed informed consent and received canakinumab (Cohort 1) and 15 patients (Controls) refused to receive the experimental drug and received institutional standard of care (Cohort 2).
Hospital discharge within 21 days was seen in 63% of patients in Cohort 1 vs. 0% in Cohort 2 (median 14 vs. 26 days, respectively; p < 0.001). There was significant clinical improvement in ventilation regimes following administration of canakinumab compared with Cohort 2 (Stuart-Maxwell test for paired data, p < 0.001). Patients treated with canakinumab experienced a significant increase in PaO2:FiO2 (p < 0.001) and reduction in lung damage by CT (p = 0.01), along with significant decreases in immune/inflammation markers that were not observed in Cohort 2. Only mild side-effects were seen in patients treated with canakinumab; survival at 60 days was 90.0% (95% CI 71.9–96.7) in patients treated with canakinumab and 73.3% (95% CI 43.6–89.1) for Cohort 2.
Treatment with canakinumab in patients with COVID-19-related pneumonia rapidly restored normal oxygen status, decreased the need for invasive mechanical ventilation, and was associated with earlier hospital discharge and favourable prognosis versus standard of care.
Oral problems in a group of oncological patients undergoing chemotherapy (CT) for solid tumors have been examined. Incidence and severity of patients' self-reported oral problems have been evaluated ...along their interaction with age, gender, tumor diagnosis and stage, presence of mestastasis, CT agent type, and number of CT cycle. We also analyzed the presence of paraesthesia and anaesthesia and their predisposing factors associated with clinical and treatment-related variables.
Patients were asked to fill in a questionnaire to evaluate the onset and the intensity of oral and perioral pain, oral mucositis, salivary gland hypofunction, dysgeusia, dysphagia, dysphonia, and sensitivity neuropathy (paraesthesia or dysaesthesia) since the last CT infusion. We also investigated which types of medications have possibly been used and who recommended it, as well as patients' degree of awareness about the possibility of oral problems arising during CT.
We recruited 194 patients and obtained 491 questionnaires. We found that a metastatic disease was a risk factor for OM (OR 2.02,
= 0.026) and salivary gland hypofunction (OR 1.66,
= 0.042) and that platinum agents, compared to mitotic inhibitors, increased the risk of developing salivary gland hypofunction (OR 2.16,
= 0.013), dysphagia (OR 3.26,
= 0.001), and anaesthesia (OR 5.16,
= 0.041). Young age was a slight protective factor for most symptoms. The 80% of enrolled patients were informed by the oncologist about possible oral problems arising during CT.
Our study highlighted the importance of collecting observational data from the patients' perspective on oral problems arising during the routine oncology practice, across a range of solid tumors and CT regimens. The relevance of these findings focused on the key role of the multidisciplinary team in advising the patients on the possible occurrence of oral problems, also by recommending their management.
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