•Boost dose is beneficial for young patients affected by breast cancer.•Intraoperative electrons (IOERT) boost and hypofractionated whole breast irradiation (HWBI) represent a suitable ...modality.•Local control with IOERT/HWBI was excellent, even in very young patients.•High tumor bed fibrosis was observed due to high cumulative EQD2 boost dose.
To evaluate outcome of intraoperative electron boost (IOERT) and hypofractionated whole breast irradiation (HWBI) for breast cancer (BC) in young women.
Women aged ≤ 48 with pT1-2 N0-1 BC received 12 Gy IOERT boost during conservative surgery followed by 3-dimensional conformal HWBI in 13 fractions (2.85 Gy/die). Local relapses (LR) and survival (disease-free, DFS; specific, BCSS; overall, OS) were analyzed.
481 consecutive BC patients, mostly node negative, with median age of 42 were treated between 2004 and 2014. Median tumor size was 1.48 cm and median IOERT collimator was 4 cm. After 25-day mean interval, HWBI was delivered. At a median follow-up of 9.6 years, there were 23 LRs (4.8 %, 9 of which were in the boost region). Ten-year LR cumulative incidence was 4.1 % (95 %CI, 2.5–6.3). Over time, local control rate decreased for Luminal A and HER2 positive with negative hormonal receptors, while remained steady for triple negative. At multivariate analysis, LR predictors included age < 40, extensive intraductal component and the use of 4-cm IOERT collimator size. Ten-year survival outcomes were as follows: DFS 80.0 % (95 % CI, 75.8–83.5), BCSS 97.5 % (95 % CI, 95.5–98.6 %), OS 96.5 % (95 % CI, 94.3–97.9). Luminal B HER2 negative had the worse survival outcomes. Perioperative complications were uncommon (16.4 %), acute toxicity was mild (<2% Grade 3), but moderate/severe fibrosis was described in 40.8 % of the cases. Cosmesis was scored as excellent/good in 86 % of the cases.
ELIOT boost and HWBI achieved an excellent local control at the cost of tumor bed fibrosis. IOERT boost dose lower than 12 Gy is advisable.
This study represents a descriptive analysis of preliminary results of a Phase II trial on a novel mixed beam radiotherapy (RT) approach, consisting of carbon ions RT (CIRT) followed by ...intensity-modulated photon RT, in combination with hormonal therapy, for high-risk prostate cancer (HR PCa) with a special focus on acute toxicity.
Primary endpoint was the evaluation of safety in terms of acute toxicity. Secondary endpoints were early and long-term tolerability of treatment, quality of life (QoL), and efficacy. Data on acute and late toxicities were collected according to RTOG/EORTC. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and sexual activity by IIEF-5.
Twenty-six patients were enrolled in the study, but only 15 completed so far the RT course and were included. Immediately after CIRT, no patients experienced GI/GU toxicity. At 1 and 3 months from the whole course RT completion, no GI/GU toxicities greater than grade 2 were observed. QoL scores were overall satisfactory.
The feasibility of the proposed mixed treatment schedule was assessed, and an excellent acute toxicity profile was recorded. Such findings instil confidence in the continuation of this mixed approach, with evaluation of long-term tolerability and efficacy.
El corazón frágil es una miniserie británica, estrenada en 1996. Dado que este drama médico ofrece, entre otras, una variedad de posibilidades de debate sobre facetas deontológicas y actitudinales ...para médicos en particular y profesionales del área de la salud en general resulta más que recomendable apreciar las varias lecturas que permite.
El objetivo de este trabajo es abordarla y presentar algunas de tales posibilidades.
The strategy to anticipate radiotherapy (RT) before surgery, for breast cancer (BC) treatment, has recently generated a renewed interest. Historically, preoperative RT has remained confined either to ...highly selected patients, in the context of personalized therapy, or to clinical research protocols. Nevertheless, in the recent years, thanks to technological advances and increased tumor biology understanding, RT has undergone great changes that have also impacted the preoperative settings, embracing the modern approach to breast cancer. In particular, the reappraisal of preoperative RT can be viewed within the broader view of personalized and tailored medicine. In fact, preoperative accelerated partial breast irradiation (APBI) allows a more precise target delineation, with less variability in contouring among radiation oncologists, and a smaller treatment volume, possibly leading to lower toxicity and to dose escalation programs. The aim of the present review, which represents a benchmark study for the AIRC IG-23118, is to report available data on different technical aspects of preoperative RT including dosimetric studies, patient’s selection and set-up, constraints, target delineation and clinical results. These data, along with the ones that will become available from ongoing studies, may inform the design of the future trials and representing a step toward a tailored APBI approach with the potential to challenge the current treatment paradigm in early-stage BC.
Trial registration:
The study is registered at clinicaltrials.gov (NCT04679454).
In an attempt to explore the role of the gut microbiome during recent canine evolutionary history, we sequenced the metagenome of 13 canine coprolites dated ca. 3,600–3,450 years ago from the Bronze ...Age archaeological site of Solarolo (Italy), which housed a complex farming community. The microbiome structure of Solarolo dogs revealed continuity with that of modern dogs, but it also shared some features with the wild wolf microbiome, as a kind of transitional state between them. The dietary niche, as also inferred from the microbiome composition, was omnivorous, with evidence of consumption of starchy agricultural foods. Of interest, the Solarolo dog microbiome was particularly enriched in sequences encoding alpha-amylases and complemented a low copy number of the host amylase gene. These findings suggest that Neolithic dogs could have responded to the transition to a starch-rich diet by expanding microbial functionalities devoted to starch catabolism, thus compensating for delayed host response.
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•Ancient DNA of Bronze Age canine coprolites from Solarolo was sequenced•Solarolo dogs share gut microbiome features with modern wolves and dogs•The gut microbiome of Solarolo dogs shows high number of reads for alpha-amylase•Neolithic canine gut microbiome complemented delay in host genome adaptation
Biological sciences; Microbiome; Evolutionary biology; Evolutionary processes; Phylogenetics; Phylogeny; Evolutionary history; Genomic analysis; Sequence analysis; Omics; Genomics
Mirad los lirios del campo (1947) María Eugenia D’Ottavio Callegari; María Silvia D’Ottavio Callegari; Alberto Enrique D’Ottavio Cattani
Revista de Medicina y Cine,
02/2022, Letnik:
18, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Este filme argentino fue rodado en 1947 a partir de la novela brasileña homónima, cuyo título extracta un fragmento del Sermón de la Montaña. Más allá de los significados que apóstoles y filósofos ...cristianos otorgan al imperativo de mirar las lilas del campo, la novela y el filme exceden la de prescindir de las necesidades mundanas y proveen valiosas enseñanzas axiológicas para el ejercicio profesional y la vida cotidiana, ligadas todas a otros disvalores y valores. De tal modo, condenan las ambiciones vanas y el incumplimiento de un compromiso por ventajoso que resulte y, en contraste, rescatan la vida austera desprovista de lujos innecesarios, la redención personal y la paternidad responsable.
The Bacillus cereus group includes important spore-forming bacteria that present spoilage capability and may cause foodborne diseases. These microorganisms are traditionally evaluated in food using ...culturing methods, which can be laborious and time-consuming, and may also fail to detect bacteria in a viable but nonculturable state. The purpose of this study was to develop a quantitative real-time PCR (qPCR) combined with a propidium monoazide (PMA) treatment to analyze the contamination of UHT milk by B. cereus group species viable cells. Thirty micrograms per milliliter of PMA was shown to be the most effective concentration for reducing the PCR amplification of extracellular DNA and DNA from dead cells. The quantification limit of the PMA-qPCR assay was 7.5×102cfu/mL of milk. One hundred thirty-five UHT milk samples were analyzed to evaluate the association of PMA to qPCR to selectively detect viable cells. The PMA-qPCR was able to detect B. cereus group species in 44 samples (32.6%), whereas qPCR without PMA detected 78 positive samples (57.8%). Therefore, the PMA probably inhibited the amplification of DNA from cells that were killed during UHT processing, which avoided an overestimation of bacterial cells when using qPCR and, thus, did not overvalue potential health risks. A culture-based method was also used to detect and quantify B. cereus sensu stricto in the same samples and showed positive results in 15 (11.1%) samples. The culture method and PMA-qPCR allowed the detection of B. cereus sensu stricto in quantities compatible with the infective dose required to cause foodborne disease in 3 samples, indicating that, depending on the storage conditions, even after UHT treatment, infective doses may be reached in ready-to-consume products.
The influence of humic substances (HS) on crops and soil microbial communities still lacks a complete understanding. The influence of HS on chemical composition of maize rhizodeposits and diversity ...of rhizosphere microbial communities was studied here in rhizobox systems. Eleven different HS were characterized by elemental analyses and 13C-CPMAS NMR, and applied to the upper compartment of rhizobox systems cultivated with maize. Once a full rhizoplane was formed, the lower compartment of the rhizoboxes was sampled with a slicing device, in order to obtain rhizopshere (0–2mm) and bulk (>10mm) soil samples, which were subjected to chemical analyses of organic acids and sugars (pentoses and hexoses), bioassays with a luminescent biosensor for the detection and quantification of bioavailable C forms, and analyzed for bacterial diversity by means of PCR-DGGE fingerprint. Multivariate techniques were applied to assess correlations between the parameters involved and to assess the most relevant chemical drivers of rhizosphere microbial diversity. Results showed that the hydrophilic and poorly aromatic HS changed the pattern of sugars and organic acids released in the rhizosphere by maize roots, and this, in turn, affected the composition of rhizosphere microbial communities. Differences in chemical and microbiological composition were also found, but to a lesser extent, among bulk soil samples of different treatments, thus indicating that rhizodeposits can influence soil composition at several mm distance from the root plane. Multiple regression analyses suggested a prominent role of succinic and malic acid in shaping the diversity of microbial communities. The approach and results described here proved to be useful to test bioactivity of HS towards an agricultural crop, and identify correlations between chemical and microbiological constituents at the tri-phase soil–roots–microbes system.
The COVID-19 pandemic is impressively challenging the healthcare system. Several prognostic models have been validated but few of them are implemented in daily practice. The objective of the study ...was to validate a machine-learning risk prediction model using easy-to-obtain parameters to help to identify patients with COVID-19 who are at higher risk of death. The training cohort included all patients admitted to Fondazione Policlinico Gemelli with COVID-19 from March 5, 2020, to November 5, 2020. Afterward, the model was tested on all patients admitted to the same hospital with COVID-19 from November 6, 2020, to February 5, 2021. The primary outcome was in-hospital case-fatality risk. The out-of-sample performance of the model was estimated from the training set in terms of Area under the Receiving Operator Curve (AUROC) and classification matrix statistics by averaging the results of fivefold cross validation repeated 3-times and comparing the results with those obtained on the test set. An explanation analysis of the model, based on the SHapley Additive exPlanations (SHAP), is also presented. To assess the subsequent time evolution, the change in paO2/FiO2 (P/F) at 48 h after the baseline measurement was plotted against its baseline value. Among the 921 patients included in the training cohort, 120 died (13%). Variables selected for the model were age, platelet count, SpO2, blood urea nitrogen (BUN), hemoglobin, C-reactive protein, neutrophil count, and sodium. The results of the fivefold cross-validation repeated 3-times gave AUROC of 0.87, and statistics of the classification matrix to the Youden index as follows: sensitivity 0.840, specificity 0.774, negative predictive value 0.971. Then, the model was tested on a new population (n = 1463) in which the case-fatality rate was 22.6%. The test model showed AUROC 0.818, sensitivity 0.813, specificity 0.650, negative predictive value 0.922. Considering the first quartile of the predicted risk score (low-risk score group), the case-fatality rate was 1.6%, 17.8% in the second and third quartile (high-risk score group) and 53.5% in the fourth quartile (very high-risk score group). The three risk score groups showed good discrimination for the P/F value at admission, and a positive correlation was found for the low-risk class to P/F at 48 h after admission (adjusted R-squared = 0.48). We developed a predictive model of death for people with SARS-CoV-2 infection by including only easy-to-obtain variables (abnormal blood count, BUN, C-reactive protein, sodium and lower SpO2). It demonstrated good accuracy and high power of discrimination. The simplicity of the model makes the risk prediction applicable for patients in the Emergency Department, or during hospitalization. Although it is reasonable to assume that the model is also applicable in not-hospitalized persons, only appropriate studies can assess the accuracy of the model also for persons at home.
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