Cancer is becoming a chronic disease, and the number of cancer survivors continues to increase. Lymphoma survivors are also increasing in numbers, and anxiety and depression are among the ...consequences they face. This study aimed to explore psychological distress in a sample of 212 lymphoma survivors. Information through a socio-demographic form and the compilation of questionnaires to assess anxiety, depression, quality of life, and the impact of cancer on lymphoma survivors was collected and analyzed. In the sample examined, 17% of lymphoma survivors were anxiety caseness, and 12.3% were depression caseness, and of these, 8% presented with concomitant anxiety depression. This study identified some variables associated with psychological distress in lymphoma survivors: female sex; living as a couple; a diagnosis of Hodgkin lymphoma; systematic treatment and/or radiotherapy; sleep disorders; no regular physical activity; and present or past use of psychiatric drugs. Our cross-sectional study results suggest that some of the variables investigated may be useful in identifying lymphoma survivors who are more likely to report psychological distress. It is important to monitor psychological distress along the entire trajectory of survivorship in order to identify early the presence of anxiety and depression and to provide timely psychological support.
Psychological distress includes all negative subjective experiences elicited by a disease and its treatments. Since psychological distress in oncology is associated with negative outcomes, its ...detection and description are helpful for designing tailored supportive interventions. This study used the Hospital Anxiety and Depression Scale (HADS) to assess the intensity and prevalence of psychological distress (i.e., anxiety and depression) in cancer inpatients and examined the relationships between these variables and sociodemographic and clinical factors. An existing dataset of HADS results, from 2021 consecutive adult cancer inpatients at a single hospital, was analyzed. Only those questionnaires with complete responses were used. The intensity of anxiety and depression was determined from HADS sub-scores. The prevalence of anxiety and depression was calculated using, as case-finding criteria, cut-offs of ≥ 10 and ≥ 8, respectively. The mean HADS scores describing intensity were 7.3 for anxiety (
= 1,990) and 5.8 (
= 1,970) for depression. The prevalence rates for anxiety and depression were 26.6 and 28.6%, respectively. Among the 1,916 patients who completed both subscales, 17.2% had both anxiety and depression, 21.0% had either anxiety or depression, and 61.7% had neither. Gender, age, occupational status, and cancer diagnosis were associated with anxiety intensity or prevalence, while age, occupational status, and cancer diagnosis were associated with depression intensity or prevalence. Anxiety intensity was affected by the interaction effect between gender and diagnosis. Our study showed anxiety and depression being distinct entities, with more intense anxiety overall. From a research perspective, it reaffirms the usefulness for assessing both intensity and prevalence concurrently to gain a more detailed description of anxiety and depression.
Background: The continuously improving treatment outcome for classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) over the last 25 years has led to a high number of long-term ...survivors. The impact of treatment, however, can sometimes be dramatic and long-lasting. Focusing on peripheral neuropathy (PN), cognitive impairment, fatigue, anxiety, and depression, researchers of the Fondazione Italiana Linfomi conducted a systematic review of the literature to collect the available data on sequelae incidence as well as evidence of follow-up strategies for long-term cHL and DLBCL survivors. Methods: The review was carried out under the methodological supervision of the Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy. The literature search was conducted on three databases (MEDLINE, Embase, and the Cochrane Library) updated to November 2019. The selection process and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 2236 abstracts were screened, 247 full texts were analyzed, and 35 papers were included in the final analysis. Fatigue was the most extensively studied among neuropsychological sequelae, with a mean prevalence among cHL survivors of 10–43%. Although many of the papers showed an increased incidence of PN, cognitive impairment, and anxiety and depression in long-term cHL and DLBCL survivors, no definite conclusions can be drawn because of the methodological limitations of the analyzed studies. No data on monitoring and follow-up strategies of PN and other neuropsychological sequelae were highlighted. Conclusions: Based on our findings, future studies in this setting should include well-defined study populations and have a longitudinal trial design to assess the outcomes of interest over time, thus as to structure follow-up programs that can be translated into daily practice.
Cognitive functioning plays a fundamental role in people's life and quality of life (QoL), and anti-cancer chemotherapy may provoke long-lasting cognitive problems. This study investigated the ...subjective perception of cognitive functioning in long-term lynfoma survivors and its associations with objectively assessed cognitive functioning and QoL. 198 long-term lynfoma survivors were administered the Cognitive Functioning Self-Assessment Scale (CFSS), the Esame Neuropsicologico Breve 2 (ENB2) and the Short Form 36 Health Survey Questionnaire (SF-36). Subjectively reported cognitive functioning was worse than the norm for the general population (p<0.001). Difficulty in recalling recent information (22%), using of periphrases or generic terms (16.7%) and tip-of-the-tongue phenomena (14.7%) were the cognitive difficulties most frequently reported. CFSS overall score correlated positively with the number of impaired performances (p<0.001) and borderline performances (p=0.014) on the ENB2. Both subjectively and objectively assessed cognitive measures correlated negatively with most assessed QoL domains, indicating that QoL is worse when cognitive functioning is poor. Subjective concerns about one's own cognitive functioning are a reality for long-term lynphoma survivors, who experience these worries more than the general population does. Since improving QoL is a priority in oncology, this study supports the use of interventions to improve cognitive functioning in cancer survivors.
Thesis: Ph. D., Massachusetts Institute of Technology, Department of Nuclear Science and Engineering, September, 2020
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical ...references (pages 118-124).
In Boiling water Reactors (BWRs), the presence of a liquid film in contact with the heated rod surface is crucial to ensure an efficient heat removal and prevent the threatening occurrence of dryout. The accurate prediction of the complex multidimensional liquid film behavior in advanced BWR fuel assemblies is critical to guarantee improved reactors performance and safety. Multiphase- CFD (M-CFD) brings the ability to model the complex three-dimensional flow structures in annular flow regime 1, while physics-based constitutive equations are needed to accurately represent the phase interactions, particularly at the liquid film interface. The development of closure relations for droplet deposition and entrainment as well as wave-induced interfacial shear, is a major priority for the modeling of annular flow in M-CFD. In annular flow conditions, liquid is continuously exchanged at the interface between the bulk steam and the film on the walls.
While liquid droplets deposit onto the film driven by turbulent diffusion, new ones are entrained from the waves appearing on the film surface. A modeling approach is proposed and assessed to represent the local subgrid-scale deposition in CFD, showing comparable results with existing integral correlations, and an average error of 30%. Available closures are also evaluated for their ability to represent entrainment in the CFD implementation. Finally, in order to drive the advancement of the representation of interfacial shear, as well as physics-based droplet entrainment, the work focuses on the analysis and modeling of disturbance waves. The recent high resolution film measurements collected by Robers 2 are analyzed and leveraged to propose a physical representation of disturbance waves, which can be implemented into a complete model.
The proposed model is successfully assessed against the experimental measurements of Sawant 3, while a large disagreement is found in comparison with the high pressure data evaluated at the RISO facility 4. The new model predictions are consistent with existing integral correlations, demonstrating the need for further advancement of high pressure experiments with high resolution, necessary to drive more general representations. The complete set of closures is implemented in a commercial CFD software, and demonstrated adopting data from the Robers experiments. While the lingering limitations of the CFD implementation to transport thick films lead to overprediction of the local film thickness, the formulation shows promising performance towards more fundamental modeling of annular flow in M-CFD.
by Giulia Agostinelli.
Ph. D.
Ph.D. Massachusetts Institute of Technology, Department of Nuclear Science and Engineering
Splenic marginal zone lymphoma (SMZL) is a B cell malignancy of unknown pathogenesis, and thus an orphan of targeted therapies. By integrating whole-exome sequencing and copy-number analysis, we show ...that the SMZL exome carries at least 30 nonsilent gene alterations. Mutations in NOTCH2, a gene required for marginal-zone (MZ) B cell development, represent the most frequent lesion in SMZL, accounting for ∼20% of cases. All NOTCH2 mutations are predicted to cause impaired degradation of the NOTCH2 protein by eliminating the C-terminal PEST domain, which is required for proteasomal recruitment. Among indolent B cell lymphoproliferative disorders, NOTCH2 mutations are restricted to SMZL, thus representing a potential diagnostic marker for this lymphoma type. In addition to NOTCH2, other modulators or members of the NOTCH pathway are recurrently targeted by genetic lesions in SMZL; these include NOTCH1, SPEN, and DTX1. We also noted mutations in other signaling pathways normally involved in MZ B cell development, suggesting that deregulation of MZ B cell development pathways plays a role in the pathogenesis of ∼60% SMZL. These findings have direct implications for the treatment of SMZL patients, given the availability of drugs that can target NOTCH, NF-κB, and other pathways deregulated in this disease.
Klinefelter syndrome is the most common sex chromosomal aneuploidy in males. It is well known that patients with this syndrome have greater mortality and morbidity compared to the general population ...due to cardiovascular diseases and endocrine metabolism disorders. This augmented risk is due both to hypogonadism and to the syndrome itself. Therefore, correct hormonal replacement therapy and early primary prevention are crucial to these patients. Even though different studies are available on this topic in adult patients, only a few authors have focused on the paediatric population. Thus, in this narrative review, we report the current knowledge of metabolic and nutritional aspects in children with Klinefelter syndrome.
In the dysphagic patient, pharyngeal residues (PR) are associated with aspiration and poor quality of life. The assessment of PR using validated scales during flexible endoscopic evaluation of ...swallowing (FEES) is crucial for rehabilitation. This study aims to validate and test the reliability of the Italian version of the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS). The effects of training and experience in FEES on the scale were also determined.
The original YPRSRS was translated into Italian according to standardised guidelines. Thirty FEES images were selected after consensus and proposed to 22 naive raters who were asked to assess the severity of PR in each image. Raters were divided into two subgroups by years of experience at FEES, and randomly by training. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics.
IT-YPRSRS showed substantial to almost perfect agreement (kappa > 0.75) in validity and reliability for both the overall sample (660 ratings), and valleculae/pyriform sinus sites (330 ratings each). No significant differences emerged between groups considering years of experience, and variable differences were observed by training.
The IT-YPRSRS demonstrated excellent validity and reliability in identifying location and severity of PR.
Gut microbiota is a complex system that starts to take shape early in life. Several factors influence the rise of microbial gut colonization, such as term and mode of delivery, exposure to ...antibiotics, maternal diet, presence of siblings and family members, pets, genetics, local environment, and geographical location. Breastfeeding, complementary feeding, and later dietary patterns during infancy and toddlerhood are major players in the proper development of microbial communities. Nonetheless, if dysbiosis occurs, gut microbiota may remain impaired throughout life, leading to deleterious consequences, such as greater predisposition to non-communicable diseases, more susceptible immune system and altered gut–brain axis. Children with specific diseases (i.e., food allergies, inborn errors of metabolism, celiac disease) need a special formula and later a special diet, excluding certain foods or nutrients. We searched on PubMed/Medline, Scopus and Embase for relevant pediatric studies published over the last twenty years on gut microbiota dietary patterns and excluded case reports or series and letters. The aim of this review is to highlight the changes in the gut microbiota in infants and children fed with special formula or diets for therapeutic requirements and, its potential health implications, with respect to gut microbiota under standard diets.
Terminal tissue differentiation and function of slan
monocytes in cancer is largely unexplored. Our recent studies demonstrated that slan
monocytes differentiate into a distinct subset of dendritic ...cells (DC) in human tonsils and that slan
cells colonize metastatic carcinoma-draining lymph nodes. Herein, we report by retrospective analysis of multi-institutional cohorts that slan
cells infiltrate various types of non-Hodgkin lymphomas (NHL), particularly the diffuse large B-cell lymphoma (DLBCL) group, including the most aggressive, nodal and extranodal, forms. Nodal slan
cells displayed features of either immature DC or macrophages, in the latter case ingesting tumor cells and apoptotic bodies. We also found in patients with DLBCL that peripheral blood slan
monocytes, but not CD14
monocytes, increased in number and displayed highly efficient rituximab-mediated antibody-dependent cellular cytotoxicity, almost equivalent to that exerted by NK cells. Notably, slan
monocytes cultured in conditioned medium from nodal DLBCL (DCM) acquired a macrophage-like phenotype, retained CD16 expression, and became very efficient in rituximab-mediated antibody-dependent cellular phagocytosis (ADCP). Macrophages derived from DCM-treated CD14
monocytes performed very efficient rituximab-mediated ADCP, however, using different FcγRs from those used by slan
macrophages. Our observations shed new light on the complexity of the immune microenvironment of DLBCL and demonstrate plasticity of slan
monocytes homing to cancer tissues. Altogether, data identify slan
monocytes and macrophages as prominent effectors of antibody-mediated tumor cell targeting in patients with DLBCL.
slan
monocytes differentiate into macrophages that function as prominent effectors of antibody-mediated tumor cell targeting in lymphoma.
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