Dose-escalated pelvic radiotherapy for prostate cancer in definitive or postoperative setting

Purpose Given the absence of standardized planning approach for clinically node-positive (cN1) prostate cancer (PCa), we collected data about the use of prophylactic pelvic irradiation and nodal boost. The aim of the present series is to retrospectively assess clinical outcomes after this approach to compare different multimodal treatment strategies in this scenario. Methods Data from clinical records of patients affected by cN1 PCa and treated in six different Italian institutes with prophylactic pelvic irradiation and boost on pathologic pelvic lymph nodes detected with CT, MRI or choline PET/CT were retrospectively reviewed and collected. Clinical outcomes in terms of overall survival (OS) and biochemical relapse-free survival (b-RFS) were explored. The correlation between outcomes and baseline features (International Society of Urological Pathology-ISUP pattern, total dose to positive pelvic nodes 60 Gy, sequential or simultaneous integrated boost (SIB) administration and definitive vs postoperative treatment) was explored. Results ISUP pattern < 2 was a significant predictor of improved b-RFS (HR = 0.3, 95% CI 0.1220-0.7647, P = 0.0113), while total dose < 60 Gy to positive pelvic nodes was associated with worse b-RFS (HR = 3.59, 95% CI 1.3245-9.741, P = 0.01). Conversely, treatment setting (postoperative vs definitive) and treatment delivery technique (SIB vs sequential boost) were not associated with significant differences in terms of b-RFS (HR = 0.85, 95% CI 0.338-2.169, P = 0.743, and HR = 2.39, 95% CI 0.93-6.111, P = 0.067, respectively). Conclusion Results from the current analysis are in keeping with data from literature showing that pelvic irradiation and boost on positive nodes are effective approaches. Upfront surgical approach was not associated with better clinical outcomes

Insights into attention and memory difficulties in post-COVID syndrome using standardized neuropsychological tests and experimental cognitive tasks

Abstract The COVID-19 pandemic has given rise to post-acute cognitive symptoms, often described as ‘brain fog’. To comprehensively grasp the extent of these issues, we conducted a study integrating traditional neuropsychological assessments with experimental cognitive tasks targeting attention control, working memory, and long-term memory, three cognitive domains most commonly associated with ‘brain fog’. We enrolled 33 post-COVID patients, all self-reporting cognitive difficulties, and a matched control group (N = 27) for cognitive and psychological assessments. Our findings revealed significant attention deficits in post-COVID patients across both neuropsychological measurements and experimental cognitive tasks, evidencing reduced performance in tasks involving interference resolution and selective and sustained attention. Mild executive function and naming impairments also emerged from the neuropsychological assessment. Notably, 61% of patients reported significant prospective memory failures in daily life, aligning with our recruitment focus. Furthermore, our patient group showed significant alterations in the psycho-affective domain, indicating a complex interplay between cognitive and psychological factors, which could point to a non-cognitive determinant of subjectively experienced cognitive changes following COVID-19. In summary, our study offers valuable insights into attention challenges faced by individuals recovering from COVID-19, stressing the importance of comprehensive cognitive and psycho-affective evaluations for supporting post-COVID individuals

Cognitive deficit in post-acute COVID-19: an opportunity for EEG evaluation?

Background and purpose: Among the most common post-COVID symptoms, many patients experienced subjective cognitive deficit, commonly named "brain fog," that might be present also in those individuals without severe acute COVID-19 respiratory involvement. Some studies have investigated some of the mechanisms that might be associated with the brain fog with objective techniques including transcranial magnetic stimulation and neuroimaging. Methods: The aim of this study was to investigate the presence of electroencephalographic (EEG) alterations in people with post-COVID self-reported cognitive deficit. Results: Out of the 90 patients attending the post-COVID neurology ambulatory service, twenty patients presenting brain fog at least 4 weeks after acute non-severe COVID-19 infection, and without previous history of epilepsy, were investigated with 19-channel EEG, Montreal Cognitive Assessment (MoCA), and magnetic resonance imaging (MRI). EEG was found altered in 65% of the sample, among which 69% presented a slowing activity and 31% were characterized by epileptic discharges principally in the frontal areas. None of the patients showed DWI MRI lesions. Conclusions: These findings highlight the usefulness of EEG analysis to objectively describe possible neurophysiological abnormalities in post-COVID patients presenting subjective cognitive deficit

Guillain-Barré syndrome and COVID-19: A 1-year observational multicenter study

Background and purpose Many single cases and small series of Guillain-Barre syndrome (GBS) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported during the coronavirus disease 19 (COVID-19) outbreak worldwide. However, the debate regarding the possible role of infection in causing GBS is still ongoing. This multicenter study aimed to evaluate epidemiological and clinical findings of GBS diagnosed during the COVID-19 pandemic in northeastern Italy in order to further investigate the possible association between GBS and COVID-19. Methods Guillain-Barre syndrome cases diagnosed in 14 referral hospitals from northern Italy between March 2020 and March 2021 were collected and divided into COVID-19-positive and COVID-19-negative. As a control population, GBS patients diagnosed in the same hospitals from January 2019 to February 2020 were considered. Results The estimated incidence of GBS in 2020 was 1.41 cases per 100,000 persons/year (95% confidence interval 1.18-1.68) versus 0.89 cases per 100,000 persons/year (95% confidence interval 0.71-1.11) in 2019. The cumulative incidence of GBS increased by 59% in the period March 2020-March 2021 and, most importantly, COVID-19-positive GBS patients represented about 50% of the total GBS cases with most of them occurring during the two first pandemic waves in spring and autumn 2020. COVID-19-negative GBS cases from March 2020 to March 2021 declined by 22% compared to February 2019-February 2020. Conclusions Other than showing an increase of GBS in northern Italy in the "COVID-19 era" compared to the previous year, this study emphasizes how GBS cases related to COVID-19 represent a significant part of the total, thus suggesting a relation between COVID-19 and GBS

The representation of the onset of the Covid-19 pandemic and the consequent lockdown in Italy: A psychosocial research by SPS, Studio di Psicosociologia of Rome

A fine febbraio 2020, in SPS4ci siamo chiesti quali fossero i vissuti evocati dalla pandemia Covid-19 in esordio, e quali fatti “derivassero” da tali vissuti. A tal fine abbiamo interpellato 419 persone, tra l’1 marzo e il 5 maggio 2020. Il corpus raccolto è stato analizzato con l’Analisi Emozionale del Testo (AET). Si ipotizzava che la pandemia avesse destrutturato le modalità abituali di rapporto, e pensavamo stessero emergendo dimensioni relazionali inedite. I nostri dati dicono che l’individualismo abituale, di avida competitività, è in crisi. In risposta alla destrutturazione dello schema relazionale amico/nemico, alla base della socialità, è emerso un nuovo individualismo. La rappresentazione del pericolo insito nel contagio pandemico ci ha reso, tutti, potenzialmente nemici gli uni degli altri. Tutti siamo vissuti come potenzialmente nemici di tutti, a meno di non essere dichiaratamente malati. I malati, di contro, non sono vissuti come nemici: sono un’alterità scissa, relegata in un altrove lontano da chi è “sano”. Le cure, nel lockdown, erano confinate nell’ospedale, caratterizzate dall’isolamento, dall’emergenza, dalla morte esperita nel peggiore dei modi. L’altrove è stato reificato in un ospedale diventato sintomatico del fallimento del sistema sanitario. Si è costituito un “noi” qui insieme, sani e maniacalmente felici, e un “loro”contagiati, dannati, isolati e “altrove”. Internet, consentendo vicinanza senza contatto, è diventata un nuovo contesto di socialità. Ha permesso di ridiventare umani, ovvero amici, a meno che non si dimostri il contrario. Ma la nuova amicalità è fondata sulla scissione dall’altro dannato: la coppia malato/curante, e tutti gli esclusi, per diverse motivazioni, dalla protezione del lockdown. Dalla nuova socialità è escluso anche il vissuto dello stare chiusi in casa con gli abituali conviventi, dove emerge la violenza delle relazioni familiari obbligate. Si evidenziano altri esclusi dal noi maniacalmente amicale: gli anziani che non usano internet e che più di tutti rischiano di morire. C’è poi una cultura che, entro il fallimento delle relazioni sociali abituali, sottolinea l’impotenza delle istituzioni (politiche, sanitarie, mediatiche etc.) nella contingenza pandemica. Infine, c’è una cultura pre-lockdown, fatta della paura che porterà a scegliere l’isolamento. Manca, nei dati, il mondo produttivo, che non ha ritrovato, per gli interpellati dalla ricerca –nel periodo di tempo da noi considerato –un codice emozionale condiviso che potesse raccogliersi in un cluster. La ricerca aveva anche un obiettivo di intervento: quello di creare un contesto in cui l’evento pandemia potesse essere interpretato, entro un setting di partecipazione. Oltre a effettuare una pubblicazione rapida dei dati, intendiamo promuovere gruppi di discussione su internet con i partecipanti. La creazione di un contesto di condivisione è anche un motivo dell’alto numero di Autori.At the end of February 2020, in SPS2we asked ourselves what were the experiences evoked by the Covid-19 pandemic in its debut, and what facts “derived”from these experiences. To this end, we interviewed 419 people, between 1 March and 5 May 2020. The collected corpus was analyzed through the Emotional Text Analysis (AET). It was assumed that the pandemic had deconstructed the usual ways of relating, and we thought that new relational dimensions were emerging. Our data show that habitual individualism, of greedy competitiveness, is in crisis. A new individualism has emerged in response to the deconstruction of the friend/foerelational schema, at the basis of sociality. The representation of the danger inherent in the pandemic contagion has made us all potentially enemies of each other. We have all lived as potentially enemies of all, unless we are admittedly sick. The sick, on the other hand, are not experienced as enemies: they are a split otherness, relegated to an elsewhere far from those who are “healthy”. Duringthe lockdown, treatments were confined to the hospital, characterized by isolation, emergency, death experienced in the worst way. The othernesswas reified in a hospital that became symptomatic of the failure of the health system. A “we”has formed here together, healthy and maniacally happy, and a “them”infected, damned, isolated and “elsewhere”. The Internet, by allowing contactless proximity, has become a new context of sociality. It has allowed us to become human again, or friends, unless proven otherwise. But the new friendship is based on the split from the damned other: the sick/caring couple, and all those excluded, for various reasons, from the protection of the lockdown. The experience of being closed at home with the usual cohabitants is also excluded from the new sociality, where the violence of forced family relationships emerges. There are others excluded from a maniacally friendlyus: the elderly who do not use the internet and who most of all risk dying. There is also a culture that, within the failure of habitual social relations, underlines the powerlessness of institutions (political, health, media, etc.) in the pandemic contingency. Finally, there is a pre-lockdown culture, made up of fear that will lead to chooseisolation. In the data, the productive world is missing, which for those interviewed by the research did not find -in the period of time we considered -a shared emotional code that could be gathered in a cluster. The research also had an intervention objective: to create a context in which the pandemicevent could be interpreted, within a setting of participation. In addition to publishing the data quickly, we intend to promote discussion groups onthe internet with participants. The creation of a sharing context is also areason for the high number of Author