579 research outputs found

    Sometimes it is better to just make it simple. De-escalation of oncoplastic and reconstructive procedures

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    © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.Eduard-Alexandru Bonci’s work has been supported by a UICC Technical Fellowship [grant number UICC-TF/2022-1429].info:eu-repo/semantics/publishedVersio

    Hepatic Steatosis and Thyroid Function Tests in Overweight and Obese Children

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    Objectives. Associations between thyroid function and nonalcoholic fatty liver disease (NAFLD) are unknown in childhood. Thus, the aim of the present study was to investigate in 402 consecutive overweight/obese children the association between thyroid function tests and hepatic steatosis as well as metabolic variables. Methods. Hepatic steatosis was diagnosed by ultrasound after exclusion of infectious and metabolic disorders. Fasting serum samples were taken for determination of thyroid function (TSH, FT4, and FT3), along with alanine aminotransferase (ALT), lipid profile, glucose, insulin, and insulin resistance (IR). Results. Eighty-eight children (21.9%) had TSH above the normal range (>4.0 mIU/L). FT3 and FT4 were within the reference intervals in all subjects. Elevated TSH was associated with increased odds of having hepatic steatosis (OR 2.10 (95% CI, 1.22–3.60)), hepatic steatosis with elevated ALT (2.42 (95% CI, 1.29–4.51)), hypertriglyceridemia, elevated total cholesterol, and IR as well as metabolic syndrome (considered as a single clinical entity), after adjustment for age, gender, pubertal status, and body mass index-SD score (or waist circumference). Conclusions. In overweight/obese children, elevated TSH concentration is a significant predictor of hepatic steatosis and lipid and glucose dysmetabolism, independently of the degree of total and visceral obesity

    Active crustal extension and strain accumulation from GPS data in the Molise region (central-southern Apennines, Italy)

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    In this paper, we report new GPS measurements which indicate active NE-SW extension and strain accumulation in the Molise region (Apennines, Italy). The GPS observations were collected during campaigns on benchmarks of the dense IGM95 network (average distance 20 km), spanning a maximum observation interval of 13 years, and have been integrated with measurements from the available permanent GPS sites. Considering the differential motion of the GPS sites, located on the Tyrrhenian and Adriatic coasts, we can evaluate a 4-5 mm/yr extension accommodated across this part of the Apennines. The velocity field exhibits clusters of sites with homogeneous velocity vectors, outlining two main divergence areas, both characterized by the largest velocity gradients: one near Venafro and the other near Isernia where two primary active faults and several historical earthquakes have been documented. These results suggest that an active extension in this part of the Apennines can be currently distributed between the two faults systems associated with the largest earthquakes of this region

    Genome sequence analysis of a distinctive Italian infectious bursal disease virus.

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    ABSTRACT In a recent study, an emerging infectious bursal disease virus (IBDV) genotype (ITA) was detected in IBDV-live vaccinated broilers without clinical signs of infectious bursal disease (IBD). VP2 sequence analysis showed that strains of the ITA genotype clustered separately from vaccine strains and from other IBDV reference strains, either classic or very virulent. In order to obtain a more exhaustive molecular characterization of the IBDV ITA genotype and speculate on its origin, genome sequencing of the field isolate IBDV/Italy/1829/2011, previously assigned to the ITA genotype, was performed, and the sequences obtained were compared to the currently available corresponding sequences. In addition, phylogenetic and recombination analyses were performed. Interestingly, multiple amino acid (AA) sequence alignments revealed that the IBDV/Italy/1829/2011 strain shared several AA residues with very virulent IBDV strains as well as some virulence markers, especially in the VP1 protein. Nevertheless, sequence analysis demonstrated the presence of several residues typical of IBDV strains at a low degree of virulence in the IBDV/Italy/1829/2011 strain. Although homologous recombination and reassortant phenomena may occur naturally among different IBDV strains, no evidence of those events was found in the genome of the IBDV/Italy/1829/2011 strain, which was confirmed to be a genetically distinctive IBDV genotype

    The α5 Subunit Regulates the Expression and Function of α4*-Containing Neuronal Nicotinic Acetylcholine Receptors in the Ventral-Tegmental Area

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    Human genetic association studies have shown gene variants in the α5 subunit of the neuronal nicotinic receptor (nAChR) influence both ethanol and nicotine dependence. The α5 subunit is an accessory subunit that facilitates α4* nAChRs assembly in vitro. However, it is unknown whether this occurs in the brain, as there are few research tools to adequately address this question. As the α4*-containing nAChRs are highly expressed in the ventral tegmental area (VTA) we assessed the molecular, functional and pharmacological roles of α5 in α4*-containing nAChRs in the VTA. We utilized transgenic mice α5+/+(α4YFP) and α5-/-(α4YFP) that allow the direct visualization and measurement of α4-YFP expression and the effect of the presence (α5+/+) and absence of α5 (-/-) subunit, as the antibodies for detecting the α4* subunits of the nAChR are not specific. We performed voltage clamp electrophysiological experiments to study baseline nicotinic currents in VTA dopaminergic neurons. We show that in the presence of the α5 subunit, the overall expression of α4 subunit is increased significantly by 60% in the VTA. Furthermore, the α5 subunit strengthens baseline nAChR currents, suggesting the increased expression of α4* nAChRs to be likely on the cell surface. While the presence of the α5 subunit blunts the desensitization of nAChRs following nicotine exposure, it does not alter the amount of ethanol potentiation of VTA dopaminergic neurons. Our data demonstrates a major regulatory role for the α5 subunit in both the maintenance of α4*-containing nAChRs expression and in modulating nicotinic currents in VTA dopaminergic neurons. Additionally, the α5α4* nAChR in VTA dopaminergic neurons regulates the effect of nicotine but not ethanol on currents. Together, the data suggest that the α5 subunit is critical for controlling the expression and functional role of a population of α4*-containing nAChRs in the VTA

    Dynamics of the Hubbard model: a general approach by time dependent variational principle

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    We describe the quantum dynamics of the Hubbard model at semi-classical level, by implementing the Time-Dependent Variational Principle (TDVP) procedure on appropriate macroscopic wavefunctions constructed in terms of su(2)-coherent states. Within the TDVP procedure, such states turn out to include a time-dependent quantum phase, part of which can be recognized as Berry's phase. We derive two new semi-classical model Hamiltonians for describing the dynamics in the paramagnetic, superconducting, antiferromagnetic and charge density wave phases and solve the corresponding canonical equations of motion in various cases. Noticeably, a vortex-like ground state phase dynamics is found to take place for U>0 away from half filling. Moreover, it appears that an oscillatory-like ground state dynamics survives at the Fermi surface at half-filling for any U. The low-energy dynamics is also exactly solved by separating fast and slow variables. The role of the time-dependent phase is shown to be particularly interesting in the ordered phases.Comment: ReVTeX file, 38 pages, to appear on Phys. Rev.

    The inhibition of the highly expressed miR-221 and miR-222 impairs the growth of prostate carcinoma xenografts in mice

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    MiR-221 and miR-222 are two highly homologous microRNAs whose upregulation has been recently described in several types of human tumors, for some of which their oncogenic role was explained by the discovery of their target p27, a key cell cycle regulator. We previously showed this regulatory relationship in prostate carcinoma cell lines in vitro, underlying the role of miR-221/222 as inducers of proliferation and tumorigenicity

    Resonance-assisted tunneling in near-integrable systems

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    Dynamical tunneling between symmetry related invariant tori is studied in the near-integrable regime. Using the kicked Harper model as an illustration, we show that the exponential decay of the wave functions in the classically forbidden region is modified due to coupling processes that are mediated by classical resonances. This mechanism leads to a substantial deviation of the splitting between quasi-degenerate eigenvalues from the purely exponential decrease with 1 / hbar obtained for the integrable system. A simple semiclassical framework, which takes into account the effect of the resonance substructure on the KAM tori, allows to quantitatively reproduce the behavior of the eigenvalue splittings.Comment: 4 pages, 2 figures, gzipped tar file, to appear in Phys. Rev. Lett, text slightly condensed compared to first versio

    Coseismic and post-seismic slip of the 2009 L'Aquila (central Italy) MW 6.3 earthquake and implications for seismic potential along the Campotosto fault from joint inversion of high-precision levelling, InSAR and GPS data

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    After the April 6th 2009 MW 6.3 (ML 5.9) L'Aquila earthquake (central Italy), we re-measured more than 100 km of high-precision levelling lines in the epicentral area. The joint inversion of the levelling measurements with InSAR and GPS measurements, allowed us to derive new coseismic and post-seismic slip distributions and to de- scribe, with high resolution details on surface displacements, the activation and the slip distribution of a second- ary fault during the aftershock sequence that struck the Campotosto area (major event MW 5.2). Coseismic slip on the Paganica fault occurred on one main asperity, while the afterslip distribution shows a more complex pattern, occurring on three main patches, including both slips on the shallow portions and on the deeper parts of the rup- ture plane. The comparison between coseismic and post-seismic slip distributions strongly suggests that afterslip was triggered at the edges of the coseismic asperity. The activation of a segment of the Campotosto fault during the aftershock sequence, with a good correlation between the estimated slipping area, moment release and distribution of aftershocks, raises the opportunity to discuss the local seismic hazard following the occurrence of the 2009 L'Aquila mainshock. The Campotosto fault appears capable of generating earthquakes as large as his- torical events in the region (M N 6.5) or as small as the ones associated with the 2009 sequence. In the case that the Campotosto fault is accumulating a significant portion of the current interseismic deformation, the 2009 MW N 5 events will have released only a small amount of the accumulated elastic strain, and then a significant hazard still remains in the area. Continuing geodetic monitoring and a densification of the GPS networks in the region are therefore needed to estimate the tectonic loading across the different recognized active fault systems in this part of the Apennines.Published168-1852T. Tettonica attivaJCR Journalrestricte
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