Personalized Medicine in Skull Base and Sinonasal Tumors

: Skull base and sinonasal tumors (SBSNTs) represent a considerable challenge for clinicians in view of their rarity, anatomical complexity of the site of origin, and great histological variety [...]

Optimal Supportive Measures during Primary Treatment

AbstractSupportive care during curative treatment of head and neck cancer patients has different scopes: reducing the burden of acute toxicities and limiting the risk of developing late adverse effects; increasing the quality of life of the patients; allowing to perform optimal curative therapy, maintaining treatment dose intensity; preventing higher grade toxicities so to reduce also the costs associated with hospitalization, examinations, visits and use of drugs. At the same time, it is necessary to give uniformity in the supportive care protocols, as these preventive and therapeutic measures may influence the results of oncological treatments and their efficacy should be evaluated in a consistent manner. Several preventive and therapeutic interventions are available, particularly in the context of chemoradiotherapy, where the adverse events are more prominent. An accurate evaluation of the patient and a tailored approach with preventative indications and therapeutic interventions represent key factors. This approach could be easily identified within a "simultaneous care" strategy, as the optimal supportive measures are provided concurrently to the best therapeutic approach since the beginning of the treatment

Ambrosio Borsano: un exponente de la escuela de ingeniería militar de Milán al servicio de la Monarquía Hispánica (1633-1661)

En este artículo se examina una etapa crucial en la vida de Ambrosio Borsano, uno de los principales ingenieros militares de la Europa de la segunda mitad del siglo XVII: la de su formación como cartógrafo militar. Una etapa sobre la que se disponía de contadas y dispersas referencias. En el mismo se intenta resolver, en primer lugar, la cuestión de su nacimiento y el marco familiar milanés en el que se educó. Después, se describen las actividades militares que llevó a cabo, entre 1648 y 1658, en el norte de Italia, durante las cuáles conoció al que terminaría siendo su maestro: Gaspare Beretta, ingeniero mayor del ejército español en el Estado de Milán. A continuación, se analiza la formación que recibió como cartógrafo militar de Beretta y que es preciso situarla en el marco de la escuela de ingeniería militar de Milán. El artículo se cierra explicando el último capítulo de su etapa de formación: el de su traslado a la península Ibérica en 1661 para luchar contra los independentistas portugueses

Ambrosio Borsano: un exponente de la escuela de ingeniería militar de Milán al servicio de la Monarquía Hispánica (1633-1661)

Lo scritto giunge per primo a ricostruire gli anni della formazione e della iniziale attività a difesa delle frontiere del Ducato milanese di Ambrosio Borsano (1633-1708), esponente di spicco della folta schiera di ingegneri militari e cartografi italiani a servizio della Corona di Spagna. Di Borsano è in particolare la Gran Mapa de Cataluña del 1687 (http://www.bne.es/es/AreaPrensa/noticias2015/1210-borsano.html), che da ultimo è stata oggetto di una digitalizzazione ad alta definizione. Lo studio, condotto con il prof. Francesc Nadal Piqué del Departament de Geografia Humana dell’Universitat de Barcelona (UB), è destinato, nelle intenzioni dell’Institut Cartogràfic i Geològic de Catalunya, a confluire, opportunamente sviluppato, in una prossima edizione a stampa della Gran Mapa

Comparative Effectiveness of DPP-4 Inhibitors Versus Sulfonylurea for the Treatment of Type 2 Diabetes in Routine Clinical Practice: A Retrospective Multicenter Real-World Study

Introduction: DPP-4 inhibitors (DPP4i) and sulfonylureas are popular second-line therapies for type 2 diabetes (T2D), but there is a paucity of real-world studies comparing their effectiveness in routine clinical practice. Methods: This was a multicenter retrospective study on diabetes outpatient clinics comparing the effectiveness of DPP4i versus gliclazide extended release. The primary endpoint was change from baseline in HbA1c. Secondary endpoints were changes in fasting plasma glucose, body weight, and systolic blood pressure. Automated software extracted data from the same clinical electronic chart system at all centers. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Results: We included data on 2410 patients starting DPP4i and 1590 patients starting gliclazide (mainly 30–60 mg/day). At baseline, the two groups differed in disease duration, body weight, blood pressure, HbA1c, fasting glucose, HDL cholesterol, triglycerides, liver enzymes, eGFR, prevalence of microangiopathy, and use of metformin. Among DPP4i molecules, no difference in glycemic effectiveness was detected. In matched cohorts (n = 1316/group), patients starting DPP4i, as compared with patients starting gliclazide, experienced greater reductions in HbA1c (− 0.6% versus − 0.4%; p < 0.001), fasting glucose (− 14.1 mg/dl versus − 8.8 mg/dl; p = 0.007), and body weight (− 0.4 kg versus − 0.1 kg; p = 0.006) after an average 6 months follow-up. DPP4i improved glucose control more than gliclazide, especially in patients who had failed with other glucose-lowering medications or were on basal insulin. Conclusions: This large retrospective real-world study shows that, in routine clinical practice, starting a DPP4i allows better glycemic control than starting low-dose gliclazide. Funding: The Italian Diabetes Society, with external support from AstraZeneca

Treatment Stratification in First-Line Recurrent or Metastatic Head and Neck Cancer, on Behalf of the EORTC Young Investigator Head and Neck Cancer Group

Multiple factors differentially influence treatment decisions in the first line treatment of recurrent/metastatic HNSCC. The EORTC Young investigator group launched a survey among treating physicians to explore the main influencing factors for treatment stratification. The questionnaire was posted as a web-survey link from May to August 2020. Next to defining the factors that mostly influence therapeutic decision the survey was complemented by a clinical case discussion of five patient cases. A total of 118 responses from 19 countries were collected. The key factors identified to guide treatment decision were performance status, PD-L1 Expression, time from last systemic treatment above or below 6 months, and disease burden.Prospective evaluation of patient characteristics and additional potential predictive biomarkers for novel treatment options remains an important question to stratify personalized treatment for RM HNSCC

Stability of circulating miRNA in saliva: The influence of sample associated pre-analytical variables

Background and aims: Increasing evidence supports the practicability of salivary cell-free (cf) miRNA as liquid biopsy markers in cancers. Its successful translation in the clinical setting requires reproducible approaches for saliva manipulation, in order to control for pre-analytical variables influencing miRNA stability. This study aims to define the optimal conditions to maintain the integrity of saliva during collection, transport and processing with respect to cf-miRNA quantification. Materials and methods: Saliva was collected from 20 healthy subjects and 8 oral cancer patients. Two sampling methods were tested and different storage temperatures and times were evaluated. Salivary expression level of target miRNAs was quantified by qPCR. Comparison between group mean values at specific conditions were performed using paired t-tests. Agreement between measurements was evaluated using a Bland-Altman plot. Results: Different collection methods revealed comparable levels of salivary miR-484 and miR-106b-5p in both subject cohorts. MiRNAs were stable for up to 48 h at 4 °C in saliva supernatant, showing significant alteration after 96 h. Mid-term storage of supernatant at -20 °C decreased miRNA stability significantly compared to standard -80 °C. Conclusions: Cf-miRNA in saliva were slightly altered by collection methods and storage conditions, both in healthy and in pathological contexts, and remained stable for a period of time compatible with main clinical routine needs

Eliciting Preferences for Clinical Follow-Up in Patients with Head and Neck Cancer Using Best-Worst Scaling.

OBJECTIVES: There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up. METHODS: A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy). Conditional logit regression with choice as the dependent variable was run to analyse the data. A covariate-adjusted analysis was performed in order to identify socio-demographic and clinical factors related to the selection of best-worst items. The participants were asked to report any difficulties encountered during the survey. RESULTS: A total of 143 patients, predominantly male (74%) and with a mean age of 58 years were enrolled in the survey. The strongest positive preference was expressed for a hospital-based program of physical examinations with frequency decreasing over time. Conversely, the lowest valued item was not performing any positron emission tomography (PET) scan during follow-up. Patients with high educational levels were more likely to value attending a primary care-based program and undergoing intensive radiological investigations. Other patient-specific variables significantly associated with the choice of items were employment and living status, time already spent in follow-up and number of treatments received. CONCLUSIONS: Overall, patients were more likely to choose an intensive follow-up scheme broadly consistent with the program currently administered by the hospital. There is little evidence of preference heterogeneity that might justify customized programs based on demographics. The best-worst scaling task appeared feasible for most participants