8 research outputs found
La Virtopsia: ruolo dell'imaging post-mortem nella radiologia forense
La Virtopsia (fusione di due parole: virtus, dal latino âvirtĂčâ, come sinonimo di forza ed eccellenza e autopsia, dal greco âvedere con i propri occhiâ), rappresenta il punto dâincontro tra la radiodiagnostica e la medicina legale.
Nata nella metĂ degli anni â90, da un progetto di ricerca dellâUniversitĂ di Berna, Svizzera, ha avuto un rapido sviluppo, divenendo di interesse internazionale e al giorno dâoggi, ancora in fase di sperimentazione.
Lâautopsia virtuale, non si propone di sostituire la tradizionale attivitĂ necroscopica medico-legale (ispezione esterna e/o autopsia), bensĂŹ deve essere considerata come una tecnica mininvasiva complementare e ausiliaria allâindagine forense, permettendone un potenziamento e miglioramento della qualitĂ .
Dal 2011 al 2016, presso lâUniversitĂ di Pisa, sono stati reclutati 62 casi legati allâattivitĂ forense, di etĂ compresa tra 5 mesi e 84 anni.
Di questi, i casi che possiamo classificare come grandi traumatismi sono stati 16, di cui:
-2 precipitazioni (etĂ compresa tra 22 e 44 anni)
-5 vittime di un incidente aviatorio (etĂ compresa tra 28 e 44 anni)
-9 incidenti del traffico stradale, di cui: - 3 investimenti di pedone,
- 2 trasportati su autoveicolo,
- 1 conducente di autoveicolo,
-3 investimenti di motociclisti/ciclisti.
Nonostante i difetti dati dalla mancanza di mezzo di contrasto o dagli artefatti post-mortem (putrefazione, livor mortis), i risultati sono incoraggianti e hanno dimostrato come la virtopsia sia una tecnica rapida, a basso costo, che permette di guidare il medico legale durante lâautopsia (targeted) e trova spazio nei casi in cui questa non venga disposta; puĂČ evidenziare reperti che si sarebbero persi con il solo esame medico-legale e consente una conservazione migliore dei risultati dellâesame post-mortem (rivalutabili in ogni momento, anche a distanza di anni), con un piĂč facile flusso di informazioni (seconde opinioni da specialisti di tutto il mondo).
Il progetto di ricerca sulla virtopsia, ha mostrato quindi al mondo, lâimportanza dellâutilizzo di tecniche di ultima generazione quali, TC spirale o multistrato, come potenziamento, miglioramento, e in alcuni casi, alternativa alla classica tecnica di indagine post-mortem
Overexpression of TK1 and CDK9 in plasma-derived exosomes is associated with clinical resistance to CDK4/6 inhibitors in metastatic breast cancer patients
Purpose Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) improve progression-free survival (PFS) in patients with hormone receptor-positive (HR+) advanced breast cancer. However, a better knowledge of predictive biomarkers of response and resistance to CDK4/6i is needed. Therefore, the present article addresses the role of the mRNA expression of thymidine kinase 1 (TK1), CDK4, 6 and 9 in plasma-derived exosomes and their relevance in the pharmacologic activity of CDK4/6i. Methods Blood samples of 40 HR+/HER2- advanced breast cancer patients were collected before (T0) the administration of palbociclib plus hormonal therapy and after 3 months (T1). RNA was isolated from exosomes and analysed for the expression of TK1, CDK 4, 6 and 9 by digital droplet PCR (ddPCR). Results A higher value of TK1 copies/ml at baseline (T0) was significantly associated with the number of previous lines of chemotherapy (p = 0.009). In patients with PD, a significant increase was observed in the number of copies/ml of TK1 (p = 0.01) and CDK9 (p = 0.03) comparing T1 vs. T0 values. No significant correlations between response to treatment and clinical parameters were found at univariate analysis. High baseline CDK4 expression was significantly correlated with longer PFS in patients treated with fulvestrant + palbociclib (low versus high: 6.45 months vs. not reached, p = 0.01). Conclusions The present study demonstrates that, in plasma-derived exosomes, high baseline CDK4 mRNA levels are associated with response to palbociclib plus hormonal therapy, while the increase in TK1 and CDK9 mRNA copies/ml is associated with clinical resistance
Humoral and cellular immune response in patients with hematological disorders after two doses of BNT162b2 mRNA COVIDâ19 vaccine: A singleâcenter prospective observational study (NCT05074706)
Abstract Hematological patients at higher risk of severe COVIDâ19 were excluded from the severe acute respiratory syndrome coronavirus 2 (SARSâCoVâ2) vaccine trials. In this singleâcenter observational prospective study (NCT05074706), we evaluate immune response in the hematological patients followed at the Hematological Division of San Gerardo Hospital, Monza (Italy) deemed to be severely immunosuppressed after vaccination with two doses of the BNT162b2 vaccine. AntiâSARSâCoVâ2 immunoglobulin G titers above the cutoff value of 33.8 BAU/ml were detected in 303 (80.2%) out of the 378 patients enrolled. Patients with lymphoproliferative disorders had a significant lower probability of immunization (43.2% vs. 88.4%, p < 0.001). Patients treated with antiâCD20 showed a significantly lower probability of immunization compared to all other treatments (21.4%, p < 0.0001). Among 69 patients who failed seroconversion, 15 patients (22.7%) showed a positive Tâcell response. Patients previously treated with antiâCD20 were 2.4 times more likely to test positive for Tâcell responses (p = 0.014). Within a followâup of 9 months from the second COVIDâ19 vaccination, symptomatic SARSâCoVâ2 infections were reported by 20 patients (5.3%) and four of them required hospitalization. Successful serological or Tâcellâmediated immunization conferred protection from symptomatic COVIDâ19. Patients treated with antiâCD20 who were not seroconverted after vaccination might still be protected from COVIDâ19 due to the Tâcell immune response
NAVIGATOR: an Italian regional imaging biobank to promote precision medicine for oncologic patients.
NAVIGATOR is an Italian regional project boosting precision medicine in oncology with the aim of making it more predictive, preventive, and personalised by advancing translational research based on quantitative imaging and integrative omics analyses. The project's goal is to develop an open imaging biobank for the collection and preservation of a large amount of standardised imaging multimodal datasets, including computed tomography, magnetic resonance imaging, and positron emission tomography data, together with the corresponding patient-related and omics-related relevant information extracted from regional healthcare services using an adapted privacy-preserving model. The project is based on an open-source imaging biobank and an open-science oriented virtual research environment (VRE). Available integrative omics and multi-imaging data of three use cases (prostate cancer, rectal cancer, and gastric cancer) will be collected. All data confined in NAVIGATOR (i.e., standard and novel imaging biomarkers, non-imaging data, health agency data) will be used to create a digital patient model, to support the reliable prediction of the disease phenotype and risk stratification. The VRE that relies on a well-established infrastructure, called D4Science.org, will further provide a multiset infrastructure for processing the integrative omics data, extracting specific radiomic signatures, and for identification and testing of novel imaging biomarkers through big data analytics and artificial intelligence
Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region.Methods This survey (25 questions), promoted by the young section of SCITO (SocietĂ Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2âpositive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisherâs exact tests for dichotomous answers and Ï2 test for trends relative to the questions with 3 or more options.Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2âpositive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patientsâ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones.Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts
Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists
The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region
Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. Methods This survey (25 questions), promoted by the young section of SCITO (Societa Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2-positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher's exact tests for dichotomous answers and chi(2)test for trends relative to the questions with 3 or more options. Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2-positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients' planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts