An Exceptional Response to Dostarlimab in Mismatch Repair Deficient, Microsatellite Instability-High and Platinum Refractory Endometrial Cancer

Until recently, effective therapies for advanced endometrial cancer progressing to a platinum-based combination were lacking. In this setting, immunotherapy with anti PD-1/PDL-1 monoclonal antibodies is rising as a new paradigm in particular for patients with microsatellites instability/mismatch repair deficiency. In this case report, we describe an exceptional and rapid response to dostarlimab in a platinum refractory endometrial cancer patient with high disease burden harboring a mismatch repair deficiency

[Officium Parvum Beatae Mariae Virginis]

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Clinical validation of full HR-HPV genotyping HPV Selfy assay according to the international guidelines for HPV test requirements for cervical cancer screening on clinician-collected and self-collected samples

Background According to international guidelines, Human Papillomavirus (HPV) DNA tests represent a valid alternative to Pap Test for primary cervical cancer screening, provided that they guarantee balanced clinical sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or more (CIN2+) lesions. The study aimed to assess whether HPV Selfy (Ulisse BioMed - Trieste, Italy), a full-genotyping HPV DNA test that detects and differentiates 14 high-risk HPV (HR-HPV) types, meets the criteria for primary cervical cancer screening described in the international guidelines, on clinician-collected as well as on self-collected samples. Methods For each participant woman, consecutively referring to Azienda Sanitaria Universitaria Giuliano Isontina (Trieste, Italy) and CRO-National Cancer Institute (Aviano, Italy) for the cervical cancer screening program, the following samples were tested: (a) a clinician-collected cervical specimen, analyzed with the reference test (Hybrid Capture (R) 2 test, HC2) and HPV Selfy; and (b) a self-collected vaginal sample, analyzed with HPV Selfy. Enrolled women were also asked to fulfill a questionnaire about self-sampling acceptability. As required by guidelines, a non-inferiority test was conducted to compare the clinical performance of the test under evaluation with its reference test. Results HPV Selfy clinical sensitivity and specificity resulted non-inferior to those of HC2. By analysis of a total of 889 cervical liquid-based cytology samples from a screening population, of which 98 were from women with CIN2+, HPV Selfy showed relative sensitivity and specificity for CIN2+ of 0.98 and 1.00 respectively (non-inferiority score test: P = 0.01747 and P = 0.00414, respectively); the test reached adequate intra- and inter-laboratory reproducibility. Moreover, we demonstrated that the performance of HPV Selfy on self-collected vaginal samples was non-inferior to the performance obtained on clinician-collected cervical specimen (0.92 relative sensitivity and 0.97 relative specificity). Finally, through HPV Selfy genotyping, we were able to describe HPV types prevalence in the study population. Conclusions HPV Selfy fulfills all the requirements of the international Meijer's guidelines and has been clinically validated for primary cervical cancer screening purposes. Moreover, HPV Selfy has also been validated for self-sampling according to VALHUDES guidelines. Therefore, at date, HPV Selfy is the only full-genotyping test validated both for screening purposes and for self-sampling. Trial registration ASUGI Trieste n. 16008/2018; CRO Aviano n.17149/201

Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

From Academia Armena Sancti Lazari to the Establishment of Armenian Studies at Ca’ Foscari

The Armenian Studies have a very long tradition in Italy. However, the establishment of the official teaching of Armenian at Ca’ Foscari is particularly significant. It is a direct continuation of many Armenian traces present in the lagoon city for centuries, such as the birth of the first Casa Armena in Europe in 1245, the prosperous diplomatic relations between the Republic of Serenissima and the Kingdom of Armenia, the printing of the first Armenian book in 1512, the arrival of Armenian merchants from Julfa, who highly contributed to the economy of Venice, and finally the institution of the Mekhitarist Congregation of the Armenian monks on the island of San Lazzaro, recognised by Napoleon as Academia Armena Sancti Lazari. After an historical excursus, the paper will go on to detail some significant periods of Armenian Studies at Ca’ Foscari

Geoambients of RPPN Serra do Caraça e features of quartzitic carste

A RPPN Serra do Caraça se enquadra na borda leste da província geológica do Quadrilátero Ferrífero, estado do Minas Gerais. A Reserva abrange refúgios ecológicos montanos e altimontanos em litologia predominantemente quartzítica, sendo portanto um forte fator de distribuição dos geoambientes locais. No local, diferentes patamares com vegetação principalmente endêmica formam um complexo entre campos cerrados e enclaves de mata atlântica. Além disso, a área em estudo contempla um dos mais complexos sistemas cársticos em quartzitos do Brasil. É notório a ocorrência de feições como dolinas e cavidades. Nesse contexto, procurou-se identificar, caracterizar e mapear os geoambientes para entender as dinâmicas e as relações ecológicas, para subsidiar as estratégias de manejo e visitação do parque. Para definir as unidades geoambientais utilizou-se uma metodologia pedogeomorfológica, identificando as principais características ecogeográficas. Utilizaram-se imagens satelitais ASTER de alta resolução e mapa 1: 50.000 planialtimétrico, para auxiliar as campanhas de estudo in loco. Foram abertos doze perfis de solos em diferentes níveis da paisagem, contemplando os topos, afloramentos, encostas, vales de acúmulo e diques. Cada perfil foi descrito e os horizontes coletado, identificação dos principais processos pedogenéticos e posteriormente submetidos às análises físicas, químicas e mineralógicas. As rochas de cavidades naturais foram analisadas por difratometria de raios-X (XRD) e microscopia eletrônica de varredura com microssonda EDS acoplada (MEV/EDS), procurando assim entender a gênese deste sistema cárstico quartzítico. Também foram identificadas as principais fitofisionomias vegetais, através da descrição em campo e coleta, quando necessário. Produziu-se o mapa das unidades geoambientais, sendo cada unidade caracterizada pormenorizadamente, procurando estabelecer as interações entre eles. Foram identificadas nove unidades: Campos rupestres, Campos cerrados, Brejos e turfeiras, Matas de encosta, Matas nebulares e Matas de candeias. Particular ênfase foi dada aos ambientes desenvolvidos sobre intrusões de rochas metabásicas, que proporcionaram solos distróficos porém texturalmente mais argilosos, com maior retenção hídrica e consequentemente desenvolveram fitofisionomias contrastantes, de maior porte. Todos os outros perfis se mostraram com texturas substancialmente arenosas, alumínicos e ácidos. Os dados levaram a entender que na RPPN, a taxa de pedogênese é menor que a morfogênese, sendo os ambientes definidos pelo controle morfoestrutural. As análises MEV/EDS das amostras de rochas mostraram mobilidade do Fe e Al intergranulares, podendo capear saprolitos e formar concreções nas paredes das grutas. A caracterização das unidades geoambientais permitiu esclarecer as relações entre os diferentes níveis da paisagem da Serra do Caraça, corroborada pelas análises físicas, químicas e mineralógicas dos solos, que em geral se mostraram gibbsiticos, com distrofismo e elevada saturação por alumínio. Assim, dado às condições extremas desses solos, as espécies vegetais ocorrentes indicam um alto grau de especialização e endemismo, que sujerem adaptações que otimizam a ciclagem biogeoquímica, tolerância à toxidez, e bioacumulação de alumínio.The RPPN Serra do Caraça falls on the eastern edge of the geologic province of the Iron Quadrangle, State of Minas Gerais. The Reserve covers ecological and montane highland refuges in lithology predominantly quartzite and is therefore a strong distribution factor of local Geoenvironments. On site, different levels with mostly endemic vegetation form a complex between savanna and niche of Atlantic forest. In addition the study area includes one of the most complex karst systems in quartzite from Brazil, it is clear the present features such as sinkholes and cavities. In this context we sought to identify, characterize and map the Geoenvironments to understand the dynamics and ecological relationships, to support management strategies and visiting the park. To define the environmental Units used a methodology pedogeomorphological identifying key characteristics ecogeographic. We used high-resolution ASTER satellite images and map 1: 50,000 planialtimetric to assist the on-site study of campaigns. Twelve soil profiles were opened at different levels of the landscape, covering the tops, outcrops, slopes, valleys and accumulation of dikes. Each profile was described and collected horizons, identifying key processes pedogenetic and subsequently subjected to physical, chemical and mineralogical. The rocks of natural cavities were analyzed by diffraction of X-ray (XRD) and scanning electron microscopy coupled with EDS microprobe (SEM / EDS), thus seeking to understand the genesis of this quartzite karst system. Also the main plant vegetation types were identified by describing the field and collect when needed. The map of the geo-environmental units was produced, each unit being characterized in detail, trying to establish the interactions between them. Nine units were identified: Outcrops, Savannas, Swamps and Bogs, Hillside Forest, Elfin Forest and Lamps. Particular emphasis was given to the developed environments on intrusion metabasic rocks, which provided dystrophic soils but texturally more clayey, with greater water retention and consequently developed contrasting vegetation types, of greater size. All other profiles have proven to substantially sandy textures, aluminic and acids. The data led to the understanding that the PRNP pedogenesis rate is less than the morphogenesis, the environments being defined by morphostructural control. Analyses SEM / EDS of rock samples showed the mobility of Fe and Al intergranular and can coat saprolite and form concretions on the walls of caves. Characterization of geoenvironmental units has clarified the relationships between the different levels of landscape Caraça, corroborated by physical, chemical and mineralogical soil, which generally showed gibbsitic, with dystrophic and high aluminum saturation. So, given the extreme conditions of these soils, the plant species occurring indicate a high degree of specialization and endemism, which suggest adaptations that optimize the biogeochemical cycling, tolerance toxicity, and aluminum bioaccumulation.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Female genital tract chronic graft-versus-host disease: review of the literature

Chronic graft-versus-host disease (cGVHD) is the most common late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the involvement of skin, oral cavity, eyes, liver and gut is well-described, gynaecological manifestations are rare, often undiagnosed and untreated

Laparoscopic treatment of sclerosing stromal tumor of the ovary in a woman with Gorlin-Goltz Syndrome: a case report and review of the literature

Gorlin-Goltz syndrome is a rare hereditary multisystemic disease. Multiple basal cell carcinomas, odontogenic keratocysts and skeletal abnormalities are the main clinical manifestations of the syndrome, but several organs can be involved. Moreover this condition is associated with the development of various benign and malignant tumors, even in the genital tract. This report describes a rare association between Gorlin-Goltz syndrome and the sclerosing stromal tumor of the ovary. Since the ultrasounds and magnetic resonance pattern of this tumor can be similar to those of a malignant neoplasm, a prompt surgical intervention and histological confirmation of diagnosis is mandatory. However this is a benign lesion and thus can be approached with a laparoscopic fertility sparing surgery. Gynecologists should be aware of this possible association, in order to provide an appropriate counseling to these women, and to perform a fertility sparing laparoscopic approach, wherever possible

Environmental Activism: An Analysis of the Italian Context

This study was conducted in the context of political participation, and it investigates the phenomenon of environmental activism in Italy. In recent years, environmental activism has been in the limelight: the impact of climate change has expanded the pool of activists and discussions on environmental issues (Cody et al., 2015). This theme is included in the broad debate on activism and its declinations. Indeed, over the past 20 years, a new type of activism has been developed that uses digital infrastructure to foster change and achieve political, social, and other goals (George & Leidner, 2018). The goal of this study is to explore the phenomenon of environmental activism by specifically examining the relationship between online and offline activism. It is relevant to clarify how online and offline activism have equal status in this study (Sivitanides & Shah, 2011). The hypothesis on which it is based is that the level of commitment (George & Leidner, 2018) and concern for specific environmental issues are conditioned by residence in a particular area (Stedman, 2002) and socioanagraphic characteristics (Schradie, 2018). The framework that supports the analysis of the phenomenon is the one proposed by Milbrath in 1965 and later reworked by George and Leidner in 2019, who studied political participation, respectively offline and online (Milbrath, 1965)(George & Leidner, 2018). The approach used for the methodology is standard (Marradi, 1984): the data collection tool was a web-survey (Veltri, 2019), posted on the main social networks and filled out by 946 users, living in Italy, during the period from June 2022 to January 2023. The web survey proved to be a useful tool for analyzing individual actions taken by people (George & Leidner, 2018), giving us a general overview of the state of activism in Italy. Moreover, it was also useful for making methodological reflections on the limitations and potential offered to us by using digital tools