Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training

Introduction: The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT. Materials and Methods: Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women. Results: Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect. Conclusions: Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management

Cancer Rehabilitation and Physical Activity: the “Oncology in Motion” Project

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Autoimmune cytopenias in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is frequently complicated by secondary autoimmune cytopenias (AIC) represented by autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red cell aplasia and autoimmune granulocytopenia. The distinction of immune cytopenias from cytopenias due to bone marrow infiltration, usually associated with a worse outcome and often requiring a different treatment, is mandatory. AIHA and ITP are more frequently found in patients with unfavorable biological risk factors for CLL. AIC secondary to CLL respond less favorably to standard treatments than their primary forms, and treating the underlying CLL with chemotherapy or monoclonal antibodies may ultimately be necessary

Please mind the gap—about equity and access to care in oncology

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Parallel processing in immune networks

In this work we adopt a statistical mechanics approach to investigate basic, systemic features exhibited by adaptive immune systems. The lymphocyte network made by B-cells and T-cells is modeled by a bipartite spin-glass, where, following biological prescriptions, links connecting B-cells and T-cells are sparse. Interestingly, the dilution performed on links is shown to make the system able to orchestrate parallel strategies to fight several pathogens at the same time; this multitasking capability constitutes a remarkable, key property of immune systems as multiple antigens are always present within the host. We also define the stochastic process ruling the temporal evolution of lymphocyte activity, and show its relaxation toward an equilibrium measure allowing statistical mechanics investigations. Analytical results are compared with Monte Carlo simulations and signal-to-noise outcomes showing overall excellent agreement. Finally, within our model, a rationale for the experimentally well-evidenced correlation between lymphocytosis and autoimmunity is achieved; this sheds further light on the systemic features exhibited by immune networks.Comment: 21 pages, 9 figures; to appear in Phys. Rev.

Knowledge translation in challenging healthcare environments: The PIOPPO experience at the National Centre of Oncological Hadrontherapy (CNAO Foundation).

Knowledge translation is the ability to translate concepts and ideas effectively among different stakeholders, leading to innovation and new knowledge. Translating knowledge is particularly challenging in the healthcare sector, which has been experiencing a shift from a centralized and sequential model of value creation to a more distributed and open model, where various stakeholders (including patients) act as co-creators of the outcome. According to management as well as the medical literature, knowledge translation in healthcare has been mainly seen as the translation of scientific research into clinical practice. However, different types of knowledge translation emerge, such as when multidisciplinary teams need to work together on a joint medical project. In this situation, multiple backgrounds, competencies, skills, and emotional feelings of the different stakeholders are a compelling barrier that prevents the effective transfer and sharing of knowledge. This is why knowledge translation needs a set of enablers to facilitate the transfer, sharing, and creation of new knowledge, innovation, and ideas. This paper investigates such a perspective by analyzing the PIOPPO project from the National Centre of Oncological Hadrontherapy (CNAO Foundation) in Pavia, Italy. The CNAO is one of the few dual-beam Hadrontherapy centres in the world that provides a beam that is able to irradiate patients with protons or carbon ions to treat radioresistant tumours. The PIOPPO project is an experimental phase 2 trial involving preoperative chemotherapy and carbon ion therapy to treat resectable and borderline-resectable pancreatic adenocarcinoma. The stakeholders involved in the PIOPPO trial have different characteristics, both in terms of competencies and emotions. The PIOPPO multidisciplinary team includes highly skilled professionals from several disciplines, which are not all related to medicine (from oncologists to physicists, from biologists to surgeons). Pancreatic cancer patients are also involved while experiencing a challenging personal time. The paper analyses the knowledge translation flows, instruments, and issues among such different stakeholders

Re-irradiation with carbon ion radiotherapy for pelvic rectal cancer recurrences in patients previously irradiated to the pelvis

Background/Aim: Re-irradiation of locally recurrent rectal cancer poses challenges due to the proximity of critical organs, such as the bowel. This study aimed at evaluating the safety and efficacy of re-irradiation with Carbon Ion Radiotherapy (CIRT) in rectal cancer patients with local recurrence. Patients and Methods: Between 2014 and 2018, 14 patients were treated at the National Center of Oncological Hadrontherapy (CNAO Foundation) with CIRT for locally recurrent rectal cancer. Results: All patients concluded the treatment. No G≥3 acute/late reaction nor pelvic infections were observed. The 1-year and 2-year local control rates were, 78% and 52%, respectively, and relapse occurred close to the bowel in 6 patients. The 1-year and 2-year overall survival rates were 100% and 76.2% each; while the 1-year and 2-year metastasis free survival rates were 64.3% and 43%. Conclusion: CIRT as re-irradiation for locally recurrent rectal cancer emerges as a safe and valid treatment with an acceptable rate of morbidity of surrounding healthy tissue

The Role of Virulence Factors in Neonatal Sepsis Caused by Enterobacterales: A Systematic Review.

Neonatal sepsis is a life-threatening condition with high mortality. Virulence determinants relevant in causing Gram-negative (GN) neonatal sepsis are still poorly characterized. A better understanding of virulence factors (VFs) associated with GN neonatal sepsis could offer new targets for therapeutic interventions. The aim of this review was to assess the role of GN VFs in neonatal sepsis. We primarily aimed to investigate the main VFs leading to adverse outcome and second to evaluate VFs associated with increased invasiveness/pathogenicity in neonates. MEDLINE, Embase, and Cochrane Library were systematically searched for studies reporting data on the role of virulome/VFs in bloodstream infections caused by Enterobacterales among neonates and infants aged 0-90 days. Twenty studies fulfilled the inclusion criteria. Only 4 studies reported data on the association between pathogen virulence determinants and neonatal mortality, whereas 16 studies were included in the secondary analyses. The quality of reporting was suboptimal in the great majority of the published studies. No consistent association between virulence determinants and GN strains causing neonatal sepsis was identified. Considerable heterogeneity was found in terms of VFs analysed and reported, included population and microbiological methods, with the included studies often showing conflicting data. This variability hampered the comparison of the results. In conclusions, pathogens responsible for neonatal sepsis are widely heterogenous and can use different pathways to develop invasive disease. The recent genome-wide approach needs to include multicentre studies with larger sample sizes, analyses of VF gene profiles instead of single VF genes, alongside a comprehensive collection of clinical information. A better understanding of the roles of virulence genes in neonatal GN bacteraemia may offer new vaccine targets and new markers of highly virulent strains. This information can potentially be used for screening and preventive interventions as well as for new targets for anti-virulence antibiotic-sparing therapies

Switched Spatial Impulse Response Convolution as an Ambisonic Distance-Panning Function

Ambisonics offers a robust and effective approach to the recording, processing and delivery of Spatial Audio. The Ambisonic system is often considered to provide a perceptually and computationally advantageous Spatial Audio experience in comparison to typical Binaural systems. This is true even when an end-step Binaural render is required, as is typical in Virtual or Augmented Reality systems which naturally imply audio delivery via headphones. Standard Ambisonic processing allows for the rotation of a sound field around an origin position. There is not, however, a strongly established means of modulating the radial distance of a virtual sound source from the origin. This paper presents a potential solution to an Ambisonic distance-panning function for both static and dynamic virtual sources in the form of a FOA (First Order Ambisonics) Switched-SIR (Spatial Impulse Response) Convolution Reverberator. This includes a presentation of the framework for such a function, and an analysis of audio rendered using prototype scripts