Surgical Prevention of Arm Lymphedema in Breast Cancer Treatment

Disruption of the axillary nodes and closure of arm lymphatics can explain the significantly high risk of early and late lymphatic complications after axillary dissection, especially the most serious complication that is arm lymphedema which occurs in about 25% (ranging from 13 to 52%) of patients. Sentinel lymph node (SLN) biopsy has reduced the severity of swelling to nearly 6% (from 2 to 7%) and, in case of positive SLN, complete axillary dissection (AD) is still required. That is why ARM method was developed aiming at identifying and preserve lymphatics draining the arm. It consists in injecting intradermally and subcutaneously a small quantity (1-2 ml) of blue dye at the medial surface of the arm which helps in locating the draining arm lymphatic pathways. ARM technique allowed to find variable clinical anatomical conditions from what was already generally known, that is the most common location of arm lymphatics below and around the axillary vein. In about one-third of the cases, blue lymphatics can be found till 3-4 cm below the vein, site where SLN can easily be located, justifying the occurrence of lymphedema after only SLN biopsy. ARM procedure showed that blue nodes were almost always placed at the lateral part of the axilla, under the vein and above the second intercostals brachial nerve. Leaving in place lymph nodes related to arm lymphatic drainage would decrease the risk of arm lymphedema, but not retrieving all nodes, the main risk is to leave metastatic disease in the axilla. Conversely, arm lymphatic pathways when they enter the axilla, cannot be site of breast tumoral disease and their preservation would certainly bring about a significant decrease of lymphedema occurrence rate

Assessment of an Extreme Rainfall Detection System for Flood Prediction over Queensland (Australia)

Flood events represent some of the most catastrophic natural disasters, especially in localities where appropriate measurement instruments and early warning systems are not available. Remotely sensed data can often help to obtain near real-time rainfall information with a global spatial coverage without the limitations that characterize other instruments. In order to achieve this goal, a freely accessible Extreme Rainfall Detection System (ERDS—erds.ithacaweb.org) was developed and implemented by ITHACA with the aim of monitoring and forecasting exceptional rainfall events and providing information in an understandable way for researchers as well as non-specialized users. The near real-time rainfall monitoring is performed by taking advantage of NASA GPM (Global Precipitation Measurement) IMERG (Integrated Multi-satellite Retrievals for GPM) half-hourly data (one of the most advanced rainfall measurements provided by satellite). This study aims to evaluate ERDS performance in the detection of the extreme rainfall that led to a massive flood event in Queensland (Australia) between January and February 2019. Due to the impressive amount of rainfall that affected the area, Flinders River (one of the longest Australian rivers) overflowed, expanding to a width of tens of kilometers. Several cities were also partially affected and Copernicus Emergency Management Service was activated with the aim of providing an assessment of the impact of the event. In this research, ERDS outputs were validated using both in situ and open source remotely sensed data. Specifically, taking advantage of both NASA MODIS (Moderate-resolution Imaging Spectroradiometer) and Copernicus Sentinel datasets, it was possible to gain a clear look at the full extent of the flood event. GPM data proved to be a reliable source of rainfall information for the evaluation of areas affected by heavy rainfall. By merging these data, it was possible to recreate the dynamics of the event

Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons

Different therapeutic options for the management of prostate cancer (PC) have been developed, and some are successful in providing crucial improvement in both survival and quality of life, especially in patients with metastatic castration-resistant PC. In this scenario, diverse combinations of radiopharmaceuticals (for targeting bone, cancer cells and receptors) and nuclear medicine modalities (e.g. bone scan, SPECT, SPECT/CT, PET and PET/CT) are now available for imaging bone metastases. Some radiopharmaceuticals are approved, currently available and used in the routine clinical setting, while others are not registered and are still under evaluation, and should therefore be considered experimental. On the other hand, radiologists have other tools, in addition to CT, that can better visualize bone localization and medullary involvement, such as multimodal MRI. In this review, the authors provide an overview of current management of advanced PC and discuss the choice of diagnostic modality for the detection of metastatic skeletal lesions in different phases of the disease. In addition to detection of bone metastases, the evaluation of response to therapy is another critical issue, since it remains one of the most important open questions that a multidisciplinary team faces when optimizing the management of PC. The authors emphasize the role of nuclear modalities that can presently be used in clinical practice, and also look at future perspectives based on relevant clinical data with novel radiopharmaceuticals

Improving an Extreme Rainfall Detection System with GPM IMERG data

Many studies have shown a growing trend in terms of frequency and severity of extreme events. As never before, having tools capable to monitor the amount of rain that reaches the Earth’s surface has become a key point for the identification of areas potentially affected by floods. In order to guarantee an almost global spatial coverage, NASA Global Precipitation Measurement (GPM) IMERG products proved to be the most appropriate source of information for precipitation retrievement by satellite. This study is aimed at defining the IMERG accuracy in representing extreme rainfall events for varying time aggregation intervals. This is performed by comparing the IMERG data with the rain gauge ones. The outcomes demonstrate that precipitation satellite data guarantee good results when the rainfall aggregation interval is equal to or greater than 12 h. More specifically, a 24-h aggregation interval ensures a probability of detection (defined as the number of hits divided by the total number of observed events) greater than 80%. The outcomes of this analysis supported the development of the updated version of the ITHACA Extreme Rainfall Detection System (ERDS: erds.ithacaweb.org). This system is now able to provide near real-time alerts about extreme rainfall events using a threshold methodology based on the mean annual precipitation

To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone

The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a 'steroid switch' from prednisone to dexamethasone. A total of 26 patients, both chemonaive (14 patients) or pretreated with docetaxel (12 patients), with biochemical and/or limited radiological progression, were enrolled in this trial. Primary endpoint was prostate specific antigen (PSA) 30 defined as the proportion of patients with a PSA level decline 30% or more after 6 weeks of treatment with abiraterone acetate + dexamethasone. Secondary endpoints were: a PSA50 rate (defined as the proportion of patients with PSA decline of 50% or more after 12 weeks on abiraterone acetate + dexamethasone), biochemical and radiological progression-free survival (bPFS and rPFS, respectively), benefit from subsequent treatment and identification of biomarkers of response. Primary endpoint was reached in 46.2% of patients (12 patients), and two patients had an objective partial response on computed tomography scan. Median bPFS and rPFS were 5.3 months and 11.8 months. We present a case series of 11 patients who were consecutively treated with a steroid switch at our institution from January 2016 to August 2018 to investigate if this strategy could be used in a 'real-life' setting. We observed a PSA30 response in two patients (18%), median bPFS was 4.77 months (95% confidence interval [CI] 2.5-14.6) and median rPFS was 7.2 months (95% CI 3.8-15.5). Seven patients had a radiological stable disease as best response to steroid switch. Three patients were being still treated with abiraterone acetate + dexamethasone at data cut-off time. Our case series confirms that switching from prednisone to dexamethasone during abiraterone acetate treatment produces biochemical and radiological responses in both a predocetaxel and a postdocetaxel setting, providing a clinical benefit in mCRPC patients. However, to date, there is no clear indication as to which patient could benefit most from this kind of strategy

Numerical and experimental investigation of a piston thermal barrier coating for an automotive diesel engine application

This paper investigates the potential of coated pistons in reducing fuel consumption and pollutant emissions of a 1.6l automotive diesel engine. After a literary review on the state-of-the-art of the materials used as Thermal Barrier Coatings for automotive engine applications, anodized aluminum has been selected as the most promising one. In particular, it presents very low thermal conductivity and heat capacity which ensure a high “wall temperature swing” property. Afterwards, a numerical analysis by utilizing a one-dimensional Computational Fluid Dynamics engine simulation code has been carried out to investigate the potential of the anodized aluminum as piston Thermal Barrier Coating. The simulations have highlighted the potential of achieving up to about 1% in Indicated Specific Fuel Consumption and 6% in heat transfer reduction. To confirm the simulation results, the coated piston technology has been experimentally evaluated on a prototype engine and compared to the baseline aluminum pistons. Despite the promising potential for Indicated Specific Fuel Consumption reduction highlighted by the numerical simulation, the experimental campaign has indicated a slight worsening of the engine efficiency (up to 2% at lower load and speed) due to the slowdown of the combustion process. The primary cause of these inefficiencies is attributed to the roughness of the coating

Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer

The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-na\uefve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient's risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers