Treatment of HER2+ metastatic salivary ductal carcinoma in a pregnant woman: a case report

Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with a high mortality and poor response to treatment in the advanced setting. Human epidermal growth factor 2 (HER2) can be amplified in a fraction of SDC. We describe the case of HER2+ metastatic SDC of the submandibular gland in a young pregnant woman treated by multimodal treatment (chemotherapy, radiotherapy and targeted therapy). During pregnancy, a 27-year-old woman developed SDC of the left submandibular gland with lung and bone metastases. Given the HER2 overexpression, she was treated with trastuzumab, paclitaxel and cisplatin. Since the tumor had arisen during pregnancy, triptorelin was administered after delivery. A complete remission was observed, and after eight cycles of chemotherapy, radiotherapy was started in association with trastuzumab and triptorelin. A prolonged disease control and complete visceral remission were observed. Multimodal therapy based on patient's tumor characteristics showed good clinical efficacy in the treatment of metastatic SDC

Antenatal syphilis serology in pregnant women and follow-up of their infants in northern Italy

ABSTRACTPositive syphilis serology was noted in 119 (0.49%) of the 24 053 pregnant women delivering at St Orsola Hospital in Bologna, Italy, from November 2000 through July 2007. Six presumptive cases of congenital syphilis with IgM western blot positive results were found. Two infants had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory test result (one also had a positive CSF PCR result), another presented long-bone lesions, and the remaining three were preterm. These observations confirmed that antenatal syphilis screening facilitates treatment during pregnancy and offsets vertical transmission; moreover, the use of IgM western blot and careful CSF examination allowed the identification and treatment of high-risk newborns

Il Pooling-score (P-score): Variabilit\ue0 inter- e intra-individuale nella valutazione endoscopica della gravit\ue0 della disfagia

This study evaluated the intra- and inter-rater reliability of the Pooling score (P-score) in clinical endoscopic evaluation of severity of swal- lowing disorder, considering excess residue in the pharynx and larynx. The score (minimum 4 - maximum 11) is obtained by the sum of the scores given to the site of the bolus, the amount and ability to control residue/bolus pooling, the latter assessed on the basis of cough, raclage, number of dry voluntary or re ex swallowing acts ( 5). Four judges evaluated 30 short lms of pharyngeal transit of 10 solid (1/4 of a cracker), 11 creamy (1 tablespoon of jam) and 9 liquid (1 tablespoon of 5 cc of water coloured with methlyene blue, 1 ml in 100 ml) boluses in 23 subjects (10 M/13 F, age from 31 to 76 yrs, mean age 58.56\ub111.76 years) with different pathologies. The lms were randomly distributed on two CDs, which differed in terms of the sequence of the lms, and were given to judges (after an explanatory ses- sion) at time 0, 24 hours later (time 1) and after 7 days (time 2). The inter- and intra-rater reliability of the P-score was calculated using the intra-class correlation coef cient (ICC; 3,k). The possibility that consistency of boluses could affect the scoring of the lms was considered. The ICC for site, amount, management and the P-score total was found to be, respectively, 0.999, 0.997, 1.00 and 0.999. Clinical evaluation of a criterion of severity of a swallowing disorder remains a crucial point in the management of patients with pathologies that predispose to complications. The P-score, derived from static and dynamic parameters, yielded a very high correlation among the scores attributed by the four judges during observations carried out at different times. Bolus consistencies did not affect the outcome of the test: the analysis of variance, performed to verify if the scores attributed by the four judges to the parameters selected, might be in uenced by the different consistencies of the boluses, was not signi cant. These initial data validate the clinical use of the P-score in the management of patients with deglutition disorders by a multidisciplinary team

The effect of wind stress anomalies and location in driving Pacific Subtropical cells and tropical climate

The importance of subtropical and extratropical zonal wind stress anomalies on Pacific Subtropical Cells (STCs) strength is assessed through several idealized and realistic numerical experiments with a global ocean model. Different zonal wind stress anomalies are employed, and their intensity is strengthened or weakened with respect to the climatological value throughout a suite of simulations. Subtropical strengthened (weakened) zonal wind stress anomalies result in increased (decreased) STCs meridional mass and energy transport. Upwelling of subsurface water into the tropics is intensified (reduced), a distinct cold (warm) anomaly appears in the equatorial thermocline and up to the surface, resulting in significant tropical sea surface temperature (SST) anomalies. The use of realistic wind stress anomalies also suggests a potential impact of mid-latitude atmospheric modes of variability on tropical climate through STC dynamics. The remotely-driven response is compared with a set of simulations where an equatorial zonal wind stress anomaly is imposed. A dynamically distinct response is achieved, whereby the equatorial thermocline adjusts to the wind stress anomaly resulting in significant equatorial SST anomalies as in the remotely-forced simulations, but with no role for STCs. Significant anomalies in Indonesian Throughflow transport are generated only when equatorial wind stress anomalies are applied, leading to remarkable heat content anomalies in the Indian Ocean. Equatorial wind stress anomalies do not involve modifications of STCs transport, but could set up the appropriate initial conditions for a tropical-extratropical teleconnection involving Hadley cells, exciting a STC anomalous transport which ultimately feeds back on the Tropics

A breach in plant defences: Pseudomonas syringae pv. actinidiae targets ethylene signalling to overcome Actinidia chinensis pathogen responses

Ethylene interacts with other plant hormones to modulate many aspects of plant metabolism, including defence and stomata regulation. Therefore, its manipulation may allow plant pathogens to overcome the host’s immune responses. This work investigates the role of ethylene as a virulence factor for Pseudomonas syringae pv. actinidiae (Psa), the aetiological agent of the bacterial canker of kiwifruit. The pandemic, highly virulent biovar of this pathogen produces ethylene, whereas the biovars isolated in Japan and Korea do not. Ethylene production is modulated in planta by light/dark cycle. Exogenous ethylene application stimulates bacterial virulence, and restricts or increases host colonisation if performed before or after inoculation, respectively. The deletion of a gene, unrelated to known bacterial biosynthetic pathways and putatively encoding for an oxidoreductase, abolishes ethylene production and reduces the pathogen growth rate in planta. Ethylene production by Psa may be a recently and independently evolved virulence trait in the arms race against the host. Plantand pathogen-derived ethylene may concur in the activation/suppression of immune responses, in the chemotaxis toward a suitable entry point, or in the endophytic colonisation

Tackling the grapevine Pectate Lyase gene family and its role in the berry texture determination

Grapevine (Vitis vinifera L.) is one of the most commercially valuable fruit trees worldwide. Table grapes represent an important economic sector, where consumers highly appreciate the berry firmness trait. Although several studies have addressed the key role of the cell wall in fruit firmness, the main players among cell wall degrading enzymes during fruit ripening are still unclear. This work characterizes the grapevine Pectate Lyase (VvPL) gene family which catalyses the eliminative cleavage of de-esterified pectin during the berry development. Using the latest grapevine genome assembly and annotation, 17 members of the family containing the PL domain were identified. To identify the VvPL members most involved in pectin degradation during fruit softening, an in-silico analysis in Expression Atlas and in public RNA-Seq repositories was performed. Additionally, gene expression of the VvPL genes was evaluated in table grape varieties showing contrasting texture profiles. Our results demonstrated that specific VvPL genes were up-regulated in the softer variety compared to the firmer one, suggesting their active role in the softening process during berry development. Furthermore, two VvPL genes were selected for functional characterization via genome editing with CRISPR/Cas9 technology in the table grape variety ‘Sugraone

Curva di apprendimento nella scialoendoscopia diagnostica e interventistica per le patologie salivari ostruttive

La scialoendoscopia è un nuovo strumento diagnostico e chirurgico che offre l’opportunità di trattare alcune patologie delle ghiandole salivari con procedure non invasive e con risultati potenzialmente superiori alle precedenti tecniche. Come per tutte le nuove tecniche, per raggiungere rapidamente risultati paragonabili a quelli riportati in letteratura, è indispensabile un corretto programma di formazione che segua una graduale curva di apprendimento. Questo include un appropriato programma diagnostico, una corretta selezione dei pazienti e la conoscenza delle possibili insidie operatorie. Abbiamo eseguito uno studio retrospettivo confrontando le prime 141 procedure (74 parotidee e 67 sottomandibolari) eseguite con questa tecnica nel nostro Dipartimento dal 2009 al 2013 con analoghe esperienze riportate in letteratura. I pazienti sono stati divisi in 3 gruppi: Gruppo A (le prime 49 procedure effettuate), gruppo B (le successive 50), Gruppo C (le ultime 42 procedure effettuate). Fra i tre gruppi non sono state evidenziate differenze statisticamente significative nei tempi medi di durata delle procedure, nella percentuale di ricorrenza della sintomatologia dopo il trattamento, nel numero di pazienti che hanno necessitato di più trattamenti e nell’incidenza di complicanze minori. Non sono state riportate complicanze maggiori. Con l’acquisizione di una maggiore esperienza da parte dei chirurghi si è evidenziato un progressivo calo del numero di interventi eseguiti in anestesia generale rispetto a quelli in anestesia locale (51% vs 18% vs 14%). Solo in tre casi su 130 ghiandole trattate (2.3%) è stato necessario eseguire un’asportazione ghiandolare. Per i calcoli salivari è stato valutato il tipo di tecnica utilizzato per l’estrazione e la percentuale d’insuccesso che era analoga nei tre gruppi (13.6% vs 15% vs 15%). I nostri risultati non differiscono sostanzialmente da quelli riportati in letteratura. Abbiamo risolto la difficoltà iniziale nella cateterizzazione del dotto con esercizi chirurgici su cadavere o su teste di maiale. La mancanza di precisione degli strumenti diagnostici radiologici può essere migliorata autonomizzando il chirurgo nell’esecuzione delle ecografie pre e post-operatorie. Viene infine sottolineata l’opportunità di creare dei centri di scialoendoscopia con un bacino di utenza di circa 1 o 2 milioni di abitanti in modo da concentrare le patologie, far fronte agli elevati costi della strumentazione necessaria e poter guadagnare la necessaria esperienza nelle gestione delle varie tecniche chirurgiche

Sensitivity of the Atlantic meridional overturning circulation to South Atlantic freshwater anomalies

The sensitivity of the Atlantic Meridional Overturning Circulation (AMOC) to changes in basin integrated net evaporation is highly dependent on the zonal salinity contrast at the southern border of the Atlantic. Biases in the freshwater budget strongly affect the stability of the AMOC in numerical models. The impact of these biases is investigated, by adding local anomaly patterns in the South Atlantic to the freshwater fluxes at the surface. These anomalies impact the freshwater and salt transport by the different components of the ocean circulation, in particular the basin-scale salt-advection feedback, completely changing the response of the AMOC to arbitrary perturbations. It is found that an appropriate dipole anomaly pattern at the southern border of the Atlantic Ocean can collapse the AMOC entirely even without a further hosing. The results suggest a new view on the stability of the AMOC, controlled by processes in the South Atlantic. <br/

Description and evaluation of the Earth System Regional Climate Model (Reg CM-ES)

We describe a new, state-of-the-art, Earth System Regional Climate Model (RegCM-ES), which includes the coupling between the atmosphere, ocean, and land surface, as well as a hydrological and ocean biogeochemistry model, with the capability of using a variety of physical parameterizations. The regional coupled model has been implemented and tested over some of the COordinated Regional climate Downscaling Experiment (CORDEX) domains and more regional settings featuring climatically important coupled phenomena. Regional coupled ocean-atmosphere models can be especially useful tools to provide information on the mechanisms of air-sea interactions and feedbacks occurring at fine spatial and temporal scales. RegCM-ES shows a good representation of precipitation and SST fields over the domains tested, as well as realistic simulations of coupled air-sea processes and interactions. The RegCM-ES model, which can be easily implemented over any regional domain of interest, is open source, making it suitable for usage by the broad scientific community

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience

La scialoadenite cronica ostruttiva rappresenta una delle più frequenti patologie non-neoplastiche delle ghiandole salivari e la scialoendoscopia è sempre più utilizzata nella sua diagnosi e nel suo trattamento, associata o meno con la litotripsia laser. La scialoendoscopia può essere inoltre associata ad approcci esterni mini-invasivi nelle litiasi troppo voluminose per essere rimosse con un approccio unicamente endoscopico. Il presente articolo riporta lesperienza delle Cliniche Otorinolaringoiatriche dellOspedale SantOrsola-Malpighi di Bologna e dellAzienda Ospedaliero Universitaria di Cagliari, Italia. È stata eseguita unanalisi retrospettiva su 48 pazienti (26 femmine, 22 maschi; età media di 45,3 anni; range 8-83 anni) trattati per patologia cronica ostruttiva delle ghiandole salivari maggiori mediante procedure chirurgiche endoscopiche o combinate da novembre 2010 ad aprile 2016 presso lAzienda-Ospedaliero-Universitaria di Cagliari. I risultati dellOspedale SantOrsola-Malpighi di Bologna erano stati precedentemente pubblicati. Gli aspetti tecnici della scialoendoscopia sono stati accuratamente descritti. I pazienti trattati presso lAzienda Ospedaliero Universitaria di Cagliari presentavano una patologia unilaterale in 40 casi e bilaterale in 8 casi; sono state trattate 56 ghiandole salivari maggiori (22 sottomandibolari e 34 parotidi). 5 pazienti sono stati sottoposti a scialoendoscopia bilaterale per parotite ricorrente giovanile, 10 per patologia ostruttiva non litiasica e 33 (68,75%) presentavano calcoli salivari (1 paziente presentava una litiasi parotidea bilaterale). Solo 8 pazienti sono stati sottoposti a scialectomia radicale per via esterna (5 scialectomie sottomandibolare e 3 parotidectomie). La chirurgia conservativa nei pazienti con scialoadenite cronica ostruttiva appare efficace e può essere realizzata mediante un approccio puramente endoscopico o combinato, con unalta percentuale di successo. La procedura richiede una strumentazione adeguata e deve essere eseguita da un chirurgo esperto, che abbia svolto un training specifico scialoendoscopico, in modo da evitare le possibili complicanze maggiori e minori. La scialectomia tradizionale rappresenta la extrema ratio, limitata nei casi in cui un approccio conservativo sia risultato inefficace o controindicato