AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Do Organochlorine Contaminants Modulate the Parasitic Infection Degree in Mediterranean Trout (<i>Salmo trutta</i>)?

We investigated the occurrence of organochlorine pollutants (OCs) in the muscle of brown trout and evaluated their potential modulation of parasite infection. The toxicological risk for consumer health was assessed, too. Trout were collected from the Sila National Park (Calabria region, South of Italy). The highest concentrations emerged for the sum of the 6 non-dioxin-like (ndl) indicator polychlorinated biphenyls (Σ6ndl-PCBs), followed by the 1,1,1-trichloro-2,2-di(4-chlorophenyl)-ethane (DDT), dioxin-like PCBs, hexachlorobenzene (HCB), and dieldrin. Measured on lipid weight (LW), the mean value of Σ6ndl-PCBs amounted to 201.9 ng g−1, that of ΣDDTs (the sum of DDT-related compounds) to 100.2 ng g−1, with the major contribution of the DDT-metabolite p,p’-DDE which was detected in all sample units (97.6 ng g−1 on average). Among dioxin-like congeners, PCB 118 showed the highest mean concentration (21.96 ng g−1 LW) and was detected in all sample units. Regression analysis of intestinal parasites on OC concentration was performed, controlling for two potential confounding factors, namely sex and sexual stage. The results evidenced the existence of interactions between the dual stressors in the host-parasite system in the wild. A negative and statistically significant correlation was estimated, suggesting that OCs may decrease parasite infection degree. Regarding the toxicological risk evaluation, OC concentrations were consistently below the current European Maximum Residue Limits

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

Background: Although positive bene ts are associated with shared decision making, no previous studies have evaluated the impact of condition on how shared decision making is implemented. Objective: To compare decision-making preferences across three conditions associated with screening, medical treatment, and invasive interventions: Screening tests for colorectal cancer, initiation of prescription medication for hypertension, and surgical treatment for hip or knee osteoarthritis. Methods: We made use of the publicly available National Survey of Medical Decisions (the DECISIONS study) data and our sample comprised of all subjects who completed the following three speci c modules of the decisions study: Colorectal cancerscreening tests, high blood-pressure medication, and knee or hip replacement surgery. Our primary outcomes of interest were (1) Who made the nal decision? (2) Extent of patients’ involvement in the decision, and (3) How con dent they were about their decision. Results: When comparing baseline characteristics across the three conditions, the group undergoing screening was youngest with a mean age of 58.7 years compared to the medication group (61.27 years), while the group undergoing surgery was oldest (63.14 years). Females constituted over half of all three groups (greater than 50%). In the invasive interventions, decisions were made mainly by the patients, unlike the other groups where shared decision making was predominant. Most patients in all three groups preferred high levels of participation in decision making. Patients undergoing surgery were signi cantly more likely to have greater con dence in their decisions, followed by patients with medication for hypertension. Conclusion: Shared decision making is less predominant among invasive interventions. Further research should describe the reasons for the limited use of shared decisions among conditions with invasive interventions, along with its consequences for healthcare quality

Does Brain Sweat Pay Off?: The Association between the Need for Cognition and Cognitive Function among the American Elderly

Background: The global incidence of impaired cognition increases with the overall aging of the population. Regarding prophylactic measures, it is unclear whether engaging in cognitively-stimulating activities can decrease the risk of cognitive impairment. Objective: To determine the association between Need for Cognition and cognitive ability within a representative mirroring sample of the elderly population in the United States. Methods: We evaluated the association between Need for Cognition (measured through cognitive effort and enjoyment scores) as a predictor and neurocognitive scores (number series, concept formation, calculations, word attack, picture vocabulary, auditory working memory and similarities) as outcomes using the CogUSA dataset. Results: A total of 1,174 participants of at least 64 years of age were part of this analysis. Participants attending college (49.4%) presented higher cognitive effort and enjoyment scores. The ndings demonstrate a two-factor structure, the rst related to neurocognitive tests and the second related to need for cognition, with good factor loadings. Conclusion: Need for Cognition and neurocognitive ability is strongly correlated and could perhaps be constructed as a single factor. Future research should focus on assessing the relationship between the Need for Cognition and cognitive function in the context of a multitude of other factors, thus determining the contribution of individual factors under different circumstances

The relationship between personality and neurocognition among the american elderly: An epidemiologic study

Background: Although different personality traits have often been associated with different levels of mental activity and cognitive functioning, no previous studies have evaluated the association in a sample that mirrors a nationally-representative sample of elderly individuals. Objective: To evaluate the association between personality traits and neurocognitive functioning among individuals 51 years and older using the Cognition and Aging in the USA (CogUSA) database. Methods: We analyzed the association between personality traits and neurocognitive scores derived from Waves I and II of the study. Neurocognitive functions were modeled as an outcome variable using the Big Five Personality Traits as predictors. Results: All personality traits were associated with higher education except Conscientiousness. Older age was associated with higher levels of the Agreeableness and Openness traits. Extraversion, Conscientiousness and Openness were positively associated with increased neurocognitive function and self-rated present memory. Extraversion and Openness also had a positive association with long-term retrieval. Agreeableness was negatively associated with several neurocognitive functions, while Neuroticism was negatively associated with memory and cognitive effort. Conclusion: Extraversion, Conscientiousness and Openness personality traits are associated with good cognitive health. Individuals scoring high in Neuroticism and Agreeableness might benefit from tailored cognitive interventions to prevent age-related cognitive decline

Keep moving without hurting: The interaction between physical activity and pain in determining cognitive function at the population level

BACKGROUND:A number of studies have evaluated the association between cognitive function, pain, and physical activity. To our knowledge, however, no previous studies have evaluated these factors at the population level. AIMS:To evaluate the association between cognitive function in the elderly with pain, physical activity, and the interaction between these variables. Estimates are generated for the United States population. METHODS:We made use of the NHANES database (1999-2002), making adjustments so that our results represent the United States population. Cognitive function was evaluated through the Digit Symbol Substitution Test. Our main predictors were (1) pain, defined as soreness of either the shoulder, neck, lower back and joint, or a severe headache (2) physical activity, measured as the performance while performing tasks at home, physical activity intensity, walking, bicycle riding, and muscle strengthening. RESULTS:Most individual pain sites were not significantly associated with cognitive function, while all physical activity factors were associated with an increase in cognitive function. When evaluating the sample subset of those with cognitive scores lower than the median, a combination of more pain and less physical activity was consistently associated with lower cognitive scores when compared to those performing more physical activity with or without pain. When evaluating individuals with cognitive scores above the median, a similar association pattern was perceived. CONCLUSIONS:Among the population of individuals above the age of 60, higher cognitive levels are associated with more physical activity and less with pain, although both factors might impact cognition. Public policy resources should be commensurate with these findings when targeting cognitive function among the aging population

SARS-CoV-2: Some Aspects of Molecular Evolution, Cellular Pathogenesis, and Immune System Mechanism Elusion

The purpose of this review is to address some of the latest aspects regarding molecular features, pathogenic mechanisms, and immune system response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on recent publications in this field from March 2020 to May 2021. Interpretation keys for periodic re-emergence of coronavirus infections and other lethal viral pandemics are suggested. Antibody-dependent enhancement (ADE) and other potential mechanisms of immune system deception are put forward. Therefore, vaccine development must take into account ADE and other unwanted side effects of immune-based medical intervention. Features reported in our review will allow both clinicians and basic science researchers to take home ideas to improve their knowledge about SARS-CoV-2

Unadjusted association between cognition and physical activity.

<p>Unadjusted association between cognition and physical activity.</p

Unadjusted association between cognitive function and individual pain site.

<p>Unadjusted association between cognitive function and individual pain site.</p