The Importance of Agronomic Knowledge for Crop Detection by Sentinel-2 in the CAP Controls Framework: A Possible Rule-Based Classification Approach

Farmers are supported by European Union (EU) through contributions related to the common agricultural policy (CAP). To obtain grants, farmers have to apply every year according to the national/regional procedure that, presently, relies on the Geo-Spatial Aid Application (GSAA). To ensure the properness of applications, national/regional payment agencies (PA) operate random controls through in-field surveys. EU regulation n. 809/2014 has introduced a new approach to CAP controls based on Copernicus Sentinel-2 (S2) data. These are expected to better address PA checks on the field, suggesting eventual inconsistencies between satellite-based deductions and farmers’ declarations. Within this framework, this work proposed a hierarchical (HI) approach to the classification of crops (soya, corn, wheat, rice, and meadow) explicitly aimed at supporting CAP controls in agriculture, with special concerns about the Piemonte Region (NW Italy) agricultural situation. To demonstrate the effectiveness of the proposed approach, a comparison is made between HI and other, more ordinary approaches. In particular, two algorithms were considered as references: the minimum distance (MD) and the random forest (RF). Tests were operated in a study area located in the southern part of the Vercelli province (Piemonte), which is mainly devoted to agriculture. Training and validation steps were performed for all the classification approaches (HI, MD, RF) using the same ground data. MD and RF were based on S2-derived NDVI image time series (TS) for the 2020 year. Differently, HI was built according to a rule-based approach developing according to the following steps: (a) TS standard deviation analysis in the time domain for meadows mapping; (b) MD classification of winter part of TS in the time domain for wheat detection; (c) MD classification of summer part of TS in the time domain for corn classification; (d) selection of a proper summer multi-spectral image (SMSI) useful for separating rice from soya with MD operated in the spectral domain. To separate crops of interest from other classes, MD-based classifications belonging to HI were thresholded by Otsu’s method. Overall accuracy for MD, RF, and HI were found to be 63%, 80%, and 89%, respectively. It is worth remarking that thanks to the SMSI-based approach of HI, a significant improvement was obtained in soya and rice classification

ER triage in patients showing acute hypersensitivity reactions: one year's experience

Acute hypersensitivity reactions include different clinical entities, the most threatening of which is anaphylaxis. In the Emergency Department, triage evaluation and decisions can be a determinant of successful treatment. We retrospectively studied 1009 patients who underwent triage in our ED because of acute hypersensitivity over a one year time period. Our aim was to correlate triage priority codes with the clinical manifestations registered at the medical examination, time spent in ED before and after the examination, and admission to hospital or discharge. Emergency codes (red or yellow code) were attributed to 10% of our cases, non-emergency codes (green o white) to 90%. Code grading was changed in 9 patients while awaiting medical evaluation. Severity of symptoms was underestimated in one case, and overestimated in 23. Hospital admission rate was greater among patients with more critical codes. No patient died. In conclusion evaluation, direct observation and re-evaluation are needed for the safe treatment of patients with hypersensitivity reactions in ED, even when initial clinical conditions appear stable

ER triage in patients showing acute hypersensitivity reactions: one year's experience

Acute hypersensitivity reactions include different clinical entities, the most threatening of which is anaphylaxis. In the Emergency Department, triage evaluation and decisions can be a determinant of successful treatment. We retrospectively studied 1009 patients who underwent triage in our ED because of acute hypersensitivity over a one year time period. Our aim was to correlate triage priority codes with the clinical manifestations registered at the medical examination, time spent in ED before and after the examination, and admission to hospital or discharge. Emergency codes (red or yellow code) were attributed to 10% of our cases, non-emergency codes (green o white) to 90%. Code grading was changed in 9 patients while awaiting medical evaluation. Severity of symptoms was underestimated in one case, and overestimated in 23. Hospital admission rate was greater among patients with more critical codes. No patient died. In conclusion evaluation, direct observation and re-evaluation are needed for the safe treatment of patients with hypersensitivity reactions in ED, even when initial clinical conditions appear stable

The Importance of Agronomic Knowledge for Crop Detection by Sentinel-2 in the CAP Controls Framework: A Possible Rule-Based Classification Approach

Farmers are supported by European Union (EU) through contributions related to the common agricultural policy (CAP). To obtain grants, farmers have to apply every year according to the national/regional procedure that, presently, relies on the Geo-Spatial Aid Application (GSAA). To ensure the properness of applications, national/regional payment agencies (PA) operate random controls through in-field surveys. EU regulation n. 809/2014 has introduced a new approach to CAP controls based on Copernicus Sentinel-2 (S2) data. These are expected to better address PA checks on the field, suggesting eventual inconsistencies between satellite-based deductions and farmers’ declarations. Within this framework, this work proposed a hierarchical (HI) approach to the classification of crops (soya, corn, wheat, rice, and meadow) explicitly aimed at supporting CAP controls in agriculture, with special concerns about the Piemonte Region (NW Italy) agricultural situation. To demonstrate the effectiveness of the proposed approach, a comparison is made between HI and other, more ordinary approaches. In particular, two algorithms were considered as references: the minimum distance (MD) and the random forest (RF). Tests were operated in a study area located in the southern part of the Vercelli province (Piemonte), which is mainly devoted to agriculture. Training and validation steps were performed for all the classification approaches (HI, MD, RF) using the same ground data. MD and RF were based on S2-derived NDVI image time series (TS) for the 2020 year. Differently, HI was built according to a rule-based approach developing according to the following steps: (a) TS standard deviation analysis in the time domain for meadows mapping; (b) MD classification of winter part of TS in the time domain for wheat detection; (c) MD classification of summer part of TS in the time domain for corn classification; (d) selection of a proper summer multi-spectral image (SMSI) useful for separating rice from soya with MD operated in the spectral domain. To separate crops of interest from other classes, MD-based classifications belonging to HI were thresholded by Otsu’s method. Overall accuracy for MD, RF, and HI were found to be 63%, 80%, and 89%, respectively. It is worth remarking that thanks to the SMSI-based approach of HI, a significant improvement was obtained in soya and rice classification

Lactobacillus Kefiri LKF01 (Kefibios^®) for Prevention of Diarrhoea in Cancer Patients Treated with Chemotherapy: A Prospective Study

Diarrhoea is one of the main side effects that cancer patients face. The literature showsthat the incidence of chemotherapy (CT)-induced diarrhoea (grade 3–4) in treated patients is in the range of 10–20%, particularly after 5-fluorouracil (5-FU) bolus or some combination therapies of irinotecan and fluoropyrimidines. The aim of the present study was to evaluate the clinical effectiveness of Lactobacillus kefiri LKF01 (Kefibios®) in the prevention or treatment of CT-related diarrhoea in the cancer population. We conducted a prospective observational study. Patients enrolled were adults treated for at least four months with 5-FU-based CT. Kefibios® was administered to patients every day. The primary outcome was the evaluation of the incidence of grade 3–4 CT-induced diarrhoea. We included 76 patients in the final analysis. A 6.6% incidence of high-grade diarrhoea was found in the evaluated population (4.7% of patients treated with 5-FU-based therapy and 8.5% of patients treated with capecitabine-based CT). The overall incidence of high-grade diarrhoea observed was higher in the 1st and 2nd cycles (3.9%), with a subsequent sharp reduction from the 3rd cycle (1.3%) and negativisation from the 5th cycle. Lactobacillus kefiri LKF01 (Kefibios®) is safe and effective in preventing severe diarrhoea in cancer patients receiving 5-FU or capecitabine-based treatment

Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials

Background and Objectives: Currently, the standard treatment for non-metastatic triple-negative breast cancer (TNBC) consists of a systemic neoadjuvant (or perioperative) anthracycline plus taxane-based chemotherapy, delivered either sequentially or concomitantly. We performed a network meta-analysis (NMA) to compare the relative efficacy of different neoadjuvant treatments for TNBC in terms of pathologic complete response (pCR). Materials and Methods: The MEDLINE, Embase, and Cochrane databases were searched from database inception to 1 November 2023. Randomized clinical trials were used that enrolled adults with stage I-III TNBC and provided data on pCR defined as residual ypT0/TisN0M0. Between-group comparisons were estimated using risk ratios (RRs) with 95% credible intervals (95% CrIs). The primary outcome was the pCR rate. Results: 1129 citations were screened, and 12 randomized clinical trials were included. In Bayesian comparisons, all regimens, except anthracycline/taxanes plus gemcitabine or capecitabine, resulted in a higher pCR than the standard regimen in both direct and indirect comparisons. In particular, immunotherapy-based regimens resulted in more than double the pCR compared to historical regimens (RR = 2.3, 95% CI 1.9–2.9) and ranked as being the optimal regimen with a probability of 97%. Disease-free survival was better for immune checkpoint inhibitor-based chemotherapy (HR = 0.36, 95% 1.21–2.09) than for historical regimens. Conclusion: This meta-analysis confirmed that incorporating immunotherapy with neoadjuvant platinum-based chemotherapy is the best option to guarantee remarkable pathologic downstaging and improve clinical outcomes

Genetic and phenotypic attributes of splenic marginal zone lymphoma

Altres ajuts: Swiss Cancer Research, ID 3746, 4395, 4660, and 4705; Swiss National Science Foundation, IDSplenic marginal zone B-cell lymphoma (SMZL) is a heterogeneous clinico-biological entity. The clinical course is variable, multiple genes are mutated with no unifying mechanism, and essential regulatory pathways and surrounding microenvironments are diverse. We sought to clarify the heterogeneity of SMZL by resolving different subgroups and their underlying genomic abnormalities, pathway signatures, and microenvironment compositions to uncover biomarkers and therapeutic vulnerabilities. We studied 303 SMZL spleen samples collected through the IELSG46 multicenter international study (NCT02945319) by using a multiplatform approach. We carried out genetic and phenotypic analyses, defined self-organized signatures, validated the findings in independent primary tumor metadata and in genetically modified mouse models, and determined correlations with outcome data. We identified 2 prominent genetic clusters in SMZL, termed NNK (58% of cases, harboring NF-κB, NOTCH, and KLF2 modules) and DMT (32% of cases, with DNA-damage response, MAPK, and TLR modules). Genetic aberrations in multiple genes as well as cytogenetic and immunogenetic features distinguished NNK- from DMT-SMZLs. These genetic clusters not only have distinct underpinning biology, as judged by differences in gene-expression signatures, but also different outcomes, with inferior survival in NNK-SMZLs. Digital cytometry and in situ profiling segregated 2 basic types of SMZL immune microenvironments termed immune-suppressive SMZL (50% of cases, associated with inflammatory cells and immune checkpoint activation) and immune-silent SMZL (50% of cases, associated with an immune-excluded phenotype) with distinct mutational and clinical connotations. In summary, we propose a nosology of SMZL that can implement its classification and also aid in the development of rationally targeted treatments

Molecular prediction of durable remission after first-line fludarabinecyclophosphamide-rituximab in chronic lymphocytic leukemia

Fludarabine, cyclophosphamide, and rituximab (FCR) has represented a significant treatment advancement in chronic lymphocytic leukemia (CLL). In the new scenario of targeted agents, there is an increasing interest in identifying patients who gain the maximum benefit from FCR. In this observational multicenter retrospective analysis of 404 CLL patients receiving frontline FCR, the combination of three biomarkers that are widely tested before treatment (IGHV mutation status, 11q deletion and 17p deletion; available in 80% of the study cohort) allowed to identify a very low-risk category of patients carrying mutated IGHV genes but neither 11q or 17p deletion that accounted for 28% of all cases. The majority of very low-risk patients (71%) remained free of progression after treatment and their hazard of relapse decreased after 4 years from FCR. The life expectancy of very low-risk patients (91% at 5 years) was superimposable to that observed in the matched normal general population, indicating that neither the disease nor complications of its treatment affected survival in this favorable CLL group. These findings need a prospective validation and may be helpful for the design of clinical trials aimed at comparing FCR to new targeted treatments of CLL, and, possibly, for optimized disease managemen