Efficacy of somatostatine analogues in survival and quality of life of a frail patient with poorly differentiated biliary neuroendocrine tumour

We describe the case of a 71-year-old woman with poorly differentiated neuroendocrine tumor of third distal biliary duct and osteolytic metastasis. The patient was evaluated as a third stage of Balducci’s criteria for the recognition of frailty. The patient received radiotherapy and octreotide LAR. This treatment allowed a good tumour progression rate (18 months), a good quality of life and a good survival (35 months). The case report describes the role of octreotide in the therapy of neuroendocrine tumours, and underlines the importance of a multidisciplinary management of cancer in frail patients

Radiofrequency thermoablation (RFA) of a scapula osteolytic metastasis with extended bone continuity solution: pain-relieving and bone-reconstructive effect - Termoablazione con radiofrequenza (RFA) di una metastasi osteolitica con estesa soluzione di continuità ossea: effetto antalgico e osteo-ricostruttivo

A high percentage of patients with neoplasm develop osteolytic metastases that, in addition to causing pain, expose them to the risk of fractures and nerve compressions. Standard therapies with chemotherapy, radiotherapy and bisphosphonates are not always effective in controlling pain and the surgical treatment is reserved to patients in fair general conditions and with a long-life expectancy because of its high morbidity and mortality. Opioid medications may also not be well tolerated due to the side effects they cause. Recently, minimally invasive techniques have been introduced to control pain by acting quickly and with few complications. One of the most used is radiofrequency thermoablation (RFA) which, through the introduction of a thermal probe into the bone, causes metastasis necrosis and allows pain control

Shear Strength Characterization of Metal-Elastomer Bonded Joints

The shear strength characterization of bonded joints involving adherends with a remarkably different stiffness has a peculiar interest in industrial applications. This work proposes and investigates three innovative specimens (an axisymmetric annular, a tensile and a torsional one) purposely developed to manage dissimilar adherends bonded with adhesive in thin film. A Thick Adherend Shear Test specimen between rigid adherends is used for the assessment of the adhesive by itself. The work focuses on metal-elastomeric polyurethane bonded joints with a solventbased adhesive. All the tests are performed through an axial dynamometer, using a purposely developed fixture to convert the tensile load in a torque for the torsional specimen. The tensile and the torsional specimens provide the most reliable shear strength characterization

Reaction of N,N'-dimethylimidazolidine-2-selone (4) with TCNQ. Characterisation and X-ray crystal structure of the mixed-valence compound 4.(TCNQ)(1.167)

The reaction of 1,3-dimethyl-2-imidazolidineselone (I) with TCNQ affords lustrous dark crystals with elemental anal. corresponding to the formula I·(TCNQ)1.167. X-Ray crystal structure detn. shows that this compd. is formed by discrete [I2]2+ dications, in which two oxidized imidazolidine mols. are bonded through an -Se-Se- bridge [2.5187(7) Å]. These dications interact on one side with a third disordered mol. of I (occupancy factor 0.5) via Se···Se soft interactions of 2.715(4) and 2.899(4) Å to give almost linear -Se-Se···Se- arrangements [Se(2)-Se(1)···Se(3), 177.64(6)° and Se(2)-Se(1)···Se(3a), 167.89(5)°]. The unit cell contains six imidazolidine mols. bearing a total of four pos. charges, balanced by four neg. charges distributed on seven TCNQ mols., stacked in two dimers and a trimer. Structural data suggest that the neg. charges are unevenly distributed on the TCNQ mols. Single crystal IR spectra also suggest the presence of at least three differently charged TCNQ's, and in addn. indicate a room temp. optical gap of ∼0.3 eV, placing this compd. among wide bandgap semiconductors (σ = 3.45 × 10-3 S cm-1). Cyclic voltammetry of I is discussed in comparison with those of previously studied 2-imidazolineselone derivs. [i.e., 1,3-dihydro-1,3-dimethyl-2H-imidazole-2-selone, 1,1'-methylenebis[1,3-dihydro-3-methyl-2H-imidazole-2-selone], 1,1'-(1,2-ethanediyl)bis[1,3-dihydro-3-methyl-2H-imidazole-2-selone]], and shows that for this donor the achievement of a mixed valence compd. with TCNQ is possible in MeCN

An Alternative Strategy to Polymorph Recognition at Work: The Emblematic Case of Coronene

We show that the development of highly accurate density functional theory calculations coupled to low-frequency Raman spectroscopy constitutes a valid method for polymorph characterization alternative/complementary to X-ray. The method is applied here to the temperature-induced, first-order phase transition of coronene, known for a long time, but has remained structurally uncharacterized due to crystal breaking during the process. The astonishing fidelity of the Raman calculated spectra to the experiments allows us to unambiguously identify the low-temperature phase with the \u3b2-coronene polymorph, recently reported as new and obtained in the presence of a magnetic field. We also suggest that additional measurements are needed to confirm that a magnetic field can actually drive the growth of a \u3b2-polymorph surviving indefinitely at ambient temperature

High-dose Radiotherapy for Oligo-progressive NSCLC Receiving EGFR Tyrosine Kinase Inhibitors: Real World Data

Background/Aim. Local ablative treatments for oligo-progressive, EGFR mutated non-small cell lung cancer (mut-NCSLC) may improve long-term disease control and survival. We analyzed the efficacy of hypo-fractionated, highdose radiation therapy (HDRT), in association with prolonged EGFR tyrosine kinase inhibitors (TKI) in oligo-progressive, EGFR mutant-NSCLC. Patients and Methods. Progressionfree survival-1 (PFS-1, date from initiation of TKI therapy until oligo-progression or death), and progression-free survival-2 (PFS-2, date of focal progression until further progression or death) were evaluated. Results. Thirty-six patients were analyzed. The median PFS 1 was 12.5 months. HDHRT consisted of intensity-modulated RT and stereotactic RT in 23 (64%) and 13 (36%) patients respectively. The median PFS 2 was 6.3 months. Overall survival was 38.7 months. Conclusion. Hypo-fractionated HDRT plus TKI therapy, is associated with a significant prolongation of disease control (overall PFS: 18.8 months), with manageable side effects. These real-world data support the use of local ablative approaches in oligo-progressive EGFR mut-NSCLC

HyperArcTM Dosimetric Validation for Multiple Targets Using Ionization Chamber and RT-100 Polymer Gel

Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy department. Before its use in clinical routine, it is recommended to perform end-to-end tests. In this work, we report the results of five HyperArcTM treatment plans obtained by both ionization chamber (IC) and polymer gel. The end-to-end tests were performed using a water equivalent Mobius Verification PhantomTM (MVP) and a 3D-printed anthropomorphic head phantom PseudoPatient® (PP) (RTsafe P.C., Athens, Greece); 2D and 3D dose distributions were evaluated on the PP phantom using polymer gel (RTsafe). Gels were read by 1.5T magnetic resonance imaging (MRI). Comparison between calculated and measured distributions was performed using gamma index passing rate evaluation by different criteria (5% 2 mm, 3% 2 mm, 5% 1 mm). Mean point dose differences of 1.01% [min −0.77%–max 2.89%] and 0.23% [min 0.01%–max 2.81%] were found in MVP and PP phantoms, respectively. For each target volume, the obtained results in terms of gamma index passing rate show an agreement >95% with 5% 2 mm and 3% 2 mm criteria for both 2D and 3D distributions. The obtained results confirmed that the use of a single isocenter for multiple lesions reduces the treatment time without compromising accuracy, even in the case of target volumes that are quite distant from the isocenter

Prediction of spontaneous vaginal delivery in nulliparous women with a prolonged second stage of labor: the value of intrapartum ultrasound

Background: A limited number of studies have addressed the role of intrapartum ultrasound in the prediction of the mode of delivery in women with prolonged second stage of labor. Objective: The objective of the study was to evaluate the role of transabdominal and transperineal sonographic findings in the prediction of spontaneous vaginal delivery among nulliparous women with prolonged second stage of labor. Study Design: This was a 2-center prospective study conducted at 2 tertiary maternity units. Nulliparous women with a prolonged active second stage of labor, as defined by active pushing lasting more than 120 minutes, were eligible for inclusion. Transabdominal ultrasound to evaluate the fetal head position and transperineal ultrasound for the measurement of the midline angle, the head-perineum distance, and the head-symphysis distance were performed in between uterine contractions and maternal pushes. At transperineal ultrasound the angle of progression was measured at rest and at the peak of maternal pushing effort. The delta angle of progression was defined as the difference between the angle of progression measured during active pushing at the peak of maternal effort and the angle of progression at rest. The sonographic findings of women who had spontaneous vaginal delivery vs those who required obstetric intervention, either vacuum extraction or cesarean delivery, were evaluated and compared. Results: Overall, 109 were women included. Spontaneous vaginal delivery and obstetric intervention were recorded in 40 (36.7%) and 69 (63.3%) patients, respectively. Spontaneous vaginal delivery was associated with a higher rate of occiput anterior position (90% vs 53.2%, P < .0001), lower head-perineum distance and head-symphysis distance (33.2 ± 7.8 mm vs 40.1 ± 9.5 mm, P = .001, and 13.1 ± 4.6 mm vs 19.5 ± 8.4 mm, P < .001, respectively), narrower midline angle (29.6° ± 15.3° vs 54.2° ± 23.6°, P < .001) and wider angle of progression at the acme of the pushing effort (153.3° ± 19.8° vs 141.8° ± 25.7°, P = .02) and delta-angle of progression (17.3° ± 12.9° vs 12.5° ± 11.0°, P = .04). At logistic regression analysis, only the midline angle and the head-symphysis distance proved to be independent predictors of spontaneous vaginal delivery. More specifically, the area under the curve for the prediction of spontaneous vaginal delivery was 0.80, 95% confidence interval (0.69–0.92), P < .001, and 0.74, 95% confidence interval (0.65–0.83), P = .002, for the midline angle and for the head-symphysis distance, respectively. Conclusion: Transabdominal and transperineal intrapartum ultrasound parameters can predict the likelihood of spontaneous vaginal delivery in nulliparous women with prolonged second stage of labor

Stereotactic body radiotherapy (SBRT) and concomitant systemic therapy in oligoprogressive breast cancer patients

Breast cancer is a heterogenous disease with a deep tailoring level. Evidence is accumulating on the role of stereotactic body radiotherapy (SBRT) in the management of oligometastatic disease, however this is limited in breast cancer. The aim of the present study is to show the effectiveness of SBRT in delaying the switch to a subsequent systemic treatment in oligoprogressive breast cancer patients. Retrospective analysis from two Institutions. Primary endpoint: time to next systemic treatment (NEST). Secondary endpoints: freedom from local progression (FLP), time to the polymetastatic conversion (tPMC) and overall survival (OS). One-hundred fifty-three (153) metastases in 79 oligoprogressive breast cancer patients were treated with SBRT. Median follow-up 24 months. Median NEST 8 months. Predictive factor of NEST at the multivariate analysis (MVA) was the number of treated oligometastases (HR 1.765, 95%CI 1.322-2.355; p = < 0.01). Systemic treatment after SBRT was changed in 29 patients for polymetastatic progression and in 10 patients for oligometastatic progression < 6 months after SBRT. The 2-year FLP in the overall population was 86.7%. A biological effective dose (BED) > 70Gy10 was associated with improved FLP (90% versus 74.2%). The median tPMC was 10 months. At the MVA the only factors significantly associated with tPMC were the number of oligometastases (HR 1.172, 95%CI 1.000-1.368; p = 0.03), and the local control of the treated metastases (HR 2.726, CI95% 1.108-6.706; p = 0.02). SBRT can delay the switch to a subsequent systemic treatment, however patient selection is necessary. Several predictive factors for treatment tailoring have been identified

An Alternative Strategy to Polymorph Recognition at Work: The Emblematic Case of Coronene

We show that the development of highly accurate density functional theory calculations coupled to low-frequency Raman spectroscopy constitutes a valid method for polymorph characterization alternative/complementary to X-ray. The method is applied here to the temperature-induced, first-order phase transition of coronene, known for a long time, but has remained structurally uncharacterized due to crystal breaking during the process. The astonishing fidelity of the Raman calculated spectra to the experiments allows us to unambiguously identify the low-temperature phase with the β-coronene polymorph, recently reported as new and obtained in the presence of a magnetic field. We also suggest that additional measurements are needed to confirm that a magnetic field can actually drive the growth of a β-polymorph surviving indefinitely at ambient temperature