Sviluppo e caratterizzazione elettromagnetica di fantocci antropomorfi a base gelatinosa per sistemi a microonde dedicati all'imaging della mammella

Il carcinoma mammario è ancora la prima causa di morte per neoplasie nelle donne; per ridurre il tasso di mortalità del tumore al seno sono attivi programmi di screening mammografico come strumento di monitoraggio e diagnosi precoce. Recentemente, come alternativa priva di rischi ai metodi a raggi X è emerso l’imaging a microonde a banda ultra larga (UWB) che sfrutta i contrasti nelle proprietà dielettriche per il rilevamento di lesioni mammarie. Per un dispositivo di imaging mammario la valutazione delle prestazioni di sistema, in termini di specificità e sensibilità dell'apparato, prevede l'impiego di “Breast Phantom”. I fantocci antropomorfi sono modelli fisici che simulano il comportamento elettromagnetico di differenti tessuti mammari esposti a microonde; sono realizzati con materiali tessuto-equivalenti non organici e poco costosi. I fantocci dovrebbero avere elevata durabilità nel tempo, facile reperibilità, riproducibilità e bassi costi di produzione. Il lavoro di tesi è stato svolto in collaborazione con UBT S.r.l e mostra l’intero processo di fabbricazione di fantocci mammari antropomorfi. Partendo da una composizione a base di gelatina, olio di girasoli e coloranti alimentari, i fantocci sono stati sviluppati e caratterizzati elettromagneticamente ed è stato trovato un metodo di conservazione per gli stessi. Il composto proposto ha permesso la creazione di tre tipologie di fantocci che simulano il tessuto sano (ad alta, media e bassa densità) e tre varietà di tumore. In aggiunta, è stato progettato uno stampo-controstampo di PLA disegnato in SolidWorks, a partire da immagini MRI e realizzato con stampante 3D, all’interno del quale è stato fatto polimerizzare il composto a base di gelatina. Sia i materiali costituenti il fantoccio che i differenti campioni sono stati caratterizzati elettromagneticamente mediante una sonda a cavo coassiale aperto e confrontati con la letteratura. È stato sperimentalmente dimostrato che, attraverso il metodo di conservazione qui proposto, le proprietà dielettriche del fantoccio rimangono inalterate fino a 14 giorni. Usando materiali facilmente reperibili e bassi costi di produzione è stato progettato un fantoccio eterogeneo, multistrato, realistico e verosimile alla condizione anatomo-patologica. Il fantoccio è stato quindi impiegato per caratterizzare la capacità di rilevamento e le prestazioni di un sistema di imaging a microonde. Breast cancer is still the leading cause of cancer death in women; to reduce breast cancer mortality rate mammography screening programs are active as an instrument of monitoring and early diagnosis. Recently, ultra-wideband (UWB) microwave imaging has emerged as a risk-free alternative to X-ray methods for breast lesions detection. Microwave imaging exploits the contrasts in dielectric properties. For a breast microwave imaging device, the evaluation of system performance in terms of specificity and sensitivity of the apparatus involves the use of “Breast Phantom”. Anthropomorphic phantoms are physical models that simulate the electromagnetic behavior of different breast tissues exposed to microwaves; they are made with non-organic and low-cost tissue-equivalent materials. Anthropomorphic phantoms should have long-term stability, easy availability, reproducibility, and low costs manufacturing and materials. This thesis work has been carried out in collaboration with UBT S.r.l and shows the entire manufacturing process of anthropomorphic mammary phantoms. Starting from a process based on a mixture of gelatin, sunflower oil, and food colorants, phantoms have been developed with ad-hoc electromagnetic properties; a preservation method has also been investigated and described. The proposed mixture allowed the creation of three types of healthy-mimicking tissues (high, medium, and low density) and three types of cancer mimicking tissues. Moreover, starting from MRI images, a PLA mould-counter mould has been designed in SolidWorks and finally fabricated with a 3D printer. The gelatin-based mixture has been polymerized in the moulder. Both the materials and the different samples have been electromagnetically characterized by using an open-ended coaxial probe and then compared with the literature data. It has been experimentally demonstrated that the dielectric properties of the phantom remain unchanged up to 14 days by using the proposed preservation method. By means of readily available materials and low production costs, a heterogeneous, multi-layered, realistic phantom for microwave imaging systems has been designed. The phantom has been then used to characterize the detection capability of a microwave imaging system

Electromagnetically characterized gelatinous-based phantoms for breast microwave imaging

The present work proposes a procedure based on a modified recipe to fabricate electromagnetically characterized phantoms, made of gelatinous-based mixture. As a main advantage we highlight the use of commercially available and very inexpensive gelatin along with the addition of food colorants for the phantom assembly. Furthermore, we have demonstrated that by storing the samples in a refrigerator at a stable temperature of 4°C, the phantoms maintain stable dielectric properties up to 14 days. Their dielectric properties have been measured in the [1-8.5] GHz frequency range using a coaxial probe kit. The promising results demonstrate the potential of the recipe method to realize multistrate breast phantoms representing different tissues

Aripiprazole-induced persistent HiCCup: A case report and review of the literature

reserved8noAripiprazole is an interesting psychoactive compound acting as a dopamine D2 partial agonist, serotonin 5-HT(1A) partial agonist and serotonin 5-HT(2A) antagonist. Aripiprazole possesses a well-documented efficacy in the treatment of both positive and negative psychotic symptoms. However, this medication may be rarely associated with the onset of hiccup. Here, we present the case of aripiprazole-induced hiccup in a young inpatient at his first psychiatric admission together with a review of the current literature about this topic. The possible etiology underlying the emergence of hiccups together with the clinical implications of this adverse event are discussed.mixedSerafini G.; Piccinini G.; Visimberga S.; Cervetti A.; Belvederi Murri M.; Monacelli F.; Pompili M.; Amore M.Serafini, G.; Piccinini, G.; Visimberga, S.; Cervetti, A.; Belvederi Murri, M.; Monacelli, F.; Pompili, M.; Amore, M

ARIPIPRAZOLE-INDUCED PERSISTENT HICCUP: A CASE REPORT AND REVIEW OF THE LITERATURE

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Uric acid and late-onset Alzheimer's disease: results from the ReGAl 2.0 project

Background: It has been suggested that oxidative stress may have a role in the pathogenesis of Alzheimer's disease (AD). Serum uric acid (UA) could exert neuroprotective effects via its antioxidant capacities. Many studies investigated serum UA levels in subjects with AD, but to date, results are conflicting and evidence in old age subjects is weak. Aims: In this study, we assess whether serum UA levels would be altered in the AD old age subjects compared to those of initial cognitive impairment and healthy controls. Methods: This is a retrospective study with data gathered from the ReGAl 2.0 project (Rete Geriatrica Alzheimer-Geriatric Network on Alzheimer's disease), a large Italian multicentric clinical-based study. A cohort of 232 subjects, including 65 (healthy controls HC), 95 mild cognitive impairment (MCI), and 72 AD, were included in the study. Serum UA was measured in all subjects by routine laboratory method. Results: The sample population includes 232 subjects, mostly women with a mean age of 79.16 ± 5.64 (range 66-93) years. No significant difference was found in gender distribution between groups. No significant correlation was found in all populations between age and uric acid levels. AD group had significantly lower UA levels as compared with HC. The association of uric acid with AD presence after adjusting for age, gender, body mass index (BMI) and creatinine levels showed that uric acid level was independently associated with the diagnosis of AD. Conclusions: These data indicate that serum UA is reduced in AD, supporting that UA may have a potential protective role against AD in old age

Fasting-mimicking diet and hormone therapy induce breast cancer regression

Approximately 75% of all breast cancers express the oestrogen and/or progesterone receptors. Endocrine therapy is usually effective in these hormone-receptor-positive tumours, but primary and acquired resistance limits its long-term benefit1,2. Here we show that in mouse models of hormone-receptor-positive breast cancer, periodic fasting or a fasting-mimicking diet3-5 enhances the activity of the endocrine therapeutics tamoxifen and fulvestrant by lowering circulating IGF1, insulin and leptin and by inhibiting AKT-mTOR signalling via upregulation of EGR1 and PTEN. When fulvestrant is combined with palbociclib (a cyclin-dependent kinase 4/6 inhibitor), adding periodic cycles of a fasting-mimicking diet promotes long-lasting tumour regression and reverts acquired resistance to drug treatment. Moreover, both fasting and a fasting-mimicking diet prevent tamoxifen-induced endometrial hyperplasia. In patients with hormone-receptor-positive breast cancer receiving oestrogen therapy, cycles of a fasting-mimicking diet cause metabolic changes analogous to those observed in mice, including reduced levels of insulin, leptin and IGF1, with the last two remaining low for extended periods. In mice, these long-lasting effects are associated with long-term anti-cancer activity. These results support further clinical studies of a fasting-mimicking diet as an adjuvant to oestrogen therapy in hormone-receptor-positive breast cancer

Author Correction: Fasting-mimicking diet and hormone therapy induce breast cancer regression

An amendment to this paper has been published and can be accessed via a link at the top of the paper

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys