miRNA signature predittivo di metastasi linfonodali da carcinoma della laringe

The discovery that miRNAs are frequently deregulated in tumours offers the opportunity to identify them as prognostic and diagnostic markers. The aim of this multicentric study is to identify a miRNA expression profile specific for laryngeal cancer. The secondary endpoint was to identify specific deregulated miRNAs with potential as prognostic biomarkers for tumour spread and nodal involvement, and specifically to search for a miRNA pattern pathognomonic for N+ laryngeal cancer and for N-tissues. We identified 20 miRNAs specific for laryngeal cancer and a tissue-specific miRNA signature that is predictive of lymph node metastases in laryngeal carcinoma characterized by 11 miRNAs, seven of which are overexpressed (upregulated) and four downregulated. These results allow the identification of a group of potential specific tumour biomarkers for laryngeal carcinoma that can be used to improve its diagnosis, particularly in early stages, as well as its prognosis

Competenze Infermieristiche Distintive in Area Ematologica: survey sulla loro diffusione

La natura specialistica dell’Ematologia richiede comprensione dei processi patologici, degli appropriati interventi terapeutici e dell’impatto che essi hanno sulla qualità di vita dei pazienti. Interventi infermieristici mirati in Ematologia richiamano il concetto di Competenze distintive. Questo studio si propone quindi di indagare la diffusione di queste tra gli Infermieri di Ematologia. È stato eseguito uno studio osservazionale multicentrico trasversale, con somministrazione di un questionario a risposta multipla ad un campione appartenente a 3 diverse Unità Operative di Ematologia Adulti delle province di Milano e Monza e Brianza. In base alla percentuale di risposte corrette alle domande del questionario, si può desumere che, tra i soggetti coinvolti nello studio, vi sia una buona diffusione delle Competenze distintive in Ematologia, ma questa appare strettamente legata all’esperienza professionale in questo ambito specifico. Si auspica che l’apprendimento di queste in futuro possa essere correlato anche ad una formazione specialistica post-base.Hematology's specialized nature requires understanding disease processes, appropriate therapeutic interventions, and their impact on a patient's quality of life. Targeted nursing interventions in Hematology invoke the concept of Distinctive Competencies. Therefore, this study aimed to investigate its prevalence among Hematology nurses. A multicenter cross-sectional observational study was performed, administering a multiple-choice questionnaire to a sample belonging to 3 different Adult Hematology Operating Units in Milan and Monza & Brianza. Based on the percentage of correct answers to the questions in the questionnaire, it can be inferred that, among those involved in the study, there is a good diffusion of Distinctive Competencies in Hematology, but this appears to be closely related to professional experience in this field. Hopefully, these learnings will also be related to specialized post-basic training in the future

Recommendations for radiation therapy in oligometastatic prostate cancer:An ESTRO-ACROP Delphi consensus

Background and purpose: Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospec-tive randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices.Material and methods: A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists' experts in prostate cancer was asked to answer a dedicated question-naire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer.Results: The panel achieved consensus on patient selection and routine use of prostate-specific mem-brane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligopro-gressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented.Conclusion: These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of random-ized trials are available.AT would like to acknowledge the support of Cancer Research UK (C33589/A28284 and C7224/A28724) . This project represents independent research supported by the National Institute for Health research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care

Enhanced Recovery After Surgery e assistenza infermieristica in urologia: utopia o futura pietra miliare? Una revisione della letteratura

BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary program of evidence-based interventions that minimizes physical response to surgical stress, allows patients to achieve better outcomes, early and safe discharge, and reduces costs. Despite the presence of evidence on the usefulness of the ERAS program in major surgery, the implementation of this multidisciplinary pathway has not yet achieved consensus in urologic surgery. AIMS: The purpose of this paper is to analyze the ERAS elements implemented in urological surgery for each stage of the surgical process, evaluate their outcomes, and investigate nursing perspectives. METHODS: After identifying the scope and research question, the PIO (Population, Intervention, Outcome) was formulated. In August and September 2022, the literature search was conducted by searching the main biomedical databases: PubMed, Cinahl, Embase. RESULTS: Fourteen papers were included. 1 qualitative design and 13 quantitative design. Several topics areas were identified, divided into the different stages of the operative process. CONCLUSIONS: The contributions analyzed in this paper add to the increasing number of evidence supporting the value of ERAS to improve outcomes in the population undergoing urologic surgery, with particular reference to patients undergoing radical cystectomy, which is a highly demolitive procedure.BACKGROUND: Enhanced Recovery After Surgery (ERAS) è un programma multidisciplinare volto a ridurre al minimo la risposta del corpo allo stress chirurgico, consente agli assistiti di ottenere outcome migliori, dimissioni precoci e sicure nonché la riduzione dei costi. Nonostante la presenza di numerose evidenze clinico-scientifiche in letteratura sull'utilità del programma ERAS nella chirurgia maggiore, l'implementazione di questo percorso multidisciplinare non ha ancora raggiunto consenso unanime nella chirurgia urologica. OBIETTIVI: Obiettivo del presente lavoro è analizzare per ogni fase del processo chirurgico gli item ERAS messi in atto in chirurgia urologica, valutarne gli esiti e indagare le prospettive infermieristiche. METODI: Dopo aver identificato l’ambito e il quesito di ricerca è stato formulato il PIO (Popolazione, Intervento, Esito). Nei mesi di agosto e settembre 2022 è stata condotta la ricerca bibliografica attraverso la consultazione delle principali banche dati biomediche: PubMed, Cinahl, Embase. RISULTATI: Sono stati ritenuti validi 14 articoli per la stesura dell’elaborato. 1 con disegno qualitativo e 13 con disegno quantitativo. Sono state identificate diverse aree tematiche, idealmente suddivise nelle diverse fasi del processo operatorio.  CONCLUSIONI: I contributi analizzati in questo elaborato assumono un significato clinico importante, aggiungendosi al crescente numero di evidenze che supportano il valore di ERAS negli sforzi messi in atto per migliorare gli esiti clinici nella popolazione sottoposta a chirurgia urologica, con particolare riferimento ai pazienti sottoposti a cistectomia radicale, procedura altamente demolitiva

Il valore della comunicazione come tempo di cura nella presa in carico del paziente a domicilio: revisione della letteratura

B BACKGROUND: Communication plays a key role in nursing care. WHO emphasizes the importance of the nurse's use of communication skills in ensuring a high standard of care. Therapeutic communication aims to promote the well-being of the person with his or her needs, facilitate adherence to the care pathway and establish a relationship of mutual trust and respect between the nurse and the person. This form of communication is the crucial foundation on which effective home care is based. AIMS: The purpose of this paper is to analyze the ways in which home nursing contributes to establishing a therapeutic relationship with the person being cared for, the family and the caregiver. METHODS: The research question were identified throught the PIO framework (Population, Intervention, Outcome). Subsequently, a narrative literature review was performed by consulting the biomedical databases of CINAHL, EMBASE, Ovid MEDLINE and SCOPUS to search for articles. RESULTS: 10 articles were included. In each of these articles, various communication modes by the home care nurse in the home care setting were identified and highlighted. CONCLUSIONS: The findings reveal the importance of therapeutic communication in the home care setting; potential obstacles that nurses may face in implementing communication were highlighted. The need for qualitative studies in Italy to explore the issues that emerged and deepen understanding of the effect of therapeutic communication on the well-being of caregivers is emphasized.BACKGROUND: La comunicazione riveste un ruolo fondamentale nell'ambito dell'assistenza infermieristica. L’OMS sottolinea l’importanza dell’utilizzo delle competenze comunicative da parte dell’infermiere nel garantire un elevato standard di assistenza. La comunicazione terapeutica mira a promuovere il benessere della persona con le sue esigenze, facilitare l'adesione al percorso di assistenza e instaurare una relazione di fiducia e rispetto reciproco tra l'infermiere e la persona. Questa forma di comunicazione rappresenta il fondamento cruciale su cui si basa un'assistenza domiciliare efficace. OBIETTIVI: L’obiettivo di questo progetto è analizzare le modalità con cui l’assistenza infermieristica domiciliare concorre nell’instaurare una relazione terapeutica con la persona assistita, la famiglia e il caregiver. METODI: Sono stati identificati l’ambito e il quesito di ricerca, quindi è stato formulato il PIO. Successivamente, è stata condotta una ricerca bibliografica attraverso la consultazione delle banche dati biomediche di CINAHL, EMBASE, Ovid MEDLINE(R) e SCOPUS per la ricerca degli articoli. RISULTATI: Sono stati inclusi 10 articoli. In ciascuno di essi, sono state individuate e messe in luce le varie modalità comunicative da parte dell’infermiere domiciliare nel contesto di assistenza domiciliare. CONCLUSIONI: Dai risultati emerge l'importanza della comunicazione terapeutica nel contesto dell'assistenza domiciliare; sono stati evidenziati i potenziali ostacoli che gli infermieri possono incontrare nell’attuare la comunicazione. Si viene a sottolineare la necessità di studi qualitativi in Italia per esplorare le tematiche emerse e approfondire la comprensione dell'effetto della comunicazione terapeutica sul benessere delle persone assistite

Clinical and audiological follow up of a family with the 8363G > A mutation in the mitochondrial DNA

Hearing loss is relatively common in mtDNA-related disorders. While auditory function has been assessed folly in the syndrome of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, few studies have investigated the degree of progressive hearing deficit in individuals bearing other mtDNA mutations. We performed a 4-year clinical and audiological follow LIP in a family carrying the 8363G > A mutation in the mitochondrial transfer ribonucleic acid lysine (tRNA(Lys)) gone who displayed a progressive neuro-muscular disease. In addition to Pore tone audiometry, we considered distortion products of otoacoustic emissions, a sensitive indicator of cochlear dysfunction, as well as brainstem auditory evoked responses. A generalized increase in the auditory threshold at follow LIP, indicating a cochlear impairment in three cases, was noted. Distortion products Of otoacoustic emissions may reveal sub-clinical cochlear dysfunction, even in oligosymptomatic patients. A complete and periodical assessment of the hearing function Should be encouraged in asymptomatic relatives of patients carrying the tRNA(Lys), 8363G > A Mutation. (C) 2009 Elsevier B.V. All rights reserved

PSMA-guided metastases directed therapy for bone castration sensitive oligometastatic prostate cancer: a multi-institutional study

: To assess the outcomes of a cohort of bone oligometastatic prostate cancer patients treated with PSMA-PET guided stereotactic body radiotherapy (SBRT). From April 2017 to January 2021, 40 patients with oligorecurrent prostate cancer detected by PSMA-PET were treated with SBRT for bone oligometastases. Concurrent androgen deprivation therapy was an exclusion criterion. A total of 56 prostate cancer bone oligometastases were included in the present analysis. In 28 patients (70%), oligometastatic disease presented as a single lesion, two lesions in 22.5%, three lesions in 5%, four lesions in 2.5%. 30.3% were spine-metastases, while 69.7% were non-spine metastases. SBRT was delivered for a median dose of 30 Gy (24-40 Gy) in 3-5 fractions, with a median EQD2 = 85 Gy2 (64.3-138.9Gy2). With a median follow-up of 22 months (range 2-48 months), local control (LC) 1- and 2-years rates were 96.3% and 93.9%, while distant progression-free survival (DPFS) rates were 45.3% and 27%. At multivariate analysis, the lower PSA nadir value after SBRT remained significantly related to better DPFS rates (p = 0.03). In 7 patients, a second SBRT course was proposed with concurrent ADT, while 11 patients, due to polymetastatic spread, received ADT alone, resulting in 1- and 2-years ADT-free survival rates of 67.5% and 61.8%. At multivariate analysis, a lower number of treated oligometastases maintained a correlation with higher ADT-free survival rates (p = 0.04). In our experience, PSMA-PET guided SBRT resulted in excellent results in terms of clinical outcomes, representing a helpful tool with the aim to delay the start of ADT

Neoadjuvant Accelerated Concomitant Boost Radiotherapy and Multidrug Chemotherapy in Locally Advanced Rectal Cancer: A Dose-Escalation Study

OBJECTIVES: To determine the maximal and safely dose of preoperative radiotherapy and concurrently intensified chemotherapy regimen (raltitrexed plus oxaliplatin) in locally advanced rectal cancer patients. METHODS: Patients with cT3-T4 and/or cN 651 or locally recurrent rectal cancer were sequentially assigned to 4 treatment schedules of chemoradiation: standard radiotherapy (50.4 Gy/5.5 wk) plus raltitrexed (cohort A), accelerated radiotherapy (55 Gy/5 wk) plus raltitrexed (cohort B), standard radiotherapy plus raltitrexed and oxaliplatin (cohort C), accelerated radiotherapy plus raltitrexed and oxaliplatin (cohort D). Patients were treated in cohorts of 6 to 12 per group. The maximal tolerated dose was exceeded if more than one-third of patients in a given cohort experienced dose-limiting toxicity (DLT). DLT was defined as any grade 653 toxicity according to the Radiation Therapy Oncology Group criteria. RESULTS: Forty-six consecutive patients were enrolled. In cohort A, 6 patients received the planned treatment with no DLT. In cohort B, 1 of 8 patients experienced a DLT. In cohort C, a DLT occurred in 2 of 6 patients and therefore, a cohort expansion was required. Three of 16 patients treated at this dose level experienced a DLT. In addition, cohort D was expanded and DLT was found in 4 of 16 patients. Therefore, the maximal tolerated dose was not exceeded at any treatment level. CONCLUSIONS: An intensified regimen of chemoradiotherapy delivering raltitrexed and oxaliplatin concurrently with concomitant boost radiotherapy (55 Gy/5 wk) can be safely administered in patients with locally advanced rectal cancer. On the basis of these results, this intensified regimen could be tested in a phase II study