'Campi terapeutici a confronto: il percorso di due gruppi analizzati attraverso il Codice di Analisi dello Stile del Campo Terapeutico'

INTRODUZIONEIl lavoro si \ue8 sviluppato all\u2019interno della sezione del progetto Val.Ter. che si occupa della valutazione dell\u2019analisi del processo nei gruppi terapeutici. Un tema che ha suscitato grande interesse \ue8 lo stile di conduzione dei gruppi terapeutici, che si differenzia notevolmente da quello delle terapie individuali. Nel presente lavoro verr\ue0 presentato un confronto tra due gruppi terapeutici privati, uno a breve termine ed uno tradizionale, condotti dallo stesso terapeuta. Il gruppo a termine, composto da otto pazienti con patologia organica (retinite pigmentosa) \ue8 stato condotto per dieci sedute a cadenza quindicinale nell\u2019arco di cinque mesi. Il gruppo analitico classico, composto da cinque pazienti con diagnosi di disturbo del comportamento alimentare (DCA) ha avuto la durata di due anni e sei mesi, con sedute a cadenza settimanale. Le dieci sedute del gruppo a termine sono state integralmente registrate e trascritte secondo il codice di Mergenthaler. Nel gruppo classico sono state invece campionate dieci blocchi di sedute (ogni blocco composto da tre sedute consecutive) nell\u2019intero arco della terapia. Anche queste sedute sono state registrate e trascritte con il codice di Mergenthaler.OBIETTIVIScopo della ricerca \ue8 di effettuare un confronto tra lo stile di conduzione di uno stesso terapeuta rispetto a due gruppi differenti sia per patologia dei pazienti che per durata della terapia. La nostra ipotesi \ue8 che il terapeuta segua nel gruppo classico uno stile di conduzione caratterizzato da una progressiva diminuzione degli interventi di tipo organizzativo e da un crescente peso degli interventi di tipo interpretativo, rispetto al gruppo a termine. Verr\ue0 anche valutato il differente apporto dato dai pazienti nei due gruppi rispetto alla costruzione del campo terapeutico, in termini di quantit\ue0 di interventi e di tipologia degli stessi (organizzativi o interpretativi).METODOLe sedute dei due gruppi verranno analizzate sia separatamente, considerando l\u2019andamento delle dieci sedute del gruppo a termine e dei dieci blocchi di sedute del gruppo classico, che confrontate rispetto ad un andamento per fasi della terapia (iniziale, intermedio e finale).Come strumento di codifica degli interventi del terapeuta abbiamo utilizzato lo SCAT (Codice dello Stile del Campo Terapeutico) (Pontalti C. et all., 1997), elaborato presso l\u2019Universit\ue0 Cattolica del Sacro Cuore. Il codice, in relazione ai modelli terapeutici della gruppoanalisi, identifica tre categorie di interventi verbali nel terapeuta (Area Organizzativa, Connettiva ed Interpretativa) e due di interventi dei pazienti (Area Organizzativa ed Interpretativa). La codifica \ue8 stata effettuata da tre giudici indipendenti, precedentemente addestrati all\u2019utilizzo dello strumento. Sui punteggi standardizzati delle diverse sedute sono stati calcolati i pesi percentuali di ogni singola classe di interventi.RISULTATIDal confronto tra i due gruppi sono emerse differenze qualitative molto precise, rispetto all\u2019utilizzo del terapeuta delle diverse tipologie di intervento. Il terapeuta ha utilizzato maggiormente interventi di tipo interpretativo personale nel gruppo classico rispetto al gruppo a termine, in un trend di complessivo maggiore utilizzo del lavoro interpretativo. L\u2019area connettiva si conferma come di strategica importanza nella conduzione di entrambi i tipi di gruppi. Anche negli interventi dei pazienti emerge un maggiore utilizzo degli interventi interpretativi nel gruppo classico rispetto al gruppo a termine durante l\u2019intero ciclo della terapia

Serum Anti-Thyroglobulin Autoantibodies Are Specific in Predicting the Presence of Papillary-like Nuclear Features and Lymphocytic Infiltrate in the Thyroid Gland

(1) Background: Previous studies have reported a correlation between serum anti-Thyroglobulin-antibodies (TgAb) and papillary thyroid carcinoma. The aim of our study was to evaluate whether serum TgAb and anti-thyroid-peroxidase antibody (TPO) positivity was also related to pre-neoplastic histological changes such as papillary-like nuclear features (PLNF) and with the presence of lymphocytic infiltrate (LI) in thyroid surgical specimens. (2) Methods: The study was retrospectively carried out on 70 consecutively recruited patients who underwent thyroidectomy for benign process and whose TgAb and TPOAb values were retrieved from clinical records. Histological sections of thyroid surgical samples were revised, looking for PLNF and lymphocytic infiltrate. HBME1 expression was assessed by immunohistochemistry. (3) Results: Our results showed a significant association between TgAb, PLNF, and lymphocytic infiltrate. The presence of TgAb was highly specific, but less sensitive, in predicting the presence of PLNF (sensitivity = 0.6, specificity = 0.9; positive predictive value (PPV) = 0.88; negative predictive value (NPV) = 0.63). TgAb positivity showed a good association with the presence of lymphocytic infiltrate (sensitivity = 0.62, specificity = 0.9; PPV = 0.88 and NPV = 0.68). HBME1 immunoreactivity was observed in the colloid of follicles showing PLNF and/or closely associated with LI. (4) Conclusions: The presence of PLNF and LI is associated with serum TgAb positivity. The presence of TgAb and of LI could be triggered by an altered thyroglobulin contained in the HBME1-positive colloid, and could be a first defense mechanism against PLNF that probably represent early dysplastic changes in thyrocytes

Transcriptional silencing of the ETS1 oncogene contributes to human granulocytic differentiation

Ets-1 is a widely expressed transcription factor implicated in several biological processes including hematopoiesis, where it contributes to the regulation of cellular differentiation. The functions of Ets-1 are regulated by transcription factors as well as by phosphorylation events: phosphorylation of threonine 38 activates Ets-1, whereas phosphorylation of a cluster of serines within exon VII reduces DNA binding activity. This study focuses on the role of Ets-1 during granulocytic differentiation of NB4 promyelocytic and HL60 myeloblastic leukemia cell lines induced by all-trans retinoic acid

Diphtheria toxin fused to variant human interleukin-3 induces cytotoxicity of blasts from patients with acute myeloid leukemia according to the level of interleukin-3 receptor expression

Leukemic blasts from patients with acute myeloid leukemia (AML) frequently express high levels of the interleukin-3 receptor α chain (IL-3Rα). In the present study, we have explored the sensitivity of primary leukemic blasts obtained from 34 patients with AML to a diphtheria toxin (DT) composed of the catalytic and translocation domains of DT (DT388) fused to IL-3 (DT388IL-3) and to DT388 fused to a variant IL-3 with increased binding affinity (DT388IL-3[K116W]). On a molar basis, DT388IL-3[K116W] was significantly more active than DT388IL-3 in mediating leukemic cell killing. The rate of cell killing induced by the 2 DT/IL-3 fusion proteins was significantly correlated with the level of IL-3Rα/IL-3Rβ expressed on leukemic blasts. These observations support a potential use of DT388IL-3[K116W] in the treatment of refractory AMLs and provide a simple biochemical parameter for the selection of eligible patients. (Blood. 2005;106:2527-2529

Improved Bone Regeneration Using Biodegradable Polybutylene Succinate Artificial Scaffold in a Rabbit Model

The treatment of extensive bone loss represents a great challenge for orthopaedic and reconstructive surgery. Most of the time, those treatments consist of multiple-stage surgeries over a prolonged period, pose significant infectious risks and carry the possibility of rejection. In this study, we investigated if the use of a polybutylene succinate (PBS) micro-fibrillar scaffold may improve bone regeneration in these procedures. In an in vivo rabbit model, the healing of two calvarial bone defects was studied. One defect was left to heal spontaneously while the other was treated with a PBS scaffold. Computed tomography (CT) scans, histological and immunohistochemical analyses were performed at 4, 12 and 24 weeks. CT examination showed a significantly larger area of mineralised tissue in the treated defect. Histological examination confirmed a greater presence of active osteoblasts and mineralised tissue in the scaffold-treated defect, with no evidence of inflammatory infiltrates around it. Immunohistochemical analysis was positive for CD56 at the transition point between healthy bone and the fracture zone. This study demonstrates that the use of a PBS microfibrillar scaffold in critical bone defects on a rabbit model is a potentially effective technique to improve bone regeneration

High-Risk HPV CISH Detection in Cervical Biopsies with Weak and/or Focal p16 Immunohistochemical Positivity

In cervical biopsies, for diagnosis of Human Papilloma Virus (HPV) related conditions, the immunohistochemical staining for p16 has a diagnostic value only if diffusely and strongly positive, pattern named “block-like”. “Weak and/or focal (w/f) p16 expression” is commonly considered nonspecific. In our previous study, we demonstrated the presence of high-risk HPV (hrHPV) DNA by LiPa method in biopsies showing w/f p16 positivity. The aim of the present study was to investigate the presence of hrHPV-DNA by CISH in the areas showing w/f p16 expression. We assessed the presence of hrHPV16, 18, 31, 33, 51 by CISH in a group of 20 cervical biopsies showing w/f p16 expression, some with increased Ki67, and in 10 cases of block-like expression, employed as control. The immunohistochemical p16 expression was also assessed by digital pathology. hrHPV-CISH nuclear positivity was encountered in 12/20 cases of w/f p16 expression (60%). Different patterns of nuclear positivity were identified, classified as punctate, diffuse and mixed, with different epithelial distributions. Our results, albeit in a limited casuistry, show the presence of HPV in an integrated status highlighted by CISH in w/f p16 positive cases. This could suggest the necessity of a careful follow-up of the patients with “weak” and/or “focal” immunohistochemical patterns of p16, mainly in cases of increased Ki67 cell proliferation index, supplemented with molecular biology examinations

Predictive Role of the p16 Immunostaining Pattern in Atypical Cervical Biopsies with Less Common High Risk HPV Genotypes

P16 immunostaining is considered a useful surrogate of transcriptionally active high-risk (hr) HPV infection. Only strong and widespread “block-like” immunoreactivity is considered specific, whereas weak/focal p16 positive immunostaining is considered not specific, and follow-up and HPV molecular detection is not indicated. The aim of the study was to evaluate the presence of HPV DNA and Ki67 immunostaining in 40 cervical atypical biopsies (CALs) with mild and focal histological features suggestive of HPV infection—20 cases with weak/focal p16 positive immunoreactivity and 20 cases negative for p16 expression. In 16/20 weak/focal p16 positive CALs (80%), the INNO-LiPA HPV genotyping detected hrHPV genotypes (HPV 31, 51, 56, 59, 26, 53, 66, 73, and 82). Co-infection of two or more hrHPV genotypes was often evidenced. HPV16 and 18 genotypes were never detected. Ki67 immunostaining was increased in 10/20 cases (50%). In 19/20 p16 negative CALs, hrHPV infection was absent and Ki67 was not increased. These results suggest that weak/focal p16 immunostaining represents the early stage of transcriptionally active infection, strongly related to the presence of less common hrHPV genotypes, probably with a slower transforming power, but with a potential risk of progression if the infection persists. HPV DNA genotyping and follow-up could be useful in these cases to verify if they are able to evolve into overt dysplastic changes and to improve knowledge of less common hrHPV genotypes

Effects of Brookite TiO₂/CeO₂ Nanocomposite on <i>Artemia salina</i>: Induction of Oxidative Stress and Apoptosis Assessment

TiO2 and CeO2 NPs are widely used in the medical field, for drug administration, oncological therapies, disinfection or diagnostic imaging. To date, their effects on aquatic ecosystems and their impacts on human health are little known but several scientific evidences show how CeO2 NPs are able to store and release oxygen, giving them antioxidant activity against oxidative stress while TiO2 NPs seem to be responsible for cytotoxicity and genotoxicity. In this study, the effects of combined nanoparticles, brookite TiO2/CeO2 nanocomposites, on A. salina nauplii following acute exposure were evaluated. Although the cytotoxicity of nanoparticles is generally dose-dependent and time-dependent, in the following investigation, exposure to combined nanoparticles, brookite TiO2/CeO2 nanocomposites, in A. salina nauplii would appear not to have had a statistically significant negative impact on the viability of the specimens. One of the mechanisms by which NPs exert toxic effects is the induction of oxidative stress. In this study, an assessment of potential oxidative stress and apoptotic damage on exposed organisms was conducted through the use of the DCFH2DA probe and acridine orange. The results obtained suggest that although acute exposure to different concentrations of brookite TiO2/CeO2 nanocomposites did not have lethal effects, the positivity to DCFH2DA and acridine orange observed does not exclude potential sublethal effects