Transformed Follicular Lymphoma: Not all fit in one

Follicular Lymphoma (FL) is the second most frequent non-Hodgkin lymphoma accounting for approximately 10-20% of all lymphomas in Western Countries. Histologic transformation (HT) is a frequent event in the clini-cal course of patients with indolent lymphoma that is often accompanied by a dramatic change in the clinical fea-tures of the disease towards a more aggressive course. Although the transformation of Follicular Lymphoma (tFL) was described several decades ago, there is a strong need for a better understanding of both the dynamics of the tumor clonal evolution and the genetic events leading to ()transformation. In addition, the management of patients with tFL is challenged by the heterogeneity of the previous treatments. The present review describes the state of art of tFL, outlining recent advances in the understanding of genetic basis and the evolutionary pro-cess governing the initiation and persistence of tumor evolution. It will be also addressed the key questions pend-ing on this incurable disease, such as a lack of a standard therapeutic strategy for tFL patients as well as its out-come in the Rituximab (R) era

Radiomics for the Discrimination of Infiltrative vs In Situ Breast Cancer

Breast cancer is the most common malignant tumor in women worldwide. Its early diagnosis relies on radiology and clinical evaluation, supplemented by biopsy confirmation. Technological advances in medical imaging, especially in the field of artificial intelligence, allow to address clinical challenges in cancer detection and classification, as well as in the assessment of treatment response, and in monitoring disease progression. Radiomics allows to extract features from images, related to tumor size, shape, intensity, and texture, providing comprehensive tumor characterization. In this paper, we briefly review some Radiomics approaches in breast cancer, focusing on the non-invasive distinction between in-situ and infiltrating breast tumors, and present a preliminary test using Radiomics signatures in DCE-MRI and machine learning, aimed to investigate the feasibility of distinguishing infiltrating cancer from ductal carcinoma in situ (DCIS) diagnosed by preoperative core needle biopsy

Posvenção com pais enlutados: uma estratégia de cuidado no contexto do suicídio

The present work aims to emphasize the importance of caring for parents who have lost young children by voluntary death, that is, suicide. Due to the theme of death by suicide still being considered a taboo and stigma, these parents often find themselves in an unrecognized or unfranchised mourning, not receiving the proper care that favors the elaboration of this mourning. The work intended to carry out a bibliographic survey of care strategies for bereaved parents in the context of suicide. For this, qualitative bibliographic research with a descriptive and exploratory approach was carried out. For the collection of literature data, a bibliographic form built by the authors was used as an instrument. After the exploratory, selective and interpretative reading of the works and articles found, the data analysis started from an integrative synthesis. The results showed that postvention is an effective intervention to help the grieving process of these parents, so that they can develop feelings and thoughts related to the traumatic event that occurred with their children. In this sense, services and public policies can be important allies to carry out this intervention with this population.El presente trabajo tiene como objetivo enfatizar la importancia del cuidado de los padres que han perdido hijos pequeños por muerte voluntaria, es decir, suicidio. Debido a que el tema de la muerte por suicidio sigue siendo considerado un tabú y un estigma, estos padres muchas veces se encuentran en un duelo no reconocido o desprovisto de derechos, sin recibir los debidos cuidados que favorezcan la elaboración de ese duelo. El trabajo pretendió realizar un levantamiento bibliográfico de las estrategias de atención a los padres en duelo en el contexto del suicidio. Para ello, se realizó una investigación bibliográfica cualitativa con enfoque descriptivo y exploratorio. Para la recolección de datos bibliográficos se utilizó como instrumento un formulario bibliográfico construido por los autores. Luego de la lectura exploratoria, selectiva e interpretativa de los trabajos y artículos encontrados, el análisis de los datos partió de una síntesis integradora. Los resultados mostraron que la postvención es una intervención eficaz para ayudar al proceso de duelo de estos padres, para que puedan desarrollar sentimientos y pensamientos relacionados con el evento traumático ocurrido con sus hijos. En este sentido, los servicios y las políticas públicas pueden ser importantes aliados para realizar esta intervención con esta población.O presente trabalho tem por objetivo salientar a importância do cuidado com pais que perderam filhos jovens por morte voluntária, ou seja, suicídio. Devido ao tema da morte por suicídio ainda ser considerada um tabu e estigma, esses pais muitas vezes encontram-se num luto não reconhecido ou não franqueado, não recebendo os devidos cuidados que favoreça a elaboração desse luto. O trabalho pretendeu realizar um levantamento bibliográfico de estratégias de cuidados para pais enlutados no contexto do suicídio. Para isso, foi realizado uma pesquisa bibliográfica de cunho qualitativa e de abordagem descritiva e exploratória. Para a coleta de dados da literatura foi utilizado como instrumento uma ficha bibliográfica construída pelas autoras. Após a leitura exploratória, seletiva e interpretativa das obras e artigos encontrados partiu-se para a análise dos dados, a partir de uma síntese integradora. Os resultados apontaram que a posvenção é uma intervenção eficaz para auxiliar o processo de luto desses pais, a fim de que consigam elaborar os sentimentos e pensamentos relativos ao evento traumático ocorrido com seus filhos. Nesse sentido, serviços e políticas públicas podem ser importantes aliados para a realização dessa intervenção com essa população.

Obstructive Sleep Apnea (OSA), an emerging health problem

Obstructive Sleep Apnea (OSA) is the most common respiratory disorder in Western societies: according to a first recent worldwide epidemiological study, it was estimated that 936 million patients aged 30-69 years with mild to moderate OSA and 425 million patients aged 30-69 years with severe OSA requiring CPAP treatment. Recently, the Centre for Research on Health and Social Care Management (CERGAS) at the Bocconi University of Milan has estimated that in Italy, the prevalence of moderate to severe OSA occurs in the 27% of the general population, with an overall prevalence of mild to medium-severe OSA of more than 24 million people aged between 15 and 74 years (54% of the adult population), while from a practical point of view, Italian doctors diagnosed only 460.000 moderate-severe patients (4 per cent of the estimated prevalence) and 230,000 patients were treated (2 per cent of the estimated prevalence), highlighting a substantial gap between diagnosis and treatment. In addition, OSA patients are often obese and the close correlation between the two conditions suggests that the prevalence of OSA will increase in the short term as obesity increases. At the individual level, OSA leads to a significant decrease in quality of life (HRQoL) and intellectual and mechanical/functional capacities with reduced physical activity, as well as a marked increase in sudden death and risk of cardiovascular and metabolic diseases. Emerging epidemiological data also suggest that the severity of OSA associated with the severity of chronic nocturnal hypoxemia (CIH) correlates with an increased risk of diabetes mellitus, metabolic syndrome (MS) and cancer. OSA is also an important risk factor for high blood pressure, acute and chronic atrial fibrillation (FAC), chronic coronary artery disease (CAD) and stroke. It is therefore intuitive that at the social level, OSA also leads to a decline in economic productivity. This article addresses OSA from a new epidemiological perspective, according to the latest prevalence studies, and addresses emerging problems related to the diagnosis

Artificial Neural Networks (ANN) for automatic detection of dendritic-shaped cancer cells of cutaneous melanoma in Reflectance Confocal Microscopy (RCM) images

Melanoma (MM) is one of the tumors with the highest incidence. In Italy, MM affected about 13,700 patients out of 373,000 new cases of cancer in 2018, with prognosis dependent on the degree of tumor invasion and presence of metastasis at diagnosis: only an early detection can lead to a better prognosis. Recent evidence suggests that MM is a family of different tumors with varying abilities to grow and metastasize: dendritic-shaped tumor cells were typically found in thin MM in situ. Reflectance Confocal Microscopy (RCM) is a non-invasive imaging tool that enables in vivo observation of the skin at a quasi-histological resolution, providing transverse-section grayscale images related to refractive index of different tissues. In this work, a dataset of RCM images, from 13 healthy subjects and 22 patients affected by MM in situ, were used to train a Multi-Layer Perceptron (MLP) artificial neural network. Each image was subdivided into sub-blocks, labeled as positive if containing significant clusters of dendritic-shaped tumour cells. In each block, various standard features were calculated, e.g. Haralick's and features from the run-length matrices. The MLP was trained to recognize the presence of clusters of dendritic-shaped cancer cells. The preliminary results are encouraging, giving AUC=0.81 with about 73% accuracy. Tests are currently underway to improve quality

The use of electronical devices and relative levels of Nomophobia within a group of Italian nurses: an Observational Study

Background: In healthcare, the use of smartphones and other electronical devices are becoming important tools among health professionals. Thanks to these devices, there are new methods of assistance. However, if used incorrectly, they may cause distraction during clinical practice. The excessive use of such devices has generated a new form of addiction in the workplace named nomophobia, a phobia still little explored in literature. We reported an analysis of the frequency and method of use of these electronical devices. The primary aim of the research was to investigate the level of dependence on electronic devices (nomophobia) and the digital habits of nurses. Secondary aim of the study was to evaluate the possible association between nomophobia and distraction in the workplace. Methods: A transversal multicenter study was conducted on a sample of Italian nurses, using the Nurses’ Use of Personal Communication Devices Questionnaire and the Nomophobia Questionnaire (NMP-Q). Results: 34.1% of the sample (n=184) declared that they used smartphones and other electronical devices a moderately during working hours. 20.2 % (n=109) used them frequently and 8.9% (n=48) uses devices during working hours constantly. However, 44.0% (n=222) never uses health apps for patient medical assistance, the 32.9% (n=166) never uses learning apps or apps for professional development. 16.6% (n=87) admit that the use of these devices negatively affected their working performance (mean 80.5; SD 40.1). Study participants showed moderated levels of nomophobia (media=50.34; SD=29.0). Conclusion: The results of the study demonstrate the scares use of such electronical tools to implement adequate care among Italian nurses. Nomophobia can have significant impact on the risk of making mistakes. Future studies should examine not only nurses but also other help professionals and support staff, to bring out an underestimated dimension

Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common\u2014but not universal\u2014accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment.The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient\u2019s specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA

Otimismo e autoeficácia no contexto da sucessão em empresas familiares

O otimismo e a autoeficácia de sucessores de empresas familiares podem contribuir para que o processo sucessório se efetive de maneira mais assertiva. Com vistas a estes temas, o trabalho buscou avaliar o índice de otimismo e autoeficácia dos sucessores de empresas familiares de Chapecó, Santa Catarina. Por meio da abordagem quantitativa, e de questionários de autorrelato, os índices de otimismo e autoeficácia dos sucessores das empresas familiares foram levantados e correlacionados. Entre os principais resultados da pesquisa, verificou-se que os participantes apresentam índices elevados nos dois constructos, que há correlação significativa entre diversas variáveis de otimismo e de autoeficácia, bem como, que o otimismo prediz a autoeficácia dos sucessores investigados. O estudo contribui para ampliar estudos sobre empresas familiares no Brasil e sobre comportamentos organizacionais positivos, especialmente o otimismo e a autoeficácia. O estudo apresenta potencial de contribuição para a ampliação do entendimento de aspectos emocionais de um público que poderá contribuir para o desenvolvimento sustentável da região oeste catarinense no futuro

Attitudes, knowledge and Practices of Nurses towards HIV/AIDS Patients. An Observational, Cross Sectional, Multicenter study

Background. Attitudes, knowledge and practices of nurses towards HIV/AIDS patients are of continuous interest, especially in developing countries. However, in Italy, this topic is still scarcely debated. Materials and methods. An observational, cross sectional, multicentre study was conducted on a sample of 144 nurses in two Italian Hospitals of the Puglia Region ("Vito Fazzi" Hospital in Lecce and "San Giuseppe da Copertino" Hospital in Copertino (Le)). Results. A large part of the sample (97.2%, n=140) stated that they never refused to take care of a patient with AIDS. Only 22.9%, (n=33), of the sample had attended a training course and almost half (63.2%, n=91) used the gloves regularly when performing blood samples or when administering therapy to patients. With regard to the assessment of HIV knowledge, the percentage of nurses who know the meaning of the terms " seropositive" (83.3%, n=120), "HIV-positive person" (91.7%, n=132) and "window period" (47.9%, n=69) decreased. Conclusions. The results of the study show that a non-negligible percentage of nurses could be considered at risk of infection due to non-routine use of gloves, incorrect handling of the patient's biological samples and not knowing how to decontaminate a surface with potentially infected blood

Attitudes, perceptions, and knowledge of the population on End-of-Life and Advance Treatment Declaration: an observational study in Southern Italy

In an advanced scientific and technological context, where it is now tangible the possibility of interfering indefinitely in the process of dying, it becomes necessary to disseminate knowledge about end of life that, for the great variety of areas that it invests, presents many controversial aspects. With the Law no. 219/2017, the right of self-determination and freedom of treatment of the patient is enshrined, aspects that to date still remain too little discussed. An online survey was conducted from December 2019 to February 2020, among the population residing in the provinces of Lecce and Brindisi, spread thanks to the collaboration of local authorities. A large part of the sample (82.4%, N=333) claims the right to self-determination, stating that therapeutic decisions are up to the patient who has signed his advance treatment dispositions, declared absolutely binding for 50% (N=205) of the sample. However, there is still a lack of information about how to draw up advance treatment agreements (AADs). 12.6% (N=51) of those interviewed stated that they knew nothing about it and only 32.9% (N=133) felt ready and adequately informed to make their own declarations. Another peculiar aspect is that topics such as euthanasia and assisted suicide seem to be considered at the margins of acceptability among End-of-Life instances. The results of the study show that knowledge on the subject has definitely improved over the years and that in most of the issues addressed, the population has an adequate degree of preparedness even though there is still some skepticism in dealing with issues such as assisted suicide and euthanasia. Future research could explore the possibility of identifying effective training tools and communication strategies that can be used by the widest possible segment of the population