Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Uncertainties of polynuclear aromatic hydrocarbon and carbonyl measurements in heavy-duty diesel emission

In this note we describe the speciated particle-phase PM2.5 polynuclear aromatic hydrocarbon (PAH) and gas-phase carbonyl emissions as collected from a heavy-duty diesel bus outfitted with an oxidation catalyst for exhaust after-treatment. The vehicle was run on a chassis dynamometer during a transient cycle test reproducing a typical city bus route (Azienda Tramviaria Municipalizzata cycle). The diluted tail-pipe emissions were sampled for PAH using a 2.5 mu m cut size cyclone glass fiber filter assembly, while carbonyls were absorbed onto dinitrophenyl hydrazine-coated silica cartridges. The former compounds were analysed by CGC-MS, the latter by HPLC-UV. Combining the two sets of speciation data resulting from 15 identical dynamometer tests provided a profile of both unregulated organic emissions. PAH emission rates decreased with the number of benzene fused rings. Fluoranthene and pyrene amounted to 90% of total PAHs quantified; six-ring PAHs accounted only for 0.5%. Similarly, formaldehyde and acetaldehyde accounted for similar to 80% of the total carbonyl emissions. Uncertainties of the method in the determination of individual emission factors were calculated. Statistical data processing revealed that all the measurements were quite unaffected by systematic errors and repeatability percentages did not exceed 50% for the majority of components of both groups

Attaccamento Insicuro E Tossicodipendenza: Uno Studio Empirico

Negli ultimi anni la ricerca sull\u2019attaccamento ha individuato il forte legame che intercorre tra attaccamento insicuro e tossicodipendenza (Mikulincer & Shaver, 2007, 2009; Schindler et al., 2005), nonch\ue9 tra questa e un ampio spettro di disturbi affettivi e della personalit\ue0, borderline e antisociale (Biederman et al., 2006; Conway et al., 2006; Dierker et al., 2007). E\u2019 stata inoltre riscontrata una compromissione delle abilit\ue0 sociali (Galanter & Kebler, 2008). Questo studio si propone di analizzare la relazione tra attaccamento, abilit\ue0 sociali e disturbi psicopatologici in un campione di tossicodipendenti. Si tratta di 40 soggetti con un\u2019et\ue0 compresa tra i 20 e i 52 anni residenti in due centri veneti di Pronta Accoglienza. Criteri d\u2019inclusione sono: tempo di permanenza nella struttura di almeno 15 giorni, assenza di disturbi psicotici e funzionamento cognitivo minimo con punteggio 65 8 (Wechsler Adult Intelligence Scale Revised; Wechsler, 1981). Sono stati utilizzati: l\u2019Adult Attachment Projective (George & West, 2001) che individua lo stile d\u2019attaccamento del soggetto; la Social Adjustment Scale-Self Report (Weissman, 1999) per il funzionamento sociale e il General Health Questionnaire-28 (Goldberg, 1978) relativo al benessere psichico attuale. In linea con le aspettative, la totalit\ue0 del campione presenta un attaccamento insicuro di cui il 70% irrisolto, il 18% distanziante e il 12% preoccupato. Sono stati rilevati livelli elevati di depressione, ansia e disturbi somatici, nonch\ue9 una grave compromissione del funzionamento sociale, per quanto concerne il lavoro, il tempo libero e i rapporti familiari. Verranno discusse le implicazioni dell\u2019attaccamento insicuro nella tossicodipendenza con attenzione alla funzione compensatoria delle sostanze rispetto al vuoto relazionale dei soggetti. L\u2019utilizzo prolungato danneggerebbe le gi\ue0 compromesse abilit\ue0 sociali accrescendo, in un circolo vizioso, il ricorso ad esse (Flores, 2008)

Polycyclic Aromatic Hydrocarbon Emission Profiles and Removal Efficiency by Electrostatic Precipitator and Wetfine Scrubber in an Iron Ore Sintering Plant

A monitoring campaign of polychlorinated dibenzo-p-dioxins and dibenzofurans, polyaromatic hydrocarbons (PAHs), and polychlorinated biphenyl was carried out in an Italian iron ore sintering plant by sampling the combustion gases at the electrostatic precipitator (ESP) outlet, at the Wetfine scrubber (WS) outlet, and by collecting the ESP dust. Few data are available on these micropollutants produced in iron ore sintering plants, particularly from Italian plants. This study investigates the PAH emission profiles and the removal efficiency of ESPs and WS. PAHs were determined at the stack, ESP outlet flue gases, and in ESP dust to characterize the emission profiles and the performance of the ESP and the WS for reducing PAH emission. The 11 PAHs monitored are listed in the Italian legislative decree 152/2006. The mean total PAH sum concentration in the stack flue gases is 3.96 mu g/N center dot m(3), in ESP outlet flue gases is 9.73 mu g/N center dot m(3), and in ESP dust is 0.53 mu g/g. Regarding the emission profiles, the most abundant compound is benzo(b)fluoranthene, which has a relative low BaP toxic equivalency factors (TEF) value, followed by dibenzo(a,l)pyrene, which has a very high BaP(TEF) value. The emission profiles in ESP dust and in the flue gases after the ESP show some changes, whereas the fingerprint in ESP and stack flue gases is very similar. The removal efficiency of the ESP and of WS on the total PAH concentration is 5.2 and 59.5%, respectively

Organic contaminants in the atmosphere of Ny-Ålesund

In-field measurements of atmospheric contaminants were undertaken in 1998 and 1999. Our concern was focused on organic chemicals, as important contributors to ambient toxicity, tracers of sources and indicators of meteo-climatic contour. As for gaseous chemicals, focus was on semi-volatile aldehydes; among particulate organics, n-alkanes, PAHs and Nitro-PAHs were investigated. Carbonyls were collected on June 1998 on Zeppelin mount (ZM) and at CNR Scientific Base CSB). Samplings lasted 2 h, starting at 8:00 h, and contaminants were collected on silica gel cartridges loaded with pentafluorophenyl hydrazine (PFPH). Degradation of hydrazones was prevented by applying ozone scrubbers. Characterization of C3-C14 aldehydes was carried out through GC-MS analysis [Cecinato et al., Chromatographia 54 (2001), 263]. Formaldehyde, acetaldehyde and acetone were not determined due to interferences. Suspended particulates (PM10 fraction) were collected at high-volume conditions on quartz filters, during summer 1998 and spring 1999. In 1998 a pair of 3-day sampling periods were undertaken in June (sunny hours); in 1999 (April-May) three sampling periods were selected, each day between last night and sunrise. Organic fraction was extracted in ultra-sonic bath, separated into three fractions through alumina column chromatography (non-polar aliphatics, polycyclic aromatics and polar organics), and analyzed for contents in n-alkanes, PAHs, Nitro-PAHs and fatty acids by means of GC-MSD. About carbonyl during June 1998, the concentrations at the two locations investigated were different and showed important daily variability. Also their percent profiles and concentration ratios between the two stations changed widely. Total carbonyls ranged ~8-45 µg/m3 at ZM and ~2-7 µg/m3 at CSB. The concentrations of n-alkanes in PM10 were different in 1998 and 1999 (~19 vs. 100 ng/m3 as period average), as well as percent distribution of <C24 homologues. According to that, in the summer bacteria and microorganisms provided important contribution to n-alkane occurrence, whilst in spring the petroleum exhausts were predominating. The emission of vegetation was scarce (CPI25≈1.4). Total PAHs were, as average, more in Apr-May 1999 (~1.4 vs. 0.6 ng/m3) and distinct distributions were identified. It could depend in part on ambient temperature (semi-volatile compounds are enriched on particulate during winter). Nonetheless, a role was played also by the nature of emission sources (as suggested by changes in PAH concentration ratios), while reactivity of the atmosphere was unimportant (BaP/BeP ratio). Though only nitrated fluoranthenes and pyrenes were investigated, Nitro-PAHs merited concern. Nitro-PAHs were more in the spring (~135 vs. 10 pg/m3) and, overall, the percent profiles were very different: 1-, 7-, 3-NFAs and 1-NPY, typical of direct emission, occurred in spring, 2-NFA and 2-NPY (generated by photochemical reactions) in the summer. Fatty acids (ranging ~20-40 ng/m3 as total)were indicative of bacterial and small vegetation sources