Is the double cross flap technique the panacea for avoiding fistula formation in hypospadias surgery?

Objective The aim of this study was to analyze retrospectively the 9-year experience of a single institution in the use of the double cross flap technique to interpose a double dartos flap to protect the neourethra with the aim of preventing fistula formation.Patients and methods Between October 2005 and September 2014 a total of 127 children with distal and midshaft primary hypospadias underwent tubularized incised plate urethroplasty by means of a double dartos flap obtained with a double cross flap to protect the neourethra. A Foley catheter was left in situ for 7 days. Success was defined as no incidence of complications requiring reintervention, along with good cosmetic result. A questionnaire was administered to estimate parental satisfaction. Parents were asked to evaluate the cosmetic appearance of the penis as good, acceptable, bad, or indifferent.Results The patient age at the time of surgery ranged from 12 months to 10 years (median 39 months). Three patients exhibited fistula at follow-up (2.3%). In two patients a glandular dehiscence of the urethroplasty occurred (1.5%). Mild stenosis of the neomeatus occurred in three patients (2.3%). No penile iatrogenic rotation occurred. A ‘good’ cosmetic result was reported by 68.5% of parents, acceptable by 22.8%, bad by 3.9% and indifferent by 4.7% of parents as per the parental questionnaire.Conclusion The double cross flap technique is not the panacea to prevent fistula formation in hypospadias surgery. Nevertheless, it offers an unquestionable advantage in terms of avoidance of fistula formation. The experience and skills of the surgeon performing urethroplasty remain the mainstay for best results

Massive pyuria as an unusual presentation of giant infected urachal remnant in a child

Urachal remnants (URs) are manifestations of an incomplete regression of the urachus; therefore, there may be different types of remnants such as cyst, sinus tract, diverticulum or patent urachus. The clinical presentation of a urachal anomaly includes umbilical discharge, lower abdominal pain and urinary tract infection, although a UR may also be asymptomatic. We present the case of a 2.5-year-old girl who presented with abdominal pain, stranguria and massive pyuria in which a giant infected UR was found. The diagnosis was made using abdominal MRI. The child was subjected to  laparoscopic-assisted drainage and had an uneventful postoperative course.Keywords: differential diagnosis, infected urachal remnant, laparoscopy, pyuri

Evidence that Prefibrotic Myelofibrosis Is Aligned along a Clinical and Biological Continuum Featuring Primary Myelofibrosis

PURPOSE: In the WHO diagnostic classification, prefibrotic myelofibrosis (pre-MF) is included in the category of primary myelofibrosis (PMF). However, strong evidence for this position is lacking. PATIENTS AND METHODS: We investigated whether pre-MF may be aligned along a clinical and biological continuum in 683 consecutive patients who received a WHO diagnosis of PMF. RESULTS: As compared with PMF-fibrotic type, pre-MF (132 cases) showed female dominance, younger age, higher hemoglobin, higher platelet count, lower white blood cell count, smaller spleen index and higher incidence of splanchnic vein thrombosis. Female to male ratio and hemoglobin steadily decreased, while age increased from pre-MF to PMF- fibrotic type with early and to advanced bone marrow (BM) fibrosis. Likely, circulating CD34+ cells, LDH levels, and frequency of chromosomal abnormalities increased, while CXCR4 expression on CD34+ cells and serum cholesterol decreased along the continuum of BM fibrosis. Median survival of the entire cohort of PMF cases was 21 years. Ninety-eight, eighty-one and fifty-six percent of patients with pre-MF, PMF-fibrotic type with early and with advanced BM fibrosis, respectively, were alive at 10 years from diagnosis. CONCLUSION: Pre-MF is a presentation mode of PMF with a very indolent phenotype. The major consequences of this contention is a new clinical vision of PMF, and the need to improve prognosis prediction of the disease

EGFR and HER2 Gene Copy Number and Response to First-Line Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer (NSCLC)

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A Real-World, Multicenter, Observational Retrospective Study of Durvalumab After Concomitant or Sequential Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer

Introduction: For unresectable stage III non-small cell lung cancer (NSCLC), the standard therapy consists of chemoradiotherapy (CRT) followed by durvalumab maintenance for responding patients. The present study reports on the safety and outcome of durvalumab use after CRT in a real-world, multicenter, retrospective cohort. Methods: Two hundred thirty-eight patients have been included. We collected data on systemic therapy, radiation therapy, the timing between CRT and durvalumab, number of durvalumab cycles, reasons for non-starting or discontinuation, incidence and grade of adverse events (AEs), and progression-free survival (PFS) and overall survival (OS). Results: One hundred fifty-five patients out of 238 (65.1%) received at least one durvalumab dose: 91 (58.7%) after concomitant CRT (cCRT) and 64 (41.3%) after sequential CRT (sCRT). Programmed-death ligand 1 (PD-L1) status was unknown in 7/155 (4.5%), negative in 14 (9.1%), and positive ≥1% in 134/155 (86.4%). The main reasons for non-starting durvalumab were progression (10.1%), PD-L1 negativity (7.5%), and lung toxicity (4.6%). Median follow-up time was 14 months (range 2–29); 1-year PFS and OS were 83.5% (95%CI: 77.6–89.7) and 97.2% (95%CI: 94.6–99.9), respectively. No significant differences in PFS or OS were detected for cCRT vs. sCRT, but the median PFS was 13.5 months for sCRT vs. 23 months for cCRT. Potentially immune-related AEs were recorded in 76/155 patients (49.0%). Pneumonitis was the most frequent, leading to discontinuation in 11/155 patients (7.1%). Conclusions: Durvalumab maintenenace after concurrent or sequential chemoradiation for unresectable, stage III NSCLC showed very promising short-term survival results in a large, multicenter, restrospective, real-world study. Durvalumab was the first drug obtaining a survival benefit over CRT within the past two decades, and the present study contributes to validating its use in clinical practice

Head and neck radiotherapy amid the COVID‑19 pandemic: practice recommendations of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

Abstract Management of patients with head and neck cancers (HNCs) is challenging for the Radiation Oncologist, especially in the COVID-19 era. The Italian Society of Radiotherapy and Clinical Oncology (AIRO) identified the need of practice recommendations on logistic issues, treatment delivery and healthcare personnel’s protection in a time of limited resources. A panel of 15 national experts on HNCs completed a modified Delphi process. A five-point Likert scale was used; the chosen cut-offs for strong agreement and agreement were 75% and 66%, respectively. Items were organized into two sections: (1) general recommendations (10 items) and (2) special recommendations (45 items), detailing a set of procedures to be applied to all specific phases of the Radiation Oncology workflow. The distribution of facilities across the country was as follows: 47% Northern, 33% Central and 20% Southern regions. There was agreement or strong agreement across the majority (93%) of proposed items including treatment strategies, use of personal protection devices, set-up modifications and follow-up re-scheduling. Guaranteeing treatment delivery for HNC patients is well-recognized in Radiation Oncology. Our recommendations provide a flexible tool for management both in the pandemic and post-pandemic phase of the COVID-19 outbreak

Potential advantages of cell administration on the inflammatory response compared to standard ACE inhibitor treatment in experimental myocardial infarction

<p>Abstract</p> <p>Background</p> <p>Bone Marrow (BM) progenitor cells can target the site of myocardial injury, contributing to tissue repair by neovascolarization and/or by a possible direct paracrine effect on the inflammatory cascade. Angiotensin Converting Enzyme inhibitors (ACE-I) are effective in reducing mortality and preventing left ventricular (LV) function deterioration after myocardial infarction.</p> <p>Methods</p> <p>We investigated the short term effects of BM mononuclear cells (BMMNCs) therapy on the pro-inflammatory cytokines (pro-CKs) and on LV remodelling and compared these effects over a standard ACE-I therapy in a rat model of myocardial cryodamage.</p> <p>Forty two adult inbread Fisher-F344 rats were randomized into three groups: untreated (UT; n = 12), pharmacological therapy (ACE-I; n = 14, receiving quinapril), and cellular therapy (BMMNCs; n = 16, receiving BMMNCs infusion). Rats underwent to a standard echocardiogram in the acute setting and 14 days after the damage, before the sacrifice. Pro-CKs analysis (interleukin (IL)1β, IL-6, tumor necrosis factor (TNF)α was performed (multiplex proteome arrays) on blood samples obtained by direct aorta puncture before the sacrifice; a control group of 6 rats was considered as reference.</p> <p>Results</p> <p>Concerning the extension of the infarcted area as well as the LV dimensions, no differences were observed among the animal groups; treated rats had lower left atrial diameters and higher indexes of LV function. Pro-Cks were increased in infarcted-UT rats if compared with controls, and significantly reduced by BMMNCs and ACE-I ; TNFα inversely correlated with LV fractional shortening.</p> <p>Conclusion</p> <p>After myocardial infarction, both BMMNCs and ACE-I reduce the pattern of pro-Ck response, probably contributing to prevent the deterioration of LV function observed in UT rats.</p

Determination of stellar parameters for Ariel targets: a comparison analysis between different spectroscopic methods

Ariel has been selected as the next ESA M4 science mission and it is expected to be launched in 2028. During its 4-year mission, Ariel will observe the atmospheres of a large and diversified population of transiting exoplanets. A key factor for the achievement of the scientific goal of Ariel is the selection strategy for the definition of the input target list. A meaningful choice of the targets requires an accurate knowledge of the planet hosting star properties and this is necessary to be obtained well before the launch. In this work, we present the results of a bench-marking analysis between three different spectroscopic techniques used to determine stellar parameters for a selected number of targets belonging to the Ariel reference sample. We aim to consolidate a method that will be used to homogeneously determine the stellar parameters of the complete Ariel reference sample. Homogeneous, accurate and precise derivation of stellar parameters is crucial for characterising exoplanet-host stars and in turn is a key factor for the accuracy of the planet properties

The homogeneous characterisation of Ariel host stars

The Ariel mission will characterise the chemical and thermal properties of the atmospheres of about a thousand exoplanets transiting their host star(s). The observation of such a large sample of planets will allow to deepen our understanding of planetary and atmospheric formation at the early stages, providing a truly representative picture of the chemical nature of exoplanets, and relating this directly to the type and chemical environment of the host star. Hence, the accurate and precise determination of the host star fundamental properties is essential to Ariel for drawing a comprehensive picture of the underlying essence of these planetary systems. We present here a structured approach for the characterisation of Ariel stars that accounts for the concepts of homogeneity and coherence among a large set of stellar parameters. We present here the studies and benchmark analyses we have been performing to determine robust stellar fundamental parameters, elemental abundances, activity indices, and stellar ages. In particular, we present results for the homogeneous estimation of the activity indices S and log (RHK') , and preliminary results for elemental abundances of Na, Al, Mg, Si, C, N. In addition, we analyse the variation of a planetary spectrum, obtained with Ariel, as a function of the uncertainty on the stellar effective temperature. Finally, we present our observational campaign for precisely and homogeneously characterising all Ariel stars in order to perform a meaningful choice of final targets before the mission launch

Enabling planetary science across light-years. Ariel Definition Study Report

Ariel, the Atmospheric Remote-sensing Infrared Exoplanet Large-survey, was adopted as the fourth medium-class mission in ESA's Cosmic Vision programme to be launched in 2029. During its 4-year mission, Ariel will study what exoplanets are made of, how they formed and how they evolve, by surveying a diverse sample of about 1000 extrasolar planets, simultaneously in visible and infrared wavelengths. It is the first mission dedicated to measuring the chemical composition and thermal structures of hundreds of transiting exoplanets, enabling planetary science far beyond the boundaries of the Solar System. The payload consists of an off-axis Cassegrain telescope (primary mirror 1100 mm x 730 mm ellipse) and two separate instruments (FGS and AIRS) covering simultaneously 0.5-7.8 micron spectral range. The satellite is best placed into an L2 orbit to maximise the thermal stability and the field of regard. The payload module is passively cooled via a series of V-Groove radiators; the detectors for the AIRS are the only items that require active cooling via an active Ne JT cooler. The Ariel payload is developed by a consortium of more than 50 institutes from 16 ESA countries, which include the UK, France, Italy, Belgium, Poland, Spain, Austria, Denmark, Ireland, Portugal, Czech Republic, Hungary, the Netherlands, Sweden, Norway, Estonia, and a NASA contribution