Simultaneous Integrated Boost in Once-weekly Hypofractionated Radiotherapy for Breast Cancer in the Elderly: Preliminary Evidence

Aim: To evaluate once-weekly hypofractionated radiotherapy in elderly patients affected by early breast cancer, reporting acute and late toxicity profiles, and treatment feasibility. Patients and Methods: Fifty patients were treated with a hypofractionated regimen: 28.5\ub12.5 Gy in five fractions at one fraction weekly. Simultaneous integrated boost (SIB) to the tumor bed in high-risk cases. Inclusion criteria: patients over 70 years old, pT1-2, N0-1a. Acute and late toxicities were assessed based on Radiation Therapy Oncology Group. Results: The median follow-up was 20 months and the median patient age was 79 years. SIB was added for 22 patients (44%). Grade 3-4 acute cutaneous toxicities were not observed; grade 2 toxicity occurred only in four patients (8%). Late subcutaneous tissue toxicity consisted of grade 2 fibrosis in two patients (4%), grade 1 in five (10%) and grade 0 in 41(85%). Conclusion: Limiting fraction numbers with a safer profile may improve the management of breast cancer for the elderly

Extracellular matrix formation enhances the ability of streptococcus pneumoniae to cause invasive disease

Extent: 17p.During infection, pneumococci exist mainly in sessile biofilms rather than in planktonic form, except during sepsis. However, relatively little is known about how biofilms contribute to pneumococcal pathogenesis. Here, we carried out a biofilm assay on opaque and transparent variants of a clinical serotype 19F strain WCH159. After 4 days incubation, scanning electron microscopy revealed that opaque biofilm bacteria produced an extracellular matrix, whereas the transparent variant did not. The opaque biofilm-derived bacteria translocated from the nasopharynx to the lungs and brain of mice, and showed 100- fold greater in vitro adherence to A549 cells than transparent bacteria. Microarray analysis of planktonic and sessile bacteria from transparent and opaque variants showed differential gene expression in two operons: the lic operon, which is involved in choline uptake, and in the two-component system, ciaRH. Mutants of these genes did not form an extracellular matrix, could not translocate from the nasopharynx to the lungs or the brain, and adhered poorly to A549 cells. We conclude that only the opaque phenotype is able to form extracellular matrix, and that the lic operon and ciaRH contribute to this process. We propose that during infection, extracellular matrix formation enhances the ability of pneumococci to cause invasive disease.Claudia Trappetti, Abiodun D. Ogunniyi, Marco R. Oggioni and James C. Pato

Writing Blindly in Incomplete Locked-In Syndrome with A Custom-Made Switch-Operated Voice-Scanning Communicator—A Case Report

Background: Locked-In Syndrome (LIS) is a rare neurological condition in which patients’ ability to move, interact, and communicate is impaired despite their being conscious and awake. After assessing the patient’s needs, we developed a customized device for an LIS patient, as the commercial augmentative and alternative communication (AAC) devices could not be used. Methods: A 51-year-old woman with incomplete LIS for 15 years came to our laboratory seeking a communication tool. After excluding the available AAC devices, a careful evaluation led to the creation of a customized device (hardware + software). Two years later, we assessed the patient’s satisfaction with the device. Results: A switch-operated voice-scanning communicator, which the patient could control by residual movement of her thumb without seeing the computer screen, was implemented, together with postural strategies. The user and her family were generally satisfied with the customized device, with a top rating for its effectiveness: it fit well the patient’s communication needs. Conclusions: Using customized AAC and strategies provides greater opportunities for patients with LIS to resolve their communication problems. Moreover, listening to the patient’s and family’s needs can help increase the AAC’s potential. The presented switch-operated voice-scanning communicator is available for free on request to the authors

Comparison of Two Techniques Performing the Supine-to-Sitting Postural Change in Patients with Sternotomy

Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was to compare the rotational movement and the use of a tied rope (individual device for supine-to-sitting, “IDSS”) to perform the supine-to-sitting postural change. A total of 92 patients (26% female) admitted to a rehabilitative post-surgery ward with sternotomy were assessed for sternal instability. Levels of pain and perceived effort during the two modalities of postural change and at rest were assessed. Patients reported higher values of pain and perceived effort (both p < 0.0005) during rotational movement with respect to the use of the IDSS. Moreover, patients with sternal instability (14%) and female patients with macromastia (25%) reported higher pain than those stable or without macromastia (both p < 0.05). No other risk factors were associated with pain. Thus, the IDSS seems to reduce the levels of pain and perceived effort during the supine-to-sitting postural change. Future studies with quantitative assessments are required to suggest the adoption of this technique, mostly in patients with high levels of pain or with sternal instability

Gestire le vendite: l'eccellenza nel sales management

A fronte dell'importanza crescente che le vendite rivestono oggi in ogni settore, anche in ambito commerciale innovazione e metodo si rivelano fattori critici di successo, soprattutto quando si tratti di aumentare la capacità delle organizzazioni di vendita nel gestire la complessità dei mercati e delle aziende. In questo scenario, i manager che vogliano eccellere devono rafforzare le proprie competenze e investire sulla propria professionalità. Alle vendite è infatti chiesto di essere sempre meno arte e sempre più scienza: al talento naturale e alla destrutturazione tipicamente associati al successo nei ruoli commerciali, si affianca progressivamente l'esigenza di solide fondamenta metodologiche che permettano di sviluppare una visione strategica e di tradurla in una programmazione più efficace e in un più attento controllo delle attività. Sulla base di una ventennale esperienza come ricercatori, formatori e consulenti d'impresa sui temi di gestione delle vendite, gli autori propongono un modello di sales management che consente di strutturare in modo logico e sintetico i più rilevanti concetti e strumenti necessari per organizzare e gestire professionalmente i processi di vendita e le risorse che li animano. Sostenuto da un forte rigore metodologico, robusto nelle argomentazioni e attento a fornire indicazioni manageriali concrete, il libro propone numerosi esempi e casi aziendali di successo

Monitoring of slow-moving landslides. The importance of integration between surface and depth measurements

&amp;lt;p&amp;gt;In landslide monitoring, the attention is mainly focused on rapidly evolving phenomena. However, slow and very slow landslides are equally significant as they often involve settlements and infrastructures. Additionally, they are characterized by remarkable extension and depth. Due to their low displacement rate, often they are underestimated as impacting events; but in a longer timespan, their continuous and slow activity may lead to damages to buildings and roads thus worsening the living conditions of the involved area. In order to assure a peaceful coexistence between phenomena and inhabitants, a multi-source monitoring network is recommended, by integrating surface data with subsoil ones in order to better understand the whole and real kinematic. Moreover, the data acquisition rate should be high enough to detect early any increases in displacements rate. Surface monitoring approaches are extremely wide (GNSS, remote sensing, InSAR&amp;amp;#8230;); on the contrary subsoil measurement systems, are few and limited to in-place inclinometers. Concerning them, the Geohazard Monitoring Group (IRPI-CNR) has developed and manufactured a robotic measuring system for the acquisition of deep-seated ground deformations and, particularly, deep horizontal displacements. The instrumentation combines the advantages of the traditional measurement technique (double readings 0/180&amp;amp;#730;) with a robotized approach improving the results in terms of revisit time, repeatability and accuracy. The robotized device also called &amp;amp;#8220;Automated Inclinometer System&amp;amp;#8221; (AIS) allows the automatic check of all the length of the borehole (up to 120m tube length) with just one inclinometer probe. The traditional cable (including probe signal and power supply) is replaced with a thin polyethylene cable (&amp;amp;#966; 2mm) for sustaining and moving the probe up/down into the standard inclinometer borehole. AIS is completely automatized, but can be also controlled by a remote web interface and, with the same mean, transmits measurement results and system diagnostic messages, such as alerts, warnings, etc. The described system is, currently and extensively, employed in landslide monitoring networks in European mountain ranges obtaining interesting results. In fact, thanks to the described features it is able to rapidly define the deep and surface kinematics of the observed phenomena and, consequently, evaluate the displacements accelerations. Furthermore, due to its high-frequency measurement, it is possible to find a relationship between rainfalls/snow melting and piezometric water levels measured by nearby stations. AIS represents a trustworthy option to realize a more complete integrated network for landslide interpretation and monitoring.&amp;lt;/p&amp;gt;</jats:p