Radiotherapy and palliative care outpatient clinic: a new healthcare integrated model in Italy

Background On the basis of substantial evidence demonstrate that palliative care combined with standard care improves patient, caregiver, and society outcomes, we have developed a new healthcare model called radiotherapy and palliative care (RaP) outpatient clinic were a radiation oncologist and a palliative care physician make a joint evaluation of advanced cancer patients. Methods We performed a monocentric observational cohort study on advanced cancer patients referred for evaluation at the RaP outpatient clinic. Measures of quality of care were carried out. Results Between April 2016 and April 2018, 287 joint evaluations were performed and 260 patients were evaluated. The primary tumor was lung in 31.9% of cases. One hundred fifty (52.3%) evaluations resulted in an indication for palliative radiotherapy treatment. In 57.6% of cases was used a single dose fraction of radiotherapy (8 Gy). All the irradiated cohort completed the palliative radiotherapy treatment. An 8% of irradiated patients received the palliative radiotherapy treatment in the last 30 days of life. A total of 80% of RaP patients received palliative care assistance until the end of life. Conclusion At the first descriptive analysis, the radiotherapy and palliative care model seem to respond to the need of multidisciplinary approach in order to obtain an improvement on quality of care for advanced cancer patients

Monitoring the Final Orbital Decay and the Re-Entry of Tiangong-1 with the Italian SST Ground Sensor Network

The uncontrolled re-entry of spacecraft and upper stages is quite common, occurring nearly every week. Among them, intact objects having a mass greater than five metric tons re-enter, on average, 1-2 times per year. Therefore, the re-entry of the first Chinese Space Station, Tiangong-1, was far from unusual, but attracted anyway a great worldwide attention and some concerns. For these reasons, the Italian component of the European SST (Space Surveillance and Tracking) consortium took this opportunity for carrying out a national exercise. According to Chinese official sources, the ground control of Tiangong-1 was lost in March 2016, precluding the planned de-orbiting in the South Pacific Ocean Unpopulated Area (SPOUA). Tiangong-1 consisted of a cylindrical section, 10:5m in length and 3:4m in (maximum) diameter, with two rectangular solar panels of 3m x 7m. The mass was estimated to be around 7500kg. The Italian network of sensors activated for the campaign included mono-static and bi-static radars, optical telescopes, a laser ranging station and a network of all-sky cameras, originally deployed for the observation of fireballs and bolides. In addition to providing complementary information, concerning the orbit, the attitude and the photometry of Tiangong-1, this quite heterogeneous collection of national assets provided also the occasion for testing, in an operational environment, the Italian sensor tasking preparedness and the data acquisition, exchange and processing capabilities within the European SST consortium. In this respect, it is important to remember that in 2014 the European Commission, well aware of the topic criticality, took the commitment to implement a European network of sensors for surveillance and tracking of objects in Earth's orbit by starting a dedicated SST support framework program. Italy, France, Germany, Spain and UK joined it and constituted, together with SatCent, the front desk for SST services, the EUSST Consortium. In this paper, a description of the Tiangong-1 monitoring activities and of the main observations results obtained by the Italian sensor network are reported. Attention is also devoted to the coordination aspects of several Italian entities (military, civil and research organizations) that worked together. Finally, a description of the re-entry prediction and alert procedure for the national civil protection authorities is presented

Nitric oxide inhibits cruzipain, the major papain-like cysteine proteinase from Trypanosoma cruzi

Nitric oxide (NO) is a pluripotent regulatory molecule showing, among others, an antiparasitic activity. Moreover, NO inhibits cysteine proteinase action by nitrosylating the Cys catalytic residue. In the present study, the inhibitory effect of the substrate N-α-benzyloxycarbonyl-L-phenylalanyl-L-arginine-(7-amino-4-methylcoumarin) and of NO on the catalytic activity of cruzipain, the major papain-like cysteine proteinase from Trypanosoma cruzi (the hemoflagellate protozoan parasite which causes the American trypanosomiasis), is reported. In particular, NO-donors S-nitroso-glutathione (GSNO), (±)-(E)-4-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide (NOR-3), 3-morpholinosydnonimine (SIN-1), S-nitroso-acetyl-penicillamine (SNAP), and sodium nitroprusside (SNP) dose-dependently inhibited cruzipain, this effect being likely attributable to the S-nitrosylation of the Cys25 catalytic residue. These results were analyzed in parallel with those concerning the inhibitory effect of the substrate and of NO on the catalytic activity of falcipain, the cruzipain-homologous cysteine proteinase from Plasmodium falciparum. The modulation of the cruzipain and falcipain activity by NO may be relevant in developing new strategies against T. cruzi and P. falciparum in human host. As a whole, the NO-mediated S-nitrosylation of pathogenic viral, bacterial, fungal, and parasitic cysteine proteinases may represent a general mechanism of antimicrobial and antiparasitic host defences. (C) 2000 Academic Press