KRAS early testing. Consensus initiative and cost-effectiveness evaluation for metastatic colorectal patients in an italian setting

KRAS testing is relevant for the choice of the most appropriate first-line therapy of metastatic colorectal cancer (CRC). Strategies for preventing unequal access to the test should be implemented, but their relevance in the practice is related to economic sustainability. The study adopted the Delphi technique to reach a consensus on several topics. Issues related to execution of KRAS testing were identified by an expert's board and proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The emerging proposal was evaluated by decision analyses models employed by technology assessment agencies in order to assess cost-effectiveness. Alternative therapeutic strategies included most commonly used chemotherapy regimens alone or in combination with cetuximab or bevacizumab. The survey indicated that time interval for obtaining KRAS test should not exceed 15 days, 10 days being an optimal interval. To assure the access to proper treatment, a useful strategy should be to anticipate the test after radical resection in patients at high risk of relapse. Early KRAS testing in high risk CRC patients generates incremental cost-effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY) gained. In extensive sensitivity analyses ICER's were always below 15,000 Euro per QALY gained, far within the threshold of 60,000 Euro/QALY gained accepted by regulatory institutions in Italy. In metastatic CRC a time interval higher than 15 days for result of KRAS testing limits access to therapeutic choices. Anticipating KRAS testing before the onset of metastatic disease in patients at high risk does not affect the sustainability and cost-effectiveness profile of cetuximab in first-line mCRC. Early KRAS testing may prevent this inequality in high-risk patients, whether they develop metastases, and is a cost-effective strategy. Based on these results, present joined recommendations of Italian societies of Oncology and Pathology should be updated including early KRAS testing

The extracellular small leucine-rich proteoglycan biglycan is a key player in gastric cancer aggressiveness

Biglycan (BGN gene), an extracellular proteoglycan, has been described to be associated with cancer aggressiveness. The purpose of this study was to clarify the clinical value of biglycan as a biomarker in multiple independent GC cohorts and determine the in vitro and in vivo role of biglycan in GC malignant features. We found that BGN is commonly over-expressed in all analyzed cohorts, being associated with disease relapse and poor prognosis in patients with advanced stages of disease. In vitro and in vivo experiments demonstrated that biglycan knock-out GC cells display major phenotypic changes with a lower cell survival, migration, and angiogenic potential when compared with biglycan expressing cells. Biglycan KO GC cells present increased levels of PARP1 and caspase-3 cleavage and a decreased expression of mesenchymal markers. Importantly, biglycan deficient GC cells that were supplemented with exogenous biglycan were able to restore biological features, such as survival, clonogenic and migratory capacities. Our in vitro and in vivo findings were validated in human GC samples, where BGN expression was associated with several oncogenic gene signatures that were associated with apoptosis, cell migration, invasion, and angiogenesis. This study provided new insights on biglycan role in GC that should be taken in consideration as a key cellular regulator with major impact in tumor progression and patients’ clinical outcome.This work was funded by FEDER funds through the Operational Programme for Competitiveness Factors-COMPETE (POCI-01-0145-FEDER-016585; POCI-01-0145-FEDER-029780; POCI-01-0145-FEDER-007274; POCI-01-0145-FEDER-029780) and National Funds through the Foundation for Science and Technology (FCT), under the projects: PTDC/BBB-EBI/0567/2014 (to C.A.R.), PTDC/MED-QUI/29780/2017 (to CG), and UID/BIM/04293 supported by Norte Portugal Regional Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). F.P. was funded by FCT cofinanced by Fundo Social Europeu-FSE with a grant with reference: SFRH/BPD/115730/2016

Fertility preservation in ovarian tumours

A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%–14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A–B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers

Quantum Cosmology in Scalar-Tensor Theories With Non Minimal Coupling

Quantization in the minisuperspace of non minimal scalar-tensor theories leads to a partial differential equation which is non separable. Through a conformal transformation we can recast the Wheeler-DeWitt equation in an integrable form, which corresponds to the minimal coupling case, whose general solution is known. Performing the inverse conformal transformation in the solution so found, we can construct the corresponding one in the original frame. This procedure can also be employed with the bohmian trajectories. In this way, we can study the classical limit of some solutions of this quantum model. While the classical limit of these solutions occurs for small scale factors in the Einstein's frame, it happens for small values of the scalar field non minimally coupled to gravity in the Jordan's frame, which includes large scale factors.Comment: latex, 18 page

Water activity in lamellar stacks of lipid bilayers: "Hydration forces" revisited

Water activity and its relationship with interactions stabilising lamellar stacks of mixed lipid bilayers in their fluid state are investigated by means of osmotic pressure measurements coupled with small-angle x-ray scattering. The (electrically-neutral) bilayers are composed of a mixture in various proportions of lecithin, a zwitterionic phospholipid, and Simulsol, a non-ionic cosurfactant with an ethoxylated polar head. For highly dehydrated samples the osmotic pressure profile always exhibits the "classical" exponential decay as hydration increases but, depending on Simulsol to lecithin ratio, it becomes either of the "bound" or "unbound" types for more water-swollen systems. A simple thermodynamic model is used for interpreting the results without resorting to the celebrated but elusive "hydration forces"Comment: 24 pages, 12 figures. Accepted for publication in The European Physical Journal

The motion of two masses coupled to a massive spring

We discuss the classical motion of a spring of arbitrary mass coupled to two arbitrary massive blocks attached at its ends. A general approach to the problem is presented and some general results are obtained. Examples for which a simple elastic function can be inferred are discussed and the normal modes and normal frequencies obtained. An approximation procedure to the evaluation of the normel frequencies in the case of uniform elastic function and mass density is also discussed.Comment: Standard Latex file plus three eps figure

REDISCOVERING CULTURAL HERITAGE SITES BY INTERACTIVE 3D EXPLORATION: A PRACTICAL REVIEW OF OPEN-SOURCE WEBGL TOOLS

Georeferenced reconstructions can help understand the dynamic evolution of the urban context surrounding a historical site, supporting decision-making processes in the field of urban planning. The development of web applications that allow the interaction between 2D and 3D products, as well as their exploration, can facilitate virtual inspections and foster collaboration in digitization of interventions and site evolutions over time. The article discusses how virtual scene reconstructions and visits can provide alternatives to traditional in-situ tourism promotion, through digital storytelling solutions for the exploration of sites. The article also describes how 3D storytelling technologies are currently being used for dissemination cultural heritage sites. The case study of the Castello Farnese, an old XVI century heritage site in Piacenza (Italy), test the adoption of two distinct free and open-source JavaScript WebGL, Potree and Cesium, for the rendering of photogrammetric and laser scanning georeferenced scaled products and for the integration of narrative features such as annotations, camera animations, texts, and other multimedia contents. Potentials and limitations of both tools are discussed in detail, highlighting how they can be implemented for enhancing user experience in virtual tour and exploration of 3D products. In order to guarantee replicability for other case studies, source code of the implemented application is shared on GitHub along with its documentation for contributions