Lenograstim in preventing chemotherapy-induced febrile neutropenia in patients with soft tissue sarcoma

Background: Neutropenia and its complications represent one of the principal dose-limiting toxicity issues in chemotherapeutic regimens for soft tissue sarcoma. Prophylactic granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN). The correct timing of G-CSF administration should be considered in order to optimize the prophylactic treatment. Patients and Methods: Patients (≥18 years old) affected by soft tissue sarcoma and treated with epirubicin and ifosfamide, underwent prophylactic treatment with G-CSF (lenograstim at 263 μg) from day 5 to day 9. The proportion of patients experiencing FN and G4 neutropenia was considered. Results: A total of 36 patients receiving three cycles of chemotherapy with epirubicin plus ifosfamide were treated. None developed FN; G4 neutropenia was reported in 17% of patients. No treatment delay or dose reduction was required, no antibiotic therapy was administered and no hospitalization occurred. Conclusion: Five-day lenograstim treatment is efficient as prophylaxis of FN for soft tissue sarcoma chemotherapy regimens and allows maintenance of chemotherapy dose intensity

Negative-Pressure Wound Therapy for Prevention of Sternal Wound Infection after Adult Cardiac Surgery : Systematic Review and Meta-Analysis

The results of current studies are not conclusive on the efficacy of incisional negative-pressure wound therapy (NPWT) for the prevention of sternal wound infection (SWI) after adult cardiac surgery. A systematic review of the literature was performed through PubMed, Scopus and Google to identify studies which investigated the efficacy of NPWT to prevent SWI after adult cardiac surgery. Available data were pooled using RevMan and Meta-analyst with random effect models. Out of 191 studies retrieved from the literature, ten fulfilled the inclusion criteria and were included in this analysis. The quality of these studies was judged fair for three of them and poor for seven studies. Only one study was powered to address the efficacy of NPWT for the prevention of postoperative SWI. Pooled analysis of these studies showed that NPWT was associated with lower risk of any SWI (4.5% vs. 9.0%, RR 0.54, 95% CI 0.34-0.84, I-2 48%), superficial SWI (3.8% vs. 4.4%, RR 0.63, 95% CI 0.29-1.36, I-2 65%), and deep SWI (1.8% vs. 4.7%, RR 0.46, 95% CI 0.26-0.74, I-2 0%), but such a difference was not statistically significant for superficial SWI. When only randomized and alternating allocated studies were included, NPWT was associated with a significantly lower risk of any SWI (3.3% vs. 16.5%, RR 0.22, 95% CI 0.08-0.62, I-2 0%), superficial SWI (2.6% vs. 12.4%, RR 0.21, 95% CI 0.06-0.69, I-2 0%), and deep SWI (1.2% vs. 4.8%, RR 0.17, 95% CI 0.03-0.95, I-2 0%). This pooled analysis showed that NPWT may prevent postoperative SWI after adult cardiac surgery. NPWT is expected to be particularly useful in patients at risk for surgical site infection and may significantly reduce the burden of resources needed to treat such a complication. However, the methodology of the available studies was judged as poor for most of them. Further studies are needed to obtain conclusive results on the potential benefits of this preventative strategy.Peer reviewe

Real World Use of Antidiabetic Drugs in the Years 2011-2017: A Population-Based Study from Southern Italy

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia. The availability of new antidiabetic drugs (ADs) has led to complex treatment patterns and to changes in the patterns of specific drug utilization. The aim of this population-based study was to describe the pattern of antidiabetic drugs (ADs) use in Southern Italy in the years 2011-2017, in relation to the updated type 2 diabetes mellitus (T2DM) therapy guidelines. A retrospective cohort study was conducted on T2DM patients using data from the Palermo Local Health Unit (LHU) claims database and diabetologist registry. The first-line treatment was investigated and incident treatments were identified and characterized at baseline in terms of demographics, complications, comorbidities, concomitant drugs and clinical parameters. Persistence to AD treatment was also evaluated. During the study period, one-third of first ever ADs users started the treatment with ADs other than metformin, in contrast to guideline recommendations. Among 151,711 incident AD treatments, the male to female ratio was 1.0 and the median age was 66 (57-75) years. More than half (55.0%) of incident treatments discontinued the therapy during the first year of treatment. In Italy, general practitioners (GPs) can only prescribe first-generation ADs, while the prescription of more recently marketed ADs, such as GLP-1RA, DPP4i and SGLT2i, is restricted to diabetologists only, based on a therapeutic plan. The role of GPs in the management of T2DM in Italy should be re-evaluated

Prime stime mediante simulazioni numeriche delle velocita' di lancio di ejecta allo stromboli e valutazioni sul rischio vulcanico indotto

The typical strombolian activity of Stromboli volcano ranges from a nearly continuous venting of ash and gases (normal strombolian activity) to moderate, up to violent explosive pulses (violent strombolian activity). Moreover, both regimes are sometimes punctuated without warning by phases of scaled up, distinct and more energetic huge bursts separated by time intervals ranging from minutes to hours (paroxysmal activity). As this eruptive style causes the blasting from the summit vents of hot fragments of new lava and blocks with different velocities, densities and impact sites, the main volcanic risk at Stromboli is related to the hazard due to ballistic showers of these ejecta on the built-up areas of the island (Stromboli and Ginostra villages). For that reason i) a land use map of the island has been produced and ii) a number of numerical simulations of ballistic trajectories for to constrain the velocity ranges of the three different explosive regimes has been performed with the "Eject!" software (L.G. Mastin, 2001) by using the average density of dense blocks (2800 kg/m3) and juvenile bombs (1970 kg/m3) from a set of 44 ejecta that we collected on the flanks of the volcano. The reliable ranges of initial velocity at the takeoff point (summit vents) that we obtained are: 40 m/s ÷ 60 m/s for normal strombolian activity, 70 m/s ÷ 100 m/s for violent strombolian activity and 120 m/s ÷ 200 m/s for paroxysmal strombolian activity. Without wind, the cross-correlation of the land use - velocity data indicates that both for the villages of Stromboli and Ginostra an ejecta impact probability is realistic only in paroxysmal activity periods, while it’s definitively absent during normal and violent strombolian regimes. Following tail-winds = 25 m/s simulations (wind velocity sometimes observed at the Stromboli island), the resulting hazard increases with respect to the tail-winds = 0 m/s simulations for both Stromboli and Ginostra during the paroxysmal regime, and become appreciable for the Ginostra village even during violent strombolian activity

Valutazione in vitro dell'affaticamento di strumenti rotanti in nichel-titanio

Riassunto Obiettivo L'obiettivo di questo lavoro e quello di valutare, in vitro, la fatica ciclica di ProFile, K3 e Twisted File, strumenti rotanti in nichel-titanio, in canali radicolari simulati aventi angoli di curvatura di 45°, 60° e 90°. Materiali e metodi Per effettuare questo studio sono stati utilizzati: 18 file 25/.06 ProFile; 18 file 25/.06 K3; 18 file 25/.06 Twisted File. La resistenza a fatica ciclica degli strumenti rotanti Ni-Ti e stata testata ad angolazioni di 45°, 60° e 90° mediante un modello sperimentale creato specificatamente. Risultati e conclusioni Dall'analisi dei dati e emersa una buona resistenza alla fatica ciclica per quanto concerne le sistematiche ProFile e Twisted File, di contro, la sistematica K3 e risultata essere inferiore alle altre per tutte le curvature prese in esame. I Twisted File all'angolazione di 90° hanno mostrato una resistenza a fatica ciclica nettamente superiore rispetto ai ProFile e ai K3

Role of Albuminuria in Detecting Cardio-Renal Risk and Outcome in Diabetic Subjects

The clinical significance of albuminuria in diabetic subjects and the impact of its reduction on the main cardiorenal outcomes by different drug classes are among the most interesting research focuses of recent years. Although nephrologists and cardiologists have been paying attention to the study of proteinuria for years, currently among diabetics, increased urine albumin excretion ascertains the highest cardio-renal risk. In fact, diabetes is a condition by itself associated with a high-risk of both micro/macrovascular complications. Moreover, proteinuria reduction in diabetic subjects by several treatments lowers both renal and cardiovascular disease progression. The 2019 joint ESC-EASD guidelines on diabetes, prediabetes and cardiovascular (CV) disease assign to proteinuria a crucial role in defining CV risk level in the diabetic patient. In fact, proteinuria by itself allows the diabetic patient to be staged at very high CV risk, thus affecting the choice of antihyperglycemic drug class. The purpose of this review is to present a clear update on the role of albuminuria as a cardio-renal risk marker, starting from pathophysiological mechanisms in support of this role. Besides this, we will show the prognostic value in observational studies, as well as randomized clinical trials (RCTs) demonstrating the potential improvement of cardio-renal outcomes in diabetic patients by reducing proteinuria

Comparing the use of ERA5 reanalysis dataset and ground-based agrometeorological data under different climates and topography in Italy

Study region: The study region is represented by seven irrigation districts distributed under different climate and topography conditions in Italy. Study focus: This study explores the reliability and consistency of the global ERA5 single levels and ERA5-Land reanalysis datasets in predicting the main agrometeorological estimates commonly used for crop water requirements calculation. In particular, the reanalysis data was compared, variable-by-variable (e.g., solar radiation, R-s; air temperature, T-air; relative humidity, RH; wind speed, u(10); reference evapotranspiration, ET0), with in situ agrometeorological obser-vations obtained from 66 automatic weather stations (2008-2020). In addition, the presence of a climate-dependency on their accuracy was assessed at the different irrigation districts. New hydrological insights for the region: A general good agreement was obtained between observed and reanalysis agrometeorological variables at both daily and seasonal scales. The best perfor-mance was obtained for T-air, followed by RH, R-s, and u(10) for both reanalysis datasets, especially under temperate climate conditions. These performances were translated into slightly higher accuracy of ET0 estimates by ERA5-Land product, confirming the potential of using reanalysis datasets as an alternative data source for retrieving the ET0 and overcoming the unavailability of observed agrometeorological data

Familial adenomatosis polyposis–related desmoid tumours treated with low-dose chemotherapy: results from an international, multi-institutional, retrospective analysis

[Introduction] Desmoid tumour (DT) is a locally aggressive fibroblastic proliferative disease representing the most common extraintestinal manifestation of familial adenomatosis polyposis (FAP). As data on the activity of chemotherapy in these patients are limited, we examined the outcomes of patients treated with low-dose methotrexate (MTX)+vinca alkaloids (vinorelbine or vinblastine).[Patients and methods] We retrospectively reviewed clinical and outcome data from all patients with confirmed FAP-associated DTs treated with weekly MTX+vinca alkaloids in seven European sarcoma reference centres between January 2000 and December 2018. Radiological responses were assessed using RECIST V.1.0 and V.1.1. The Kaplan-Meier method associated to the log-rank test was used to estimate and compare survival curves.[Results] We identified 37 patients (median age 29 years, range 7–44). According to RECIST, 20/37 (54.1%) patients achieved partial response (PR), 15/37 (40.5%) patients had stable disease and 2/37 (5.4%) had progressive disease as best response. Overall, the median progression-free survival (PFS) was 6.5 years (range, 0.3–12.1 years). In the subset of patients achieving PR as best response, the median PFS was not reached. In a subset of 11 patients with progressive disease offered MTX+vinca alkaloids rechallenge (after chemotherapy withdrawal following prolonged disease control), the disease control rate was 100%, resulting in a median PFS after rechallenge of 5.8 years.[Conclusions] This is the largest series on the activity of low-dose chemotherapy in patients with FAP-related DT. In this population, MTX+vinca alkaloids is an active combination, as already reported in patients with sporadic DT