Gestione delle pazienti con tumore fillode della mammella: esperienza triestina nel periodo 2006-2014

La diagnosi e la gestione dei tumori fillodi della mammella \ue8 complessa a causa del basso tasso di incidenza e dell\u2019imprevedibilit\ue0 del comportamento di questo tipo di neoplasie (meno dell\u20191% tra tutti i tumori della mammella [1]). L\u2019obiettivo di questo studio \ue8 analizzare i casi di tumori filloidi diagnosticati a Trieste nel periodo 2006-2014 al fine di contestualizzare il comportamento particolarmente aggressivo di un tumore fillode maligno insorto in una paziente con pregressi fillodi benigni

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

Wildfires Impact Assessment on PM Levels Using Generalized Additive Mixed Models

Wildfires are relevant sources of PM emissions and can have an important impact on air pollution and human health. In this study, we examine the impact of wildfire PM emissions on the Piemonte (Italy) air quality regional monitoring network using a Generalized Additive Mixed Model. The model is implemented with daily PM10 and PM2.5 concentrations sampled for 8 consecutive years at each monitoring site as the response variable. Meteorological data retrieved from the ERA5 dataset and the observed burned area data stored in the Carabinieri Forest Service national database are used in the model as explanatory variables. Spline functions for predictive variables and smooths for multiple meteorological variables’ interactions improved the model performance and reduced uncertainty levels. The model estimates are in good agreement with the observed PM data: adjusted R2 range was 0.63–0.80. GAMMs showed rather satisfactory results in order to capture the wildfires contribution: some severe PM pollution episodes in the study area due to wildfire air emissions caused peak daily levels up to 87.3 µg/m3 at the Vercelli PM10 site (IT1533A) and up to 67.7 µg/m3 at the Settimo Torinese PM2.5 site (IT1130A)

Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C

11Introduction: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. Methods: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 degrees C and after rewarming at 37 degrees C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. Results: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 degrees C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. Conclusions: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.openopenRoman-Pognuz, Erik; Elmer, Jonathan; Guyette, Frank X; Poillucci, Gabriele; Lucangelo, Umberto; Berlot, Giorgio; Manganotti, Paolo; Peratoner, Alberto; Pellis, Tommaso; Taccone, Fabio; Callaway, CliftonRoman-Pognuz, Erik; Elmer, Jonathan; Guyette, Frank X; Poillucci, Gabriele; Lucangelo, Umberto; Berlot, Giorgio; Manganotti, Paolo; Peratoner, Alberto; Pellis, Tommaso; Taccone, Fabio; Callaway, Clifto

Multimodal long-term predictors of outcome in out of hospital cardiac arrest patients treated with targeted temperature management at 36◦c

Introduction: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. Methods: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36◦C and after rewarming at 37◦C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. Results: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37◦C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. Conclusions: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Parit\ue0 e Allattamento quali fattori protettivi di carcinoma mammario nelle donne triestine

Introduzione: Il ruolo dell\u2019allattamento come fattore protettivo nell\u2019insorgenza del carcinoma (ca) mammario trova posizioni contrastanti in letteratura. Questo studio analizza i fattori legati alla storia riproduttiva della donna per confrontare la realt\ue0 della popolazione femminile triestina rispetto a quanto proposto in letteratura. A Trieste l\u2019 incidenza standardizzata europea \ue8 di 148 nuove diagnosi di ca mammario all\u2019anno ogni 100.000 donne residenti, che \ue8 ben pi\uf9 alta della media italiana (105 nuovi casi, IARC 2006). Materiali e Metodi: Dal 2006 presso l\u2019unit\ue0 senologica della provincia di Trieste, a tutte le donne con patologia mammaria benigna e maligna e ad un ampio campione di donne sane, viene somministrato un questionario per valutare i fattori correlati all\u2019insorgenza di ca mammario per complessive 4307 donne (pari al 6.2% della popolazione femminile triestina). La casistica \ue8 stata suddivisa in base alla decade di nascita (1930-39,\u20261970-79) e sono state analizzate le variabili \u201cnumero figli\u201d, \u201cet\ue0 al primo parto\u201d e \u201callattamento\u201d. Inoltre \ue8 stato condotto uno studio retrospettivo caso-controllo per valutare l\u2019eventuale ruolo protettivo delle gravidanze e dell\u2019allattamento nell\u2019\u2019insorgenza del carcinoma, studio focalizzato sulle donne nate nel periodo 1930-1969 (\ue8 stata esclusa per scarsa numerosit\ue0 la decade 1970-79). Ogni caso \ue8 stato appaiato ad un controllo con lo stesso anno di nascita. Per l\u2019analisi statistica \ue8 stato utilizzato il software R. Risultati: Lo studio \ue8 rappresentativo degli importanti cambiamenti a livello \u201csociale\u201d registrati nel corso delle decadi: incremento delle donne nullipare (dal 15% al 27%) ed un aumento dell\u2019et\ue0 delle donne al primo parto, (da un\u2019et\ue0 mediana di 24 anni a 30 anni). L\u2019analisi conferma il dato, gi\ue0 segnalato dalla letteratura, che l\u2019avere avuto figli riduce, soprattutto per le donne pi\uf9 giovani, il rischio di ca mammario: per le nate negli anni 1950-1959 il rischio relativo (RR) \ue8 pari a 0.56 [0.39-0.97], che passa a 0.40 [0.21-0.74], per quelle nate negli anni 1960-69; la parit\ue0 invece, in accordo con la letteratura non \ue8 pi\uf9 un fattore rilevante nelle donne della classe 1930-1949. Nel nostro campione anche l\u2019allattamento risulta un fattore protettivo nelle donne in et\ue0 fertile (RR=0.30 [0.11-0.76] ) soprattutto se questo si protrae fino al 12\ub0 mese (RR=0.16 [0.06-0.44]). Al contrario, e in accordo con i dati di letteratura, l'allattamento non riduce il rischio di ca mammario dopo la menopausa. Discussioni e Conclusioni: Nello studio triestino, la parit\ue0 e l\u2019allattamento risultano fattori protettivi per il ca della mammella solo per le donne in et\ue0 fertile e, in accordo con la letteratura , non riscontra significativa protezione nelle donne in post menopausa

Detrimental effects of the ‘bath salt’ methylenedioxypyrovalerone on social play behavior in male rats

Methylenedioxypyrovalerone (MDPV) is the most popular synthetic cathinone found in products marketed as 'bath salts', widely abused among teenagers and young adults. Synthetic cathinones have pharmacological effects resembling those of psychostimulants, which are known to disrupt a variety of social behaviors. However, despite the popular use of MDPV by young people in social contexts, information about its effects on social behavior is scarce. To investigate the impact of MDPV on social behavior at young age, and the underlying neurobehavioral mechanisms, we focused on social play behavior. Social play behavior is the most characteristic social behavior displayed by young mammals and it is crucial for neurobehavioral development. Treatment with MDPV reduced social play behavior in both juvenile and young adult male rats, and its play-suppressant effect was subject to tolerance but not sensitization. As the behavioral effects of MDPV have been ascribed to dopaminergic and noradrenergic neurotransmission, and given the role of these neurotransmitters in social play, we investigated the involvement of dopamine and noradrenaline in the play-suppressant effects of MDPV. The effects of MDPV on social play were blocked by either the α2 adrenoceptor antagonist RX821002 or the dopamine receptor antagonist flupenthixol, given alone or together at sub-effective doses. In sum, MDPV selectively suppresses the most vigorous social behavior of developing rats through both noradrenergic and dopaminergic mechanisms. This study provides important preclinical evidence of the deleterious effects of MDPV on social behavior, and as such increases our understanding of the neurobehavioral effects of this popular cathinone