Abbreviated Versus Multiparametric Prostate MRI in Active Surveillance for Prostate-Cancer Patients: Comparison of Accuracy and Clinical Utility as a Decisional Tool

(1) Purpose: To compare the diagnostic accuracy between full multiparametric contrast-enhanced prostate MRI (mpMRI) and abbreviated dual-sequence prostate MRI (dsMRI) in men with clinically significant prostate cancer (csPCa) who were candidates for active surveillance. (2) Materials and Methods: Fifty-four patients with a diagnosis of low-risk PCa in the previous 6 months had a mpMRI scan prior to a saturation biopsy and a subsequent MRI cognitive transperineal targeted biopsy (for PI-RADS ≥ 3 lesions). The dsMRI images were obtained from the mpMRI protocol. The images were selected by a study coordinator and assigned to two readers blinded to the biopsy results (R1 and R2). Inter-reader agreement for clinically significant cancer was evaluated with Cohen’s kappa. The dsMRI and mpMRI accuracy was calculated for each reader (R1 and R2). The clinical utility of the dsMRI and mpMRI was investigated with a decision-analysis model. (3) Results: The dsMRI sensitivity and specificity were 83.3%, 31.0%, 75.0%, and 23.8%, respectively, for R1 and R2. The mpMRI sensitivity and specificity were 91.7%, 31.0%, 83.3%, and 23.8%, respectively, for R1 and R2. The inter-reader agreement for the detection of csPCa was moderate (k = 0.53) and good (k = 0.63) for dsMRI and mpMRI, respectively. The AUC values for the dsMRI were 0.77 and 0.62 for the R1 and R2, respectively. The AUC values for the mpMRI were 0.79 and 0.66 for R1 and R2, respectively. No AUC differences were found between the two MRI protocols. At any risk threshold, the mpMRI showed a higher net benefit than the dsMRI for both R1 and R2. (4) Conclusions: The dsMRI and mpMRI showed similar diagnostic accuracy for csPCa in male candidates for active surveillance

Effects of exercise training on airway responsiveness and airway cells in healthy subjects

J Appl Physiol. 2010 Aug;109(2):288-94. Epub 2010 Jun 10. Effects of exercise training on airway responsiveness and airway cells in healthy subjects. Scichilone N, Morici G, Zangla D, Chimenti L, Dav\uec E, Reitano S, Patern\uf2 A, Santagata R, Togias A, Bellia V, Bonsignore MR. SourceDept. of Internal Medicine, Div. of Pulmonology (DIBIMIS Univ. of Palermo, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, 90146 Palermo, Italy. [email protected] Abstract Airway responsiveness to methacholine (Mch) in the absence of deep inspirations (DIs) is lower in athletes compared with sedentary individuals. In this prospective study, we tested the hypothesis that a training exercise program reduces the bronchoconstrictive effect of Mch. Ten healthy sedentary subjects (M/F: 3/7; mean + or - SD age: 22 + or - 3 yr) entered a 10-wk indoor rowing exercise program on rowing ergometer and underwent Mch bronchoprovocation in the absence of DIs at baseline, at weeks 5 and 10, as well as 4-6 wk after the training program was completed. Exercise-induced changes on airway cells and markers of airway inflammation were also assessed by sputum induction and venous blood samples. Mean power output during the 1,000 m test was 169 + or - 49 W/stroke at baseline, 174 + or - 49 W/stroke at 5 wk, and 200 + or - 60 W/stroke at 10 wk of training (P < 0.05). The median Mch dose used at baseline was 50 mg/ml (range 25-75 mg/ml) and remained constant per study design. At the pretraining evaluation, the percent reduction in the primary outcome, the inspiratory vital capacity (IVC) after inhalation of Mch in the absence of DIs was 31 +/- 13%; at week 5, the Mch-induced reduction in IVC was 22 + or - 19%, P = 0.01, and it further decreased to 15 + or - 11% at week 10 (P = 0.0008). The percent fall in IVC 4-6 wk after the end of training was 15 + or - 11% (P = 0.87 vs. end of training). Changes in airway cells were not associated with changes in airway responsiveness. Our data show that a course of exercise training can attenuate airway responsiveness against Mch inhaled in the absence of DIs in healthy subjects and suggest that a sedentary lifestyle may favor development of airways hyperresponsiveness. Comment in J Appl Physiol. 2010 Aug;109(2):267-8. PMID:20538849[PubMed - in process

TheKnowRISKproject:Tools and strategies for risk communication and learning

Damage of non-structural elements of buildings (i.e. partitions, ceilings, cladding, electrical and mechanical sys- tems and furniture) is known to cause injuries and human losses. Also it has a significant impact on earthquake resilience and is yet being worldwide underestimated. The project KnowRISK (Know your city, Reduce seISmic risK through non-structural elements) is financed by the European Commission to develop prevention measures that may reduce non-structural damage in urban areas. Pilot areas of the project are within the three European participating countries, namely Portugal, Iceland and Italy. They were chosen because they are prone to damage level 2 and 3 (EMS-98, European Macroseismic Scale) that typically affects non-structural elements. We will develop and test a risk communication strategy taking into ac- count the needs of households and schools, putting into practice a portfolio of best practice to reduce the most common non-structural vulnerabilities. Wewilltargetouractionstodifferentsocietalgroups,consideringtheirculturalbackgroundandsocialvulnerabil- ities, and implement a participatory approach that will promote engagement and interaction between the scientific community, practitioners and citizens to foster knowledge on everyone’s own neighborhoods, resilience and vul- nerability. A Practical Guide for citizens will highlight that low-cost actions can be implemented to increase safety of house- holds,meantasbeingtheplaceswherethemostvulnerablesocietalgroups,includingchildrenandelderlypeople, spend much of their time. Since our actions towards communication will include education, we will define tools that allow a clear and direct understanding of elements exposed to risk. Schools will be one of our target societal groups and their central role played at the community level will ensure spreading and strengthening of the communication process. Schools are often located in old or re-adapted build- ings,formerlyusedforotheruses,orwhenthegrowingnumberofstudentsornewneedsrequireadaptingthespace to the necessities, often without taking enough care of safety. Moreover, in urban areas, schools may be hosted in tall buildings where the shaking of moderate-to-low magnitude earthquakes can cause damage level 2 and 3. Students will be involved into looking after their own situation in terms of non-structural vulnerability to promote education and prevention, while increasing resilience in terms of societal capacity to cope with future disasters. The actions will undergo specific effectiveness assessment with ex-ante and ex-post surveys. The results of this assessmentwillallowanevaluationofon-siteriskcommunicationactivities,thecomparabilitybetweenpilot-areas achievements, and an opportunity for learning and guidance for future risk communication.PublishedVienna, Austria3T. Pericolosità sismica e contributo alla definizione del rischioope

Prevalence of Use and Cost of Biological Drugs for Cancer Treatment: A 5-Year Picture from Southern Italy

Background and Objectives: Considering the clinical and economic burden of biological drugs in cancer treatment, it is necessary to explore how these drugs are used in routine care in Italy and how they affect the sustainability of the National Health Services. This study aimed to investigate the prevalence of use and costs of biological drugs for cancer treatment in a general population of Southern Italy in the years 2010–2014. Methods: This was a retrospective, observational study using data from the healthcare administrative databases of Messina Province for the years 2010–2014. In this study, users of biological drugs for cancer treatment were characterized and the prevalence of use and costs were calculated over time. The potential impact of biosimilars on the expenditure was also estimated. Results: Of a population of 653,810 residents in the Messina area during the study years, 2491 (0.4%) patients received at least one study drug. The most frequently used were monoclonal antibodies (mAbs) (n = 1607; 64.5%) and tyrosine kinase inhibitors (TKIs) (n = 609; 24.4%). mAbs were mainly used by females (60.3%) for metastasis due to an unspecified primary tumor, lymphomas, or breast cancer (24.2, 16.7, and 13.7%, respectively). Most users of small molecules were males (56.3%) being treated for multiple myeloma, metastasis due to unspecified primary tumor, leukemia, and lung cancer (13.1, 12.6, 9.5, and 8.9%, respectively). During the study years, the prevalence of use doubled from 0.9 to 1.8 per 1000 inhabitants; likewise, the related expenditure grew from €6.6 to €13.6 million. Based on our forecasts, this expenditure will grow to €25 million in 2020. Assuming a 50% biosimilar uptake (trastuzumab and rituximab), a potential yearly saving of almost €1 million may be achieved. Conclusions: In recent years, the use and costs of biological drugs in cancer patients have increased dramatically in a large population from Southern Italy. This trend may be counterbalanced by adopting biosimilars once they are available. Claims databases represent a valid tool to monitor the uptake of newly marketed biological drugs and biosimilars

Analogue modelling of basin inversion: a review and future perspectives

Basin inversion involves the reversal of subsidence in a basin due to compressional tectonic forces, leading to uplift of the basin's sedimentary infill. Detailed knowledge of basin inversion is of great importance for scientific, societal, and economic reasons, spurring continued research efforts to better understand the processes involved. Analogue tectonic modelling forms a key part of these efforts, and analogue modellers have conducted numerous studies of basin inversion. In this review paper we recap the advances in our knowledge of basin inversion processes acquired through analogue modelling studies, providing an up-to-date summary of the state of analogue modelling of basin inversion. We describe the different definitions of basin inversion that are being applied by researchers, why basin inversion has been historically an important research topic and what the general mechanics involved in basin inversion are. We subsequently treat the wide range of different experimental approaches used for basin inversion modelling, with attention to the various materials, set-ups, and techniques used for model monitoring and analysing the model results. Our new systematic overviews of generalized model results reveal the diversity of these results, which depend greatly on the chosen set-up, model layering and (oblique) kinematics of inversion, and 3D along-strike structural and kinematic variations in the system. We show how analogue modelling results are in good agreement with numerical models, and how these results help researchers to better understand natural examples of basin inversion. In addition to reviewing the past efforts in the field of analogue modelling, we also shed light on future modelling challenges and identify a number of opportunities for follow-up research. These include the testing of force boundary conditions, adding geological processes such as sedimentation, transport, and erosion; applying state-of-the-art modelling and quantification techniques; and establishing best modelling practices. We also suggest expanding the scope of basin inversion modelling beyond the traditional upper crustal “North Sea style” of inversion, which may contribute to the ongoing search for clean energy resources. It follows that basin inversion modelling can bring valuable new insights, providing a great incentive to continue our efforts in this field. We therefore hope that this review paper will form an inspiration for future analogue modelling studies of basin inversion.</p

Development aid and international migration to Italy: Does aid reduce irregular flows?

In recent years, donors have claimed to tackle the root causes of migration from low‐income countries using aid. While others have studied the effects of aid on regular migration, we test whether aid deters irregular migration to Italy using two innovative dependent variables: asylum applications and apprehensions at border. For asylum applications, the largest significant effect size implies we should expect one extra application for an additional $162,000 in bilateral aid. For border crossings, the only significant effect implies the marginal cost in bilateral aid is$1.8 million per deterred migrant. The conclusion that effect sizes are small is robust to different types of aid, measures of migration and various controls. We find robust evidence that irregular migration flows are significantly affected by conflict, poverty, and the pre‐existing stocks from that country. Comparing our results to the existing aid‐migration literature, we find similar effect sizes. The cost per deterred (regular) migrant is in the range $4‐7 million. Statistically significant estimates for the effect of aid on regular migration are only found for sub‐samples or specific specifications. In short, aid does not deter regular or irregular migration, so should be used for other purposes