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

Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

Volcano monitoring and early warning on Mt Etna, Italy, using volcanic tremor – Methods and technical aspects

Recent activity on Mt Etna was characterized by 25 lava fountains occurred on Mt Etna in 2011 and the first semester of 2012. In summer 2012 volcanic activity in a milder form was noticed within the Bocca Nuova crater, before it came to an essential halt in August 2012. Together with previous unrests (e. g., in 2007-08) these events offer rich material for testing automatic data processing and alert issue in the context of volcano monitoring. Our presentation focuses on the seismic background radiation – volcanic tremor – which has a key role in the surveillance of Mt Etna. From 2006 on a multi-station alert system exploiting STA/LTA ratios, has been established in the INGV operative centre of Catania. Besides, also the frequency content has been found to change correspondingly to the type of volcanic activity, and can thus be exploited for warning purposes. We apply Self Organizing Maps and Fuzzy Clustering which offer an efficient way to visualize signal characteristics and its development with time. These techniques allow to identify early stages of eruptive events and automatically flag a critical status before this becomes evident in conventional monitoring techniques. Changes of tremor characteristics are related to the position of the source of the signal. Given the dense seismic network we can base the location of the sources on distribution of the amplitudes across the network. The locations proved to be extremely useful for warning throughout both a flank eruption in 2008 as well as the 2011 lava fountains. During all these episodes a clear migration of tremor sources towards the eruptive centres was revealed in advance. The location of the sources completes the picture of an imminent volcanic unrest and corroborates early warnings flagged by the changes of signal characteristics. Automatic real time data processing poses high demands on computational efficiency, robustness of the methods and stability of data acquisition. The amplitude based multi-station approach is not sensitive to the failure of single stations and therefore offers a good stability. On the other hand, the single station approach, exploiting unsupervised classification techniques, limits logistic efforts, as only one or few key stations are necessary. A common characteristics of both strategies is their robustness to disturbances (undesired transients like earthquakes, noise, short gaps in the continuous data flow). False alarms were not encountered so far. A critical issue it the reliability of data storage and access. Therefore, a specific hardware cluster architecture has been proposed for failover protection, including a Storage Area Network system. We present concepts of the software architectures which allow easy data access following predefined user policies. We also envisage the integration of seismic data and those originating from other scientific fields (e. g., volcano imagery, geochemistry, deformation, gravity, magneto-telluric). This will facilitate cross-checking of evidences encountered from the single data streams, in particular allow their immediate verification with respect to ground truth

The July 2006 eruption of Mount Etna (Italy) monitored through continuous soil radon measurements

Radon (222Rn) is a short-lived decay product derived from 238U, with a half-life of only 3.8 days. This gas ascends towards the earth’s surface mainly through cracks or faults. In recent decades radon has been used as a tool for predicting earthquakes and volcanic eruptions, because anomalous variations of its activity have often been reported before the occurrence of such geodynamic events. The recent eruptive activity of Mount Etna in Sicily (Italy) has been documented by multidisciplinary visual, geochemical, and instrumental observations. Here we describe the results obtained during the 10-day July 2006 Strombolian-effusive eruption of Mount Etna by using a radon probe installed near Torre del Filosofo (˜2950 m above sea level). This site is located ˜1 km south of the Southeast Crater, the youngest and most active of the four summit craters of the volcano, and the site of the July 2006 eruption. In order to better interpret the soil radon data we have compared them with simultaneously acquired volcanic tremor signals and a relative measurement of the thermal radiance emitted from the eruption area, derived from thermal camera measurements. During the month prior to the onset of the 2006 eruption, soil radon activity remained at low levels (˜1 x 103 Bq/m3); similar values persisted even when effusive activity started late on 14 July 2006. Only at ˜02:50 on the 15th July, radon activity showed a sharp increase (up to ˜50 x 103 Bq/m3) in a 20 minute interval, and a further increase to ˜20 x 106 Bq/m3 during the following hours. Explosive activity started at 04:30, 100 minutes after the initial rise in soil radon activity. High values in radon activity with numerous peaks persisted through the following four days, and were then followed by a marked decline until early on 20th July, when an extremely sharp rise brought the levels of radon activity to unprecedented values of nearly 1.7 x 108 Bq/m3, and remained very high for the next ˜24 hours. The episode of lava fountaining of 20th July occurred during this interval, starting 10 hours after the maximum in radon activity. From then on through the end of the eruptive phase, the levels of radon activity fluctuated with values rarely exceeding 106 Bq/m3 and then gradually declined starting from around noon on 22nd July. At the end of the eruption, radon levels remained higher (10-100 x 103 Bq/m3) than those recorded before the eruption. In conclusion, the onset of the Strombolian activity (15 July) and the lava fountaining (20 July) were related to significant changes in the magma pressure within the conduit. These two events were preceded by some hours with increases in radon soil emission by 4-5 orders of magnitude. For this reason we can imagine in the future the use of this signal as a potential precursor of this type of volcanic activity. Minor changes in eruptive behaviour did not produce significant variations in the monitored parameters. We interpret peaks in radon activity as due primarily to microfracturing of uranium-bearing rock. These observations suggest that radon measurements in the summit area of Etna are strongly controlled by the state of stress within the volcano and demonstrate the usefulness of radon data acquisition before and during eruptions

Su un caso di carcinoma a cellule squamose dello stomaco nel cavallo

SUMMARY - The Authors describe thè clinical, pathological and histotogical features of a case of squamous celi carcinoma (SCC) in a borse. A 13 year old, male, castrated, Irish horse, was kepi under observation after being sick for 9 months with thè following symptoms: dysoressia, chronic weight loss, sensory depression, pallor of thè apparent mucosae and, in thè last 30 days, diarrhoea, raeìena and diffuse oedemas. Physical and endoscopie examination and laboratory test» suggested a cachectic syndrome secondary to a neoplastic disease involving thè alimentary traci. Due to thè unfavourable prognosis, thè horse was euthanised according to thè owner's will, Anatomo-histopathological examination showed thè presence of stomach SCC. In this note thè Authors emphasize thè difficuity in diagnosing such neoplastic disease intra vitam

Neural stem cells engrafted in the adult brain fuse with endogenous neurons.

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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

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