Lung Ultrasound Severity Index: Development and Usefulness in Patients with Suspected SARS-Cov-2 Pneumonia—A Prospective Study

Coronavirus disease 2019 (COVID-19) has spread across the world with a strong impact on populations and health systems. Lung ultrasound is increasingly employed in clinical practice but a standard approach and data on the accuracy of lung ultrasound are still needed. Our study's objective was to evaluate lung ultrasound diagnostic and prognostic characteristics in patients with suspected COVID-19. We conducted a monocentric, prospective, observational study. Patients with respiratory distress and suspected COVID-19 consecutively admitted to the Emergency Medicine Unit were enrolled. Lung ultrasound examinations were performed blindly to clinical data. Outcomes were diagnosis of COVID-19 pneumonia and in-hospital mortality. One hundred fifty-nine patients were included in our study; 66% were males and 63.5% had a final diagnosis of COVID-19. COVID-19 patients had a higher mortality rate (18.8% vs. 6.9%, p = 0.04) and Lung Ultrasound Severity Index (16.14 [8.71] vs. 10.08 [8.92], p < 0.001) compared with non-COVID-19 patients. This model proved able to distinguish between positive and negative cases with an area under the receiver operating characteristic (AUROC) equal to 0.72 (95% confidence interval [CI]: 0.64–0.78) and to predict in-hospital mortality with an AUROC equal to 0.81 (95% CI: 0.74–0.86) in the whole population and an AUROC equal to 0.76 (95% CI: 0.66–0.84) in COVID-19 patients. The Lung Ultrasound Severity Index can be a useful tool in diagnosing COVID-19 in patients with a high pretest probability of having the disease and to identify, among them, those with a worse prognosis

Co-occurrence of symptoms after radiochemotherapy in locally advanced cervix cancer patients:a cluster analysis

Background: State of the art combined radiochemotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) has shown improved disease control and survival as well as a significant reduction of organ related morbidity. However, LACC cancer survivors are still experiencing a spectrum of symptoms. The aim of this study was to identify co-occurring symptoms in cervix cancer survivors by using patient-reported outcome and physician assessed morbidity. Materials and method: EMBRACE I is a multicenter prospective observational study with 1416 LACC patients (2008–2015). Information on physician-assessed morbidity and patient-reported outcome was assessed at baseline and at regular follow-ups up with the CTCAE v.3 and EORTC-C30/CX24, respectively. Patients with at least 2 years of follow-up were included and data from 3 months to 2 years was used in the analysis. Factor analysis was used on both EORTC and CTCAE data with symptoms and follow-ups as observations. The extracted factors represent clusters of symptoms. Subsequently, regression models were built to investigate associations between the symptom clusters and QOL. Results: The analysis included 742 patients. Despite the differences in the definition of physician-assessed and patient-reported symptoms, similar clusters are identified by the two assessment methods. Three main organ-related clusters are recognized for urinary, gastro-intestinal and vaginal morbidity. Furthermore, a general symptoms cluster where fatigue, pain, insomnia, neuropathy, and hot flashes have large weights is found. Lastly, a cluster with nausea, vomit and lack of appetite is also identified. The general, gastrointestinal and nausea clusters show significant associations with general QOL.Conclusions: This analysis on both PRO and physician-assessed morbidity found a cluster associated with general symptoms and organ-related symptom clusters (urinary, gastrointestinal, vaginal). This shows that LACC survivors experience a variety of co-occurring symptoms. Our analysis also shows that the cluster of general symptoms is associated with a decrease in QOL.</p

Investigation by pXRF of Caltagirone Pottery Samples Produced in Laboratory

In the study of archaeological ceramics, it is important to have compositional data to identify their origin and source. The fabric also provides useful information on the production technology, especially with regard to the firing steps. The work presented here is connected to this field and focuses on the main parameters related to the terracotta artefacts preparation. Thus, one can consider the effects in terracotta characteristics of different raw materials and firing parameters, in particular for pottery of Caltagirone, which is one of most important centres of pottery production in Italy, active since the Neolithic. To this end, terracotta samples have been reproduced in a laboratory setting according to the ancient procedure of Caltagirone manufacture, starting from clay and degreaser extraction in local historical sites. The analysis was conducted using a portable X-Ray Fluorescence (pXRF) spectrometer for elemental characterization of sand degreaser and of clays during each step of the realization process and in different firing conditions. SEM-ED techniques were also employed to verify the method and results for some of the samples after firing process. Framing the technological context of manufacture production, known in the specific case, it is also possible to identify potential outcomes and limits in the study of potsherds using pXRF technology, in applying the methodology to historic artefacts

A New HRCT Score for Diagnosing SARS-CoV-2 Pneumonia: A Single-Center Study with 1153 Suspected COVID-19 Patients in the Emergency Department

The 2019 coronavirus disease (COVID-19) pandemic is affecting millions of people worldwide. Chest high-resolution computed tomography (HRCT) is commonly used as a diagnostic test for suspected COVID-19; however, despite numerous attempts, there is no single scoring system that is widely accepted and used in clinical practice to estimate the probability of SARS-CoV-2 pneumonia. The aim of this single-center retrospective study is to develop a radiological score to predict the probability of COVID-19 with HRCT. Patients admitted to the emergency department with symptoms suggestive of COVID-19 who underwent both HRCT and RT-PCR on nasopharyngeal swab to detect SARS-CoV-2 infection between 1 March and 30 April 2020 were included. A multivariable regression analysis was conducted to identify all HRCT signs independently associated with a positive RT-PCR assay for SARS-CoV-2 and build the HRCT score. A total of 1153 patients were enrolled in this study. The number of segments with ground glass opacities (OR 1.18, 95% CI 1.11–1.26), number of segments with linear opacities (OR 1.21, 95% CI 1.05–1.42), crazy paving patterns (OR 6, 95% CI 3.79–9.76), and vascular ectasia in each segment (OR 2.46, 95% CI 1.1.5–5.8) were included in the score. The HRCT score showed high discriminatory power (area under the ROC curve of 0.8267 [95% CI 0.8–0.85]) with 72.2% sensitivity, 86.6% specificity, 78% PPV, and 83% NPV for its best cut-off. In summary, the HRCT score has good diagnostic and discriminatory accuracy for COVID-19 and is easy and quick to perform

Dose-effect relationship between vaginal dose points and vaginal stenosis in cervical cancer: An EMBRACE-I sub-study

Background and purpose: To evaluate dose–effect relationships between vaginal dose points and vaginal stenosis in patients treated for locally advanced cervical cancer with radio(chemo)therapy and image-guided adaptive brachytherapy. Material and methods: Patients from six centres participating in the EMBRACE-I study were included. Information on doses to different vaginal dose points, including the Posterior-Inferior Border of Symphysis (PIBS) points and recto-vaginal reference (RV-RP) point, were retrieved from the treatment planning system. In addition, the vaginal reference length (VRL) was evaluated. Vaginal stenosis was prospectively assessed according to the CTCAEv3.0 system at baseline and follow-up. Primary endpoint was grade 2 or higher (G ≥ 2) vaginal stenosis. Impact of dose to the vaginal dose points, and impact of VRL, age, vaginal involvement and applicator on vaginal stenosis G ≥ 2 was evaluated with a Cox proportional-hazard regression model. Results: 301 patients were included. Median follow-up was 49 months. During follow-up, the incidence of G0, G1, G2, and G3 vaginal stenosis was 25% (76), 52% (158), 20% (59) and 3% (8), respectively. Median total doses to PIBS+2 cm, PIBS, PIBS-2 cm and the RV-RP were 52.9 (IQR 49.3–64.7), 41.0 (IQR 15.4–49.0), 4.1 (IQR 2.9–7.0) and 64.6 (IQR 60.0–70.6) Gy EQD23, respectively. Higher doses to the PIBS, PIBS + 2 cm and RV-RP points were significantly associated with increased risk for vaginal stenosis G ≥ 2. Other risk factors for vaginal stenosis were: vaginal involvement at diagnosis, higher age, shorter VRL and use of a tandem-ovoid applicator. Conclusion: Higher doses to the PIBS+2 cm, PIBS and RV-RP dose points are associated with vaginal stenosis G ≥ 2

Evidence-Based Dose Planning Aims and Dose Prescription in Image-Guided Brachytherapy Combined With Radiochemotherapy in Locally Advanced Cervical Cancer

The last 2 decades have witnessed the development and broad adoption of image-guided adaptive brachytherapy (IGABT) combined with radiochemotherapy in patients with locally advanced cervical cancer. A variety of brachytherapy techniques and dose/fractionation schedules have been applied, and until recently, there was no strong evidence available for preferring one approach to another. However, large volumes of data have now provided high level clinical evidence for dose-effect relations for both disease and morbidity endpoints. It is therefore now possible to apply evidence based dose planning aims and dose prescription protocols in IGABT for locally advanced cervical cancer. This review gives an overview of targets/organs-at-risk and disease/morbidity endpoints which are relevant in the context of treatment planning and dose prescription in IGABT. The dosimetric and clinical evidence is summarized to support the implementation of dose prescription protocols which include hard and soft constraints for targets and organs at risk