Fiducial markers in adjuvant setting for a patient affected by endometrial cancer: a case report

Introduction: Intermediate-high and high-risk endometrial cancer often require adjuvant treatments such as radiotherapy (RT) or brachitherapy (BT) to reduce the risk of loco-regional relapse. Inter- and intra-fraction variability of internal pelvic anatomy are possibly the largest source of error affecting pelvic RT. The implantation of Fiducial Makers (FMs) in the vaginal cuff of patients receiving RT or BT could help patient daily setup, image guidance and intra-fraction detection of the radiation targets. Clinical case: We have evaluated the case of an 80-year-old woman treated with surgery for endometrioid adenocarcinoma G2 (stage pT1b Nx LVSI+) who underwent adjuvant pelvic IMRT after the implantation of vaginal cuff FMs. Ct-simulation treatment planning and igrt strategy: Patient underwent planning CT scan 10 days after FMs implantation. RT consisted of 45Gy in 25 daily fractions to pelvic lymph nodes and surgical bed with simultaneous integrated boost up to 52.5Gy to the vaginal cuff and the upper two-thirds of the vagina. Cone beam Computed Tomography (CBCT) was acquired prior to every RT fraction for IGRT. Bladder and rectum were re-contoured on every CBCTs. Bladder and rectal volumes and median shifts were reported on a prospective database to quantify the impact of the pelvic organ variations. Results: The patient reported no discomfort during the FMs implantation, and no complications were seen. No evidence of FMs migration was reported. Bladder and rectal volumes planned contours were 245 and 55.3cc. Median bladder volumes for approved and "not acceptable" CBCTs were 222cc (range: 130-398) and 131cc (range: 65-326), respectively. Median rectal volumes for approved and "not acceptable" CBCTs were 75cc (range: 58-117) and 90cc (range: 54-189), respectively. The median values of the anterior-posterior, superior-inferior, lateral direction shifts were 3.4, 1.8 and 2.11 mm, respectively. Conclusion: In our clinical case, the implantation of FMs in the vaginal cuff of a patient who underwent pelvic adjuvant RT was well tolerated and reported no complications. The use of IGRT procedures based on FMs surrogating the vaginal vault may reduce inter-observer variability and pave the way for adaptive strategies or stereotactic treatments as external beam pelvic boost in gynecological field

Strongly structured populations and reproductive habitat fragmentation increase the vulnerability of the Mediterranean starry ray Raja asterias (Elasmobranchii, Rajidae)

1. The Mediterranean starry ray (Raja asterias) populations within the Mediterranean Sea are susceptible to high rates of bycatch in the multispecies trawl fisheries. Understanding its population structure and identifying critical habitats are crucial for assessing species vulnerability and setting the groundwork for specific management measures to prevent population decline. 2. To assess the population structure of R. asterias in the Mediterranean, the genetic variation in nine population samples at one mitochondrial marker and eight nuclear microsatellite loci was analysed. Moreover, 172 egg cases collected in the Strait of Sicily were identified at species level using integrated molecular and morphological approaches. 3. Genetic analyses revealed that the Mediterranean starry ray comprises three distinct units inhabiting the western, the central-western, and the central-eastern areas of the Mediterranean. An admixture zone occurs in the Strait of Sicily and the Ionian Sea, where individuals of the central-western and central-eastern population units intermingle. 4. The joint morphometric–genetic analyses of rajid egg cases confirmed the presence of more than one species in the admixture area, with a predominance of egg cases laid by R. asterias. DNA barcoding revealed that egg cases and embryos of R. asterias shared several haplotypes with adult individuals from the centralwestern and central-eastern Mediterranean Sea, revealing that females of both populations laid numerous eggs in this area. 5. According to these findings, detailed taxonomic determination of egg cases, when combined with seasonal migration studies, could improve the capability to identify important spawning or nursery areas for the Mediterranean starry ray, particularly in those admixture zones relevant to maintaining genetic diversity. 6. Finally, these new insights should be considered to update the Action Plan for the Conservation of Cartilaginous Fishes in the Mediterranean Sea with effective measures to reduce the impact of skate bycatch in trawling and safeguard egg cases in nursery areas

Puzzling over spurdogs : molecular taxonomy assessment of the Squalus species in the Strait of Sicily

The actual occurrence of Squalus megalops in the Mediterranean Sea has recently been questioned. Several research works which sought to assess available morphological and meristic features that differentiate S. megalops from other Squalus species in the Mediterranean Sea, revealed poor discriminatory power and high variability of the assessed characters, especially when comparing S. megalops and S. blainville. The application of molecular tools does not support the presence of S. megalops. In the present study, we screened spurdog species from the Strait of Sicily using a molecular taxonomy approach based on two mitochondrial DNA markers and we report the occurrence of two Squalus lineages characterizing specimens collected from the stretch of sea between Tunisia, southern Sicily, Malta and Libya. The results support the hypothesis that a common species, S. blainville, currently inhabits the Mediterranean Sea, while a second and rare species is probably an occasional visitor with high morphological similarity to the S. megalops and S. blainville but is genetically distinct from both. Within this perspective, the occurrence of S. megalops in the Mediterranean Sea is not confirmed and our study highlights the taxonomic uncertainties in relation to the occurrence and distribution of Squalus species in this region. We encourage the establishment of a coordinated international effort to implement a comprehensive and integrated taxonomic assessment on this genus which represents an irreplaceable component of the biodiversity of the area.peer-reviewe

Cryptic Leishmania infantum infection in Italian HIV infected patients

<p>Abstract</p> <p>Background</p> <p>Visceral leishmaniasis (VL) is a protozoan diseases caused in Europe by <it>Leishmania (L.) infantum</it>. Asymptomatic <it>Leishmania </it>infection is more frequent than clinically apparent disease. Among HIV infected patients the risk of clinical VL is increased due to immunosuppression, which can reactivate a latent infection. The aims of our study were to assess the prevalence of asymptomatic <it>L. infantum </it>infection in HIV infected patients and to study a possible correlation between <it>Leishmania </it>parasitemia and HIV infection markers.</p> <p>Methods</p> <p>One hundred and forty-five HIV infected patients were screened for the presence of anti-<it>Leishmania </it>antibodies and <it>L. infantum </it>DNA in peripheral blood. Statistical analysis was carried out by using a univariate regression analysis.</p> <p>Results</p> <p>Antibodies to <it>L. infantum </it>were detected in 1.4% of patients. <it>L. infantum </it>DNA was detected in 16.5% of patients. Significant association for PCR-<it>Leishmania </it>levels with plasma viral load was documented (p = 0.0001).</p> <p>Conclusion</p> <p>In our area a considerable proportion of HIV infected patients are asymptomatic carriers of <it>L. infantum </it>infection. A relationship between high HIV viral load and high parasitemic burden, possibly related to a higher risk of developing symptomatic disease, is suggested. PCR could be used for periodic screening of HIV patients to individuate those with higher risk of reactivation of <it>L. infantum </it>infection.</p

I consigli populares del 29 aprile e del 6 maggio 1450. Confronto istituzionale e confl itto politico a Palermo

Il contributo analizza come il moto di protesta del 1450 a Palermo, osservato attraverso gli atti delle sedute del consiglio municipale, esprima precise rivendicazioni socio-politiche riuscendo a influenzare gli equilibri di potere all’interno della città

Identità cittadina e dominio territoriale in Sicilia. Il caso dell'universitas di Randazzo nel tardo Medioevo

L’universitas di Randazzo rappresenta una delle realtà di maggiore interesse nell’universo urbano della Sicilia tardo-medievale. La vita degli abitanti appare fortemente radicata all’interno delle mura, in uno spazio rigidamente suddiviso nei tre quartieri convergenti sulle tre parrocchie fulcro della vita locale. D’altro canto, il centro urbano rivela una marcata proiezione esterna con un controllo sul districtus, che tra Trecento e Quattrocento si consolida in maniera significativa. I quartieri, le parrocchie, il distretto sono luoghi solo apparentemente distinti ma in realtà correlati, in modo speculare a una progressiva maturazione della identità cittadina. Infine, nella serrata comunicazione esistente fra le universitates, Randazzo non si limita a recepire i modelli esterni ma interagisce con questi affermando così la propria specificità. serrata comunicazione esistente fra le universitates, Randazzo non si limita a recepire i modelli esterni ma interagisce con questi affermando così la propria specificità.Titone Fabrizio. Identità cittadina e dominio territoriale in Sicilia : il caso dell’universitas di Randazzo nel tardo Medioevo. In: Mélanges de l'École française de Rome. Moyen-Age, tome 120, n°1. 2008. pp. 173-188

Il ruolo delle universitates nella produzione normativa in Sicilia, secoli XIV-XV

Il presente saggio considera il ruolo della corte regia e delle comunità (universitates) nella formazione degli ordinamenti normativi locali nella Sicilia del basso Medioevo. Si mette in luce come il rapporto di subordinazione delle comunità rispetto al re non escludesse che le prime potessero sia conseguire un ruolo significativo nella produzione normativa, in corrispondenza a un incremento della strategia regia d’apertura alle richieste dal basso, sia ottenere gradualmente d’influenzare la politica del sovrano sui governi locali. Si tratta di processi che emergono con maggiore evidenza durante fasi di contrapposizioni politiche. L’accesso alle assemblee, la regolamentazione della politica economica, il controllo della magistratura preposta alla giurisdizione criminale ecc., erano tutti ambiti su cui le universitates potevano intervenire e sui quali il re fungeva da autorità regolatrice.The present essay considers the respective role of the royal court and of the communities (universitates) in the local formation of normative systems in the Sicily of the late Middle Ages. It highlights how the communities’ relationship of subordination to the king did not preclude room for manoeuvre. Indeed, the universitates were able both to play a significant role in the production of norms, as the royal strategy of responding to requests from below was further refined, and gradually to obtain influence over royal policy regarding the local governments. We are concerned here with processes that are more in evidence during phases of political confrontation. Access to the various assemblies, the regulation of economic policy, the control of magistracies responsible for criminal jurisdiction etc., were all contexts in which the universitates could intervene and over which the king functioned as a regulatory authority