Flessibilita' Psicologica e distress psicologico in eta' evolutiva

La letteratura empirica suggerisce come il distress genitoriale sia una delle condizioni alla base della messa in atto di strategie genitoriali disfunzionali ed inefficaci e dello sviluppo di ansia e depressione nei figli. Secondo il modello ACT, alla base del benessere nel contesto familiare vi sarebbe la Flessibilità Psicologica (FP) dei membri della famiglia, definita come la capacità di restare, da essere umano consapevole, in contatto con il momento presente pienamente e senza inutili difese per come si è e non per quello che si dice di essere e di conservare o modificare un comportamento in funzione dei valori scelti. Ad oggi, l’evidenza empirica sul rapporto tra FP e distress psicologico nel contesto familiare è scarsa e limitata metodologicamente. L’obiettivo di questo studio è esplorare la relazione fra FP e distress psicologico in soggetti in età evolutiva e nei loro genitori. Hanno partecipato allo studio 31 bambini/pre-adolescenti dai 7 ai 14 anni con difficoltà scolastiche e loro genitori. I partecipanti allo studio sono stati reclutati in diversi centri privati per il supporto dei disturbi dell’apprendimento ed altre difficoltà nell’infanzia e nell’adolescenza. I figli hanno compilato misure self-report di FP, abilità di mindfulness, ansia, depressione e somatizzazione. I genitori hanno compilato misure self-report di FP, ansia e depressione e misure etero-valutative per l’ansia e la depressione dei figli. I risultati dello studio indicano che alti livelli di FP si associano a minori livelli di ansia e depressione, ma solo per le madri e non per i padri. I risultati mostrano come anche nei giovani alti livelli di FP correlano con più bassi livelli d’ansia e depressione. Inoltre, i risultati mostrano una correlazione significativa tra la FP dei padri e quella dei figli. Infine, bassi livelli di FP dei genitori si associano a più alti livelli di ansia e depressione dei figli. I risultati ottenuti mostrano non solo il peso diverso che i genitori esercitano sul benessere del figlio collegandosi ad aree psicologiche ed emotive diverse: la mamma prevalentemente sugli aspetti depressivi, mentre i padri sulla somatizzazione dei figli. Ma suggeriscono come la FP e le abilità di mindfulness costituiscano dei fattori protettivi nella trasmissione del distress tra i genitori e i figli, poiché sembrano essere degli elementi cardine alla base del benessere psicologico sia degli adulti che dei giovani. Dallo studio si evince anche la necessità di approfondire gli studi che indaghino la FP all’interno del contesto familiare, sia in popolazione generale sia attraverso studi longitudinali che permettano di valutare il peso della FP nei molti cambiamenti evolutivi che i genitori e i figli devono superare nel corso della vita

Consolidative thoracic radiation therapy for extensive-stage small cell lung cancer in the era of first-line chemoimmunotherapy: preclinical data and a retrospective study in Southern Italy

BackgroundConsolidative thoracic radiotherapy (TRT) has been commonly used in the management of extensive-stage small cell lung cancer (ES-SCLC). Nevertheless, phase III trials exploring first-line chemoimmunotherapy have excluded this treatment approach. However, there is a strong biological rationale to support the use of radiotherapy (RT) as a boost to sustain anti-tumor immune responses. Currently, the benefit of TRT after chemoimmunotherapy remains unclear. The present report describes the real-world experiences of 120 patients with ES-SCLC treated with different chemoimmunotherapy combinations. Preclinical data supporting the hypothesis of anti-tumor immune responses induced by RT are also presented.MethodsA total of 120 ES-SCLC patients treated with chemoimmunotherapy since 2019 in the South of Italy were retrospectively analyzed. None of the patients included in the analysis experienced disease progression after undergoing first-line chemoimmunotherapy. Of these, 59 patients underwent TRT after a multidisciplinary decision by the treatment team. Patient characteristics, chemoimmunotherapy schedule, and timing of TRT onset were assessed. Safety served as the primary endpoint, while efficacy measured in terms of overall survival (OS) and progression-free survival (PFS) was used as the secondary endpoint. Immune pathway activation induced by RT in SCLC cells was explored to investigate the biological rationale for combining RT and immunotherapy.ResultsPreclinical data supported the activation of innate immune pathways, including the STimulator of INterferon pathway (STING), gamma-interferon-inducible protein (IFI-16), and mitochondrial antiviral-signaling protein (MAVS) related to DNA and RNA release. Clinical data showed that TRT was associated with a good safety profile. Of the 59 patients treated with TRT, only 10% experienced radiation toxicity, while no ≥ G3 radiation-induced adverse events occurred. The median time for TRT onset after cycles of chemoimmunotherapy was 62 days. Total radiation dose and fraction dose of TRT include from 30 Gy in 10 fractions, up to definitive dose in selected patients. Consolidative TRT was associated with a significantly longer PFS than systemic therapy alone (one-year PFS of 61% vs. 31%, p<0.001), with a trend toward improved OS (one-year OS of 80% vs. 61%, p=0.027).ConclusionMulti-center data from establishments in the South of Italy provide a general confidence in using TRT as a consolidative strategy after chemoimmunotherapy. Considering the limits of a restrospective analysis, these preliminary results support the feasibility of the approach and encourage a prospective evaluation

The Questionable Quality Profile of Food Supplements: The Case of Red Yeast Rice Marketed Products

Food supplements (FS) containing red yeast rice (RYR) are largely employed to reduce lipid levels in the blood. The main ingredient responsible for biological activity is monacolin K (MoK), a natural compound with the same chemical structure as lovastatin. Concentrated sources of substances with a nutritional or physiological effect are marketed in “dose” form as food supplements (FS). The quality profile of the “dosage form” of FS is not defined in Europe, whereas some quality criteria are provided in the United States. Here, we evaluate the quality profile of FS containing RYR marketed in Italy as tablets or capsules running two tests reported in The European Pharmacopoeia 11 Ed. and very close to those reported in the USP. The results highlighted variations in dosage form uniformity (mass and MoK content) compliant with The European Pharmacopoeia 11 Ed. specifications, whereas the time needed for disintegrating tablets was longer for 44% of the tested samples. The bioaccessibility of MoK was also investigated to obtain valuable data on the biological behaviour of the tested FS. In addition, a method for citrinin (CIT) determination was optimized and applied to real samples. None of the analyzed samples demonstrated CIT contamination (LOQ set at 6.25 ng/mL). Considering the widespread use of FS, our data suggest that greater attention should be paid by fabricants and regulatory authorities to ensure the quality profile and the safe consumption of marketed products

Towards the development of a novel bioinspired functional material: Synthesis and characterization of hybrid TiO 2/DHICA-melanin nanoparticles

A large number of recent literature data focus on modification/modulation of surface chemistry of inorganic materials in order to improve their functional properties. Melanins, a wide class of natural pigments, are recently emerging as a powerful organic component for developing bioinspired active material for a large number of applications from organoelectronics to bioactive compounds. Here we report the use of the approach referred as "chimie douce", involving in situ formation of the hybrids through reactions of precursors under mild conditions, to prepare novel hybrid functional architectures based on eumelanin like 5,6 dihydroxyindole-2-carboxylic acid (DHICA) polymer and TiO 2. Two synthesis procedures were carried out to get DHICA-melanin coated TiO 2 nanoparticles as well as mixed DHICA/TiO 2 hybrid nanostructures. Such systems were characterized through EPR, FT-IR and fluorescence spectroscopy, thermogravimetric analysis (TGA), X-ray diffraction (XRD), and TEM microscopy in order to assess the effect of synthesis path as well as of DHICA content on structural, morphological and optical properties of TiO 2 nanostructures. In particular, EPR, FT-IR spectra and TGA analysis confirmed the presence of DHICA-melanin in these samples. TEM measurements indicated the formation of the nanoparticles having relatively narrow size distribution with average particle size of about 10 nm. DHICA-melanin does act as a morphological agent affecting morphology of hybrid nanostructures. XRD analysis proved that TiO 2 hybrid nanoparticles kept anatase structures for DHICA-melanin contents within the range of investigated compositions, i.e. up to 50% wt/wt. © 2012 Elsevier B.V. All rights reserved

Immune Checkpoint Blockade for Advanced NSCLC: A New Landscape for Elderly Patients

The therapeutic scenario for elderly patients with advanced NSCLC has been limited to radiotherapy and chemotherapy. Recently, a novel therapeutic approach based on targeting the immune-checkpoints has showed noteworthy results in advanced NSCLC. PD1/PD-L1 pathway is co-opted by tumor cells through the expression of PD-L1 on the tumor cell surface and on cells within the microenvironment, leading to suppression of anti-tumor cytolytic T-cell activity by the tumor. The success of immune-checkpoints inhibitors in clinical trials led to rapid approval by the FDA and EMA. Currently, data regarding efficacy and safety of ICIs in older subjects is limited by the poor number of elderly recruited in clinical trials. Careful assessment and management of comorbidities is essential to achieve better outcomes and limit the immune related adverse events in elderly NSCLC patients

Articular and other immune-mediated extra-intestinal manifestations in inflammatory bowel diseases

The articular involvement in patients with inflammatory bowel diseases is included in the group of immune-mediated extra-intestinal manifestations, occurring approximately in a range from 6.2-36% of the patients. This group is also made up of the skin and eyes manifestations, that usually but not invariably are correlated with intestinal inflammatory disease activity. Rheumatic manifestations are the most frequent extra-intestinal findings of this group with a prevalence from 20-50%. They are divided into two different clinical subsets: peripheral and axial joint involvement (including sacroiliitis with or without spondylitis). Peripheral arthritis is the most frequent finding in both Crohn's disease and ulcerative colitis, occurring with a frequency ranging from 17-20%, and it is more common in Crohn's disease. Axial involvement is more common in Crohn's disease (5-22%) than in ulcerative colitis (2-6%) and generally the prevalence of sacroiliitis (asymptomatic and symptomatic) is between 12-20% and of spondylitis is between 2-16%. The IBD is also associated with other rheumatic diseases such as rheumatoid arthritis, Sjogren syndrome, Takayasu arteritis and fibromyalgia. The management of patients with EA requires an active cooperation between gastroenterologists and rheumatologists. Copyright © by BIOLIFE, s.a.s

Enhancing transmucosal delivery of CBD through nanoemulsion: in vitro and in vivo studies

Cannabidiol (CBD) has gained significant attention as a complementary and alternative medicine due to its promising therapeutic properties. However, CBD faces obstacles when administered orally due to its poor solubility in water, leading to limited absorption into the bloodstream and low and variable bioavailability. Therefore, the development of innovative delivery approaches that can enhance CBD's bioavailability, facilitate administration, and promote patient adherence is crucial. We propose a new approach for buccal delivery of CBD based on a self-assembling nanoemulsion (NE) made of a mixture of surfactants (Tween 80 and Labrasol) and medium chain triglycerides (MCTs). The NE formulation showed properties suitable for buccal administration, including appropriate size, CBD content, and surface properties, and, if compared to a CBD-MCT solution, it exhibited better control of administered doses, faster dissolution in buccal medium, and enhanced stability. The CBD-NE effectively released its active load within 5 h, remained stable even when diluted in simulated buccal fluids, and could be easily administered through a commercially available spray, providing consistent and reproducible doses of NE with optimized properties. In vitro permeation studies demonstrated that the CBD-NE facilitated swift and consistent permeation through the buccal mucosa, resulting in a higher concentration in the acceptor compartment compared to CBD-MCT. Furthermore, the in vivo study in mice showed that a single buccal administration of CBD-NE led to a quicker onset of action than a CBD solution in MCT, while maintaining the same plasma levels over time and leading to typically higher plasma concentrations compared to those usually achieved through oral administration. In conclusion, our CBD-NE represents a promising alternative formulation strategy for buccal CBD administration, overcoming the challenges associated with conventional formulations such as variable bioavailability and low control of administered doses