A benchmark study on 883 nasopharyngeal cancer patients treated in two Italian centres from 1977 to 2000. Part II: Evolving technical choices and toxicity patterns

PURPOSE

The authors sought to define toxicity patterns according to the different accrual periods and clinical-therapeutic features in a large series of nasopharyngeal cancer (NPC) patients treated in two Italian centres over more than two decades.

MATERIALS AND METHODS

A total of 883 patients consecutively treated with radiotherapy from 1977 to 2000 at the Florence (FLO) and Brescia (IRA) radiation oncology centres were studied. The crude incidence of late treatment toxicity in the different subgroups of patients was calculated and compared.

RESULTS

Higher total and fractional doses and the "older" treatment techniques were related with an increased incidence of the main late effects of treatment. More recently treated patients experienced less treatment-related complications.

CONCLUSIONS

Results of this benchmark study may have implications for understanding and developing new radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT) and, in particular, intensity-modulated radiotherapy (IMRT) for NPC patients.

Femtosecond laser machined microfluidic devices for imaging of cells during chemotaxis

Microfluidic devices designed for chemotaxis assays were fabricated on fused silica substrates using femtosecond laser micromachining. These devices have built-in chemical concentration gradient forming structures and are ideally suited for establishing passive diffusion gradients over extended periods of time. Multiple gradient forming structures, with identical or distinct gradient forming characteristics, can be integrated into a single device, and migrating cells can be directly observed using an inverted microscope. In this paper, the design, fabrication, and operation of these devices are discussed. Devices with minimal structure sizes ranging from 3 to 7 lm are presented. The use of these devices to investigate the migration of Dictyostelium discoideum cells toward the chemoattractant folic acid is presented as an example of the devices' utility.

Hospital resource utilization and treatment cost of skeletal-related events in patients with metastatic breast or prostate cancer: estimation for the Portuguese National Health System

BACKGROUND

Skeletal-related events (SREs) occur frequently in patients with bone metastases as a result of breast (BC) and prostate (PC) cancers. They increase both morbidity and mortality and lead to extensive health-care resource utilization.

METHODS

Health care resource utilization by BC/PC patients with at least one SRE during the preceding 12 months was assessed through retrospective chart review. SRE-treatment costs were estimated using the Portuguese Ministry of Health cost database and analyzed using generalized linear models.

RESULTS

This study included 152 patients from nine hospitals. The mean (SD) annual SRE-treatment cost per patient was €5963 (€3646) and €5711 (€4347), for BC (n=121) and PC (n=31) patients, respectively. Mean cost per single episode ranged between €1485 (radiotherapy) and €13,203 (spinal cord compression). Early onset of bone metastasis (P = 0.03) and diagnosis of bone metastases at or after the occurrence of the first SRE (P < 0.001) were associated with higher SRE-treatment costs.

CONCLUSION

These results reveal the high hospital SRE-treatment costs, highlighting the need for early diagnosis and treatment, and identify key factors determining the economic value of therapies for patients with skeletal metastases.

Phomopsins: an overview of phytopathological and chemical aspects, toxicity, analysis and occurrence

Phomopsis leptostromiformis, and its teleomorph Diaporthe toxica, is a lupin pathogen that causes stem blight in young lupins and, as a saprophyte, has been detected on dead lupine material. Under favourable conditions, the fungus produces phomopsins (PHOs), a family of macrocyclic hexapeptide mycotoxins capable of binding tubulin through the tripeptide side chain. The toxic effects appear largely confined to the liver. In particular, the ingestion of PHO contaminated lupin stubble has been linked to lupinosis, a debilitating disease of sheep (the most sensitive animal) characterised by disorientation, blindness, lethargy, and eventually death. The chemical structures of PHO A, B and D have been identified. Analytical methods to determine PHOs are mainly enzyme-linked immunosorbent assays or chromatographic separations, in combination with ultraviolet and mass spectrometric detection. The data about the PHOs occurrence are limited to Australia, restricted to lupin seed. Only one survey has been carried out on lupin seeds and flours from the Swiss market. Not many strategies have been developed to limit lupin seed contamination. Efforts devoted to control lupinosis in Australia focused on the development of cultivars resistant to Phomopsis infection. There are few examples in literature of decontamination or detoxification of PHOs; moreover, they have been shown to be resistant to extensive processing, including cooking. Australia and New Zealand are the only countries that included PHOs in their mycotoxin regulations, with a limit of 5 µg/kg in lupin seeds and derived products. Phomopsins are poorly studied mycotoxins and risk assessment on PHOs has not been done at the European level. The collection of all available scientific data was requested by EFSA in a specific project and partners involved considered it of general interest preparing this review to highlight the limited available information, which indicate that the assessment of potential risk related to PHOs is currently not feasible.

[Innovative materials in orthopaedics: the crosslinked polyethylene (XPE)]

More than 150.000 hip and knee arthroplasties are performed every year in Italy. More than 50% of the patients receive a polyethylene component (Ultra High Molecular Weight PolyEthylene, UHMWPE). Polyethylene abrasive wear induces over time in vivo a foreign-body response and consequently osteolysis, pain and need of implant revision. Furthermore, oxidative wear due to gamma-rays sterilization caused in the '90ies several and severe failures. To solve these problems, since then, the orthopaedics research has been addressed to: 1) develop new cross linked polyethylene with a higher molecular mass than UHMWPE and, consequently, a higher abrasive wear resistance; 2) avoid the oxidative wear induced by gamma-rays sterilization, by using other sterilization methods and by stabilizing UHMWPE by means of antioxidants such as Vitamin E. According to the most recent studies, performed on limited cohorts and mostly funded by manufacturers, cross linked polyethylene shows a better abrasive wear resistance if compared to the conventional polyethylene but no significant differences have been detected in the clinical outcomes. Clinical follow up of Vitamin E stabilized PE are not yet available. The organization of national arthroplasties registries, able to trace and characterize the implanted devices and based on the whole patients population, will facilitate the early detection of devices that show a performance inferior than the expected one. In Italy, the National Institute of Health has been entrusted by the Ministry of Health to organize the national arthroplasty registry.

Optimization of processing conditions for the quantification of enterococci biofilms using microtitre-plates

We performed a comparison of four selected protocols from the literature using microtitre-plate and colorimetric biomass assay for evaluation of enterococci biofilm formation ability and optimized a protocol after the identification and stringent performance of biofilm formation steps. The optimized protocol uses a dynamic model that provided a greater discrimination of enterococci biofilm formation ability, and could better simulate in vivo real conditions. Moreover different biofilm quantification approaches, such as the colorimetric biomass (crystal violet), the resazurin and CFU's assays could be used with the optimized protocol, with adequate reproducibility. This study also recognizes that parameters such as the biofilm formation index (BFi), the cut-off values and the Z' factor provide greater accuracy, possibility of inter and intra laboratory comparison and quality evaluation of the biofilm screening assays, respectively.

Electrospray technique for solid lipid-based particle production

BACKGROUND

Different preparation methods for the production of lipid micro- and nanoparticles as controlled release formulations have been widely developed. Novel techniques are attracting increasing attention for their preparation.

METHOD

The objective of the present investigation was to produce solid lipid-based micro-nanospheres using the electrohydrodynamic atomization (electrospraying) and to evaluate whether it is a suitable method to prepare drug-loaded particles.

RESULTS

Narrowly dispersed spherical particles lower than 1 mum, easily internalized in cells, were obtained using stearic acid and ethylcellulose in a 4.5:0.5 (w/w) ratio. Tamoxifen, as model drug, was encapsulated with good entrapment efficiency. The in vitro release, after an initial burst effect, showed a prolonged drug release.

CONCLUSION

The electrospraying method might be proposed to prepare in a single-step monodisperse lipid-based micro- and nanoparticles in powder form for drug delivery.

[Portuguese recommendations on "How to diagnose, monitor, and treat undifferentiated peripheral arthritis": systematic review of the literature and the experts' opinion]

OBJECTIVE

The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context.

METHODS

An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed.

RESULTS

A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment.

CONCLUSION

Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.

s-Wave interaction in a two-species Fermi-Fermi mixture at a narrow Feshbach resonance

We investigate s-wave interactions in a two-species Fermi-Fermi mixture of 6Li and 40K. We develop for this case the method of cross-dimensional relaxation and find from a kinetic model, Monte Carlo simulations, and measurements that the individual relaxation rates differ due to the mass difference. The method is applied to measure the elastic cross section at the Feshbach resonance that we previously used for the production of heteronuclear molecules. Location (B0=155.09(5)  G) and width are determined for this resonance. This reveals that molecules are being produced on the atomic side of the resonance within a range related to the Fermi energies, therefore establishing the first observation of a many body effect in the crossover regime of a narrow Feshbach resonance.

Assessment of the relationship between the upper and lower arch changes with the opening of the expanding screw after the rapid maxillary expansion

OBJECTIVE

The purpose of this study is to assess the relationship of the upper and lower arch dimension changes after the rapid maxillary expansion (RME) with the screw opening of the modified Hyrax® type appliance.

MATERIALS AND METHODS

Initial (T1) and final (T2) models of study of 63 children between 7 years and 6 months and 16 years and 5 months were performed. From these, 21 showed maxillary atresia and/ or posterior crossbite and were submitted to expansion and 42 children formed the control group .The appliance used in this work was the modified Hyrax appliance using the 7mm expanding screws "Dentarum". The measures of the upper intercanine and the upper and lower intermolar distances were performed in plaster models with the help of a digital paquimeter. The opening of the appliance's screw was also assessed.

RESULTS

The RME provoked a statistically significant increase in the upper interdental distances and no statistic significance in the lower interdental distances, i.e. the change in the 16 - 26, 13 - 23 and 36 - 46 distance was of 5,85 mm, 5,31 and 0,34 mm respectively. The average opening of the expander screw, which was of 6,27 mm.

CONCLUSION

The appliance's opening is related to the interdental distance changes, i.e. for each appliance's opening mm, a 0,94 variation in the upper intermolar distance, a 0,87 in the upper intercanine distance and 0,054 in the lower intermolar distance are provoked.