Radiofrequency echographic multispectrometry compared with dual X-ray absorptiometry for osteoporosis diagnosis on lumbar spine and femoral neck

An innovative, non-ionizing technique to diagnose osteoporosis on lumbar spine and femoral neck was evaluated through a multicenter study involving 1914 women. The proposed method showed significant agreement with reference gold standard method and, therefore, a potential for early osteoporosis diagnoses and possibly improved patient management.

INTRODUCTION

To assess precision (i.e., short term intra-operator precision) and diagnostic accuracy of an innovative non-ionizing technique, REMS (Radiofrequency Echographic Multi Spectrometry), in comparison with the clinical gold standard reference DXA (dual X-ray absorptiometry), through an observational multicenter clinical study.

METHODS

In a multicenter cross-sectional observational study, a total of 1914 postmenopausal women (51-70 years) underwent spinal (n = 1553) and/or femoral (n = 1637) DXA, according to their medical prescription, and echographic scan of the same anatomical sites performed with the REMS approach. All the medical reports (DXA and REMS) were carefully checked to identify possible errors that could have caused inaccurate measurements: erroneous REMS reports were excluded, whereas erroneous DXA reports were re-analyzed where possible and otherwise excluded before assessing REMS accuracy. REMS precision was independently assessed.

RESULTS

In the spinal group, quality assessment on medical reports produced the exclusion of 280 patients because of REMS errors and 78 patients because of DXA errors, whereas 296 DXA reports were re-analyzed and corrected. Analogously, in the femoral group there were 205 exclusions for REMS errors, 59 exclusions for DXA errors, and 217 re-analyzed DXA reports. In the resulting dataset (n = 1195 for spine, n = 1373 for femur) REMS outcome showed a good agreement with DXA: the average difference in bone mineral density (BMD, bias ± 2SD) was -0.004 ± 0.088 g/cm² for spine and - 0.006 ± 0.076 g/cm² for femur. Linear regression showed also that the two methods were well correlated: standard error of the estimate (SEE) was 5.3% for spine and 5.8% for femur. REMS precision, expressed as RMS-CV, was 0.38% for spine and 0.32% for femur.

CONCLUSIONS

The REMS approach can be used for non-ionizing osteoporosis diagnosis directly on lumbar spine and femoral neck with a good level of accuracy and precision. However, a more rigorous operator training is needed to limit the erroneous acquisitions and to ensure the full clinical practicability.

The epidemiology of osteoporosis in Italian postmenopausal women according to the National Bone Health Alliance (NBHA) diagnostic criteria: a multicenter cohort study

PURPOSE

The study was aimed at evaluating the prevalence of osteoporosis, defined by BMD and the National Bone Health Alliance (NBHA) criteria, and the prevalence of clinical risk factors for fractures in Italian postmenopausal women.

METHODS

This is a cross-sectional, multicenter, cohort study evaluating 3247 postmenopausal women aged ≥ 50 and older in different areas of Italy in the period 2012-2014. All the participants were evaluated as far as anthropometrics; questionnaires for FRAX^® and DeFRA calculation were administered and bone mineral density was measured at lumbar spine, femoral neck and total hip by DXA.

RESULTS

The prevalence of osteoporosis, as assessed by BMD and NBHA criteria was 36.6 and 57%, respectively. Mean ± SD values of FRAX^® and DeFRA were: 10.2 ± 7.3 and 11 ± 9.4 for major fractures, and 3.3 ± 4.9 and 3.9 ± 5.9 for hip fractures, respectively. Among clinical risk factors for fracture, the presence of previous fracture, particularly non-spine/non-hip fracture, parental history of hip fracture and current smoking were the most commonly observed.

CONCLUSIONS

Our study showed that more that the half of postmenopausal women aged 50 and older in Italy has osteoporosis on the basis of the NBHA criteria. There is a relevant high risk of femur fracture, as assessed by the FRAX^® and DeFRA and previous fracture, parental history of hip fracture and current smoking are the most common risk factors. The data should be considered particularly in relation to the need to increase prevention strategies on modifiable risk factors and therapeutic intervention.

Protein arginine methyltransferase 5 has prognostic relevance and is a druggable target in multiple myeloma

Arginine methyltransferases critically regulate cellular homeostasis by modulating the functional outcome of their substrates. The protein arginine methyltransferase 5 (PRMT5) is an enzyme involved in growth and survival pathways promoting tumorigenesis. However, little is known about the biologic function of PRMT5 and its therapeutic potential in multiple myeloma (MM). In the present study, we identified and validated PRMT5 as a new therapeutic target in MM. PRMT5 is overexpressed in patient MM cells and associated with decreased progression-free survival and overall survival. Either genetic knockdown or pharmacological inhibition of PRMT5 with the inhibitor EPZ015666 significantly inhibited growth of both cell lines and patient MM cells. Furthermore, PRMT5 inhibition abrogated NF-κB signaling. Interestingly, mass spectrometry identified a tripartite motif-containing protein 21 TRIM21 as a new PRMT5-partner, and we delineated a TRIM21-dependent mechanism of NF-κB inhibition. Importantly, oral administration of EPZ015666 significantly decreased MM growth in a humanized murine model of MM. These data both demonstrate the oncogenic role and prognostic relevance of PRMT5 in MM pathogenesis, and provide the rationale for novel therapies targeting PRMT5 to improve patient outcome.

Observation of 7pP23/2→7dD2 optical transitions in 209 and 210 francium isotopes

We report on the direct experimental observation of the 7pP2_3/2→7dD2 optical transitions in 209 and 210 francium isotopes. By continuously monitoring the fluorescence emitted by the isotopes collected in a magneto-optical trap (MOT), the electric dipole transitions 7pP2_3/2→7dD2_5/2 of Fr209, not yet experimentally observed, and 7pP2_3/2→7dD2_5/2, 7pP2_3/2→7dD2_5/2 of Fr210 were detected as sub-Doppler depletion dips of the cold atom population. This approach allowed unambiguous identification of the excited state hyperfine structures, even in the absence of a large stable vapor. Our findings demonstrate the effectiveness and the flexibility of fluorescence monitoring of trap depletion upon laser excitation, and broaden the experimental knowledge of francium isotopes and their electronic and nuclear properties. These results will have a relevant impact on ongoing researches for low-energy testing of fundamental symmetries with francium, from atomic parity non-conservation to the electron dipole moment.

Impact of residual disease after "unplanned excision" of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single Institution

BACKGROUND

Soft tissue sarcomas are often inappropriately excised; it is, however, still a matter of debate whether the presence of residual disease in the re-excision specimen can affect patients' prognosis. The aim of this study is to investigate the impact of re-excision after unplanned surgery of primary soft tissue sarcomas (STS) of the extremities.

PATIENTS AND METHODS

We retrospectively evaluated 452 adults with grade 2-3, localized STS (349 primary and 103 unplanned excisions).

RESULTS

In the re-excision group, a full 43% of the patients had residual tumor. The re-excision group achieved a significantly better outcome in terms of sarcoma-specific survival (SS) (p = 0.002), local recurrence (LR) (p = 0.004) and distant metastasis (DM) (p = 0.028). Residual tumor was associated with a higher risk of DM (p = 0.005).

CONCLUSION

We confirm that unplanned surgery does not compromise patients' prognosis; scar re-excision guarantees at least the same SS, LR and DM rates compared to STS primarily treated in a referral center. Routine use of radiation therapy after re-excision could improve local control. Distant metastases seem to be negatively affected by the presence of residual tumor, and therefore, the use of CT in deep and large STS is suggested. The main goal is to avoid unplanned surgery by referring suspected lumps (especially deep, large, increasing in size) to a specialist center.

The impact on disability of initial treatment with methotrexate in patients with rheumatoid arthritis: results from the MARI study

The study aimed to assess in a population of subjects with rheumatoid arthritis (RA) treated with methotrexate (MTX) how the initial approach to the treatment influenced subsequent disability. We performed a cross-sectional analysis of data collected during the baseline visit of the MARI study, a multicenter observational study on patients with RA on treatment with MTX for at least 12 months. Subjects who fulfilled the Health Assessment Questionnaire (HAQ) were included in the evaluation. For every patient we retrospectively evaluated the disease duration, the duration of symptoms before the diagnosis, the time elapsed before first MTX treatment, the initial MTX dose, and the concomitant medications in the first six months of therapy. Disability was defined as a DI-HAQ score ≥1. The study population included 1015 subjects. Patients with a DI-HAQ score ≥1 had a longer duration of symptoms before diagnosis, a higher delay in treatment initiation, a lower initial dose of MTX and a more frequent co-treatment with symptomatic drugs. Disability was found less frequently in subjects treated with other concomitant disease modifying anti-rheumatic drugs (DMARDs) but not with biological agents. Logistic regression analysis identified as significant predictors of disability: older age, female sex, a longer time to complete diagnosis, a delay in starting MTX treatment higher than 6 months, and a concomitant treatment with symptomatic drugs, while a combination therapy with other DMARDs was associated with a lower risk of disability. A late diagnosis and a delay in starting a treatment with MTX are associated with poorer functional outcomes in patients with RA.

Effect of supplementation with linseed or a blend of aromatic spices and time on feed on fatty acid composition, meat quality and consumer liking of meat from lambs fed dehydrated alfalfa or corn

Cross-bred lambs (n=72) were fed finishing diets using a factorial arrangement of treatments: BASAL DIET (alfalfa pellets or corn), SUPPLEMENT (none, linseed or aromatic spices), TIME ON FEED (41 or 83days). Carcass and meat quality traits, fatty acid composition, color stability and consumer liking were determined. Feeding alfalfa improved sensory ratings and fatty acid composition of lamb. However, corn or longer alfalfa feeding would be recommended if heavier and fatter carcasses are sought. Consumer liking and fatty acid composition of lamb were improved with addition of spices and linseed, respectively. But additional antioxidant strategies should be considered to delay meat color deterioration during storage if lambs are fed corn-linseed for 83days. Although alfalfa basal diet and linseed supplementation improved fatty acid composition, feeding the basal diets for at least 41days resulted in low n-3 fatty acid concentrations in muscle.

Experience of the Rizzoli Institute in Radiofrequency Thermal Ablation of Musculoskeletal Lesions

Thermal ablation with radiofrequency (RF) is gaining increasing attention for the treatment of musculoskeletal lesions. This treatment offers several advantages compared to other methods: reduced invasiveness, low cost, and short hospitalisation time. In June 2001 we began using RF thermal ablation on osteoid osteomas (OO) in the appendicular and axial skeleton. Later, we also treated local benign and/or malignant tumors, some surgical recurrences, and some secondary localizations. Altogether we have performed over 270 procedures, mainly on OO. The experience we have gained has led us to think that the indication for this treatment can be extended to other thermosensitive lesions.

Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy

PURPOSE

To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity.

METHODS AND MATERIALS

537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis.

RESULTS

The mean age was 74 (range 46-91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months. G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively. Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p < 0.01) were found to be statistically significant on the occurrence of late fibrosis, but a multivariate analysis did not show any factors connected. The boost administration (p < 0.01), the breast volume (p = 0.05), dose inhomogeneities (p < 0.01) and boost volume (p = 0.04) were found to be statistically significant as concerns the occurrence of acute skin reaction at the univariate analysis, but only the boost administration (p = 0.02), at multivariate analysis.

CONCLUSIONS

The results of our study, according to the large randomized trials, confirmed that hypofractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity.

Database of research structures in public and private institutions in the south of Italy

The development of the research project "The scientific system in Southern Italy" of the National Research Council has required a series of studies aimed at enhancing the knowl edge and analysis of specific problems of southern Italy (Mez zogiorno). The methodology of a specific inquiry about the structure and the research activities of the institutions operat ing in the Mezzogiorno is presented. The project included setting up a database with a conceptual schema which concerns structures, activities and ongoing research projects in public and private institutions in the Mezzogiorno, that can be con sidered as necessary infrastructure, in order to know the geo graphical distribution of the existing deficiencies and the more advanced areas in science and technology. The prototype of the database includes all public and private institutions carry ing out R&D activities but does not yet include academic structures. It also contains information and data on related activities such as training courses, scientific information and documentation activities.

The need to choose a formal data model which will allow the correct execution of the design of the complex conceptual schema has been resolved by the adoption of the second generation formal model Entity Relationship. This model, be sides being the object of much research in the academic world, has been widely used in industrial applications also because it is highly functional as a "common language" for end-users and analysts in the description of requirements and solutions. The main characteristics of the tool used to develop the database, ADEPT (Application Design with Entity Relationship Program ming Techniques) are explained. Examples of basic informa tion on research units and the main menus for database queries are given.