Prevalence and antimicrobial susceptibility of genital Mycoplasmas detected by Mycoplasma IST 2 from urogenital samples in Padua, Italy, between January 2014 and December 2015

<em>Background and aims.</em> The aim of this study is to define the epidemiology and the antimicrobial resistance profile of <em>Ureaplasma</em> spp. and <em>Mycoplasma hominis</em> isolated from urogenital specimens of patients attending the Microbiology and Virology Unit of Padua between January 2014 and December 2015. <br /><em>Materials and methods</em>. The analysis was carried out on a total of 10861 samples. Species identification and antimicrobial susceptibility tests were performed using bioMérieux Mycoplasma IST 2. <br /><em>Results</em>. 2668 samples (24.6%) from 2043 patients were positive: 2466 samples positive for <em>Ureaplasma</em> spp. (1897 patients) and 8 samples positive for <em>M. hominis</em> (8 patients), while in 194 samples (138 patients) was detected a coinfection. As for antimicrobial susceptibility of <em>Ureaplasma</em> spp. we found a resistance (R+I) rate of 90.6% for ciprofloxacin, of 74,1% for ofloxacin, of 52.8% for azithromycin and of 47.0% for erythromycin.<br /><em>Conclusions</em>. Our report shows a high prevalence of <em>Ureaplasma</em> spp. in the study population. Surveillance of antibiotic resistance is critical for an appropriate therapeutic approach, which must always be contextualized with patient’s symptomatology.

Abstract P3-12-06: Saving in clinical trials: A possible challenge for improving health care for breast cancer patients

Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.

Citation Format: Taverniti C, Bonfadini C, Pradotto M, Cagnazzo C, Demartini P, Rossi L, Ignazzi G, Arizio F, Beano A. Saving in clinical trials: A possible challenge for improving health care for breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-06.

White clover: the forgotten component of high-producing pastures?

The contribution of white clover (Trifolium repens L.) to nitrogen fixation and feed quality in mixed pastures is indisputable, but the benefits of clover inclusion to total herbage accumulation (HA) are less clear. Results from four experiments comparing mixed pastures of white clover–perennial ryegrass (Lolium perenne L.) with perennial ryegrass monocultures are presented. These experiments covered a range of environments (dryland northern New Zealand and irrigated southern New Zealand), management inputs (nitrogen (N) fertiliser rates and defoliation management), and genotypes of ryegrass and white clover. Mixtures resulted in a significantly greater HA than did monocultures in 7 of the 8 years for which data were available; the interaction between pasture type (monoculture or mixture) and N rate was significant in six of those years, with a greater advantage in HA for mixtures under low N rates (mean = 3.08 t DM/ha.year) than under high N rates (mean = 1.54 t DM/ha.year). Two-thirds to four-fifths of the yield advantage under grazing was due to the direct effect of clover contribution (which ranged between 10% and 30% of total annual yield) to HA, most of which accrued in summer. The remainder was due to the capture of additional clover-derived N by the grass component of the mixture, estimated to equate to 50–60 kg N/ha under low N-fertiliser rates and 15–35 kg N/ha under high N rates. The magnitude and consistency of the yield advantages observed here indicates that there are unrealised yield and other benefits not currently being captured in New Zealand dairy production systems, largely because they are negated by the use of high N-fertiliser rates. The agronomic practices required to support clover-rich mixed pastures receiving moderate rates of N fertiliser are well documented and can be applied to help deal with nutrient loss limits required by environmental regulations plus volatility in farm-gate milk prices.

Vibrio cholerae non-O1, non-O139 bacteraemia associated with pneumonia, Italy 2016

This paper describes an elderly male patient, living in the Veneto Region, Italy, who developed Vibrio cholerae bacteraemia and pneumonia. Some days previously, while on holiday in the Lagoon of Venice, he had been collecting clams in seawater, during which he suffered small abrasions of the skin. On admission to hospital, he was confused, had fever and a cough, but neither diarrhoea nor signs of gastroenteritis were found. Both blood and stool cultures grew V. cholerae of non-O1 non-O-139 type, and the patient recovered after prompt administration of intravenous ceftriaxone for 2 weeks. This clinical case emphasises the role of global warming and climate changes in causing increasing numbers of water-borne infections.

A new vinyl selenone-based domino approach to spirocyclopropyl oxindoles endowed with anti-HIV RT activity

Herein, we disclose a general and flexible access to spirocyclopropyl oxindoles by a domino Michael/intramolecular nucleophilic substitution pathway with variously substituted vinyl selenones and enolizable oxindoles in aqueous sodium hydroxide solution. The spirocyclopropyl oxindole being a privileged scaffold, some of the synthesized compounds were selected for biological evaluation. Compound showed selective anti-HIV-1 activity thanks to its ability to inhibit the reverse transcriptase.

Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients

PURPOSE

The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features.

METHODS

A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features.

RESULTS

The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %.

CONCLUSION

Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.

Efficacy and Toxicity of Long-Term Administration of 2′,3′-dideoxycytidine in the LP-BM5 Murine-Induced Immunodeficiency Model

The LP-BM5 murine retrovirus-induced immunodeficiency model was used to evaluate the efficacy and toxicity of long-term 2′,3′-dideoxycytidine (DDC) therapy. A mean plasma drug concentration of 0.2 + 0.02 μm of DDC for 3 months was found to reduce splenomegaly, lymphoadenopathy and hypergammaglobulinemia in infected mice. However, DDC also reduced spleen weight in control mice and spleen haemopoiesis in both infected and uninfected animals. In the bone marrow the most prominent feature of DDC treatment was a marked reduction of megakariocytes, while in the liver an hepatocellular vacuolation was evident in uninfected animals. DDC reduced, but did not prevent, LP-BM5 integration in lymph node DNA and Pr 60gag expression in spleen lymphocytes and bone marrow cells. Furthermore, DDC reduced the mitochondrial DNA content and restored the mitogen proliferation of T cells but not that of B cells in infected mice. Thus, DDC appears to be of some, but limited, efficacy in murine AIDS, with a toxicity profile involving more cell types than previously thought.

Inhibition of HIV-1 and LP-BM5 Replication in Macrophages by Dideoxycytidine and Dideoxycytidine 5′-Triphosphate

The antiviral agent 2′,3′-dideoxycytidine (ddC) has been shown to be active against HIV-1 infectivity. However, conflicting results have been reported concerning its efficacy in macrophages. Because macrophages possess low levels of the kinase(s) responsible for ddC phosphorylation, we investigated the ability of ddC and 2′,3′-dideoxycytidine 5′-trisphosphate (ddCTP) to suppress HIV-1 and LP-BM5 replication in these cells. Retrovirus replication was only partially inhibited in the two systems investigated by a high (1 μM) ddC concentration. The direct administration of ddCTP, using autologous red blood cells as a delivery system, was found to inhibit HIV-1 and LP-BM5 replication by more than 90% in macrophages without affecting major cell functions. These data, together with those already reported for FIV [Magnani et al. (1994) AIDS Res Hum Retroviruses 10: 1179-1186], suggest that the anabolic phosphorylation of ddC is an important determinant of its anti-HIV activity and that pharmacological interventions that modulate ddC metabolism may be useful for improving its antiretroviral activity in macrophages.

Vasculogenic potential evaluation of bottom-up, PCL scaffolds guiding early angiogenesis in tissue regeneration

Vascularization is a key factor in the successful integration of tissue engineered (TE) grafts inside the host body. Biological functions of the newly formed tissue depend, in fact, on a reliable and fast spread of the vascular network inside the scaffold. In this study, we propose a technique for evaluating vascularization in TE constructs assembled by a bottom-up approach. The rational, ordered assembly of building blocks (BBs) into a 3D scaffold can improve vessel penetration, and-unlike most current technologies-is compatible with the insertion of different elements that can be designed independently (e.g. structural units, growth factor depots etc.). Poly(ε-caprolactone) scaffolds composed of orderly and randomly assembled sintered microspheres were used to assess the degree of vascularization in a pilot in vivo study. Scaffolds were implanted in a rat subcutaneous pocket model, and retrieved after 7 days. We introduce three quantitative factors as a measure of vascularization: the total percentage of vascularization, the vessels diameter distribution and the vascular penetration depth. These parameters were derived by image analysis of microcomputed tomographic scans of biological specimens perfused with a radiopaque polymer. The outcome of this study suggests that the rational assembly of BBs helps the onset and organization of a fully functional vascular network.

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

BACKGROUND AND AIMS

Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients.

METHODS

We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies.

RESULTS

27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %.

CONCLUSIONS

Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.