The economic and fiscal impact of incremental use of cell-based quadrivalent influenza vaccine for the prevention of seasonal influenza among healthcare workers in Italy

BACKGROUND

Seasonal influenza has a significant impact on public health, generating substantial direct healthcare costs, production losses and fiscal effects. Understanding these consequences is crucial to effective decision-making and the development of preventive strategies. This study aimed to evaluate the economic and the fiscal impact of implementing an incremental strategy for seasonal influenza prevention using the cell-based quadrivalent influenza vaccine (QIVc) among healthcare workers (HCWs) in Italy.

METHODS

To estimate the economic impact of implementing this strategy, we performed a cost analysis that considered direct healthcare costs, productivity losses and fiscal impact. The analysis considered a 3-year time horizon. A deterministic sensitivity analysis was also conducted.

RESULTS

Assuming a vaccination coverage rate of 30% among HCWs, the analysis considered a total of 203 018 vaccinated subjects. On analysing the overall differential impact (including direct costs, indirect costs and fiscal impact), implementing QIVc vaccination as a preventative measure against influenza among HCWs in Italy would yield societal resource savings of €23 638.78 in the first year, €47 277.56 in the second year, and €70 916.35 in the third year, resulting in total resource savings of €141 832.69.

CONCLUSIONS

The study demonstrated that implementing the incremental use of QIVc as part of a preventive strategy for seasonal influenza among HCWs in Italy could yield positive economic outcomes, especially in terms of indirect costs and fiscal impact. The resources saved could be utilized to fund further public health interventions. Policy-makers should consider these findings when making decisions regarding influenza prevention strategies targeting HCWs.

Absorbed dose evaluation of a blood irradiator with alanine, TLD-100 and ionization chamber

Irradiation of blood bags using X-ray irradiators and dosimetry services are required to ensure uniform dose levels in the range 25-50 Gy to prevent Transfusion Associated Graft versus Host Disease (TA-GvHD). An absorbed dose characterization of a Raycell MK2 X-Irradiator was performed using three different dosimetric systems. Results showed a dosimetric accuracy of the ionization chamber together with the Alanine dosimeter. TLDs measurements exhibited a small overestimation by 4% of the absorbed dose. The Dose Uniformity Ratio (DUR), between maximum and minimum dose levels in the canister, was in good agreement with the manufacturer specifications (≤1.5).

Epidemiological Impact of Metabolic Syndrome in Overweight and Obese European Children and Adolescents: A Systematic Literature Review

The prevalence of overweight and obesity is continuously increasing, both in the adult and pediatric populations, posing a substantial challenge to public health. Understanding the epidemiological burden of metabolic syndrome (MetS) among children, particularly regarding its complications and long-term effects in adulthood, is crucial for identifying effective preventive measures and enhancing the clinical care of obese children. Therefore, by searching two databases, a systematic review was conducted in order to evaluate studies that specifically addressed the epidemiological MetS impact among overweight/obese European children and adolescents. Overall, 15 studies were considered. The epidemiological data concerning the MetS impact were contingent on the diagnostic criteria used and varied across countries, resulting in a prevalence range of 1.44% to 55.8%. Spanish studies were the most numerous (34%), revealing a country prevalence rate ranging from 2.5% to 19.6%. Males (prevalence range: 1.4-55.8%) and subjects with overweight/obesity (prevalence range: 12.9-55.8%) were mainly affected. Obesity emerged as the main risk factor in the MetS development and the consequent onset of cardiovascular complications and diabetes. Knowing the MetS burden and its risk factors could improve their prevention, detection, and treatment, and guide the development of targeted public health interventions to appropriately address the health needs of younger patients.

The Impact of Vaccination on COVID-19 Burden of Disease in the Adult and Elderly Population: A Systematic Review of Italian Evidence

COVID-19 is a major global health threat, with millions of confirmed cases and deaths worldwide. Containment and mitigation strategies, including vaccination, have been implemented to reduce transmission and protect the population. We conducted two systematic reviews to collect nonrandomized studies investigating the effects of vaccination on COVID-19-related complications and deaths in the Italian population. We considered studies conducted in Italian settings and written in English that contained data on the effects of vaccination on COVID-19-related mortality and complications. We excluded studies that pertained to the pediatric population. In total, we included 10 unique studies in our two systematic reviews. The results showed that fully vaccinated individuals had a lower risk of death, severe symptoms, and hospitalization compared to unvaccinated individuals. The review also looked at the impact of vaccination on post-COVID-19 syndrome, the effectiveness of booster doses in older individuals, and nationwide adverse events. Our work highlights the crucial role that vaccination campaigns have played in reducing the burden of COVID-19 disease in the Italian adult population, positively impacting the pandemic trajectory in Italy.

Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

BACKGROUND

Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care.

METHODS

A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy.

RESULTS

Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery.

CONCLUSIONS

PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.

Cervical cancer elimination in Italy: Current scenario and future endeavors for a value based prevention

Background

Cervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level.

Methods

The study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy.

Results

As for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7-89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates.

Conclusions

The assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices.

The frequency of UTIs in people who undertake intermittent catheterization: A systematic review

Background

Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC.

Methods

A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included.

Results

Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted.

Conclusions

Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients’ quality of life and also reduce the impact of diseases associated with this procedure on health systems and society.

Key messages

Peristomal skin complications in ileostomy and colostomy patients: a systematic literature review

Background

Peristomal skin complications (PSCs) are one of the main post-operative complications of ostomy surgery. They have a considerable impact on patients’ quality of life and represent a challenge for healthcare professionals involved in their management. The majority of PSCs is preventable and costly. Knowing their burden could guide decision makers on the ostomy patients’ management who are predominantly cancer and chronic bowel disease patients. Thus, the aim of this study was to summarize existing literature regarding the clinical-epidemiological burden of PSCs in ostomy patients.

Methods

A systematic literature review was performed querying three database (PubMed, Scopus, Web of Science) from January 2012 to February 2022. It included studies in English language and focused on the clinical and epidemiological burden of PSCs in the adult patients with ileostomy and colostomy.

Results

Overall, 35 studies were considered. Epidemiological data on PSCs were not systematically collected in the available literature. The principal underlying disease requiring the ostomy surgery were rectal, colon and gynaecological cancers, inflammatory bowel diseases, diverticulitis, occlusion and intestinal perforation. It was described a range of PSCs from 11% to 45%. The PSCs were most commonly erythema, papules, erosion, ulceration and vesciculation. Skin complications increased the average number of hospitalization days and of hospital readmission within 120-day following surgery.

Conclusions

The data on PSCs are still limited. Estimating the PSCs burden could support healthcare professionals and decision makers called upon to identify the most appropriate responses to patients’ health needs. The management of these complications plays a vital role to improve patient’s quality of life and a multidisciplinary approach with the active involvement of stomatherapist, surgeon and dermatologist is critical. Furthermore, a better patient education and empowerment is needed.

Key messages

• Developing a multidisciplinary approach to managing PSCs is essential in order to provide the best treatment possible and the best outcomes for patients.

• Further studies should be conducted in order to better define the clinical-epidemiological burden of ileo- and colostomies and to support better health planning.

The Economic and Fiscal Impact of Influenza Vaccination for Health Care Workers in Italy

Influenza has a significant impact on the health care system and also on production and economic systems. Vaccinated health care workers (HCWs) are more likely to have improved productivity compared to unvaccinated workers. The study aim was to estimate the economic and fiscal impact of an influenza vaccination program for HCWs in Italy. We performed a cost analysis aimed to estimate the indirect costs (productivity losses due to working days lost) and the increase in tax revenues derived from the increase in vaccination coverage among HCWs. Assuming an incremental increase in vaccination coverage of 10% per year over a period of 5 years, total savings could be obtained in terms of a reduction in productivity losses equal to −€4,475,497.16 and an increase in tax revenues of €327,158.84. This revenue could be used to finance other health interventions. Our results are fundamental in view of the sustainability of health systems and of a value-based allocation of health resources. Therefore, a complete social perspective, including the fiscal impact of flu vaccination, should be adopted to assess the economic value of influenza vaccines. Currently, health policies based on the whole value of flu vaccination are needed.

Economic Aspects in the Management of Diabetic Macular Edema in Italy

Background

Diabetic Macular Edema (DME) is the most common cause of vision loss in diabetic patients. Currently, the Vascular Endothelial Growth Factor inhibitors (anti-VEGFs) are used as the first line of DME treatment and corticosteroid implants are usually used as a second-line treatment. These implants are a safe and effective therapeutic option that can improve the quality of life of DME patients by reducing the intravitreal injections number. We determined the economic impact related to DME, also from the social perspective, and the consequences of the increased use of the dexamethasone implant.

Methods

The analysis compares two scenarios: the first based on the current rate of recourse to the therapeutic alternatives available in the Italian healthcare setting (as is) and the second based on the assumption of an increased recourse to dexamethasone implants (to be). The results are expressed both in terms of the resource absorption associated with the two scenarios and in terms of the cost differential yielded by their comparison.

Results

The increased use of the dexamethasone implant allows considerable savings in terms of healthcare professionals' time, follow-up and productivity lost by patients/caregivers. These savings would reduce healthcare costs for the management of DME patients in Italy by €2,058,238 in 5 years.

Conclusions

To optimize the healthcare resources allocation, it is necessary to implement treatments that yield not only cost reductions but also a clinical benefit for patients. The dexamethasone implant use is an example of DME management that generates value for patients, health system and society.

Seasonal influenza in children: Costs for the health system and society in Europe

Background

Methods

Results

Conclusion

HPV Vaccination in Women Treated for Cervical Intraepithelial Neoplasia: A Budget Impact Analysis

Human Papillomavirus (HPV) is the most common sexually transmitted infection. Its progression is related to the development of malignant lesions, particularly cervical intraepithelial neoplasias (CINs). CINs correlate with a higher risk of premature births, and their excisional and ablative treatment further increases this risk in pregnant women. These complications are also correlated with higher healthcare costs for their management. In Italy, more than 26,000 new cases of CINs are estimated to occur yearly and their economic burden is significant. Therefore, the management of these conditions is a public health priority. Since HPV vaccination is associated with a reduced risk of relapse in women surgically treated for HPV-related injuries, we estimated the economic impact of extending HPV vaccination to this target population. This strategy would result in a significant reduction in the general costs of managing these women, resulting in an overall saving for the Italian Health Service of €155,596.38 in 5 years. This lower cost is due not only to the reduced incidence of CINs following vaccination, but also to the lower occurrence of preterm births. Extending HPV vaccination to this target population as part of a care path to be offered to women treated for HPV injuries is therefore desirable.

Acquired neuromyotonia in thymoma-associated myasthenia gravis: a clinical and serological study

Background and purpose

Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinical prognostic significance of such comorbidity is largely unknown. The clinico‐pathological features were investigated along with the occurrence of neuromyotonia as predictors of tumour recurrence in patients with thymoma‐associated myasthenia.

Methods

A total number of 268 patients with thymomatous MG were studied retrospectively. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell‐surface proteins and cell‐based assays for contactin‐associated protein 2 (CASPR2), leucine‐rich glioma inactivated 1 (LGI1), glycine receptor and Netrin‐1 receptor antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography abnormalities and/or autoantibodies against LGI1/CASPR2.

Results

Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, four with typical autoantibodies, including LGI1 (n = 1), CASPR2 (n = 1) or both (n = 2). Three patients had Netrin‐1 receptor antibodies, two with neuromyotonia and concomitant CASPR2+LGI1 antibodies and one with spontaneous muscle overactivity without electromyography evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than in those without (28/263, 10%, P < 0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.93–0.97], Masaoka stage ≥IIb (OR 10.73, 95% CI 2.38–48.36) and neuromyotonia (OR 41.78, 95% CI 4.71–370.58).

Conclusions

De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumour recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG.

Control of Probe Density at DNA Biosensor Surfaces Using Poly(l-lysine) with Appended Reactive Groups

Biosensors and materials for biomedical applications generally require chemical functionalization to bestow their surfaces with desired properties, such as specific molecular recognition and antifouling properties. The use of modified poly(l-lysine) (PLL) polymers with appended oligo(ethylene glycol) (OEG) and thiol-reactive maleimide (Mal) moieties (PLL-OEG-Mal) offers control over the presentation of functional groups. These reactive groups can readily be conjugated to, for example, probes for DNA detection. Here we demonstrate the reliable conjugation of thiol-functionalized peptide nucleic acid (PNA) probes onto predeposited layers of PLL-OEG-Mal and the control over their surface density in the preceding synthetic step of the PLL modification with Mal groups. By monitoring the quartz crystal microbalance (QCM) frequency shifts of the binding of complementary DNA versus the density of Mal moieties grafted to the PLL, a linear relationship between probe density and PLL grafting density was found. Cyclic voltammetry experiments using Methylene Blue-functionalized DNA were performed to establish the absolute probe density values at the biosensor surfaces. These data provided a density of 1.2 × 10¹² probes per cm² per % of grafted Mal, thus confirming the validity of the density control in the synthetic PLL modification step without the need of further surface characterization.

What is the optimal management of an intra-operative air leak in a colorectal anastomosis?

AIM

An airtight anastomosis on intra-operative leak testing has been previously demonstrated to be associated with a lower risk of clinically significant postoperative anastomotic leak following left-sided colorectal anastomosis. However, to date, there is no consistently agreed upon method for management of an intra-operative anastomotic leak. Therefore, we powered a noninferiority study to determine whether suture repair alone was an appropriate strategy for the management of an intra-operative air leak.

METHOD

This is a retrospective cohort analysis of prospectively collected data from a tertiary care referral centre. We included all consecutive patients with left-sided colorectal or ileorectal anastomoses and evidence of air leak during intra-operative leak testing. Patients were excluded if proximal diversion was planned preoperatively, a pre-existing proximal diversion was present at the time of surgery or an anastomosis was ultimately unable to be completed. The primary outcome measure was clinically significant anastomotic leak, as defined by the Surgical Infection Study Group at 30 days.

RESULTS

From a sample of 2360 patients, 119 had an intra-operative air leak during leak testing. Sixty-eight patients underwent suture repair alone and 51 underwent proximal diversion or anastomotic reconstruction. The clinically significant leak rate was 9% (6/68; 95% CI: 2-15%) in the suture repair alone arm and 0% (0/51) in the diversion or reconstruction arm.

CONCLUSION

Suture repair alone does not meet the criteria for noninferiority for the management of intra-operative air leak during left-sided colorectal anastomosis. Further repair of intra-operative air leak by suture repair alone should be reconsidered given these findings.

Characterization of Self-Assembled Monolayers on a Ruthenium Surface

We have modified and stabilized the ruthenium surface by depositing a self-assembled monolayer (SAM) of 1-hexadecanethiol on a polycrystalline ruthenium thin film. The growth mechanism, dynamics, and stability of these monolayers were studied. SAMs, deposited under ambient conditions, on piranha-cleaned and piranha + H₂SO₄ cleaned substrates were compared to monolayers formed on H-radical-cleaned Ru surfaces. We found that alkanethiols on H-radical-cleaned Ru formed densely packed monolayers that remained stable when kept in a nitrogen atmosphere. X-ray photoelectron spectroscopy (XPS) shows a distinct sulfur peak (BE = 162.3 eV), corresponding to metal-sulfur bonding. When exposed to ambient conditions, the SAM decayed over a period of hours.

High prevalence of diabetes-specific autoimmunity in first-degree relatives of Sardinian patients with type 1 diabetes

BACKGROUND

The incidence of type 1 diabetes mellitus (T1DM) in Sardinia is among the highest in the world (44.8 cases/100,000 person-years). Recommendations of the Immunology of Diabetes Society advise evaluating autoantibody positivity in first-degree relatives (FDRs) of patients with T1DM, for their higher risk to develop the disease. The aim of this study was to determine the prevalence of beta-cell autoimmunity in FDRs of T1DM patients in Sardinia.

METHODS

A total of 188 Sardinian families were recruited in collaboration between diabetes and pediatric units of university and district hospitals in Sardinia. The recruitment involved 188 patients with diagnosed T1DM and all their available FDRs (n = 447). Autoantibodies (Aabs) against GAD, IA2, insulin, and ZnT8 were measured in all subjects. Human leukocyte antigen (HLA) risk genotypes (HLA-DR and DQ loci) were analyzed in 43 Aabs-positive FDR.

RESULTS

The prevalence of Aabs (any type of autoantibody, single or multiple) in FDR was 11.9% (53/447). Of those with autoantibodies, 62.3% (33/53) were positive to only 1 autoantibody, 22.6% (12/53) had 2 autoantibodies, 7.55% (4/53) had 3 autoantibodies, and 7.55% (4/53) had all 4 autoantibodies. Typing of HLA-DR and DQ loci showed that 89% of FDR carried moderate- to high-risk genotypes, with only 5 FDR with low-risk genotypes.

CONCLUSIONS

The prevalence of T1DM autoantibodies in FDRs of T1DM patients was very high (11.9%) in the Sardinian population, higher than in other populations from the United States and Europe, and similar to that observed in Finland. Autoantibody positivity strongly associated with HLA risk. This study provides evidence of the high risk of T1DM in FDR of T1DM patients in Sardinia and warrants longitudinal follow-up to estimate the risk of progression to T1DM in high-risk populations.

Learning curves of a resident surgeon performing transobturator tape procedures for stress urinary incontinence

OBJECTIVE

To evaluate the number of procedures necessary for an untrained resident surgeon to learn transobturator tension-free vaginal tape (TVT-O) procedures for treatment of stress urinary incontinence (SUI).

METHODS

A prospective study was performed among patients aged 18-75 years who underwent TVT-O procedures at a center in Rome, Italy, between March 2, 2009, and November 30, 2012. The TVT-O procedure was performed by a right-handed resident surgeon working under the supervision of an expert surgeon. Total and partial operative times were recorded.

RESULTS

Among 18 patients included in analysis, the mean operative time was 22.2minutes (range 7-44). All total operative times fell within the confidence interval after the 10th procedure, with a difference between the mean times recorded in the first nine and the last eight procedures (29.5 vs 13.1minutes; P<0.001). The resident surgeon required nine procedures to learn right tunneling and 13 to learn left tunneling.

CONCLUSION

Ten procedures were required for a resident surgeon to learn TVT-O procedures for SUI.

Nanocatalysis in Flow

Nanocatalysis in flow is catalysis by metallic nanoparticles (NPs; 1-50 nm) performed in microstructured reactors. These catalytic processes make use of the enhanced catalytic activity and selectivity of NPs and fulfill the requirements of green chemistry. Anchoring catalytically active metal NPs within a microfluidic reactor enhances the reagent/catalyst interaction, while avoiding diffusion limitations experienced in classical approaches. Different strategies for supporting NPs are reviewed herein, namely, packed-bed reactors, monolithic flow-through reactors, wall catalysts, and a selection of novel approaches (NPs embedded on nanotubes, nanowires, catalytic membranes, and magnetic NPs). Through a number of catalytic reactions, such as hydrogenations, oxidations, and cross-coupling reactions, the advantages and possible drawbacks of each approach are illustrated.

The role of ovarian fossa evaluation in patients with ovarian endometriosis

PURPOSE

The aim of this study is to evaluate prospectively the presence of endometriosis in the peritoneum of the ovarian fossa of patients affected by endometriomas and its correlation with the adhesion between this peritoneum and endometrioma.

METHODS

Patients presenting ovarian endometriomas and candidate to laparoscopy were considered for inclusion in the study. Patients underwent laparoscopic excision of endometriomas. The presence of adherence of the ovarian fossa to endometrioma was investigated. In all patients, the removal of a peritoneum fragment from the ovarian fossa of the affected ovary was carried out.

RESULTS

68 patients were enrolled in the study. 48 patients presented adhesions to the ovarian fossa. Histopathologic examination of the peritoneum of the ovarian fossa revealed the presence of endometriosis in 87 % of patients presenting adhesions of the endometriomas with ovarian fossa; surprisingly it was present only in 15 % of patients not presenting this condition (p < 0.0001). Pain symptoms were more frequent in patients with endometriomas adhesion to the ovarian fossa. CA125 levels were not statistically significantly different between groups. At 12-month follow-up, four patients presented endometrioma recurrence. All of them presented adhesion of the ovarian fossa to the endometrioma in the first operation.

CONCLUSIONS

There is a strong association between adhesion of the endometriomas to the ovarian fossa and the presence of endometriosis on the peritoneal surface of the fossa. This condition significantly correlates with pain symptoms and may predict endometrioma recurrence. The removal of this peritoneum in case of adherent endometrioma may potentially reduce the incidence of recurrence.

Dendrimer-encapsulated Pd nanoparticles as catalysts for C–C cross-couplings in flow microreactors

Dendrimer-encapsulated Pd nanoparticles anchored within continuous flow microreactors are efficient for C–C cross-coupling reactions. This is witnessed by the good catalytic performance for the Heck–Cassar and Suzuki–Miyaura couplings.

The impact of gynecologic oncology training in the management of cancer patients: is it really necessary? A prospective cohort study

OBJECTIVES

To assess patients' perceptions of physician, nurse, and care organization quality of care and services received during hospitalization with or without a sub-specialized setting in gynaecological oncology.

STUDY DESIGN

Consecutive patients affected by gynaecologic cancer, referred to the Division of Gynaecology of University Campus Bio-Medico of Rome to underwent to surgery (surgical ward) or to chemotherapy (medical ward) from January 2010 to April 2014, were enrolled. Eligible subjects were divided into two groups: Group A: standard unit care, consisting of doctors and nurses without a specific training and Group B: Expert unit care, consisting of doctors and nurses with specific training in gynecologic oncology. Patients were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer Module (QLQ-C30) and the Patient Satisfaction Questionnaire (IN-PATSAT32).

RESULTS

The sample (n = 150) is organized into two groups: 78 patients (Group A) and 72 patients (Group B). Analysing the results of IN-PATSAT32, comparing Group A versus Group B, we find statistically significant difference considering doctors' information provision (items 7-9) (p = 0.0470), nurses' technical skills (items 12-14) (p = 0.0369) and nurses' information provision (items 18-20) (p = 0.0089) and general satisfaction (item 32) (p = 0.0214).

CONCLUSIONS

This study highlights the potential benefits specialty training for doctors and nurses that work in an oncologic ward (surgical or medical). In fact, the necessity for a separate sub-specialty in gynaecological oncology and a distinct training programme may be the key to achieve the higher satisfaction in this setting of patients.

Uracil-DNA glycosylases-structural and functional perspectives on an essential family of DNA repair enzymes

Uracil-DNA glycosylases (UDGs) are evolutionarily conserved DNA repair enzymes that initiate the base excision repair pathway and remove uracil from DNA. The UDG superfamily is classified into six families based on their substrate specificity. This review focuses on the family I enzymes since these are the most extensively studied members of the superfamily. The structural basis for substrate specificity and base recognition as well as for DNA binding, nucleotide flipping and catalytic mechanism is discussed in detail. Other topics include the mechanism of lesion search and molecular mimicry through interaction with uracil-DNA glycosylase inhibitors. The latest studies and findings detailing structure and function in the UDG superfamily are presented.

Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study

PURPOSE

Studies on the influence of CO₂ pneumoperitoneum on the abdominal cavity during robotic procedures are lacking. This is the first study to evaluate surgical field modifications related to CO₂ pressure, during laparoscopic and robotic surgery.

METHODS

Consecutive patients scheduled for laparoscopic or robotic hysterectomy were enrolled in the study. To evaluate the level of operative field visualization, a dedicated form has been designed based on the evaluation of four different areas: Douglas space, vesico-uterine fold and, bilaterally, the broad ligament. During the initial inspection, an assistant randomly set the CO₂ pressure at 15, 10 and 5 mmHg, and the surgeon, not aware of the CO₂ values, was asked to give an evaluation of the four areas for each set pressure.

RESULTS

In laparoscopic group, CO₂ pressure significantly influenced the surgical field visualization in all four areas analyzed. The surgeon had a good visualization only at 15 mmHg CO₂ pressure; visualization decreased with a statistically significant difference from 15 to 5, 15-10 and 10-5 mmHg. In robotic group, influence of CO₂ pressure on surgical areas visualization was not straightforward; operative field visualization remained stable at any pressure value with no significant difference.

CONCLUSIONS

Pneumoperitoneum pressure significantly affects the visualization of the abdomino-pelvic cavity in laparoscopic procedures. Otherwise, CO₂ pressure does not affect the visualization of surgical field during robotic surgery. These findings are particularly significant especially at low CO₂ pressure with potential implications on peritoneal environment and the subsequent post-operative patient recovery.

Improved catalytic activity and stability using mixed sulfonic acid- and hydroxy-bearing polymer brushes in microreactors

Sulfonic acid-bearing polymer brushes were grown on the inner walls of continuous flow glass microreactors and used in the acid-catalyzed hydrolysis of benzaldehyde dimethyl acetal as a test reaction. Randomly 1:1 mixed polymer brushes of poly-3-sulfopropyl methacrylate (PSPM) and poly-2-hydroxyethyl methacrylate (PHEMA) showed a 6-fold increase of the TOF value compared to the solely PSPM-containing microreactor. This remarkable improvement is attributed to the cooperative stabilizing effect of proximal OH groups on the active sulfonic acid moieties within the brush architecture. In fact, the rational mixing of SPM with methyl methacrylate (MMA) as an OH-free comonomer caused a drop in the activity of the resulting catalytic platform. A 5-fold increase of the TON of the 1:1 PSPM-PHEMA versus the PSPM homopolymer brush systems additionally demonstrates the substantial increase in the stability of the mixed brushes catalytic platform, which could be continuously run over 7 days without significant loss of activity. The 1:1 PSPM-PHEMA mixed brush catalytic system also showed a good activity in the deprotection of 2-benzyl tetrahydropyranyl ether.

Structure of the uracil complex of Vaccinia virus uracil DNA glycosylase

Poxvirus uracil DNA glycosylases are the most diverse members of the family I uracil DNA glycosylases (UNGs). The crystal structure of the uracil complex of Vaccinia virus uracil DNA glycosylase (D4) was determined at 2.03 Å resolution. One uracil molecule was located in the active-site pocket in each of the 12 noncrystallographic symmetry-related D4 subunits. Although the UNGs of the poxviruses (including D4) feature significant differences in the characteristic motifs designated for uracil recognition and in the base-excision mechanism, the architecture of the active-site pocket in D4 is very similar to that in UNGs of other organisms. Overall, the interactions of the bound uracil with the active-site residues are also similar to the interactions previously observed in the structures of human and Escherichia coli UNG.

Gallium-containing polymer brush film as efficient supported Lewis acid catalyst in a glass microreactor

Polystyrene sulfonate polymer brushes, grown on the interior of the microchannels in a microreactor, have been used for the anchoring of gallium as a Lewis acid catalyst. Initially, gallium-containing polymer brushes were grown on a flat silicon oxide surface and were characterized by FTIR, ellipsometry, and X-ray photoelectron spectroscopy (XPS). XPS revealed the presence of one gallium per 2-3 styrene sulfonate groups of the polymer brushes. The catalytic activity of the Lewis acid-functionalized brushes in a microreactor was demonstrated for the dehydration of oximes, using cinnamaldehyde oxime as a model substrate, and for the formation of oxazoles by ring closure of ortho-hydroxy oximes. The catalytic activity of the microreactor could be maintained by periodic reactivation by treatment with GaCl3.

Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer

5093

Background: The aim of this study is to evaluate the efficacy, in terms of overall survival and progression free survival, and safety of adjuvant chemotherapy after neoadjuvant chemotherapy followed by radical surgery both in patients with and without node metastases. Methods: Between June 2000 to May 2007, all patients with diagnosis of locally advanced cervical cancer referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were elegible for this protocol.All enrolled patients received 3 cycles of platinum-based chemotherapy every 3 weeks according to the scheme cisplatin 100 mg/mq and paclitaxel 175 mg/mq. After neoadjuvant chemotherapy all patients with stable or progression to treatment were excluded from the protocol, all other were submitted classical radical hysterectomy and bilateral systematic pelvic lymph node dissection, and after to adjuvant treatment with 6 cycles of platinum based chemotherapy with cisplatin 100 mg/mq and paclitaxel 175 mg/mq. Results: 110 patients with local advanced cervical cancer received the treatment with neoadjuvant chemotherapy followed by radical surgery and adjuvant chemotherapy.Our study focused on clinical and operative data , in terms of overall survival and disease free survival at 5 and 3 years. 5-year OS of our series was 78% at five years and 86% at 3-years, with encouraging results also in subgroup with and without node mestastases. Conclusions: The adjuvant chemotherapy regimen after neoadjuvant chemotherapy and radical surgery rappresents a valid treatment option for patients with locally advanced cervical cancer without lymph node involvement, both in terms of overall survival than in terms of disease-free interval, the results have also confirmed the validity of this approach in lymph node metastases, with a complication rate lower than the standard radio-chemotherapy regime.

Does HE4 have a role in the recurrence of ovarian cancer?

e15550

Background: Human epididymis protein 4 (HE4) has been recently described as a new marker for early ovarian cancer, with higher sensitivity (76.9%) compared to CA125. This is the third study in literature on the role of HE4 in recurrence of ovarian cancer and the first evaluating the sensitivity of HE4 and CA125 in these patients Methods: Plasma was obtained 24 hours before secondary cytoreductive surgery from consecutive patients with suspicious recurrence ovarian cancer operated from November 2010 to April 2011 at University Campus Bio-Medico of Rome. CA125 levels were evaluated by a one-step "sandwich" radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 cut-off was less than 35 U/mL. Two cut-off were considered for HE4: less than 150 pmol/L (according to the manufacturer's indications) and less than 70 pmol/L. Results: Fourteen patients were histologically confirmed as recurrence ovarian cancer. Mean Ca125 plasma concentration was 31.95 ± 22.09 U/mL (range 1.1 – 64.3). Mean HE4 plasma concentration was 225.83± 286.82 pmol/L (range 21.61- 633.6). The sensitivity of CA125 was 35.7 %. The sensitivity of HE4 was 71.4% and 28.6% above the cut-off of 70 pmol/L and 150 pmol/L, respectively. The dual marker combination of CA125 and HE4 at 70 pmol/L cut-off yielded the highest sensitivity (85.7%) to detect recurrence ovarian cancer. Conclusions: Even if a standard cut-off point has not been determined, this study suggested that HE4 may potentially be a more sensible marker for recurrence ovarian cancer than CA125 and the association between CA125 and HE4 at cut-off of 70 pmol/L seems to yield the highest sensitivity.

Use of liposome encapsulated doxorubicin citrate (LEDC) as a valid drug in patients affected by ovarian cancer suffering from chemotherapy side-effects

e15547

Background: Doxorubicin had a wide spectrum of cytotoxic activity in gynecological cancer. Moreover, this drug is associated with chronic cardiac toxicity, often irreversible, which limits lifetime dose. A new liposomal formulations has been developed in the past decades to limite side-effects of doxorubicin: liposome encapsulated doxorubicin citrate (LEDC). In this study we report our experience with LEDC in patients affected by advanced/recurrent gynaecological cancer, suffering from chemotherapy side effects. Methods: From 2000 to December 2008, 43 patients who showed palmoplantar erythrodysesthesia (PPE) during adjuvant or palliative setting treatment of metastatic/recurrent epithelial ovarian cancer. All patients enrolled in the study were treated with liposomal encapsulated doxorubicin citrate (LEDC), administered at the dose of 50 mg/mq every 3 weeks until disease progression or adverse effects. Results: We have enrolled 43 patients who suspended previously chemotherapy treatment for severe PPE. A total of 32 patients completed planned 6 cycles of chemotherapy. After 6 cycles of chemotherapy 3 out of 43 patients (6%) continued to show a complete response, 9 patients (20%) maintained partial response, 16 patients (37%) showed stable disease and 4 patients (9%) suffered disease progression. No severe G3–G4 hematologic toxicity was showed, but neutropenia and anemia continued to be the most common side effects. No cutaneous toxicity were reported. Conclusions: LEDC is a well tolerated drug and a valid alternative in patients affected by ovarian cancer suffering from cutaneous toxicity by other drugs.

The novel biomarker HE4 versus CA125 in detecting endometrial cancer: A case control prospective study

5094

Background: In endometrial cancer, there are no markers routinely used in clinical practice. This study prospectively investigates the sensitivity and specificity of new marker HE4 in detection of endometrial cancer. Methods: Serum samples were prospectively obtained 24 hours before surgery from 25 patients with endometrial cancer and from 25 patients with uterine benign pathology, operated from January 2011 to October 2011 at University Campus Bio-Medico of Rome. Preoperative CA125 levels were evaluated by a one-step “sandwich” radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 normal value is considered less than 35 U/mL. Two HE4 cut-off are considered: less than 70 pmol/L and less than 150 pmol/L. The specificity analysis was performed using the parametric T-Test for comparing the HE4 series and the Mann-Whitney test for the CA125 series. The level of statistical significance is set at p < 0.05. Results: The sensitivity of CA125 in detecting endometrial cancer is 16% whereas the sensitivity of HE4 is 48% and 28 % for 70 pmol/L and 150 pmol/L cut-off respectively. The specificity of HE4 is 100% (positive predictive value = 100%, negative predictive value = 65.79% and 58.14% considering the two HE4 cut-off, respectively), whereas the CA125 specificity is 72 % (positive predictive value = 36.36%, negative predictive value = 46.15%) in detection of endometrial cancer. Conclusions: HE4 has a good sensitivity and a specificity of 100% in detection of endometrial cancer and may be useful for detecting early stage endometrial cancer. In particular the HE4 at cut-off of 70 pmol/L yields the best sensitivity and specificity.

Use of carboplatinum as neoadjuvant setting for patients affected by locally advanced cervical cancer

e15553

Background: The aim of this study is to evaluate the efficacy and safety of the combination of carboplatin and paclitaxel as neoadjuvant chemotherapy (NACT) in patients affected by locally advanced cervical cancer. Methods: Between June 2007 to May 2009, all patients with diagnosis of IB2-IIB cervical cancer were considered eligible for this protocol. All enrolled patients received 3 cycles of carboplatin (AUC6) and paclitaxel at 175 mg/mq in neadjuvant setting. The chemotherapy induced toxicity and response to the treatment were evaluated according to World Health Organization criteria. Results: We have enrolled 23 patients with diagnosis of locally advanced cervical cancer. A total of 22 patients completed planned 3 cycles of neoadjuvant chemotherapy. After 3 cycles of chemotherapy 9 out of 23 patients (42%) showed a complete response, 7 patients (35%) partial response, 5 patients (16%) stable disease and 2 patients (11%) showed disease progression. The most common toxicity was haematologic (43%), extra haematologic toxicities were nausea/vomiting, neuropathy and alopecia, that occurred in 45%, 13% and 25% respectively. No renal and grade 3 and 4 haematologic toxicities were registered. Conclusions: Our results suggest that the use of carboplatin, in neadjuvant setting, is a well tolerated drug, produces manageable toxicity with a response rate similar to standard cisplatin. Then, it rappresents a valid alternative in patients affected by locally advanced cervical cancer.

Surgical primary treatment of stage IVA cervical cancer: A multicenter retrospective study

e15551

Background: The aim of the present study is to describe feasibility, surgical technique, perioperative data, early and late complications of anterior and total pelvic exenteration after neoadjuvant chemotherapy as primary treatment for stage IVa cervical cancer. Methods: It is a retrospective study which included 73 consecutive patients affected by stage IVa cervical cancer who required anterior or total pelvic exenteration referred to 3 international gynaecologic oncology centres. The steps of this extirpative surgical procedure were: 1) staging laparotomy; 2) frozen section biopsy of the paraaortic lymph nodes; 3) systematic lymphadenectomy, radical hysterectomy with adnexectomy and total or anterior pelvic exenteration; 4) continent urinary diversions and low colorectal anastomosis if it was possible. Results: The treatment of patients affected by FIGO stage IVA cervical cancer remains one of the most complex procedures gynecologic oncologists are faced with. Our study focused on clinical and operative data , in terms of overall survival (OS) and disease free survival (DFS) at 5 years. 5-year OS of our series was 43%. Conclusions: The surgical treatment of stage IVA cervical cancer appears therefore a suitable and valid alternative. Stage IVA cervical cancer patients in good general condition, with a disease resectable with clear surgical margins, should be considered for primary exenteration in referral centers where the surgical experience to perform this procedure is available.

How often do patients return to the operating room after colorectal resections?

AIM

We sought to identify the rate of re-operation after an index colorectal surgical procedure and potential contributing risk factors.

METHOD

This is a retrospective cohort study from the American College of Surgeons National Surgical Quality Improvement Program. We identified all patients who either returned or did not return to the operating room after any colorectal resection from January 2005 to December 2008.

RESULTS

From a total cohort of 635, 265 patients included in the National Surgical Quality Improvement Program over the 4-year study period, we identified 54, 237 patients who underwent colorectal operations. A return to the operating room was coded in 5.4 ± 0.1% of non colorectal resection patients and 7.6 ± 0.2% of colorectal resection patients (P < 0.001). The multivariate model identified patients with postoperative diagnostic codes for abdominal cavity hernia or colostomy complication as having the highest odds of return to the operating room within 30 days. Patients returning to the operating room had longer length of stay and higher overall mortality compared with those patients who did not return to the operating room.

CONCLUSION

Return to the operating room is a relatively common occurrence after colorectal resections, with an associated high rate of mortality. Given the association between return to the operating room and adverse patient outcomes, emphasis should be placed on determining strategies to reduce the need for return to the operating room.