What to do in an oncology department to face the new COVID-19 era challenges?

Italy was the first European country to be hit by COVID-19 pandemic. As a consequence, Italian oncologists had to guarantee essential treatments although minimizing exposure to the virus, and accidental infection, of patients and healthcare professionals. As Department of Medical Oncology of the University Hospital of Udine, in this short report, we describe the measures that we have taken, and gradually updated, since February 26, 2020. All accesses to our Oncology facilities are currently regulated by entrance check-points where patients are screened for infections following dedicated algorithms. Up to date, after 6 weeks of systematic execution of swabs no physician, nurse or other individual of the staff has been found positive to COVID-19. Only one patient admitted for therapy has been identified as COVID-19 positive. The aim of our work is to propose a model, made up of a set of operative procedures, that may be adopted by all the oncologists that daily struggle to guarantee safety and care in Oncology during this COVID-19 emergency.

Control of enteric neuromuscular functions by purinergic A(3) receptors in normal rat distal colon and experimental bowel inflammation

BACKGROUND AND PURPOSE

Adenosine A(3) receptors mediate beneficial effects in experimental colitis, but their involvement in enteric neuromuscular functions during bowel inflammation is undetermined. This study investigated the regulatory role of A(3) receptors on colonic motility in the presence of experimental colitis.

EXPERIMENTAL APPROACH

Colitis was induced in rats by 2,4-dinitrobenzenesulfonic acid. A(3) receptors and adenosine deaminase (ADA, adenosine catabolic enzyme) mRNA were examined by RT-PCR. Tissue distribution of A(3) receptors was detected by confocal immunofluorescence. The effects of 2,3-ethyl-4,5-dipropyl-6-phenylpyridine-3-thiocarboxylate-5-carboxylate (MRS1523) (MRS, A(3) receptor antagonist), 2-chloro-N(6) -(3-iodobenzyl)-adenosine-5'-N-methyluronamide (2Cl-IB-MECA) (CIB, A(3) receptor agonist), dipyridamole (DIP, adenosine transport inhibitor) and ADA were assayed on contractile responses evoked by electrical stimulation (ES) or carbachol in colonic longitudinal muscle preparations (LMP).

KEY RESULTS

RT-PCR showed A(3) receptors and ADA mRNA in normal colon and their increased level in inflamed tissues. Immunofluorescence showed a predominant distribution of A(3) receptors in normal myenteric ganglia and an increased density during colitis. MRS enhanced ES-induced cholinergic contractions in normal LMP, but was less effective in inflamed tissues. After pretreatment with dipyridamole plus ADA, to reduce extracellular adenosine, CIB decreased cholinergic motor responses of normal LMP to ES, with enhanced efficacy in inflamed LMP. A(3) receptor ligands did not affect carbachol-induced contractions in LMP from normal or inflamed colon.

CONCLUSIONS AND IMPLICATIONS

Normally, adenosine modulated colonic cholinergic motility via activation of A(3) receptors in the myenteric plexus. A(3) receptor-mediated tonic inhibitory control by adenosine was impaired in inflamed bowel, despite increased density of functioning and pharmacologically recruitable A(3) receptors.

A reasonable methodology to estimate the relationship between workload and human resources demand in a cancer unit

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Background: Costs of cancer care account for a growing proportion of European health care spending. Despite the rising price of new cancer drugs draws the attention of medical oncologists and decision makers, personnel spending takes the largest share of health care costs. Nonetheless, few data exist about the relationship between workload and human resources demand in a cancer unit. Here we describe an empirical model to determine staffing requirements according to the annual number of patients. Methods: The Department of Oncology at the University Hospital of Udine, Italy, is a computerized Unit within the regional cancer network taking care of about 1,500 pts/year. Each clinical episode is recorded on a centralized database. Standard time limits are set for different types of consultation. We queried the database to obtain the total number of consultations for every pt taken charge of by the Unit during 2006. Considering both the time scheduled for each type of visit and the number of yearly working hours per employee, we could reach a reasonable estimate of the annual physician and nurse hours per pt and of the number of needed personnel. Results: In 2006, each case generated an average of 16 clinical evaluations, with small differences among breast, lung and colorectal cancer. Corresponding physician- and nurse-time per pt was of 8 and 16 hours, respectively. For the first year - in Units with a mean number of 1,500 pts/year - this translates into a global amount of about 12,000 physician- and 24,000 nurse-hours and a needed number of 7 physicians and 13 nurses, respectively. In the second year, the same cases induced a mean of 4.5 consultations; using a similar approach, the demand for additional time and resources could be estimated as well. Conclusions: A preliminary assessment of the time required for different types of consultation, together with a centralized recording of each clinical episode, allows a reasoned estimate of needed time and personnel resources, thus providing a simple tool to determine the total staff expenditure of a cancer unit.

No significant financial relationships to disclose.

Cytochrome P450 and radiopharmaceutical metabolism

Positron emission tomography (PET) is a powerful non-invasive probe to investigate human physiology. A large number of radiotracers have been studied as imaging agents, but only a few have found clinical applications in pharmacology. A potential radiopharmaceutical is designed with very specific physiochemical characteristics, but, generally, less attention is paid to its adsorption, distribution, metabolism, and excretion properties, especially metabolism. Understanding the metabolic fate of radiopharmaceutical probes is essential for an accurate analysis and interpretation of PET measurements. The inherent inability of PET to differentiate between a parent compound and its metabolites confounds the interpretation of images and may impact the identification of the pathologically induced biochemical changes under investigation. Cytochrome P450 plays a major role in mammalian xenobiotic biotransformation and many in vitro methods are available to study and predict drug metabolism. The purpose of this review is to highlight the existing in vitro techniques available to investigate the biotransformation of xenobiotics in a fashion analogous to small molecule drug discovery. The aim is to facilitate the development and validation phases of PET tracers during preclinical evaluation. Emphasis is placed also on describing how cross species comparisons are essential in establishing appropriate translational pharmacology. Procedures of analysis (tandem liquid chromatography-mass spectrometry), typically used for studying the metabolism of drugs, are proposed as quick and accurate tools for the determination of a radiopharmaceutical's metabolic stability at the tracer level.

Ozonation of Reactive Blue 81 in the bubble column

The decolourisation process of the Reactive Blue 81 was carried out in a laboratory bubble column reactor with inner diameter 110 mm and working height 550 mm, equipped with a porous glass ozone diffuser (diameter 50 mm). A model of ozone absorption with the chemical reaction in the liquid phase was employed. It was found that the decolourisation proceeds in the fast pseudo first-order regime. The average value of the enhancement factor was calculated from the experimental results and compared with those calculated according to the theory of mass transfer with a second-order chemical reaction. In order to determine the intrinsic kinetics of ozonation, a stopped-flow technique was employed. The rate constant of the dyestuff reaction with ozone was determined as equal to 4.5 x 10(7) mol/(dm3.s).