Re-activating life skills in cancer patients through expressive-creative workshops: A qualitative exploratory study

Background: Cancer strongly impacts on patients' lives, undermining their life skills. This research aimed to explore the perception of efficacy of participants in a series of expressive-creative workshops (ArtLab) designed to reactivate life skills in cancer patients.Methods:Quotations of two semi-structured focus groups with ten participants in ArtLab (Mean Age = 59; SD = 11.19) enrolled at [Fondazione IRCCS Istituto Nazionale dei Tumori] have been analyzed through a priori (top-down) thematic analysis which allowed us to identify life skills provided by WHO 1948: Emotional, Relational and Cognitive.Results:Thematic analysis showed ArtLab program's effectiveness, especially regarding Emotional and Relational life skills. Cognitive skills, instead, seemed to be only partially expressed. Sub-themes articulation for each life skill has been discussed.Conclusion:This study provides encouraging results with respect to the effectiveness of expressive-creative group workshops among cancer patients.

Real time control of water distribution networks: A state-of-the-art review

This paper presents a review of the current state of the art of real time control (RTC) of water distribution networks (WDNs). After proving the basic concept and terms of RTC and presenting sensors, regulation devices and controllers typically used in WDNs, the paper goes on by describing the most frequent control objectives, which mainly include service pressure regulation, control of tank filling and energy production in each WDN district. Various control methodologies recently proposed in the scientific literature are presented and discussed, along with experimental and numerical results achieved. Also, aspects related to the cost-effectiveness of RTC are critically analyzed. The paper ends by giving an outlook into potential future developments in the area of RTC for WDNs.

Prostate-specific antigen percentage: An early predictive tool after iodine-125 interstitial brachytherapy for prostate cancer

BACKGROUND

After interstitial prostate iodine-125 brachytherapy (BT), prostate-specific antigen (PSA) evolution in time could predict overall biochemical relapse, but, considering the single patient, it is influenced by the presentation PSA amount and by the prostatic volume. It is also challenging to differentiate a PSA bounce from a biochemical relapse.

PURPOSE

To determine the usefulness of PSA percentage (PP) defined as the rate between PSA presented by a patient at time "t" and the PSA that the same patient had presented at the time of diagnosis (t0) assumed as 100% in predicting biochemical relapse and in differentiating them from PSA Bounces.

METHODS AND MATERIALS

We included 721 patients from Milan S. Raffaele Turro (399) and Lucca Campo di Marte (then S. Luca) Hospital (322). The mean age of patients was 66.5 years (range, 50-79). Mean followup was 150 months (range, 24-180). For each patient, PSA was recorded before and after iodine-125 BT, and PPs were calculated. Cox regression model, relative operating characteristic curves, and Kaplan-Meier regression model were elaborated, and a cutoff of 20% was defined.

RESULTS

We observed that PP >20% is an independent variable highly associated with relapse risk (p < 0.0001) with a sensitivity of 79.7%, a specificity of 82%, and an hazard ratio of 12.1, since the 6 months of followup. A PSA increase above the nadir should be because of bounce (sensitivity and specificity of 81.4%, p < 0.0001) if patient had experienced at 6 months a PP <20%.

CONCLUSIONS

PP might represent an early and useful tool, predictive of clinical outcome in patients after BT for prostate cancer.

Experimental assessment of level pool routing in preliminary design of floodplain storage

Among control structures in flood management, floodplain storage represents one of the most effective measures, since it holds part of flood volume in a delimited area thus reducing the peak discharge. Sizing of floodplain storage, both on-stream and off-stream, is complex and several methodologies for preliminary design are available in literature, almost all assuming level pool reservoir routing, i.e. the water level in the floodplain is horizontal during the storage filling. Few studies examine the accuracy of that assumption. The present paper work reports an extensive experimental investigation to assess the reliability of level pool routing in the design of on-stream floodplain storages. The good agreement between numerical and experimental values during the filling phase confirmed the reliability of the hypothesis in the preliminary sizing of on-stream floodplain storage. In contrast, even significant differences can be shown during the floodplain draining, due to vegetation and bottom irregularities.

Is prostate-specific antigen percentage decrease predictive of clinical outcome after permanent iodine-125 interstitial brachytherapy for prostate cancer?

OBJECTIVE

To determine the usefulness of prostate-specific antigen (PSA) percentage (vs. pretreatment value assumed as 100%) in prediction of biochemical relapse, after iodine-125 ((125)I) permanent brachytherapy for prostate cancer, to employ a parameter independent by the initial PSA amount and by the individual prostatic volume.

METHODS AND MATERIALS

Our study included 133 patients, 102 still disease free (Group A) and 31 who experienced proven biochemical recurrence (Group B). PSA levels before and after (125)I brachytherapy were recorded, and PSA percentage vs. pretreatment values were calculated. Cox regression model, receiver operating characteristic curves, and Kaplan-Meier regression model with log-rank test were calculated.

RESULTS

We observed that, in patients submitted to brachytherapy for prostate cancer, a PSA percentage >20% of pretreatment value is highly associated with relapse risk (p<0.0001) and that this association is strongly present since t=6 months of followup (p<0.0001), with a hazard ratio near to five times (4.965), a sensitivity of 72.4%, and specificity of 79.8% related to the chosen cutoff.

DISCUSSION

Despite the amount of PSA is the only parameter that the clinicians can deploy to monitor patient's followup after permanent interstitial brachytherapy for prostate cancer, its evolution in time seems unable to predict early biochemical relapse as it is influenced by prostatic volume and initial PSA amount.

CONCLUSIONS

Our data suggest that a PSA percentage >20% of pretreatment value at 6 months might represent an early, inexpensive, and useful predictive tool of bad outcome in patients after permanent brachytherapy.

A new diterpenoid with antispasmodic activity from Salvia cinnabarina

From the leaf surface exudate of the aerial parts of Salvia cinnabarina a new secoisopimarane diterpenoid with a non-specific spasmolytic activity on histamine-, acetylcholine-, and barium chloride-induced contractions in the isolated guinea-pig ileum was obtained. The IC50 value obtained was comparable with that obtained for papaverine. The structure of 3,4-secoisopimara-4(18),7,15-triene-3-oic acid was established by 1D and 2D NMR spectroscopic techniques.

Evaluation of the 1997 tumour, nodes and metastases classification of renal cell carcinoma: experience in 172 patients

OBJECTIVE

To compare the prognostic relevance of the 1987 and 1997 tumour, nodes and metastases (TNM) systems for staging renal cell carcinoma (RCC) in predicting patient outcome.

PATIENTS AND METHODS

A series of 172 consecutive patients with RCC who underwent radical nephrectomy from January 1990 to October 1997 was evaluated comparatively according to the 1987 and 1997 TNM classifications. The median (range) follow-up of the patients was 50 (19-112) months. The probability of survival was estimated by the Kaplan-Meier method, using the log-rank test to estimate differences among levels of the analysed variables.

RESULTS

Using the 1997 TNM classification resulted in a redistribution of 99 patients from stage pT2 on the 1987 TNM classification to stage pT1. As the staging criteria for pT3 and pT4 did not change, there was no re-classification of these patients. Kaplan-Meier survival curves showed a similar separation in 5-year survival between stage pT1 and pT2 using both systems; 100% vs 80% for the 1987 TNM and 86% vs 69% for the 1997 TNM systems. This difference in survival rates between patients with pT1 and pT2 disease was statistically significant only for the 1997 TNM staging system. However, when the 1987 TNM staging classification was applied, the separation in 5-year survival rates between pT2 and pT3 disease was greater.

CONCLUSION

This study confirms the prognostic relevance of the 1987 TNM system, as established in the present patients. The 1997 TNM classification resulted in a better stratification of patients with pT1-pT2 disease, but had similar prognostic value for pT2 and pT3 disease.

Functional evaluation of different ileal neobladders and ureteral reimplantation techniques

OBJECTIVES

To compare and assess the function of ileal neobladders with different reconfiguration and with several types of ureteral reimplantation.

METHODS

Forty-five male patients underwent radical cystectomy and detubularized ileal neobladder. In 20 patients an ileal neobladder was carried out according to Studer's technique, in 12 a 'W'- and in 13 a 'U'-shaped neobladder. In the Studer's patients 60 cm of ileum was used, in the 'W' 40 and in the 'U' 30 cm. For the uretero-ileal anastomosis Nesbit's technique was utilized in the Studer's, in the 'W' and 'U' neobladders Camey Le Duc's technique was performed instead. Four patients underwent a serous-lined extramural tunnel reimplantation. Follow-up included a functional and morphological study of the urinary system and a urodynamic study.

RESULTS

All Nesbit's uretero-ileum anastomoses resulted refluent when the reservoir was filled up, 15 of 50 ureteral reimplantations according to the Camey Le Duc technique showed reflux at full filling. At 3, 6 and 12 months follow-up, the double reconfiguration reservoirs (Studer's and 'W') showed a larger capacity and a lower maximum pressure than neobladders with a single bending. At 12 months, continence and the voiding interval time was significantly higher in the double reconfiguration than in the 'U' neobladders.

CONCLUSION

The double reconfiguration of the reservoir ('W') might be preferable to that with a single one. As for the type of ureteral anastomosis to select, the problem is still debatable even if in our case-control study we have had better results in terms of reflux and stenosis with the uretero-enteric anastomosis with Nesbit's and associated afferent long tubular ileal limb than with Studer's technique.

The use of a modified surgical instrument for the ligation of a Santorini's venous plexus

The authors, after reviewing the literature concerning various instruments used for ligating the Santorini's plexus, have reported their experience to control the dorsal venous complex with a Deschamps' needle modified by themselves.

Urodynamic evaluation of urinary incontinence following radical prostatectomy: our experience

Thirty-four patients after retropubic radical prostatectomy, were evaluated with urodynamic studies. Patients were divided in three groups depending on the degree of urinary continence. A statistically significant difference was found between different groups for the mean functional profile length and maximal urethral closure pressure. Detrusor instability was detected in 11 patients with moderate incontinence and in 1 patient with severe incontinence. Neither differences of age, previous prostatic surgery, tumour extension, nor preservation of the neurovascular bundles had any significant influence on recovery of continence.

Bladder instability and incontinence after radical prostatectomy

Thirty-nine patients were evaluated after retropubic prostatectomy, by urodynamic studies. They were divided into three groups depending upon the degree of urinary continence. A statistically significant difference was found between different groups in mean functional profile length and maximal urethral closure pressure. Differences in age, previous prostatic surgery, tumour extension, or preservation of the neurobundles did not have any significant influence on recovery of continence.

[The ultrasonographic examination in hematuria. Evaluation of its diagnostic possibilities]

Hematuria is a very frequent clinical occurrence and is connected with a number of genito-urinary diseases. Our present work is aimed at checking the usefulness of ultrasonography (US) in etiological diagnostic of hematuria. 516 patients with hematuria and 1788 controls were included in the present study. Renal and urological diseases were found in 74% of patients with hematuria and in 22.7% of those without. Their prevalence is analogous of the general population for those diseases easily detectable by US, such as cystic and heteroplastic diseases. On the contrary, no correspondence was observed for cases of inflammatory, for which echography has never been a reliable diagnostic tool. Furthermore, US sensitivity, if associated with hematuria, was 93%, specificity was 100%, diagnostic accuracy 99% and predictive value about 100%. Ultrasonography is easy to perform, well tolerated, involves low cost and may therefore be considered as the investigation technique of choice for the study of hematuria.

The stomach in liver cirrhosis. Endoscopic, morphological, and clinical correlations

The stomachs of cirrhotic patients are frequently subject to a number of alterations, detectable by endoscopy, the presence of which indicates a disturbance in the mucosa. Several investigators believe that portal hypertension plays an etiopathogenetic role. Three groups of subjects were studied prospectively: 83 cirrhotic patients with portal hypertension, 53 cirrhotic patients without portal hypertension, and 135 control subjects. Snake skin, scarlatina rash, and petechia were the most frequent endoscopic findings in the cirrhotic patients with portal hypertension (P less than 0.001); these findings were also most frequently present in association with each other in this group. There was no correlation between the endoscopic findings, the clinical gravity of liver cirrhosis (Child-Pugh grade), and the gravity of esophageal varices (Beppu score). There were no characteristic inflammatory findings in the gastric mucosa. Hypergastrinemia was often observed in cirrhotic patients with and without angiodysplasias.

The duodenum in liver cirrhosis: endoscopic, morphological and clinical findings

Endoscopic studies were performed to determine whether changes occurred in the duodenum related to portal hypertension in patients with liver cirrhosis. The total of 271 patients studied were subdivided into three groups: 83 patients with liver cirrhosis and portal hypertension, 53 with liver cirrhosis but no portal hypertension, and 135 controls. In the duodenum of cirrhotic patients with portal hypertension several changes were observed on endoscopy that were also present in the other two groups. Atrophy and vascular malformations, however, were present only in the duodenum of cirrhotic patients with portal hypertension, although in only a few patients and with statistical significance only for vascular malformations (p less than 0.01, phi = 0.21). Eleven percent of the patients had more than one endoscopic finding, but the associations of findings were without statistical significance. No statistically significant correlation was observed between the clinical severity of cirrhosis or the severity of esophageal varices and the endoscopic findings. Finally, there was no statistically significant difference between the histological findings of duodenitis in the three groups of patients.

[Ursodeoxycholic acid for the treatment of chronic diseases of the liver. Short-term results]

The tolerance and the effect of ursodehoxycholic acid (UDCA) on the level of transaminases and gammaglutamyl-transpeptidase (GGT) has been estimated, over the short term, in 27 patients affected by compensated liver cirrhosis in comparison to 24 patients, representing the control group. The results were good with regard to GGT values, as a meaningful reduction was observed during the first month of therapy which then improved in the next five months. There was also a significant reduction in transaminase levels at the end of the second month of therapy, which was maintained until treatment was stopped; mean values however were not within the normal range. These results, together with tolerance of the drug confirm a role of UDCA in the treatment of chronic liver diseases in an advanced stage.

[Role of endoscopy in lymphomatous pathology of the digestive tract]

Increasingly frequent reports of lymphoma with a gastro-intestinal primary location have stimulated much interest. Symptomatology has been shown not to be very specific, and scarcely different to that of other gastro-intestinal pathologics, both benign and malignant. The identification of some endoscopic pictures which suggest a lymphomatosic pathology and the possibility of collecting targeted biopsy samples, have placed endoscopy among the most important tests in the diagnostic and staging phase of gastro-intestinal lymphoma. This technique plays an equally important role in the follow-up period, since it allows the therapeutic efficacy of treatment to be assessed and the early identification of possible relapses.