Detection of clustered circulating tumour cells in early breast cancer.

Circulating tumour cell (CTC) clusters have been proposed to be major players in the metastatic spread of breast cancer, particularly during advanced disease stages. Yet, it is unclear whether or not they manifest in early breast cancer, as their occurrence in patients with metastasis-free primary disease has not been thoroughly evaluated. In this study, exploiting nanostructured titanium oxide-coated slides for shear-free CTC identification, we detect clustered CTCs in the curative setting of multiple patients with early breast cancer prior to surgical treatment, highlighting their presence already at early disease stages. These results spotlight an important aspect of metastasis biology and the possibility to intervene with anti-cluster therapeutics already during the early manifestation of breast cancer.

A novel method for the isolation of single cells mimicking circulating tumour cells adhered on Smart Bio Surface slides by Laser Capture Microdissection.

In recent years, the importance of isolating single cells from blood circulation for several applications, such as non-invasive tumour diagnosis, the monitoring of minimal residual disease, and the analysis of circulating fetal cells for prenatal diagnosis, urged the need to set up innovative methods. For such applications, different methods were developed. All show some weaknesses, especially a limited sensitivity, and specificity. Here we present a new method for isolating a single or a limited number of cells adhered to SBS slides (Tethis S.p.a.) (a glass slide coated with Nanostructured Titanium Dioxide) by Laser Capture Microdissection (LCM) and subsequent Whole Genome Amplification. SBS slides have been shown to have an optimal performance in immobilizing circulating tumour cells (CTCs) from early breast cancer patients. In this work, we spiked cancer cells in blood samples to mimic CTCs. By defining laser parameters to cut intact samples, we were able to isolate genetically intact single cells. We demonstrate that SBS slides are optimally suited for isolating cells using LCM and that this method provides high-quality DNA, ideal for gene-specific assays such as PCR and Sanger sequencing for mutation analysis.

Antibody purification-independent microarrays (PIM) by direct bacteria spotting on TiO2-treated slides.

The preparation of effective conventional antibody microarrays depends on the availability of high quality material and on the correct accessibility of the antibody active moieties following their immobilization on the support slide. We show that spotting bacteria that expose recombinant antibodies on their external surface directly on nanostructured-TiO(2) or epoxy slides (purification-independent microarray - PIM) is a simple and reliable alternative for preparing sensitive and specific microarrays for antigen detection. Variable domains of single heavy-chain antibodies (VHHs) against fibroblast growth factor receptor 1 (FGFR1) were used to capture the antigen diluted in serum or BSA solution. The FGFR1 detection was performed by either direct antigen labeling or using a sandwich system in which FGFR1 was first bound to its antibody and successively identified using a labeled FGF. In both cases the signal distribution within each spot was uniform and spot morphology regular. The signal-to-noise ratio of the signal was extremely elevated and the specificity of the system was proved statistically. The LOD of the system for the antigen was calculated being 0.4ng/mL and the dynamic range between 0.4ng/mL and 10µg/mL. The microarrays prepared with bacteria exposing antibodies remain fully functional for at least 31 days after spotting. We finally demonstrated that the method is suitable for other antigen-antibody pairs and expect that it could be easily adapted to further applications such as the display of scFv and IgG antibodies or the autoantibody detection using protein PIMs.

Impact of SARS-CoV-2 Infection in Children with Asthma and Impact of COVID-19 Vaccination: Current Evidence and Review of the Literature.

The clinical aspects of SARS-CoV-2 infection, as well as the COVID-19 vaccines' safety, efficacy and effectiveness in pediatric patients with asthma, are crucial to adapting clinical management in this fragile population and for prevention strategies. The aim of this narrative review was to evaluate the impact of SARS-CoV-2 infection in children with asthma and the impact of COVID-19 vaccination. Systematic research using the principal medical databases was conducted using specific search query strings from the early spreading of COVID-19 globally until March 2023; further relevant data were drawn from the main national and supranational institutions. No significant differences in SARS-CoV-2 incidence and morbidity were found in asthmatic pediatric patients compared to non-asthmatic ones; however, subjects with uncontrolled asthma were found to be at increased risk of developing a serious disease during SARS-CoV-2 infection. Regarding COVID-19 vaccines, accumulating data support their safety, efficacy and effectiveness on asthmatic children regardless of asthma severity. Further cohort-based studies are needed as the evidence of new epidemic waves caused by new viral variants makes the current knowledge outdated.

Liquid Biopsy Detecting Circulating Tumor Cells in Patients with Non-Small Cell Lung Cancer: Preliminary Results of a Pilot Study.

Lung cancer is still the leading cause of cancer-related death worldwide. Interest is growing towards early detection and advances in liquid biopsy to isolate circulating tumor cells (CTCs). This pilot study aimed to detect epithelial CTCs in the peripheral blood of early-stage non-small cell lung cancer (NSCLC) patients. We used Smart BioSurface® (SBS) slide, a nanoparticle-coated slide able to immobilize viable nucleated cellular fraction without pre-selection and preserve cell integrity. Forty patients undergoing lung resection for NSCLC were included; they were divided into two groups according to CTC value, with a cut-off of three CTCs/mL. All patients were positive for CTCs. The mean CTC value was 4.7(± 5.8 S.D.) per ml/blood. In one patient, next generation sequencing (NGS) analysis of CTCs revealed v-raf murine sarcoma viral oncogene homolog B(BRAF) V600E mutation, which has also been identified in tissue biopsy. CTCs count affected neither overall survival (OS, p = 0.74) nor progression-free survival (p = 0.829). Multivariable analysis confirmed age (p = 0.020) and pNodal-stage (p = 0.028) as negative predictors of OS. Preliminary results of this pilot study suggest the capability of this method in detecting CTCs in all early-stage NSCLC patients. NGS on single cell, identified as CTC by immunofluorescence staining, is a powerful tool for investigating the molecular landscape of cancer, with the aim of personalized therapies.

Peer support between healthcare workers in hospital and out-of-hospital settings: a scoping review.

BACKGROUND AND AIM: The healthcare workers, mostly in emergency departments, are exposed to emotionally strong situations that can lead to psychological trauma. Often those who experience the "second victim" phenomenon find comfort in dealing with Peers that can help to understand emotions and normalize lived experiences. A scoping review was conducted to clarify the key concepts available in the literature and understand Peer Support characteristics and methods of implementation.  Methods. Scoping review J.B.I. approach was used. The reviewers analyzed the last twenty-one years of literature and extracted data from relevant studies.  Results. The research revealed 49 articles that discuss Peer Support in the healthcare system. Often articles involve healthcare workers without work area and role distinctions. 56% of the articles have been published in the last two years and the Anglo-Saxon countries are the main geographical area of ​​origin (82%). Peer support emerges as a preclinical psychological support for people involved in tiring situations. It's based on mutual respect and on voluntary and not prejudicial help. Peers are trained to guide the support relationship and identify the signs of possible pathologies. Peer Support can be proposed as one to one/group peer support, or through online platforms.  Conclusion. It can be said that Peer Support programs had an important development in the years of the Covid 19 pandemic. Many of the studies affirm that the personnel involved have benefited from the programs available. It is necessary to carry out further research to determine the pre and post intervention benefits.

Advanced competence in intensive care unit: expectations, role ambiguity between physicians and nurses in intensive care units. Multi - method survey.

BACKGROUND AND AIM: The roles of physicians and nurses have undergone profound changes in recent years, becoming more complex and creating, at times, overlapping competencies with consequent negative repercussions in terms of problems related to autonomy and inter-professional collaboration. The study aims to detect the opinions of intensive care physicians and nurses with respect to their skills and role expectations. METHOD: The study was conducted in two phases. In the first phase, with a qualitative design, data were collected through the focus group. In the second phase, with quantitative design, an ad hoc questionnaire was constructed from the results of the previous phase.   Results: 3 main themes emerged from the focus groups: the need to increase the system of inter-professional collaboration; autonomy and professional role; and the need for a shared advanced training system for physicians and nurses. The results of the questionnaire show that both professionals believe that the development of advanced skills does not lead to conflicting situations and role ambiguity unless the skills are recognized and respected. Both professionals agree that it is useful and necessary to implement a shared educational pathway.   Conclusion: Inter-professional collaboration, specialist skills and specific training are a key element of the ICU teamwork.

The experience of the emergency psychologist during the Covid-19 pandemic.

BACKGROUND AND AIM OF THE WORK: the new coronavirus pandemic COVID-19 has had a strong psy- chological impact on the world population. Volunteer psychologists, and psychologists that work in the emer- gencies have also been exposed to the consequences of the impact of the pandemic. The purpose of this study was to explore the experiences of the psychologist during the Covid-19 emergency intervention. METHODS: an exploratory study, following a qualitative design using Focus Group method was adopted. A total of 24 psychologists was recruited from volunteers of the "Pronto Pșy - Covid-19" service, organized by the Ital- ian Society of Emergency Psychology Social Support, Emilia Romagna. Focus Group Discussions (FGDs) was held about: their experiences during the online psychological support; needs detected by users; training needs that emerged during the intervention and professional skills applied. RESULTS: five themes were identi- fied: psychological distress of rescuers; online emergency setting; support of colleagues and gratitude as stress management strategies; need of skill and tools in pandemic emergency intervention; integrated psychological intervention. DISCUSSION: the stress reaction of the emergency psychologists was due in particular to the type of emergency and lack of standardized approach. The group meetings represented an important resource to face traumatic stress. CONCLUSIONS: this study showed the role the need for specific tools for pandemic intervention to protect the well-being of the professional from impact of stress. Further research is needed. (www.actabiomedica.it).

The intervention of the emergency psychologist: the SIPEM SoS Emilia Romagna during the first lockdown from COVID-19.

Background and purpose of this work: WHO 11 March 2020 declares that Sars-Cov-2 infection is not only a health emergency but must be considered a pandemic. Covid-19 required the urgency of a new psychological intervention model to better address the crisis and ensure a direct support response to the people involved in the pandemic. The present study aimed to detect the symptoms and reactions of the population with respect to the event. The survey was carried out by describing the clinical symptoms that emerged from the triage card used by SIPEM SoS Emilia Romagna (Italy), connoting the criteria of emergency psychology. METHODS: A retrospective quantitative study was conducted on 288 psychological triage cards. RESULTS: only 11% of users who ask for support say they are positive while 85% report not having contracted the virus. Of the total, 40.9% call for psychological support in the management of anxiety symptoms, a need also reported by 55% of the subsample who declared previous psychological problems. In reaction to the pandemic event, 51.1% of the total refers to coping resources and availability for help. DISCUSSIONS: the need for support of the population to manage symptoms highlights the need for early interventions, also to facilitate that slice of the population that does not have effective individual coping strategies and resources available to help. CONCLUSIONS: it can be deduced that interventions during these types of emergencies must be timely and aimed not only at those affected but also at the general population.

Pirin delocalization in melanoma progression identified by high content immuno-detection based approaches.

BACKGROUND: Pirin (PIR) is a highly conserved nuclear protein originally isolated as an interactor of NFI/CTF1 transcription/replication factor. It is a member of the functionally diverse cupin superfamily and its activity has been linked to different biological and molecular processes, such as regulation of transcription, apoptosis, stress response and enzymatic processes. Although its precise role in these functions has not yet been defined, PIR expression is known to be deregulated in several human malignancies. RESULTS: We performed immunohistochemical analysis of PIR expression in primary samples from normal human tissues and tumors and identified a dislocation of PIR to the cytoplasm in a subset of melanomas, and a positive correlation between cytoplasmic PIR levels and melanoma progression. PIR localization was subsequently analyzed in vitro in melanoma cell lines through a high content immunofluorescence based approach (ImmunoCell-Array). CONCLUSIONS: The high consistency between in vivo and in vitro results obtained by immunohistochemistry and ImmunoCell-Array provides a validation of the potential of ImmunoCell-Array technology for the rapid screening of putative biological markers, and suggests that cytoplasmic localization of PIR may represent a characteristic of melanoma progression.

Characterization of cluster-assembled nanostructured titanium oxide coatings as substrates for protein arrays.

Protein microarray technologies are rapidly expanding to fulfill current needs of proteome discovery for disease management. Nanostructured materials have been shown to present interesting features when used in biological settings: nanostructured titanium oxide film (ns-TiOx), synthesized by supersonic cluster beam deposition (SCBD), has recently emerged as a biocompatible substrate in different biological assays. The ns-TiOx surface is characterized by a morphology at the nanoscale that can be tuned to modulate specific biomolecule-material interactions. Here we present a systematic characterization of ns-TiOx coatings as protein binding surfaces, comparing their performances with those of most common commercial substrates in protein and antibody microarray assays. Through a robust statistical evaluation of repeatability in terms of coefficient of variation (CV) analysis, we demonstrate that ns-TiOx can be used as reliable substrate for biochips in analytical protein microarray application.

Recruitment of the histone methyltransferase SUV39H1 and its role in the oncogenic properties of the leukemia-associated PML-retinoic acid receptor fusion protein.

Leukemia-associated fusion proteins establish aberrant transcriptional programs, which result in the block of hematopoietic differentiation, a prominent feature of the leukemic phenotype. The dissection of the mechanisms of deregulated transcription by leukemia fusion proteins is therefore critical for the design of tailored antileukemic strategies, aimed at reestablishing the differentiation program of leukemic cells. The acute promyelocytic leukemia (APL)-associated fusion protein PML-retinoic acid receptor (RAR) behaves as an aberrant transcriptional repressor, due to its ability to induce chromatin modifications (histone deacetylation and DNA methylation) and silencing of PML-RAR target genes. Here, we indicate that the ultimate result of PML-RAR action is to impose a heterochromatin-like structure on its target genes, thereby establishing a permanent transcriptional silencing. This effect is mediated by the previously described association of PML-RAR with chromatin-modifying enzymes (histone deacetylases and DNA methyltransferases) and by recruitment of the histone methyltransferase SUV39H1, responsible for trimethylation of lysine 9 of histone H3.

ImmunoCell-Array: a novel technology for pathway discovery and cell profiling.

A major challenge in drug discovery is the definition of the activity of therapeutic compounds before they enter clinical trials. Currently, many tools are available to profile drug response at a multiparametric level. Furthermore, the novel discipline of systems biology is offering interpretative cues to the amount of data generated by the so-called omics technologies. Nonetheless, novel approaches are needed to comprehensively evaluate drug response. This review will describe a recent technology for protein profiling, the ImmunoCell-Array, which, in to the authors' opinion, can enter the scenario of profiling technologies with the goal of offering a comprehensive description of proteome dynamics in a cellular context.

Retroviral microarray-based platform on nanostructured TiO2 for functional genomics and drug discovery.

Living-cell microarrays are powerful tools for functional genomics and drug discovery. However, despite several attempts to improve this technology, it is still a challenge to obtain microarrays of cells efficiently overexpressing or downregulating specific genes to address complex phenotypes. Here, we present a cell-based microarray for phenotype screening on primary and cancer cells based on the localized reverse infection by retroviruses. Viral vectors are immobilized on a nanostructured titanium dioxide (ns-TiO2) film obtained by depositing a supersonic beam of titania clusters on a glass substrate. We validated the retroviral cell array by overexpression of GFP reporter genes in primary and cancer cells, and by RNA interference of p53 in primary cells by analyzing effects in cell growth. We demonstrate that ns-TiO2 retroviral arrays are an enabling tool for the study of gene function of families of genes for complex phenotypes and for the identification of novel drug targets.

In vitro biocompatibility of a ferrimagnetic glass-ceramic for hyperthermia application.

Ferrimagnetic glass-ceramics containing magnetite crystals were developed for hyperthermia applications of solid neoplastic tissue. The present work is focused on in vitro evaluation of the biocompatibility of these materials, before and after soaking in a simulated body fluid (SBF). X-ray diffraction, scanning electron microscopy, atomic absorption spectrophotometry, X-ray photoelectron spectrometry and pH measurements were employed in glass-ceramic characterisation. The free-radical mediated reactivity of the glass-ceramic was evaluated by Electron Paramagnetic Resonance (EPR) spin trapping. Cell adhesion and proliferation tests were carried out by using 3T3 murine fibroblasts. Cytotoxicity was performed by qualitative evaluation of human bone osteosarcoma cells U2OS cell line. The results show that almost two times more 3T3 cells proliferated on the samples pre-treated in SBF, compared with the untreated specimens. Moreover a decrease of confluence was observed at 48 and 72h for U2OS cells exposed to the untreated glass-ceramic, while the powder suspensions of glass-ceramic pre-treated in SBF did not influence the cell morphology up to 72h of exposition. The untreated glass-ceramic exhibited Fenton-like reactivity, as well as reactivity towards formate molecule. After pre-treatment with SBF the reactivity towards formate was completely suppressed. The concentration of iron released into the SBF solution was below 0.1ppm at 37°C, during one month of soaking. The different in vitro behaviour of the samples before and after SBF treatment has been correlated to the bioactive glass-ceramic surface modifications as detected by morphological, structural and compositional analyses.

Biocompatibility of cluster-assembled nanostructured TiO2 with primary and cancer cells.

We have characterized the biocompatibility of nanostructured TiO2 films produced by the deposition of a supersonic beam of TiOx clusters. Physical analysis shows that these films possess, at the nanoscale, a granularity and porosity mimicking those of typical extracellular matrix structures and adsorption properties that could allow surface functionalization with different macromolecules such as DNA, proteins, and peptides. To explore the biocompatibility of this novel nanostructured surface, different cancer and primary cells were analyzed in terms of morphological appearance (by bright field microscopy and immunofluorescence) and growth properties, with the aim to evaluate cluster-assembled TiO2 films as substrates for cell-based and tissue-based applications. Our results strongly suggest that this new biomaterial supports normal growth and adhesion of primary and cancer cells with no need for coating with ECM proteins; we thus propose this new material as an optimal substrate for different applications in cell-based assays, biosensors or microfabricated medical devices.

PML NBs associate with the hMre11 complex and p53 at sites of irradiation induced DNA damage.

PML nuclear bodies (PML NBs) respond to many cellular stresses including viral infection, heat shock, arsenic and oncogenes and have been implicated in the regulation of p53-dependent replicative senescence and apoptosis. Recently, the hMre11/Rad50/NBS1 repair complex, involved in Double Strand Breaks (DSBs) repair, was found to colocalize within PML NBs, suggesting a role for these nuclear sub-domains in the DNA repair signalling pathway. We report here that in normal human fibroblasts, after ionizing radiation (IR), the PML NBs are modified and recognize sites of DNA breaks (ssDNA breaks and DSBs). Eight to 12 h after radiation PML NBs associate with hMre11 Ionizing Radiation-Induced Foci (IRIF), and subsequently with p53 within discrete foci. The PML, hMre11 and p53 colocalizing structures mark sites of DSBs as identified by immunolocalization with anti phosphorylated histone gamma-H2AX. Furthermore, we demonstrate that ionizing radiation induces the stable association of p53 with hMre11 and PML. These results suggest that the PML NBs are involved in the recognition and/or processing of DNA breaks and possibly in the recruitment of proteins (p53 and hMre11) required for both checkpoint and DNA-repair responses.

microFIND(®) approach to fluorescent in situ hybridization (FISH).

FISH technology has gained increasing attention in the management of cancer disease, either for predictive or prognostic indications. Molecular cytogenetics has greatly improved diagnostic capability of classical cytogenetics analysis of metaphase-based chromosome for the identification of genetic aberrations. The availability of a large number of fluorescent probes, each specific for different genetic lesions, together with a robust protocol for interphase FISH, provide the pathologist with the essential tools for an accurate evaluation of patient's disease. Hemato-oncological and many of the solid tumors have been comprehensively characterized by peculiar genetic defects and are now routinely evaluated by interphase FISH. Despite the reliability of the method, which has undergone only minor changes since the 1970s, FISH assay is still hampered by reagents cost, preventing its adoption in large-scale oncological screening. In this chapter we describe a major improvement of interphase FISH assay for cytological samples through the description of the miniaturized device microFIND(®) that offers, besides reduction of cost per assay, a completely novel vision to the FISH technology, thanks to the perspective of full automation of FISH assay using a dedicated robotic platform for microFIND(®) handling, (not presently described in the chapter).

The effect of surface nanometre-scale morphology on protein adsorption.

BACKGROUND: Protein adsorption is the first of a complex series of events that regulates many phenomena at the nano-bio interface, e.g. cell adhesion and differentiation, in vivo inflammatory responses and protein crystallization. A quantitative understanding of how nanoscale morphology influences protein adsorption is strategic for providing insight into all of these processes, however this understanding has been lacking until now. METHODOLOGY/PRINCIPAL FINDINGS: Here we introduce novel methods for quantitative high-throughput characterization of protein-surface interaction and we apply them in an integrated experimental strategy, to study the adsorption of a panel of proteins on nanostructured surfaces. We show that the increase of nanoscale roughness (from 15 nm to 30 nm) induces a decrease of protein binding affinity (

Miniaturized FISH for screening of onco-hematological malignancies.

Fluorescence in situ hybridization (FISH) represents a major step in the analysis of chromosomal aberrations in cancer. It allows the precise detection of specific rearrangements, both for diagnostic and prognostic purposes. Here we present a miniaturized FISH method performed on fresh and fixed hematological samples. This procedure has been developed together with a microfluidic device that integrates cluster-assembled nanostructured TiO2 (ns-TiO2) as a nanomaterial promoting hematopoietic cell immobilization in conditions of shear stress. As a result of miniaturization, FISH can be performed with at least a 10-fold reduction in probe usage and minimal cell requirements, creating the possibility of using FISH in genetic screening applications. We developed the protocol on tumor cells and bone marrow (BM) from a normal donor using commercially sex-specific and onco-hematology probes. The procedure was then validated using either BM or peripheral blood (PB) from six patients with hematological diseases, each associated with different genetic lesions. Miniaturized FISH demonstrated comparable performance to standard FISH, indicating that it is suitable for genetic screenings, in research, and in clinical settings for the diagnosis of samples from onco-hematological malignancies.