Carbon nanomaterials: multi-functional agents for biomedical fluorescence and Raman imaging.

Carbon based nanomaterials have emerged over the last few years as important agents for biomedical fluorescence and Raman imaging applications. These spectroscopic techniques utilize either fluorescently labelled carbon nanomaterials or the intrinsic photophysical properties of the carbon nanomaterial. In this review article we present the utilization and performance of several classes of carbon nanomaterials, namely carbon nanotubes, carbon nanohorns, carbon nanoonions, nanodiamonds and different graphene derivatives, which are currently employed for in vitro as well as in vivo imaging in biology and medicine. A variety of different approaches, imaging agents and techniques are examined and the specific properties of the various carbon based imaging agents are discussed. Some theranostic carbon nanomaterials, which combine diagnostic features (i.e. imaging) with cell specific targeting and therapeutic approaches (i.e. drug delivery or photothermal therapy), are also included in this overview.

Recent developments in carbon nanomaterial sensors.

Carbon nanomaterials are among the most broadly discussed, researched and applied of synthetic nanomaterials. The structural diversity of these materials provides an array of unique electronic, magnetic and optical properties, which when combined with their robust chemistry and ease of manipulation, makes them attractive candidates for sensor applications. Furthermore, the biocompatibility exhibited by many carbon nanomaterials has seen them used as in vivo biosensors. Carbon nanotubes, graphene and carbon dots have come under intense scrutiny, as either discrete molecular-like sensors, or as components which can be integrated into devices. In this review we consider recent developments in the use of carbon nanoparticles and nanostructures as sensors and consider how they can be used to detect a diverse range of analytes.

Signal communication between molecular switches.

[structure: see text]. Efficient strategies for the communication of signals between molecules must be identified for the development of molecule-based nanoprocessors. We have demonstrated that photoinduced proton transfer can be exploited to implement intermolecular digital transmission. Light inputs operate a three-state molecular switch inducing the transfer of a proton to or from a two-state molecular switch. The signal transduction protocol of the two communicating molecular switches is equivalent to that of a sequential logic circuit incorporating three logic gates.

Digital communication through intermolecular fluorescence modulation.

[see reaction]. Ultraminiaturized processors incorporating molecular components can be developed only after devising efficient strategies to communicate signals at the molecular level. We have demonstrated that a three-state molecular switch responds to ultraviolet light, visible light, and H+, attenuating the emission intensity of a fluorescent probe. Intermolecular communication is responsible for the transduction of three input signals into a single optical output. The behavior of the communicating ensemble of molecules corresponds to that of a logic circuit incorporating seven gates.

A phase III study on intermittent versus weekly cisplatin and etoposide in the treatment of advanced non-small cell bronchogenic carcinoma.

A group of 55 patients with advanced non-small cell bronchogenic carcinoma entered a random study on combined cisplatin (CDDP) and etoposide (VP16), either intermittently (I = CDDP 60 mg/m2 day 1 and VP16 120 mg/m2 day 1-3 every 3-4 weeks) or weekly (W = CDDP 20 mg/m2 and VP16 120 mg/m2). Five out of 31 (16%) evaluable patients in group I and 6/27 (22%) in group W obtained partial remission (no statistical difference). Toxicity was mild and survival was similar for both groups. The authors conclude that the weekly combination of CDDP plus VP16 is neither less toxic nor more effective than the intermittent one.

Small cell bronchogenic carcinoma: a cyclical alternating combination of epirubicin plus cisplatin and cyclophosphamide plus etoposide.

Forty-seven patients with advanced small-cell bronchogenic carcinoma (SCLC) were treated with a combination of epirubicin (4-EPIDX) (60 mg/m2 i.v.) and cisplatin (CDDP) (50 mg/m2 i.v.) on day 1, alternated with cyclophosphamide (CTX) (800 mg/m2 i.v.) day 1 and etoposide (VP16) (120 mg/m2 i.v.) on days 21-23. Four patients (9%) obtained a complete remission and 27 (57%) a partial remission with an overall remission rate of 66%. The median duration of response was 37 weeks (range 13-150) and the median duration of survival was 43 weeks (range 10-150). No severe bone marrow depression was noted. The other side-effects were of a mild grade.

Hospital-at-Home for advanced cancer patients within the framework of the Bologna Eubiosia project: an evaluation.

AIMS AND BACKGROUND: An evaluation of the Bologna Hospital-at-Home (BHH) was undertaken to examine the following aspects: 1) median daily costs of the BHH; 2) delivery of medical services; 3) patient satisfaction with the care received and frequency of requests for transfer to the alternative setting. Delivery of services and patient's satisfaction in the BHH were compared with data collected for a traditional hospital (Ospedale Sant'Orsola Malpighi, Bologna--OSM). METHODS: Our analysis was performed as a cost analysis considering two periods of time in 1992 and 1993/94. Included were direct and indirect costs; no intangible costs were found. The patient's perspective was selected for the analysis. The observational study examining delivery of service and quality of life of patients admitted to the two care settings, BHH and OSM, considered patient's clinical history and an interview conducted by the evaluation team 6 weeks after admission to either facility. Data included patient's characteristics, quantity of diagnostic and therapeutic measures, circumstances of life, satisfaction with the care received, and intention for transfer to the alternative setting of nursing. The statistical significance of our assumption of comparable care intensity and better patient quality of life in the BHH was tested by the Pearson Chi-square test. RESULTS: A survey was carried out of 236 patients treated in the BHH or the OSM. The setting of assistance did not influence the provision of services. The time of "talking to the doctor" was notably higher for BHH than for OSM patients. The analysis of satisfaction showed that 98% of the surveyed BHH patients believed it matched the actual needs. The quality of life was considered to be reduced/bad in 67% of the OSM patients but in only 51% of BHH patients. An opinion was also requested with regard to transfer to the alternative setting of nursing: 47% of OSM patients judged BHH care would be better than traditional hospital. The median daily costs in BHH reached 118,789 Lire (range, 108,569-129,027 Lire, depending on performance status). CONCLUSIONS: Although the economic advantage of hospital-at-home care certainly is important, we would like to stress that better quality and dignity of life should be the main point supporting the idea of hospital-at-home care.

Home artificial nutrition in advanced cancer.

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2-36.9 in subsequent years, being 4-10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15-23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.

[Home hospital for advanced stage cancer patients: costs and benefits]. / Homehospital für Krebskranke im fortgeschrittenen Stadium: Kosten und Nutzen.

15,290 patients have been treated in the Bologna home hospital (BHH) until June 30, 1996. The average daily costs in BHH were estimated as 118789 Liras (ranging from 108 569-129027 Lire depending on the nursing category). Care intensity and patient's quality of life in the BHH are high. 98% of patients were content with the setting in which they were nursed. A questionnaire on the degree of satisfaction with the care was completed by 134 BHH patients and 102 patients of Division Oncologia Medica. Azienda Ospedaliera Sant, Orsola Malpighi, Bologna. Satisfaction with respect to sleeping, meals and family communications was expressed more often by BHH patients. Less patients of the BHH evaluated "quality of life" reduced or bad (51% vs. 67%) or requested a transfer to the alternative setting (03% vs. 47%). Advocating step by step introduction of home care, quality of life aspects have priority. Certainly, home care deserves greatest attention providing care during the life with cancer. However the final decision about the settings of nursing has to be made by the patients themselves in accordance with his understanding of quality of life.

Active surveillance for asymptomatic carriers of carbapenemase-producing Klebsiella pneumoniae in a hospital setting.

The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) is a challenging public health threat. Early identification and isolation of infected patients and carriers are key measures of control. This study describes a CPKP screening strategy in a tertiary Italian hospital. During the five-month study period, 1687 patients were screened by rectal swabs. Of these, 65 (3.9%) tested positive for CPKP; 5.1% of case contacts tested positive. Screening case contacts appears to be the essential surveillance component for detecting asymptomatic carriers of CPKP. The added value of selective CPKP screening on hospital admission depends on the frequency of carriers among incoming patients.

Natural killer cells and lymphocyte subsets in active MS and acute inflammation of the CNS.

Cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocyte subsets were determined by flow cytometry (FCM) in 15 patients with active multiple sclerosis (MS) and 15 patients with acute inflammatory diseases (ID) of the central nervous system (CNS) in order to establish correlations between the two groups of diseases, as well as between the CSF and PB subsets distribution. A panel of monoclonal antibodies was applied to all the samples: Leu3 (CD4), Leu4 (CD3), Leu2 (CD8), Anti-HLA-DR, Leu11 (CD16). Statistical analysis did not show differences in CD3+ nor in CD3+ DR+ T-cells both in the CSF and PB in the two groups of patients. CD4+ cells were significantly higher in the CSF than in the PB, while CD8+, DR+ CD3- and CD16+ cells were constantly lower in the CSF without differences between the two groups of diseases.

4'-Epidoxorubicin plus cisplatin as first-line therapy in the treatment of small cell bronchogenic carcinoma.

Twenty-seven patients with small cell bronchogenic carcinoma were treated with a combination of 4'-Epidoxorubicin 60 mg/m2 and cisplatin 50 mg/m2 i.v. every 3-4 weeks. Three patients (11%) had a complete remission (CR), and 12 (44%) had a partial remission (PR) with a 55% overall remission rate. The median duration of response was 36 weeks (range 11-256+). No severe bone marrow depression was noted. The other side effects were of mild grade. Because of the "minimal aggressiveness" of this combination for the patients, the results obtained in this preliminary phase can probably be improved by the integration of other drugs in the scheme.

Phase II studies on weekly cisplatinum plus epirubicin or etoposide in the treatment of advanced non-small cell bronchogenic carcinoma.

Thirty-six patients with advanced non-small cell bronchogenic carcinoma were divided in 2 groups for treatment with two different platinum-based combination therapy regimens. All 16 patients who received the weekly administered combination of 10 mg/m2 cisplatin (CDDP) plus 10 mg/m2 epirubicin (4EPIDX) experienced no clinical response. Among the 20 patients who received the combination CDDP (10 mg/m2) plus etoposide (VP16, 60 mg/m2) weekly, 4 of them (20%) showed partial remission (PR). The side effects of both combinations were of mild grade. Further study is needed to verify the effectiveness of the weekly combination of CDDP and VP16 by comparing the above regimen with the "standard" intermittent doses.