Management of patients with extensive locally advanced thyroid cancer: results of multimodal treatments.

PURPOSE: Surgery plays a key role in the treatment of thyroid cancer (TC) patients. Locally advanced cases, however, can require an extensive surgical approach with technical issues and a high risk of complications. In these cases, a multidisciplinary evaluation should be carried out to evaluate pros and cons. The aim of this study was to share our experience, as a multidisciplinary team, in the management of patients with locally advanced TC with a particularly extensive local disease, whose surgical approach could be challenging and part of a multimodal treatment. METHODS: We retrospectively evaluated clinical, surgical, and oncologic features of all patients with locally advanced TC who had undergone multidisciplinary surgery from January 2019 to June 2020. RESULTS: Six patients (two cases each of poorly differentiated, papillary, and medullary TC) were included. Four out of six were suffering from symptoms related to the advanced disease. At pre-surgical evaluation, a multidisciplinary team proposed extended surgery with radical intent via cervicotomy and sternotomy, considering other therapies not feasible or probably ineffective without it. No one passed away in intra- or perioperative time. At the end of follow-up (median 2.6 years), all patients presented a remission of symptoms due to the advanced disease, four patients were submitted to adjuvant therapies and only one patient died for a cause unrelated to the disease. CONCLUSION: This series of very advanced TCs shows the effectiveness of a surgery performed by a multidisciplinary team in controlling symptoms, allowing adjuvant therapies, and improving the survival of patients whose cases would otherwise be very difficult to manage.

Eruption guidance appliance: a review.

AIM: Eruption guidance appliance (Occlus-o-Guide) is recommended for early orthodontic treatment or prevention of malocclusions. The aim of this work is to review the literature about the use of eruption guidance appliance and to evaluate its effects during the treatment of Class II division I malocclusion, increased overbite, increased overjet, and anterior crowding. The aims of the eruption guidance appliance are to increase mandibular length and to increase anterior facial height without affecting maxillary growth. The effects of Occlus-O-Guide are mainly dentoalveolar such as mesial shift of lower molars, extrusion of posterior teeth, lingual tipping and retrusion of upper incisors, protrusion of lower incisors. CONCLUSION: All the analysed works showed great results in the treatment of anterior crowding, increase of the overbite and overjet, both in small deviations of the median line and in minor TMJ problems.

Presence, enzymatic activity, and subcellular localization of paraoxonases 1, 2, and 3 in human lung tissues.

AIMS: The human paraoxonases family (PONs) includes three calcium-dependent esterases: PON1, PON2, and PON3. The presence of PONs mRNA in human lungs is known, however, their enzymatic activity and subcellular localization have not been sufficiently explored. MAIN METHODS: In this work, the presence of PONs in human lung tissues, at both mRNA and protein levels, was confirmed by Real-Time RT-PCR and Western blot analysis. Moreover, the activities of PONs were determined in cytosol and microsomes of 30 subjects and in mitochondria of 8 representative lung tissues using selective and non-selective substrates. Besides, to exclude the possible contribution of other esterases on PON1 organophosphate activity, the effect of bis-p-nitrophenyl phosphate (BNPP) and phenylmethylsulfonyl fluoride (PMSF), esterase inhibitors, and ethylenediaminetetraacetic acid (EDTA), a general paraoxonase inhibitor, was tested. Finally, the presence and activities of PONs in the A549 pulmonary cell line were also evaluated in order to be used as a model for studies on paraoxonases' metabolism. KEY FINDINGS: Our results demonstrated high interindividual variability in both PONs mRNA/protein levels and enzymatic activities and pointed out the presence of all PONs in human lungs and their subcellular distribution in the cytosol, microsomes, and mitochondria. SIGNIFICANCE: These findings add further information to our knowledge of pulmonary metabolism and, given that PON1 can metabolize some drugs used for respiratory diseases, the presence of PON1 activity in the lung tissue should no longer be ignored in the development of treatment plans and the design of new drugs.

Effects of a generalised ban on smoking in bars and restaurants, Italy.

CONTEXT: Italy implemented a law in January 2005 banning smoking in all enclosed public spaces. OBJECTIVES: To document perceived obstacles and effects of the law and observed client smoking behaviours in bars and restaurants. DESIGN: Four surveys were conducted between December 2004 and February 2006. Protocols and questionnaires were posted on a public health website to solicit participation among local health units (LHUs). Participating LHUs randomly selected 50 bars and restaurants using the electronic Yellow Pages. Self-administered questionnaires were delivered to owners or managers of selected locales; all of them were revisited during peak hours to collect questionnaires and observe client smoking. RESULTS: Before the ban, smokers were observed in 31% of locales; 24% of owners predicted major financial losses. One year later, no smokers were observed and only 7% reported major financial losses. Only 30% had received law enforcement visits. Most owners/managers (88%) reported positive attitudes about the law and 79% reported such attitudes among clients. CONCLUSIONS: The Italian smoking law has drastically reduced smoking in bars and restaurants despite minimal enforcement visits. Perceived negative effects on profits appear limited, and the owners and managers and their clients are satisfied.

Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma.

OBJECTIVES: No clear evidence of which surgical procedure should be performed for early stage mesothelioma is available to date. We analyzed our 10-year experience in the treatment of early stage mesothelioma with surgery and Hyperthermic IntraTHOracic Chemotherapy. METHODS: We retrospectively analyzed all cases of histologically proven epithelioid or biphasic IMIG stage I and II mesothelioma that we operated between 2005 and 2014. We performed an open pleurectomy and partial decortication of any visible lesion on the visceral pleura in all cases and both diaphragm and pericardium were always spared; Hyperthermic IntraTHOracic Chemotherapy was ran using Cisplatin 80 mg/m2 and Doxorubicin 25 mg/m2 at a target temperature of 42.5 °C for 60 min. RESULTS: We operated on 26 patients (23 male and 3 female); epithelioid tumor was diagnosed in 23 cases. Twelve patients were in IMIG stage I and 14 in IMIG stage II; median overall survival for all patients, stage I and II were 35.6, 46 and 23 months respectively and disease free survival was 18, 18 and 16 months respectively. Our results for stage I were better than those reported in literature and were similar for stage II. We observe no 30- and 90- mortality and the rate of severe complication (all CTCAE stage 3) were 30%; the median postoperative stay was 7.5 days. CONCLUSIONS: Our lung sparing approach for the treatment of pleural mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic function. Larger studies are needed to confirm our good results.