Impact of the Multidisciplinary Cancer Team on the Diagnostic and Therapeutic Care Pathway of Early Breast Cancer Patients and Perception of Team Members: The Experience of a Cancer Centre in Italy.

Literature on the role of multidisciplinary team (MDT) in cancer is still controversial. We aimed to investigate MDT impact on a panel of indicators in breast cancer care in a single-center retrospective study performed in a Cancer Reference Center in Italy. We analysed the diagnostic and therapeutic care pathway (DTCP) of 266 early breast cancer patients managed by our MDT during 2019-2020. Process indicators reflecting the change of the diagnostic and therapeutic care pathways occurred after the MDT discussion were computed. Further, the performance of some quality care indicators in breast cancer care since the establishment of the MDT activity and the breast cancer MDT members' perceptions were also investigated. According to our study, the MDT approach improves breast cancer management by increasing the completion of staging and by encouraging neo-adjuvant treatment and an appropriate and faster surgery. In MDT members' perspective it also improves decision-making and training and creates a positive work environment. Globally, our study encourages MDT rollout in breast cancer care. However, to enhance the reliability and comparability of the results of studies investigating MDT effectiveness in clinical practice, shared guidelines on its operationalisation are strongly desirable.

Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy).

OBJECTIVES: To describe the ophthalmological characteristics in a Juvenile idiopathic arthritis (JIA) cohort and to evaluate how therapeutic advances have changed the course of the uveitis. METHODS: Analysis of a retrospective cohort study of consecutive JIA pediatric patients including JIA-associated uveitis (JIA-U) and comparison with a previous study in the same uveitis center assessed before the wide-spread of biological therapy. RESULTS: The total of 49 JIA patients were analyzed, of whom 18 JIA-U, compared with a JIA-U past cohort of 66 patients. Systemic corticosteroids were used significantly less in the current JIA-U group (p = 0.008) than in the past one. JIA-U present cohort was on therapy more frequently with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) than the past group (p = 0.039), mostly treated with methotrexate (93.3%). Furthermore, a larger use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) was described in the current JIA-U group (p = 0.005) also associated with csDMARDs (p = 0.003). Adalimumab was used more (72.7%) in the present JIA-U cohort compared to a larger treatment with infliximab (61.5%) in the past (p = 0.005). Higher number of uveitis recurrences was observed in the previous cohort compared to the current one (p = 0.005). Fewer complications were described in this study than in the previous: posterior synechiae (p = 0.007), cataract (p < 0.001), band keratopathy (p < 0.001), and elevated intraocular pressure (IOP) (p = 0.047). CONCLUSION: Current therapies reduced the uveitis recurrences and ocular complications including cataract due also to the lower use of corticosteroids. The new close collaboration with the pediatric rheumatologic center in the same University has contributed to the care improvement and decrease of uveitis complications.

Cardiovascular Diseases Risk Factors in oil and gas workers: a ten years observational retrospective cohort.

OBJECTIVES: The study aim was to examine the trend of major clinical biochemistry factors associated with cardiovascular diseases and dyslipidemia onset over a 10-year period (2000-2010) in Oil and Gas workers. METHODS: The information extracted from "Computerized management of individual medical services database" regarding 439 Italian workers of an oil and gas company were analysed. RESULTS: A constant and significant increase of the average Body Mass Index and serum cholesterol were found, and in particular in workers < 36 years: BMI was 24.4 (2000) and 25.8 (2010) with p < 0.001, and cholesterol was 188.3 mg/dL (2000) and 206.5 mg/dL (2010) with p < 0.001. CONCLUSION: Analysed variables are the most important risk factor for cardiovascular, neurological and neoplastic diseases, as well as they reduce life expectancy. Occupational medicine in particular in extreme working environmental conditions, such as for workers in oil and gas companies, monitoring health status and promoting healthy life style, has a strategic role to perform cost-effective strategies to reduce health risks, thus improving the workers lifestyle.

Predictive role of thymidylate synthase, dihydropyrimidine dehydrogenase and thymidine phosphorylase expression in colorectal cancer patients receiving adjuvant 5-fluorouracil.

OBJECTIVE: The combined assessment of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) gene expressions in metastatic colorectal cancer has been reported to be able to predict the efficacy of fluoropyrimidine-based chemotherapy. In order to evaluate the prognostic role in the adjuvant setting, we investigated the TS, DPD and TP expression in primary tumors of colorectal cancer patients treated with 5-fluorouracil (5-FU). METHODS: TS, DPD and TP expression levels were determined by immunohistochemistry in paraffin-embedded primary tumor tissues from 62 patients with Dukes' stage B and C colorectal cancers who underwent surgery and received adjuvant systemic chemotherapy with 5-FU. The median follow-up was 90 months (range 17-127). RESULTS: Dukes' stage C cancer and high TS expression were independent markers of poor prognosis for disease-free survival (DFS; p = 0.0009 and p = 0.007, respectively) and overall survival (OS; p = 0.0005 and p = 0.011, respectively). By multivariate analysis, patients with high DPD expression had significantly shorter DFS (p = 0.007) and OS (p = 0.005) compared to patients with low DPD expression. In the combined analysis of 2 markers, patients with low TS and low DPD had the best outcome in terms of DFS (p = 0.007) and OS (p = 0.03). The analysis of all 3 proteins showed that the patients with low expression of all 3 markers had significantly longer DFS (p = 0.04) and OS (p = 0.01) than patients with a high value of any one of the protein expressions. However, the joint analysis of 3 markers (group with TS-/DPD-/TP-) could not identify a subgroup of patients with a better prognosis compared to the analysis of 2 markers (group with TS-/DPD-). The analysis of Dukes' stage C cancer patients confirmed a significant benefit in terms of DFS and OS (p = 0.001 and p = 0.006, respectively) when all 3 markers had low expression. We also found a positive significant correlation between TS and TP protein expression (p = 0.033). CONCLUSIONS: This retrospective investigation suggests that the combined assessment of TS and DPD may be useful to evaluate the prognosis of patients with Dukes' B and C colon carcinoma receiving 5-FU adjuvant chemotherapy. The role of TP as a predictor for 5-FU-based therapy needs further investigations.

Auditory attention at the onset of West syndrome: correlation with EEG patterns and visual function.

At the onset of West syndrome a specific impairment of visual function has been clearly demonstrated, while other aspects of sensorial development, and in particular of the auditory function, have been less studied. The aim of this study was to evaluate auditory function and orienting responses at the onset of West syndrome, and to relate the results with EEG patterns, visual function and neurodevelopmental competence. A prospective multicentric study was performed on 25 successively enrolled infants with West syndrome; all the patients underwent a full clinical assessment, including MRI and video-EEG, visual function and auditory orienting responses (AORs) as well as Griffiths' developmental scales. The whole assessment performed at the onset of spasms (T0) was repeated after two months (T1). AORs resulted significantly impaired both at T0 and T1. At the onset of spasms a highly significant relationship of auditory attention with visual function and neurodevelopmental competence was shown in both cryptogenic and symptomatic forms, but it was no longer present after two months. Our results may suggest a possible pervasive effect of the epileptic disorder on sensory processing, associated to a deficit of neurodevelopment. Although we failed to show a significant correlation between auditory orienting responses and EEG patterns, some evidence seems to support at least partially an influence of the epileptic disorder per se on the genesis of the sensorial impairment. A longer follow up and a larger cohort will be useful for a better clarification of these findings.

Bioactivity of sol-gel bioactive glass coated alumina implants.

Alumina on alumina total hip arthroplasty has been in use for more than 25 years with encouraging results. However, an improvement of the alumina/bone interface still is required. The objective of this study was to investigate the in vitro and in vivo osteoconductive properties of sol-gel bioactive glass coated alumina implants. Two sol-gel glass compositions (58S Bioglass(R) and 77S Bioglass(R)) were used as coatings on alumina substrates and implanted in a rabbit model. The 58S sol-gel coating was employed in two configurations, single (A58S1) and double layer (A58S2). SEM analysis after one week in simulated body fluid revealed small crystals assumed to represent the initial phase of hydroxyapatite formation, whereas no clear conclusion could be drawn from Fourier transform infrared spectroscopy data. The percentage of bone in direct contact was greater for coated implants when compared to bulk alumina implants (p <0.001). In the case of A58S1 implants, bone percentage significantly increased from 45.1% after 3 weeks up to 87. 8% after 24 weeks of implantation (p = 0.0004). The presence of osteoid tissue, related to an aluminum release from the alumina substrates, was greatly diminished when compared to melt-derived glass-coated alumina implants.

Uretrotomia interna en el tratamiento de la estenosis de uretra bulbar (EUB) / Internal urethrotomy as a treatment of the bulbar urethral stricture

Objetivo: Determinar el porcentaje de reestenosis posterior al tratamiento de la EUB con uretrotomía interna. Material y Métodos: Fueron tratados un total de 31 pacientes portadores de EUB cuya longitud fuera igual o menor de 0,5 cm, en los cuales el seguimiento promedio fue de 25,3 meses. Se excluyeron aquellos con áreas de espongiofibrosis, tratamiento previo por su estenosis o en tratamiento por carcinoma transicional de vejiga. En al 90 por ciento de los casos el procedimiento se realizó en forma ambulatoria bajo anestesia local. Resultados: El 58 por ciento de los pacientes presentaromn estenosis postoperatorias en un tiempo promedio de 5,4 meses. La distribución del tiempo de estenosis mostró una curva bimodal en el primer y cuarto trimestre, detectándose el 83 por ciento de las recurrencias dentro del primer año. El 100 por ciento de los pacientes que fueron tratados nuevamnete con uretrotomía interna (n:10) sufrieron reestenosis en el primer trimestre del postoperatorio. Conclusión: Aun en popblaciones altamente seleccionadas como la presente, el porcentaje de reestenosis es cvonsiderable, debiendo extenderse el seguimiento de los pacientes a largo plazo. El empleo reiterado de la uretrotomía interna en el tratamiento de la EUB res uina opción desaconsejable como tratamiento definitivo en poblaciones similares a las estudiadas. El empleo de anestesia local y manejo ambulatorio de estos pacientes debe ser considerado

Uretrotomia interna en el tratamiento de la estenosis de uretra bulbar (EUB) / Internal urethrotomy as a treatment of the bulbar urethral stricture

Objetivo: Determinar el porcentaje de reestenosis posterior al tratamiento de la EUB con uretrotomía interna. Material y Métodos: Fueron tratados un total de 31 pacientes portadores de EUB cuya longitud fuera igual o menor de 0,5 cm, en los cuales el seguimiento promedio fue de 25,3 meses. Se excluyeron aquellos con áreas de espongiofibrosis, tratamiento previo por su estenosis o en tratamiento por carcinoma transicional de vejiga. En al 90 por ciento de los casos el procedimiento se realizó en forma ambulatoria bajo anestesia local. Resultados: El 58 por ciento de los pacientes presentaromn estenosis postoperatorias en un tiempo promedio de 5,4 meses. La distribución del tiempo de estenosis mostró una curva bimodal en el primer y cuarto trimestre, detectándose el 83 por ciento de las recurrencias dentro del primer año. El 100 por ciento de los pacientes que fueron tratados nuevamnete con uretrotomía interna (n:10) sufrieron reestenosis en el primer trimestre del postoperatorio. Conclusión: Aun en popblaciones altamente seleccionadas como la presente, el porcentaje de reestenosis es cvonsiderable, debiendo extenderse el seguimiento de los pacientes a largo plazo. El empleo reiterado de la uretrotomía interna en el tratamiento de la EUB res uina opción desaconsejable como tratamiento definitivo en poblaciones similares a las estudiadas. El empleo de anestesia local y manejo ambulatorio de estos pacientes debe ser considerado(AU)