Multianalyte Serum Biomarker Panel for Early Detection of Pancreatic Adenocarcinoma.

PURPOSE: We determined whether a large, multianalyte panel of circulating biomarkers can improve detection of early-stage pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS: We defined a biologically relevant subspace of blood analytes on the basis of previous identification in premalignant lesions or early-stage PDAC and evaluated each in pilot studies. The 31 analytes that met minimum diagnostic accuracy were measured in serum of 837 subjects (461 healthy, 194 benign pancreatic disease, and 182 early-stage PDAC). We used machine learning to develop classification algorithms using the relationship between subjects on the basis of their changes across the predictors. Model performance was subsequently evaluated in an independent validation data set from 186 additional subjects. RESULTS: A classification model was trained on 669 subjects (358 healthy, 159 benign, and 152 early-stage PDAC). Model evaluation on a hold-out test set of 168 subjects (103 healthy, 35 benign, and 30 early-stage PDAC) yielded an area under the receiver operating characteristic curve (AUC) of 0.920 for classification of PDAC from non-PDAC (benign and healthy controls) and an AUC of 0.944 for PDAC versus healthy controls. The algorithm was then validated in 146 subsequent cases presenting with pancreatic disease (73 benign pancreatic disease and 73 early- and late-stage PDAC cases) and 40 healthy control subjects. The validation set yielded an AUC of 0.919 for classification of PDAC from non-PDAC and an AUC of 0.925 for PDAC versus healthy controls. CONCLUSION: Individually weak serum biomarkers can be combined into a strong classification algorithm to develop a blood test to identify patients who may benefit from further testing.

Impact and Value of Hospital Antibiotic Stewardship: Retrospective Pre-COVID-19-Pandemic Analysis.

AIM: "Antimicrobial stewardship" (AMS) is defined as a healthcare-system-wide approach to promoting and monitoring the judicious use of antimicrobials to preserve their future effectiveness. Therefore, we structured an observational study to monitor the hospital trend of antibiotic consumption and related expenditure before the COVID-19 pandemic and to evaluate how much AMS could affect this trend. METHODS: The research covered the antibiotic prescriptions at the University Hospital (U.H.) "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy, comparing data on the therapies prescribed from 1 January to 31 December 2017 (27,384 patients) with those collected during the same period in 2019 (27,047 patients). RESULTS: Unlike national data, our results highlighted a decreasing trend in the consumption of antibiotics that did not concern only carbapenems and fluoroquinolones, but also the third-generation cephalosporins. Noteworthily, there was also a reduction in 2019 compared with 2017 in the consumption of colistin, an antibiotic towards which an increase in bacterial resistance in animals has been found nationally. In agreement with the national data, our research confirms a trend of an increase (+3.7%) in the total antibiotic consumption corresponding to more than 26% and 29% reductions in the total and therapy per-day costs, respectively. CONCLUSIONS: The results show a positive impact of the AMS at the University Hospital "San Giovanni di Dio e Ruggi d'Aragona".

Burnout and Psychological Vulnerability in First Responders: Monitoring Depersonalization and Phobic Anxiety during the COVID-19 Pandemic.

BACKGROUND: It is common knowledge that first responders are among the helping professionals most at risk of burnout and psychological vulnerability. During the COVID-19 pandemic, their mental health has been subjected to various risk factors. METHODS: Data on socio-demographic characteristics, the Maslach Burnout Inventory (MBI) and psychological vulnerability (SCL-90-R) were obtained from 228 subjects (55.3% female; M age = 45.23, SD = 13.14) grouped on the basis of their actual involvement during the emergency phases (82% First Responders and 18% Second Responders). RESULTS: First responders exceeded the MBI clinical cut-off, while SRs did not (χ² ≥ 0.5); specifically, EE = 89.8%, DP = 85.8%, and PA = 82.1%. The FR group showed a higher mean in the global severity index (GSI = 49.37) than did the SRs (=43.95), and the FR group exceeded the clinical cut-off in the SCL-90-R scales of SOM (51.06), ANX (52.40), and PHOB (53.60), while the SF group did so only for the PHOB scale (50.41). The MBI dimensions correlated significantly (p = 0.05) with all investigated clinical scales of the SCL-90-R. CONCLUSIONS: Emergency situations expose first responders to specific risk factors related to work performance and relational aspects, which contribute to increased psychological vulnerability and burnout.

[Tertullianus and Agostinus. Approaches to dreams in ancient Christianity]. / Tertulliano e Agostino due approcci al sogno nel Cristianesimo antico.

The author analyzes the nature and typologies of dreams in Tertullianus' De anima and, briefly, in the work of Agostinus, two centuries later. What are made dreams of? Are they autonomous productions of psyché or phantasia, or rather messages sent by demons or God, according to dreams' bad or good intimate nature? Is there a relation between time of the night and nature of the dreams? Moreover, is there a relation between seasons and dreams? Does a specific relationship between food, regimen and dreams exist? Which is the soul's faculty able to generate dreams? Is phantasia moved by some other deep and mysterious principle? Which are the connections linking human physiology and dreams?