First-in-human liver transplantation from a centenarian deceased donor after brain death.

Liver transplantation from elderly donors is expanding due to demand for liver grafts, aging of recipients and donors, and introduction of machine perfusion. We report on a liver transplant from a 100-year-old deceased donor after brain death. The liver was transplanted after the use of hypothermic machine perfusion to a 60-year-old recipient with advanced hepatocellular carcinoma undergoing neoadjuvant immunotherapy. Nine months after the transplant, the patient is alive with a functioning graft and no evidence of acute rejection or tumor recurrence.

Real-world analysis of the economic and therapeutic burden in advanced breast cancer patients in Italy.

BACKGROUND: This real-world analysis evaluated drug utilization focusing on wastage and healthcare costs for treatment of patients with advanced breast cancer (aBC) hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2-) in Italy. METHODS: A retrospective analysis was conducted on administrative data covering about 13.3 million health-assisted individuals. Across January/2017-June/2021, all patients with HR+/HER2-aBC were identified by ≥ 1 prescription for cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). Cost analysis was performed and updated referring to the prices of November 2021. RESULTS: Overall, 3,647 HR+/HER2-aBC patients were included (2,627 palbociclib treated, 729 ribociclib treated, and 291 abemaciclib treated). After 12 months of follow-up, 35% of palbociclib patients had a dose reduction (on average 8.9 wasted pills/patient), 44.7% of abemaciclib patients had a dose reduction (on average 6.7 wasted pills/patient), 22.1% of ribociclib patients had a dose reduction (no wasted pills). Therapy wastage added up to 528,716€ for palbociclib-treated patients (524€/patient) and 5,738€ in abemaciclib-treated patients (151€/patient). No wastage was attributed to ribociclib. CONCLUSIONS: Dose reduction was associated with drug wastage in palbociclib and abemaciclib-treated patients, but not in ribociclib-treated ones. These findings might be helpful to policy decision-makers who, for healthcare strategies implementation, among several variables should consider the possible restraining of drug wastage.

Radiomics and Molecular Classification in Endometrial Cancer (The ROME Study): A Step Forward to a Simplified Precision Medicine.

Molecular/genomic profiling is the most accurate method to assess prognosis of endometrial cancer patients. Radiomic profiling allows for the extraction of mineable high-dimensional data from clinical radiological images, thus providing noteworthy information regarding tumor tissues. Interestingly, the adoption of radiomics shows important results for screening, diagnosis and prognosis, across various radiological systems and oncologic specialties. The central hypothesis of the prospective trial is that combining radiomic features with molecular features might allow for the identification of various classes of risks for endometrial cancer, e.g., predicting unfavorable molecular/genomic profiling. The rationale for the proposed research is that once validated, radiomics applied to ultrasonographic images would be an effective, innovative and inexpensive method for tailoring operative and postoperative treatment modalities in endometrial cancer. Patients with newly diagnosed endometrial cancer will have ultrasonographic evaluation and radiomic analysis of the ultrasonographic images. We will correlate radiomic features with molecular/genomic profiling to classify prognosis.

Older migrants reflecting on aging through attachment to and identification with places.

With increasing numbers of older migrants adopting a transnational lifestyle or returning to their country of origin following retirement, the sense of attachment to and identification with the places they inhabit remains an under explored field of enquiry. Through an ethnographic approach, this paper seeks to raise awareness of the diversity within a group of older migrants, given the heterogeneity of affective bonds established with places. By highlighting the perspective of older Italian migrants living in Newcastle upon Tyne, UK, this paper illustrates the role of a sense of identification with the context of migration in later life. In referring to migration as a process of transformation, some older Italians re-define their identities, as these become interwoven with the characteristics of the places in which they grow older. However, older migrants' sense of attachment to places also reveals the complexity of aging in the context of migration, when a sense of identification with these is never fully achieved in older age. This paper argues that the notion of aging that these older Italian migrants uphold is not only altered by their experience of migration, but also shaped through their identification with the places they inhabit, given formal and informal practices of identification. Thus, by addressing the determinants for a positive experience of aging in the context of migration, this paper challenges the ways in which older migrant groups are conceptualized in gerontological scholarship.

Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study.

BACKGROUND: The enhanced dexterity offered by robotic assistance could be excessive for distal pancreatectomy but not enough to improve the outcome of laparoscopic pancreaticoduodenectomy. Total pancreatectomy retains the challenges of uncinate process dissection and digestive reconstruction, but avoids the risk of pancreatic fistula, and could be a suitable operation to highlight the advantages of robotic assistance in pancreatic resections. METHODS: Eleven laparoscopic robot-assisted total pancreatectomies (LRATP) were compared to 11 case-matched open total pancreatectomies. All operations were performed by one surgeon during the same period of time. Robotic assistance was employed in half of the patients, based on robot availability at the time of surgery. Variables examined included age, sex, American Society of Anesthesiologists score, body mass index, estimated blood loss, need for blood transfusions, operative time, tumor type, tumor size, number of examined lymph nodes, margin status, post-operative complications, 90-day or in-hospital mortality, length of hospital stay, and readmission rate. RESULTS: No LRATP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery despite two patients (18.1 %) required vein resection and reconstruction. LRATP was associated with longer mean operative time (600 vs. 469 min; p = 0.014) but decreased mean blood loss (220 vs. 705; p = 0.004) than open surgery. Post-operative complications occurred in similar percentages after LRATP and open surgery. Complications occurring in most patients (5/7) after LRATP were of mild severity (Clavien-Dindo grade I and II). One patient required repeat laparoscopic surgery after LRATP, to drain a fluid collection not amenable to percutaneous catheter drainage. One further patient from the open group required repeat surgery because of bleeding. No patient had margin positive resection, and the mean number of examined lymph nodes was 45 after LRATP and 36 after open surgery. CONCLUSIONS: LRATP is feasible in selected patients, but further experience is needed to draw final conclusions.

Minimally invasive video-assisted thyroidectomy in differentiated thyroid cancer: a 1-year follow-up.

BACKGROUND: There are few reports on the use of minimally invasive video assisted thyroidectomy (MIVAT) technique in the treatment of differentiated thyroid carcinoma. MATERIALS AND METHODS: From January 2007 to September 2007, we treated 227 patients for benign or malignant diseases with a total thyroidectomy. We have selected 68 cases consecutively treated for thyroid carcinoma with a total thyroidectomy. The inclusion criteria considered the patients treated with conventional thyroidectomy and the patients treated with the MIVAT. Our follow-up examination was conducted in agreement with the guidelines of the European Consensus Conference. RESULTS: We have identified a first group of cases; group A, which stored the cases treated with the MIVAT technique. This group contained 9 males and 27 females; the median age was 49.69+/-9.26 years. Group B contained 6 males and 26 females treated with the conventional thyroidectomy; the median age was 44.15+/-11.73 years. The postoperative pain at 24 hours after the surgical procedure in A group was 1.033+/-0.87, whereas in B group it was 1.915+/-1.24 (P<0.05).The neoplastic node diameter was 13.31+/-6.31 mm in group A and 16.36+/-8.15 mm in group B (P=ns). All of the patients were treated with radioiodine. The value of thyroglobulin after 12 months in group A was 0.648+/-0.2 ng/mL whereas the value was 0.705+/-0.2 ng/mL in group B (P=ns). DISCUSSION: We think that MIVAT for the right cases is a safe and valid surgical procedure for differentiated thyroid cancer. This technique has a challenging learning curve, and the surgeons must be experts in conventional thyroid surgery.