Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer.

OBJECTIVE: To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS: 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS: Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION: re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE: Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.

Neurological soft signs in primary headache patients.

Neurological soft signs (NSS) are semeiotic anomalies not assessed by the standard neurological examination, primarily developed in psychiatric settings and recently proposed as potential markers of minor brain circuit alterations, especially the cerebellar-thalamic-prefrontal network. Primary headache patients present with normal neurological examination and frequent psychiatric comorbidity. Aim of this exploratory study consisted in assessing NSS in 20 episodic frequent migraine (MH) and in 10 tension-type headache (ETTH) outpatients compared to 30 matched healthy controls. NSS were assessed by the Heidelberg scale; clinical characteristics and brain MRI were additionally obtained in all patients. NSS were increased by ∼70 and ∼90% in ETTH and MH, respectively, with respect to controls (p<0.001) and the difference remained significant even after controlling for age and education. Headache type and characteristics did not influence NSS presentation, while headache patients with white matter hyperintensities (WMH) at brain MRI had higher NSS scores compared both to normal controls and patients without WMH. NSS identify a subset of primary headache patients sharing the same comorbidities or minimal brain anomalies, suggesting that tailored prophylactic options might apply.

Communicating medical information: a little lesson from Italian patients.

OBJECTIVE: To construct and validate a questionnaire that could be used to investigate the clarity of the medical information received by patients and their satisfaction with it, as well as their knowledge and opinions concerning advance directives and their associated variables. METHODS: We administered a 30-item questionnaire to 157 adult patients affected by progressive neurological, oncological and nephrological diseases. RESULTS: The results indicate the good reliability and structure of the questionnaire, which identifies three factors: "information and knowledge" (alpha .91), "need for physical and mental support" (alpha .89), and "determination and decision-making capacity" (alpha .75). The amount of time dedicated to medical communication proved to be one of the variables determining the patients' knowledge of their disease and their capacity to express their needs, neither of which changed over time. The oldest patient, a man in the most advanced phase of disease, was the most fragile in expressing his needs and making decisions. Advance directives, living wills, active/passive euthanasia and therapeutic obstinacy' at most only marginally reach the cognitive and emotional sphere of the patients. CONCLUSION: Patients' needs unequivocally lead us back to the primary matrices of medical act: paying attention to patients, offering adequate time, listening to him/her concerns and asking when no question emerges. This so obvious evidence does not match with the increasingly techno-oriented attitude of health professional, who also have to guarantee more productivity in less time. The quality of medical information received by patients impacts their decision making process, particularly in the oldest people. In Italy, as well as in other countries, it is necessary to pay more attention to this issue, keeping in mind that nobody can really choose without knowing exactly what it is going to happen.

[Perception and opinions on the right of choice in medical field: what caregivers teach us on the communication]. / Percezione e opinioni sul diritto di scelta in campo medico: cosa ci insegnano i caregiver sulla comunicazione.

The aim of the present study was to analyse caregivers' perceptions and opinions concerning medical information and advance directives. Fifty-one subjects (mean age 63.07+/-12.2) were enrolled and filled in some questionnaires: the Family Strain Questionnaire (FSQ), the SF-12 and a specifically assembled questionnaire which we named Communication and Consent (CCQ). Correlations were found between FSQ factors, which refer to caregiving-related problems, and SF-12, which refers to the self-perception of mental and physical health. The subjects who resulted emotionally distressed referred to care for more critical patients and that they had not received sufficient attention by physician at the time of diagnosis. Self-determination and decision-making resulted inversely correlated to caregivers' age and education. In general, caregiver's role itself influences attitudes towards medical information and advanced directives. The study also indicates that health professionals have to pay more attention to the relationship than they use to do, trying to understand which kind of emotional sound a technical term may produce for the patients and their caregivers.

[Perceived self-efficacy and respiratory rehabilitation]. / L'autoefficacia percepita e la riabilitazione respiratoria.

AIMS: To analyse if rehabilitation treatment can enhance perceived self-efficacy in performance of daily living activities in patients affected by chronic respiratory diseases (prevalently over 65 years of age and living in a poor socio-cultural context). METHODS. One-hundred and fifteen inpatients undergoing rehabilitation in hospital were administered two questionnaires: the A-D scale which evaluates state anxiety and depressive symptoms, and the Self-Efficacy and Independent Daily Living (SEIDL) questionnaire which evaluates expected self-efficacy in performing daily living activities. SEIDL was re-administered by phone after patients' discharge home, asking about their perceived actual self-efficacy in that moment. RESULTS: Subjects showed significantly higher scores on the A-D scale compared to the Italian normative sample. Females had lower expectations of self-efficacy than males (p = 0.000) and had a lower perception of their effective self-efficacy at follow-up (p = 0.01). State anxiety and depressive symptoms showed a significant negative correlation with expected self-efficacy and perceived self-efficacy at follow-up. CONCLUSIONS: Adequate psychological assessment is necessary before the start of rehabilitation treatment, as emotional disturbances can cancel the beneficial effects of rehabilitation. The creation of community day-centres would also be opportune, to support people affected by chronic respiratory diseases who may experience increased emotional disturbances when family support is lacking or insufficient.

Caregiving and Parkinson's disease.

Relatively little has been published in the international literature concerning the caregiving-related problems associated with Parkinson's disease. We therefore undertook two exploratory studies that have allowed us to identify the needs and specific problems perceived by such caregivers in both qualitative and quantitative terms.

Analysis of the petunia MADS-box transcription factor family.

Transcription factors are key regulators of plant development. One of the major groups of transcription factors is the MADS-box family, of which at least 80 members are encoded in the Arabidopsis genome. In this study, 23 members of the petunia MADS-box transcription factor family were investigated by Northern hybridisation, phylogenetic and yeast two-hybrid analyses. Many of the genes characterised appeared to have one or more close relatives that shared similar expression patterns. Comparison of the binding interactions of these proteins revealed that some show similar interaction patterns, and hence are likely to be functionally redundant. From an evolutionary point of view, their coding genes are probably derived from a recent duplication event. Furthermore, protein-protein interaction patterns, in combination with expression patterns and phylogenetic classification, appear to offer good criteria for the identification of functional homologues. Based on comparison of such data between petunia and Arabidopsis, functions can be predicted for several MADS-box transcription factors in both species.

A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers.

We recruited 50 cancer patients and their caregivers with the aim of extending our knowledge of emotional, personality and psychosocial variables, and comparing their reciprocal experience of the disease. The patients and caregivers were administered four of the questionnaires included in the Cognitive Behavioral Assessment 2.0, the Family Strain Questionnaire and the Satisfaction with Life Scale. The patients were characterised by significantly greater emotional disturbances than their caregivers, who were emotionally stable and had a relatively low level of perceived strain despite their high level of hostility and state anxiety. The intra-scale correlations highlighted the fact that the perception of distress depends on neuroticism and the presence of anxiety and depression (which are themselves known to be connected with neuroticism). The everyday life of the caregivers seemed to be characterised by restricted social relationships and interests; a relatively large proportion also declared that they had practical problems related to disease management, economics and some embarrassing and stigmatic aspects of the disease itself.

[Assessment of problems associated with caregiving: the family strain questionnaire]. / Assessment delle problematiche caregiving-correlate: il family strain questionnaire.

Our study concerns a questionnaire for the evaluation of caregiving-related problems: the Family Strain Questionnaire. The questionnaire, which is composed by a structured interview and 47 dychotomous items, was administered to 409 caregivers of patients with different kinds of chronic diseases. Factorial analysis shows a structure of 5 factors named: emotional strain, social involvement, knowledge of the disease, family relationships and thoughts about death. The FSQ is sensible in discriminating different groups of caregivers. This paper presents the psychometric properties as well as the clinical advantages evidenced by the FSQ.

Caregiver strain associated with tracheostomy in chronic respiratory failure.

STUDY OBJECTIVES: The aim of this study was to evaluate the psychological and psychosocial impact of tracheostomy on the caregivers of patients who have undergone tracheostomies. SETTING: Rehabilitation facility. PARTICIPANTS: Sixty-three lay caregivers of inpatients and outpatients with various underlying diseases who have undergone tracheostomies. METHODS: At the beginning of the study, the 63 caregivers completed a previously validated questionnaire designed to assess the problems related to caring for patients with chronic diseases. Approximately 1 year later, 40 of the 63 caregivers completed the same questionnaire a second time. The results were analyzed statistically in order to investigate the caregivers' perceptions of the factors associated with their own particular situation. RESULTS: The answers of the 40 subjects who completed the questionnaire twice revealed the existence of perceived strain persisting over time, which was greater in female caregivers and in those caring for patients who had had a tracheostomy for < 14 months. The younger caregivers (age < 59 years) and those caring for patients receiving nocturnal ventilation expressed a continuing need for information about the disease. Finally, the caregivers said that they, as well as their patients led very restricted personal lives. CONCLUSIONS: Tracheostomy causes a substantial amount of caregiver strain, which should be taken into account when deciding on any treatment plan.

Patients in a persistent vegetative state: caregiver attitudes and reactions.

OBJECTIVES: This exploratory study investigated the problems encountered by caregivers of long-stay hospital patients in a persistent vegetative state. MATERIAL AND METHODS: Sixteen primary caregivers completed questionnaires designed to assess their personality, psychophysical distress, coping strategies and caregiving-related problems. RESULTS: Males showed a higher level of emotional distress and neuroticism than females. All of the caregivers used situation-oriented coping strategies less over time. had apparently unsatisfactory family relationships, and their emotional distress increased with disease duration. The thoughts of the possible death of the patient were associated with anxiety and depressive symptoms. The caregivers' everyday lives were characterized by limited social relationships, and indoor and outdoor interests. CONCLUSION: Our study underlines the importance of psychosocially assessing PVS patient caregivers, who are often alone in coping with a irreversible situation. It also introduces a questionnaire (FSQ2) that seems to be sufficient to assess the caregiving-related problems.

A petunia MADS box gene involved in the transition from vegetative to reproductive development.

We have identified a novel petunia MADS box gene, PETUNIA FLOWERING GENE (PFG), which is involved in the transition from vegetative to reproductive development. PFG is expressed in the entire plant except stamens, roots and seedlings. Highest expression levels of PFG are found in vegetative and inflorescence meristems. Inhibition of PFG expression in transgenic plants, using a cosuppression strategy, resulted in a unique nonflowering phenotype. Homozygous pfg cosuppression plants are blocked in the formation of inflorescences and maintain vegetative growth. In these mutants, the expression of both PFG and the MADS box gene FLORAL BINDING PROTEIN26 (FBP26), the putative petunia homolog of SQUAMOSA from Antirrhinum, are down-regulated. In hemizygous pfg cosuppression plants initially a few flowers are formed, after which the meristem reverts to the vegetative phase. This reverted phenotype suggests that PFG, besides being required for floral transition, is also required to maintain the reproductive identity after this transition. The position of PFG in the hierarchy of genes controlling floral meristem development was investigated using a double mutant of the floral meristem identity mutant aberrant leaf and flower (alf) and the pfg cosuppression mutant. This analysis revealed that the pfg cosuppression phenotype is epistatic to the alf mutant phenotype, indicating that PFG acts early in the transition to flowering. These results suggest that the petunia MADS box gene, PFG, functions as an inflorescence meristem identity gene required for the transition of the vegetative shoot apex to the reproductive phase and the maintenance of reproductive identity.

Paternity and multiple signaling: effects of a secondary sexual character and song on paternity in the barn swallow.

Multiple signals may evolve because they provide independent information on the condition of a signaler. Females should pay attention to male characters relative to their reliability as signals of male attractiveness or quality. Since behavioral traits are flexible and, therefore, subject to strong environmental influences, females should weigh stable morphological signals higher in their choice of mates for genetic benefits than flexible behavioral traits, for example, by paying particular attention to phenotypically plastic traits when produced in combination with an exaggerated morphological signal. Consistent with this prediction, female barn swallows Hirundo rustica, which are known to prefer males with the longest tail feathers (a secondary sexual character), also preferred males with extreme expressions of a behavioral trait (song rate), as determined from patterns of paternity assessed by microsatellites. However, a statistical interaction between tail length and song rate implied that song rate was relatively unimportant for males with a short tail but more important for longtailed males. Since song rate is a flexible behavioral trait, females appear to have responded to this flexibility by devaluing the importance of song rate in assessment of unattractive sires.

Serum bone Gla protein and carboxyterminal cross-linked telopeptide of type I collagen in patients with Cushing's syndrome.

Serum bone Gla protein, a marker of bone formation, and carboxyterminal cross-linked telopeptide of type I collagen levels, an index of bone resorption, were evaluated in eight patients with active Cushing's syndrome and in four with 'preclinical' Cushing's syndrome, before and after surgery. In basal conditions, serum bone Gla protein levels were significantly lower (p < 0.0001) in patients with active Cushing's syndrome (1.0 +/- 0.35 ng/ml) than in controls (5.4 +/- 0.15 ng/ml); two out of four patients with the 'preclinical' form had reduced bone Gla protein levels, while in the other two cases levels were in the normal range. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (3.0 +/- 0.4 ng/ml), although slightly reduced, were similar to those recorded in controls (4.1 +/- 0.3 ng ml), both in patients with active and with preclinical Cushing's syndrome. After surgery serum levels of both marker proteins significantly increased in seven out of eight patients with active Cushing's syndrome; in one patient, who was not cured after surgery, bone Gla proteins levels remained lower than in normals, while levels of carboxyterminal cross-linked telopeptide of type I collagen had a transient increase after six months. In the two patients with a 'preclinical' Cushing's syndrome who underwent surgery, a significant rise of the levels of both marker proteins was observed, similar to that observed in patients with active Cushing's syndrome. It was concluded that serial determinations of these new markers of bone formation and resorption may be usefully employed to follow-up the clinical course of Cushing's syndrome and provide information on the rate of bone turnover in response to medical and/or surgical therapies. Moreover, the evaluation of these markers in preclinical states of Cushing's syndrome might suggest the need for surgery.

Modifications of biochemical markers of bone and collagen turnover during corticosteroid therapy.

Serum bone Gla protein (BGP), carboxyterminal cross-linked telopeptide of type I collagen (ICTP) and aminoterminal propeptide of type III procollagen (PIIINP) levels were determined in 8 patients with autoimmune disorders (2 with systemic lupus erythematosus, 3 with rheumatoid arthritis, 2 with Sjögren's syndrome and 1 with mixed connective tissue disease) before and after 1, 2 and 4 months of treatment with oral prednisone (at a dosage of 1 mg/kg bw/day, p.o. during the first month, then reduced to 0.1-0.2 mg/kg bw/day). Before treatment mean serum BGP (mean +/- SE: 5.3 +/- 0.4 ng/ml) and ICTP (2.8 +/- 0.2 ng/ml) levels were similar to those recorded in an age and sex matched control group (n = 40: 5.4 +/- 0.1 ng/ml and 4.1 +/- 0.3 ng/ml, respectively). On the other hand, serum PIIINP levels (2.2 +/- 0.3 ng/ml) were significantly (p < 0.008) lower than those found in controls (3.3 +/- 0.2 ng/ml). During glucocorticoid therapy, serum BGP levels significantly decreased after 1 month (2.9 +/- 0.4 ng/ml; P < 0.001), but returned to baseline values after 2 and 4 months of treatment (4.7 +/- 0.4 ng/ml and 5.3 +/- 0.3 ng/ml, respectively). On the contrary, no significant changes were observed in serum ICTP levels during treatment (1st month: 2.7 +/- 0.4 ng/ml; 2nd month: 3.0 +/- 0.4 ng/ml; 4th month: 2.4 +/- 0.3 ng/ml). Serum PIIINP mean concentration significantly decreased after 1 (1.6 +/- 0.3 ng/ml; P < 0.004) and 2 months of glucocorticoid administration (1.5 +/- 0.2 ng/ml; P < 0.01); after 4 months, serum PIIINP levels were again reduced as before therapy (1.8 +/- 0.2 ng/ml). In conclusion, our study shows the presence of normal bone turnover indexes and of altered collagen synthesis in patients with autoimmune disorders. The use of high doses of oral steroids is associated with a prompt decrease of bone formation and collagen synthesis, without any significant changes in bone resorption; however, the negative effects on bone formation and collagen synthesis seem to revert after lowering corticosteroid dosage. Serial determinations of the markers of bone and collagen turnover are able to give useful and reliable information on the peripheral effects of steroids excess.

Sporophytic response to pollen selection for Alachlor tolerance in maize.

In order to assess the efficiency of male gametophytic selection (MGS) for crop improvement, pollen selection for tolerance to herbicide was applied in maize. The experiment was designed to test the parallel reactivity to Alachlor of pollen and plants grown in controlled conditions or in the field, the response to pollen selection in the sporophytic progeny, the response to a second cycle of MGS, and the transmission of the selected trait to the following generations. The results demonstrated that pollen assay can be used to predict Alachlor tolerance under field conditions and to monitor the response to selection. A positive response to selection applied to pollen in the sporophytic progeny was obtained in diverse genetic backgrounds, indicating that the technique can be generally included in standard breeding programs; the analysis of the data produced in a second selection cycle indicated that the selected trait is maintained in the next generation.

Immuno chemical characterization of nitrate reductase from spinach leaves and roots.

Nitrate reductase from spinach (Spinacia oleracea L.) leaves was purified to homogeneity and specific antibodies against the protein were raised by the immunization of rabbits. Using immunodiffusion and immunoprecipitation techniques, the enzymes from leaves and roots were compared. It was demonstrated that the two nitrate reductases were different proteins on the basis of their antigenic behaviour.