Colorectal cancer prevention in Europe: burden of disease and status of screening programs.

Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of incidence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortality, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various states have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 European Union report on the state of screening program, activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, Screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013.

Randomized trial to evaluate cardiometabolic and endothelial function in patients with plasma HIV-1 RNA suppression switching to darunavir/ritonavir with or without nucleoside analogues.

BACKGROUND: We performed a study to evaluate change in cardiometabolic and endothelial function in HIV-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy versus triple therapy. METHODS: The MONARCH trial recruited 30 patients who were taking triple combination therapy and with HIV RNA<40 copies/ mL. Patients were randomized to either DRV/r 800/100 mg once daily (OD) monotherapy or DRV/r 800/100 mg OD plus 2 nucleoside reverse transcriptase inhibitors (NRTIs). The primary objective was to assess endothelial function change from baseline to 24 and 48 weeks in brachial artery flow-mediated dilation (FMD) test; changes in endothelial precursor cells (EPCs) and circulating endothelial cells (CECs) were secondary objectives. RESULTS: At baseline, the median age of participants was 43 years, 77% were men, and median CD4 cell count was 585 cells/µL. The median FMD (%) decreased in both arms in the study period (P ≯ .05), with no statistically significant difference between arms (10.7% at baseline and 6.7% at week 48 in the DRV/r + 2 NRTIs arm; 11.1% at baseline and 8.8% at week 48 in the DRV/r arm). The changes at week 48 were similar in the 2 arms for EPCs and CECs. Total cholesterol and low-density lipoprotein (LDL) cholesterol showed larger rises to week 48 in the DRV/r arm monotherapy group than in the triple-therapy group (+26 vs +9 mg/dL for total cholesterol and +14 vs +5 mg/dL for LDL cholesterol). CONCLUSIONS: In the MONARCH trial, switching from triple combination treatment to DRV/r, with or without nucleoside analogues, did not translate into clinically meaningful reductions in endothelial function as measured by FMD.

The effect of self-sampled HPV testing on participation to cervical cancer screening in Italy: a randomised controlled trial (ISRCTN96071600).

BACKGROUND: In Italy, cervical cancer screening programmes actively invite women aged 25-64 years. Programmes are hindered by low participation. METHODS: A sample of non-responder women aged 35-64 years, belonging to three different programmes (in Rome, Florence and Teramo), was randomly split into four arms: two control groups received standard recall letters to perform either Pap-test (first group) or human papillomavirus (HPV) test (second group) at the clinic. A third arm was sent letters offering a self-sampler for HPV testing, to be requested by phone, whereas a fourth group was directly sent the self-samplers home. RESULTS: Compliance with standard recall was 13.9% (N619). Offering HPV test at the clinic had a nonsignificant effect on compliance (N616, relative risk (RR)=1.08; 95% CI=0.82-1.41). Self-sampler at request had the poorest performance, 8.7% (N622, RR=0.62; 95% CI=0.45-0.86), whereas direct mailing of the self-sampler registered the highest compliance: 19.6% (N616, RR=1.41; 95% CI=1.10-1.82). This effect on compliance was observed only in urban areas, Florence and Rome (N438, RR=1.69; 95% CI=1.24-2.30), but not in Abruzzo (N178, RR=0.95; 95% CI=0.61-1.50), a prevalently rural area. CONCLUSIONS: Mailing self-samplers to non-responders may increase compliance as compared with delivering standard recall letters. Nevertheless, effectiveness is context specific and the strategy costs should be carefully considered.

Role of pulsatility on particle dispersion in expiratory flows.

Expiratory events, such as coughs, are often pulsatile in nature and result in vortical flow structures that transport respiratory particles. In this work, direct numerical simulation (DNS) of turbulent pulsatile jets, coupled with Lagrangian particle tracking of micron-sized droplets, is performed to investigate the role of secondary and tertiary expulsions on particle dispersion and penetration. Fully developed turbulence obtained from DNS of a turbulent pipe flow is provided at the jet orifice. The volumetric flow rate at the orifice is modulated in time according to a damped sine wave, thereby allowing for control of the number of pulses, duration, and peak amplitude. Thermodynamic effects, such as evaporation and buoyancy, are neglected in order to isolate the role of pulsatility on particle dispersion. The resulting vortex structures are analyzed for single-, two-, and three-pulse jets. The evolution of the particle cloud is then compared to existing single-pulse models. Particle dispersion and penetration of the entire cloud are found to be hindered by increased pulsatility. However, the penetration of particles emanating from a secondary or tertiary expulsion is enhanced due to acceleration downstream by vortex structures.

Handgrip impairment in Charcot-Marie-Tooth disease.

AIM: Charcot-Marie-Tooth disease (CMT) is a genetic neuropathy causing muscle weakening in the feet, legs and hands, with consequent impairment of ambulation and handgrip. For fast clinical evaluation and rehabilitation management of handgrip deficits, a functional classification in 4 stages or levels of clinical severity, based on the loss of handgrip types from the finest to the roughest, has been recently proposed. The aim of this study is to evaluate the prevalence of each level of handgrip impairment in a wide population of patients affected with demyelinating and axonal CMT. METHODS: Two-hundred and forty-eight non-operated hands were examined to evaluate if and how the pinch between the pulp of the thumb and the pulp of the second or third finger was made, starting from the palm-up position with the fingers abducted or, in case of impossibility to do so, if a lateral pinch or only a grasp was possible. Following to this observation, each hand was fitted in 1 of the 4 stages described in the above-mentioned classification and then the frequency of each stage was determined. RESULTS: As a whole, 75.4% hands were at stage 1; 9.7 were at stage 2; 10.9% at stage 3; 4% at stage 4. CONCLUSIONS: The results of this survey reveal that, in the majority of the CMT cases, handgrip is affected mildly so that only simple recommendations to prevent further muscle and joint damage are required; however, in more than 1 out 5 cases, the handrip impairment is quite severe and requires a detailed rehabilitative program with daily exercises, and, in a small number of cases, is so severe that independence in the daily living activities is lost or very reduced.

[Sociobiology and psychobiology: in the pantheon of science or in the basement of failures?]. / Sociobiologia e "psicobiologia": nel Pantheon della scienza o nella soffitta dei fallimenti?

The term sociobiology, coined by Wilson to describe the concept that human behaviour has a biological basis rooted in the genes, has aroused considerable controversy. The present report not only Wilson's hypothesis but takes it even further by putting forward the hypothesis that every human personality trait and resultant behavioural pattern is brought about by certain protein molecules, coded by the genes which activate special closed brain neuron circuits. The term "psychobiology" is suggested for this hypothesis, and "molecular personality code" for the whole complex of molecules mentioned above.

[Note on glycosaminoglycans]. / Note sui glicosoaminoglicani.

Having briefly recalled the chemical structure of glycosamine glycans (GAG) and the therapeutic use of standard heparin at conventional doses (anticoagulant action) and at low dosage (antithrombotic action), the properties and therapeutic employment of low molecular weight heparins (LMWH) are illustrated, and their advantages and disadvantages compared to standard heparin are discussed. Subsequently, the characteristics of heparan sulfates and other GAGs of the vascular endothelium and their therapeutic properties are described. Finally, GAGs found in articular structures are also mentioned.

[Oncogenes: a ray of light on the genesis and therapy of cancer?]. / Oncogèni: uno spiraglio di luce nella genesi e nella terapia del cancro?

The criteria that have led to the hypothesis according to which oncogenes play a role in the pathogenesis of cancer are briefly reviewed: "Certain genes normally present in cells in which they exert physiologic functions may become altered so as to induce cancer. Before acquiring carcinogenic properties, i.e. while they still exert their physiological function, these genes are referred to as proto-oncogenes; once they acquire their carcinogenic properties, they are called oncogenes". The importance modern techniques of molecular biology (genetic engineering and recombinant DNA) have had for the formulation of this hypothesis is stressed, as well as the involuntary contribution of retroviruses. The prospects are examined for therapeutic application that might derive from the oncogene hypothesis.

[The issue of authorship and proliferation of scientific research]. / La questione dell'authorship e la proliferazione dei lavori scientifici.

In conducting scientific research, certain ethical standards must be applied, not only in the actual performance of the research, in particular the choice of appropriate methodology, but also in writing about science. Authorship is an important aspect of ethical standards in scientific writing. In this article, we discuss the benefits and drawbacks of the most universally recognised guidelines for scientific authorship (i.e., those of the Vancouver Convention), in an attempt to contribute to resolving the recent debate on their presumed inapplicability. In addition to possible solutions to this problem, we provide indications regarding the closely related problem of the proliferation of scientific publications, which affects publication bias and contributes to the confusion surrounding the Impact Factor. Regardless of the specific solution adopted, it must be stressed that writing about science is an ethical decision.

A protocol for the treatment of mandibular condylar fractures.

The authors suggest a protocol for the treatment of mandibular condylar fractures classified by fracture level: the condylar head, the condylar neck and subcondylar fractures. The protocol provides a guide to individualizing intervention according to the type of fracture, the patient's age, the degree of restriction of mandible movement and the possible presence of fractured condyle displacement, which is often associated with functional disorders. The age of the patient is a key factor in the choice of treatment. The therapeutic goal in adult patients differs from that in growing patients, since in children the condyle is a major growth center for the mandible. Management may be surgical or nonsurgical; surgical intervention may be conservative with or without immobilization with closed or open reduction and fixation.

Breast cancer in European Union: an update of screening programmes as of March 2014 (review).

Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.