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Although high sensitive imaging modalities such as MRI and PSMA PET/CT are becoming available for prostate cancer (PCa), the clinical benefit of an earlier detection of subclinical disease remains yet undetermined. Given these uncertainties, univocal recommendations are often lacking. The present survey was therefore developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of expert radiation oncologists and delineate a representation of current clinical practice in our country. A nationwide cross-sectional survey was conducted in Italy by administering an anonymous questionnaire to experienced radiation oncologists, representative of the genitourinary (GU) tumor board at their Institution, using the cloud-based platform SurveyMonkey®. For each question, a consensus was achieved when ≥ 75% of the responders agreed on the same response. Thirty nine AIRO members from different Italian centers who were deemed experts in GU field accessed the proposed survey and completed all sections. Explored topics included staging of organ-confined disease, management of biochemical and local recurrence, imaging in the metastatic setting, imaging following metastasis-directed therapy (MDT), and future considerations. Response rate for single item of the questionnaire ranged between 51.2% and 100%. Expert GU AIRO members agree that advanced molecular and functional imaging are expanding their role in local and distant staging of PCa, as well as in the oncologic management and in the assessment of treatment response. However, many controversial issues still exist on the best timing for a diagnostic evaluation and the most appropriate imaging to aim at this purpose.

Purpose: Our study investigated the association between treatment-related lymphopenia and overall survival (OS) in a series of glioblastoma (GBM) patients. We also explored clinical and dosimetric predictors of lymphocytes depletion. Methods: Between 2015 and 2019, 64 patients were treated at the same institution with postoperative chemoradiotherapy. Peripheral lymphocyte count (PLC) data and dose–volume histogram parameters were collected. Radiotherapy (RT) schedule consisted in standard total dose of 60 Gy in 30 daily fractions, with concomitant and adjuvant temozolomide (TMZ). Posttreatment acute absolute lymphopenia (nadir AAL) was calculated as a PLC lower than 1.0 × 103/mm3. Acute relative lymphopenia (ARL) was expressed by the nadir-PLC/baseline-PLC ratio < 0.5. Nadir-PLC was the lowest PLC registered between the end of RT and the first month of follow-up. Survival rates were estimated with Kaplan–Meier curves. Clinical and dosimetric variables related to AAL/ARL and OS were identified by univariate and multivariate analyses. Results: A total of 57 patients were eligible and included in the analyses. The median PLC was significantly decreased following chemoradiotherapy (2180/mm3 vs 900/mm3). Median OS was 16 months (range 5–55 months), with no significant difference between patients who developed nadir AAL and those who did not (16 months vs 16.5 months; p = 0.304). When considering ARL vs non-ARL, median OS was 14 months vs 26 months (p = 0.013), respectively. In multivariate Cox regression only age, sex, extent of surgery, access to adjuvant chemotherapy and brain D98% were independently associated with OS. Conclusion: Although iatrogenic immunosuppression could be associated with inferior clinical outcomes, our data show that treatment-related lymphopenia does not adversely affect GBM survival. Prospective studies are required to confirm these findings.

Purpose/objectives: To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilotÒ System) to account for intra-fractional organ motion. Material/methods: Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. Results: All patients completed the treatment in the expected time (10.2 +/− 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of

Purpose/objectives: To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilotÒ System) to account for intra-fractional organ motion. Material/methods: Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. Results: All patients completed the treatment in the expected time (10.2 +/− 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of

Objectives: We aimed to analyze the impact of a 3-week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced breast cancer (BC). Methods: Eligible patients were females with Stage IIA – IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Locoregional recurrence (LRR), distant metastases-free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated. Results: 57 patients with a median age of 60 years (32–85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). 34 (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT. At a median follow-up of 80 months (30–113), the 7-year LRR-free survival was 93% (95% CI, 74%–95%). The same features for DMFS and OS were 76% (95% CI, 52%–78%) and 67% (95% CI, 50%–80%), respectively. Only one (2%) patient experienced G3 acute skin toxicity. No grade ≥2 late toxicity was observed. Conclusion: Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow-up is needed to strengthen further analyses on late toxicity and clinical outcomes. Advances in knowledge: This paper adds to the evidence that post-operative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week HF regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless

BACKGROUND AND AIM: Approximately 80% of women become pregnant at some point during their career in the United States. Prenatal depression (PD) has been associated with adverse health outcomes in pregnant women and their offspring, particularly in lower sociodemographic (SES) populations. We examined the occupational risk factors associated with PD in a population of lower SES pregnant workers in New York City. METHODS: Analyses included 487 women aged ≥18 years visiting obstetrics and gynecology clinics during pregnancy or within 2 months of child delivery between March to September 2017, with employment status at the time or after January 2014, when the Pregnant Workers Fairness Act legislation was enforced in NYC. Detailed occupational and sociodemographic data were collected via in-person interviews. Women completed a 10-item Edinburgh Depression Scale (EDS); EDS score ≥13 was classified as probable PD. Scores for established subconstructs of EDS (anxiety, anhedonia, classical depression) were also calculated. Multivariable adjusted regressions were used to identify the occupational factors that predict higher scores of EDS and its subconstructs, adjusting for age, race/ethnicity, education, marital status, and manager status. RESULTS: Majority of women were black and/or Hispanic (84%), reporting <$30,000 annual household income (64%). Unconventional work shifts (night/evening or rotating shiftwork) [adjusted odds ratio {aOR} (95% CI)=2.01(1.14-3.55)], higher perceived work stress [aOR=2.91(1.27-6.70)], and health, science, or technology-related industry [aOR=2.74 (1.07-7.03)] were independently associated with elevated EDS score. For EDS subconstructs, higher perceived stress level at job was significantly positively associated with all three subconstructs, while job duty of lifting/pulling heavy objects was significantly associated with classical depression subconstruct (all p<0.05). CONCLUSIONS: As more women continue to work during pregnancy, workplace

This paper highlights advantages and drawbacks due to the use of portable and low-cost devices for aerosol sampling, showing their performances during an aerosol monitoring campaign with the parallel use of the gravimetric sampling reference method and a cascade impactor. A specific monitoring campaign was held running all instruments in parallel in indoor, confined, and outdoor environments characterized by local emission sources or particulate matter background concentra-tions. PM2.5 concentrations were used to compare data emerging from the different instruments adopted. Significant underestimation of PM2.5 emerged when comparing data coming from optical sensors with those estimated by the cascade impactor, whose data resulted in being coherent with gravimetric determination, integrated over the same sampling time. A cause–effect relationship between PM2.5 concentrations and specific emission sources was found when observing the daily patterns of all the real-time sampling devices. It emerged that optical devices are useful for detecting concentration trends, the presence of peak values, or changes in the background value, even if with limited accuracy and precision. The comparison with particle size distributions obtained by the cascade impactor data allowed us to define which particle sizes are not detected by different optical devices, evidencing a low representativeness of optical low-cost sensors for health exposure measurements. The correlations among the specific particle size fractions detected by the cascade im-pactor and their specific emission sources were particularly high for car emissions in a semi-confined garage area.

Background/Aim: Hypoparathyroidism is the most significant morbidity after neck dissection for thyroid cancer. Addition of lateral neck dissection (ND) to central ND combined with total thyroidectomy (TT) increases the risk of postoperative hypoparathyroidism compared to TT plus central ND. The aim of this study was to verify if a modified procedure and different access to the neck for lateral ND may improve safety. Patients and Methods: In 62 patients with papillary thyroid cancer (PTC) undergoing TT plus central and lateral ND between 2010 and 2013, lateral ND was performed as first step approaching the neck via extrathyroideal space. Calcium in serum and parathormone (PTH) were determined preoperatively, intraoperatively and during the follow-up. Results: Twenty patients (32%) developed postoperative hypocalcemia. Calcium levels and PTH completely recovered for 58 out of 62 patients from 3 to 6 months after surgery. After a mean of 12 months' follow-up, only four patients (6.5%) had developed permanent hypoparathyroidism. The incidence of parathyroid complication after TT plus central ND and lateral ND did not differ from postoperative hypoparathyroidim after TT plus central ND. Conclusion: The presented surgical procedure may provide a better outcome in terms of parathyroid morbidity.

Background: For the past century, ferroalloy industries in Brescia province, Italy produced particulate emissions enriched in manganese (Mn), lead (Pb), zinc (Zn), copper (Cu), cadmium (Cd), chromium (Cr), iron (Fe), and alu- minum (Al). This study assessed metal concentrations in soil and vegetables of regions with varying ferroalloy industrial activity levels. Methods: Home gardens (n = 63) were selected in three regions of varying ferroalloy plant activity durations in Brescia province. Total soil metal concentration and extractability were measured by X-Ray Fluorescence (XRF), aqua regia extraction, and modified Community Bureau of Reference (BCR) sequential extraction. Unwashed and washed spinach and turnips cultivated in the same gardens were analyzed for metal concentrations by flame atomic absorption spectrometry. Results: Median soil Al, Cd, Fe, Mn, Pb, and Zn concentrations were significantly higher in home gardens near ferroalloy plants compared to reference home gardens. The BCR method yielded the most mobile soil fraction (the sum of extractable metals in Fractions 1 and 2) and all metal concentrations were higher in ferroalloy plant areas. Unwashed spinach showed higher metal concentrations compared to washed spinach. However, some metals in washed spinach were higher in the reference area likely due to history of agricultural product use. Over 60% of spinach samples exceeded the 2- to 4-fold Commission of European Communities and Codex Alimentarius Commission maximum Pb concentrations, and 10% of the same spinach samples exceeded 2- to 3-fold maximum Cd concentrations set by both organizations. Turnip metal concentrations were below maxi- mum standard reference values. Conclusions: Prolonged industrial emissions increase median metal concentrations and most soluble fractions (BCR F1 + F2) in home garden soils near ferroalloy plants. Areas near ferroalloy plant sites had spinach Cd and Pb metal concentrations several-fold above maximum standard referen

Behavioral toxicology is an important discipline of toxicology that traces its roots back to the origin of psychology. A parallel development can be traced for behavioral toxicology and psychology, in that both were focused on the mind or behavior, as distinct from neurology, that recognized the brain as the ultimate target. Ancient physicians and non-medical authors incidentally described the effects of neurotoxic agents on mood. In the last two centuries, experimental psychology, behaviorism and behavioral pharmacology further developed the observation of behavior with scientific methodology. During the Industrial Revolution exposure to neurotoxicants became widespread in the western world and the consequent " psycho-organic syndrome" was likely to affect a large part of the working population. Occupational Medicine met behavioral toxicology in the 1960s. The assessment of the effects of exposure on behavior was achieved with specific tests for motor and cognitive functions, and computer technology could be used to control and analyze behavioral experiments. The contribution of this discipline became further important in the identification of early adverse effects, also from environmental and dietary exposure. The detection of behavioral changes can precede the detection of neural changes, which makes the assessment of behavior especially suitable for risk assessment. Neurobehavioral methodology has further developed in the latest years towards a global and integrated approach to the different life stages of individuals, from early life to old age. © 2012 Elsevier Inc.