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BackgroundProphylactic Bilateral Salpingo-Oophorectomy (PBSO) reduces the risk of developing ovarian cancer. However, the psychological mechanisms that may affect post-surgery Quality of Life (QoL) among patients who underwent PBSO are still largely unknown. Thus, this study aimed at exploring the direct and indirect associations of satisfaction with medical communication and cancer anxiety on post-surgery QoL among women at high risk of developing ovarian cancer.MethodFifty-nine women (mean age: 50.64 ± 6.7 years) who underwent PBSO took part in this cross-sectional study, filling out a sociodemographic and clinical questionnaire, a battery of validated psychological measures and an ad hoc developed scale for the assessment of cancer anxiety. We first examined the correlations among all variables of interest, and then tested if cancer anxiety mediated the association between satisfaction with medical communication and post-surgery psychological QoL, controlling both for time from surgery and education.ResultsPost-surgery psychological QoL was unrelated from any sociodemographic or clinical variable. Cancer anxiety had a significant direct negative effect on psychological QoL, while satisfaction with medical communication had a significant positive direct effect on it. Finally, cancer anxiety significantly mediated the association between satisfaction with medical communication and post-surgery psychological QoL.DiscussionResults suggest that post-surgery psychological QoL of patients who underwent PBSO may be increased with interventions, delivered in a genetic counselling setting, targeting quality of medical communication and cancer anxiety.

Il contributo descrive un esperimento di sintesi e condivisione di serie spazio-temporali di misurazioni della deformazione del suolo a supporto della pianificazione urbana condotto nell'ambito del progetto PRIN "URBAN GEOmatics for Bulk Data Generation, Data Assessment e Technology Awareness (URBAN GEO BIG DATA)". Le serie temporali sono derivate attraverso le misurazioni di interferometria radar differenziale (DInSAR) nelle aree urbane di cinque città Italiane: Milano, Padova, Napoli, Roma e Torino. Il fuoco del contributo è la sperimentazione di un metodo di sintesi, visualizzazione e condivisione interoperabile di tali informazioni, adatto sia agli scienziati sia ai non esperti.

Geospatial metadata are largely denormalized inasmuch as resource descriptions typically accommodate property values as plain text. Hence, it is not possible to bring multiple references to the same entity (say, a keyword from a controlled vocabulary) under the same umbrella. This practice is ultimately the main source for the heterogeneities in metadata descriptions by which geospatial discovery is hampered. In this paper, we elaborate on ex-post semantic augmentation of metadata, a technique generally referred to as semantic lift, which complements our previous research on semantic characterization of metadata via transparent association of uniform resource identifiers with metadata items at editing time. The latter is accomplished by means of a template-based metadata editor that can be tailored to any XML-based metadata schema. By repurposing the template language previously defined for metadata editing, we broaden the expressiveness of the former and integrate heterogeneous, XML-based resource descriptions in our semantics-aware metadata management workflow. URI-based indirection in metadata provision not only entails normalization of individual information items and allows one to overcome the aforementioned heterogeneities, but also elicits decentralized, multi-tenanted management of metadata.

Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.

Proposal of integration of VGI created by smart applications within an OGC standard geospatial data infrastructure.

This contribution discusses the role of novel Information and Communication Technologies and specifically of Smart Applications and Spatial Data Infrastructures (SDI) for creating and sharing on the Internet Volunteered Geographic Information (VGI) in order to support the promotion of territory's vocations, Points Of Interest and touristic sites. Some guidelines are drawn to adopt an open and integrated SDI framework to manage and share VGI and heterogeneous multisource geo-information, thus achieving interoperability among different information sources and thus making it possible a wider fruition of the information available on the Web by the public. Critical issues are also identified that shall be considered when collecting and managing VGI to promote Points Of Interests.

Agriculture is a global issue nowadays. At the European level, it is a sector, in which we are investing many resources. In particular, the Agri-Food sector plays a central role in the policies of the European Commission and the Horizon 2020 research and innovation program, as well as being the main theme of Expo 2015 that will be held in Milan, Lombardy. In the Lombardy region, the farmers represent 2% of the entire population, cultivating about 80% of the agricultural land. Increasing needs to develop a common body of knowledge shared at the regional and national level so as to make it possible to effectively monitor cropping systems, water stress and impacts of climate changes affecting more frequently the territory, are becoming more and more urgent. In this context, the project Space4Agri (S4A) intends to support the regional and local needs in terms of management of the agriculture sector, by designing and developing an information and knowledge based platform for managing geospatial and mainstream information by making it accessible over the Internet by standard communication technologies (Geo&Mainstream ICT). This platform has been designed to allow data workflows integrating i) spatial data and observations, ii) non-spatial information available from existing agronomic databases, iii) data collected in the field by farmers, agronomists and volunteers using mobile applications, iv) data collected by unmanned aerial sensors, and/or data produced by researchers as a result of applying scientific analysis on high quality remote sensing data. Foreseen results of the Space4Agri project and from other similar ongoing research activities may significantly spur the socio-economic development of Europe and create new growth opportunities for companies, public administrations, students and citizens.

Agriculture is a global issue nowadays. At the European level, it is a sector, in which we are investing many resources. In particular, the Agri-Food sector plays a central role in the policies of the European Commission and the Horizon 2020 research and innovation program, as well as being the main theme of Expo 2015 that will be held in Milan, Lombardy. In the Lombardy region, the farmers represent 2% of the entire population, cultivating about 80% of the agricultural land. Increasing needs to develop a common body of knowledge shared at the regional and national level so as to make it possible to effectively monitor cropping systems, water stress and impacts of climate changes affecting more frequently the territory, are becoming more and more urgent. In this context, the project Space4Agri (S4A) intends to support the regional and local needs in terms of management of the agriculture sector, by designing and developing an information and knowledge based platform for managing geospatial and mainstream information by making it accessible over the Internet by standard communication technologies (Geo&Mainstream ICT). This platform has been designed to allow data workflows integrating i) spatial data and observations, ii) non-spatial information available from existing agronomic databases, iii) data collected in the field by farmers, agronomists and volunteers using mobile applications, iv) data collected by unmanned aerial sensors, and/or data produced by researchers as a result of applying scientific analysis on high quality remote sensing data. Foreseen results of the Space4Agri project and from other similar ongoing research activities may significantly spur the socio-economic development of Europe and create new growth opportunities for companies, public administrations, students and citizens.

Background: the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT) for people with chronic and acute wounds.Methods: the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients). safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs) comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies.Results: we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001), with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity).We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT.Conclusions: despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....

To evaluate efficacy and safety of a neoadjuvant treatment with irinotecan and cisplatin [cis-diamminedichloroplatinum(II); CDDP] in patients with locally advanced cervical cancer.A phase 2 study was conducted at 13 centers located in Italy. Eighty-seven were enrolled between 2000 and 2003. Patients received irinotecan 175 mg/m2 on day 1 every 3 weeks followed by CDDP 80 mg/m2. Each patient was to receive 3 cycles of treatment. Tumor response was to be evaluated by magnetic resonance imaging 3 weeks after the end of the third cycle. At the end of therapy, all patients were to be examined for radical surgery.Of 71 patients included in the primary analysis, 9 (12.7%) showed a complete response; and 43 (60.6%), a partial response for an overall response rate of 73.2% (95% confidence interval [CI], 61.4%-83.1%). Complete pathological responses were observed in 13.6% of the patients (95% CI, 7.0%-23.0%). Overall survival rate at 4 years was 87.0% (95% CI, 79.5%-94.5%).There were no study-related deaths. Most common adverse events were alopecia in 76 patients (87.4%) and gastrointestinal disorders in 79 patients (90.8%). Serious adverse events were vomiting in 18 patients (20.7%), nausea in 14 (16.1%), diarrhea in 8 (9.2%), and neutropenia in 50 (57.5%). A total of 3 patients (3.4%) were discontinued from the study owing to the occurrence of 1 or more serious adverse event.Irinotecan and CDDP as neoadjuvant chemotherapy in locally advanced cervical cancer showed a promising response rate. These data warrant confirmation with a phase 3 study.

The levels of accumulation of recombinant vaccines in transgenic plants are protein specific and strongly influenced by the subcellular compartment of destination. The human immunodeficiency virus protein Nef (negative factor), a promising target for the development of an antiviral vaccine, is a cytosolic protein that accumulates to low levels in transgenic tobacco and is even more unstable when introduced into the secretory pathway, probably because of folding defects in the non -cytosolic environment. To improve Nef accumulation, a new strategy was developed to anchor the molecule to the cytosolic face of the endoplasmic reticulum (ER) membrane. For this purpose, the Nef sequence was fused to the C-terminal domain of mammalian ER cytochrome b5, a long-lived, tail-anchored (TA) protein. This consistently increased Nef accumulation by more than threefold in many independent transgenic tobacco plants. Real-time polymerase chain reaction of mRNA levels and protein pulse-chase analysis indicated that the increase was not caused by higher transcript levels but by enhanced protein stability. Subcellular fractionation and immunocytochemistry indicated that Nef-TA accumulated on the ER membrane. Over-expression of mammalian or plant ER cytochrome b5 caused the formation of stacked membrane structures, as observed previously in similar experiments performed in mammalian cells; however, Nef-TA did not alter membrane organization in tobacco cells. Finally, Nef could be removed in vitro by its tail-anchor, taking advantage of an engineered thrombin cleavage site. These results open up the way to use tail anchors to improve foreign protein stability in the plant cytosol without perturbing cellular functions.

It has been proposed that extending the platinum-free interval with intervening non-platinum therapy increases the efficacy of a later re-treatment with platinum in platinum-sensitive recurrent ovarian cancer. This hypothesis is based on data from small series and although it has not been validated prospectively, this strategy has entered general practice in Italy in the last years. The SOCRATES study retrospectively assessed the pattern of care of a cohort of patients with recurrent platinum-sensitive ovarian cancer observed in the years 2000-2002 in 37 Italian centres. Data were collected between April and September 2005.Patients with recurrent ovarian cancer with a platinum-free interval6 months were eligible. 493 patient files were collected and 428 were eligible and analyzed.The interval from the end of the 1st line to relapse was 6-12 months in 164 patients (39.5%) and12 months in 251 cases (60.5%). Patients received a 2nd (100%), 3rd (80.1%), 4th (50.2%), 5th (28.3%), and 6th (11.9%) line of chemotherapy. At 2nd line 282 (65.9%) received platinum (group A), while 146 (34.1%) received non-platinum chemotherapy (group B). In the latter group, 67 patients received platinum at later progression (group B1), while 79 never received platinum (group B2). Median time to platinum re-treatment was 20 and 23.1 months in patients of groups A and B1, respectively. The response rate to the first platinum received was 74.4 and 57.4% in groups A and B1, respectively (p = 0.02). Group B2 was characterized by the worst response rate and survival. At multivariate analysis time of first platinum re-treatment (2nd line vs. later; p = 0.0132; OR = 2.34) and age (p = 0.0029; OR = 2.41) was independently associated with a higher possibility of response to platinum.With the limits of a retrospective study, our data question the hypothesis that extending the platinum-free interval with an intervening non-platinum therapy in patients with recurrent platinum-sensitive ovarian cancer improves the response rate of a further platinum re-treatment.

Citato 156 volte in letteratura internazionale (Fonte: www.scopus.com). Citato 143 volte in letteratura internazionale (Fonte: apps.webofknowledge.com). Citato 212 volte in letteratura internazionale (Fonte: http://scholar.google.com/) Studio multicentrico. I membri dei vari centri sono indicati singolarmente in quota al proprio dipartimento universitario/centro di appartenenza nel paragrafo "Acknowledgment". Abstract Summary Background Data: The epidemiology of venous thromboembolism (VTE) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis (DVT). However, the clinical relevance of asymptomatic venography-detected DVT is unclear, and the population of these clinical trials is not necessarily representative of the overall cancer surgery population. Objective: The aim of this study was to evaluate the incidence of clinically overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE. Methods: @RISTOS was a prospective observational study in patients undergoing general, urologic, or gynecologic surgery. Patients were assessed for clinically overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days. All outcome events were evaluated by an independent Adjudication Committee. Results: A total of 2373 patients were included in the study: 1238 (52%) undergoing general, 685 (29%) urologic, and 450 (19%) gynecologic surgery. In-hospital prophylaxis was given in 81.6% and postdischarge prophylaxis in 30.7% of the patients. Fifty patients (2.1%) were adjudicated as affected by clinically overt VTE (DVT, 0.42%; nonfatal pulmonary embolism, 0.88%; death 0.80%). The incidence of VTE was 2.83% in general surgery, 2.0% in gynecologic surgery, and 0.87% in urologic surgery. Forty percent of the events occurred later than 21 days from surgery. The overall death rate was 1.72%; in 46.3% of the cases, death was caused by VTE. In a multivariable analysis, 5 risk factors were identified: age above 60 years (2.63, 95% confidence interval, 1.21-5.71), previous VTE (5.98, 2.13-16.80), advanced cancer (2.68, 1.37-5.24), anesthesia lasting more than 2 hours (4.50, 1.06-19.04), and bed rest longer than 3 days (4.37, 2.45-7.78). Conclusions: VTE remains a common complication of cancer surgery, with a remarkable proportion of events occurring late after surgery. In patients undergoing cancer surgery, VTE is the most common cause of death at 30 days after surgery. Copyright © 2005 by Lippincott Williams & Wilkins.

The binding protein (BiP; a member of the heat-shock 70 family) is a major chaperone of the endoplasmic reticulum (ER). Interactions with BiP are believed to inhibit unproductive aggregation of newly synthesized secretory proteins during folding and assembly. In vitro, BiP has a preference for peptide sequences enriched in hydrophobic amino acids, which are expected to be exposed only in folding and assembly intermediates or in defective proteins. However, direct information regarding sequences recognized in vivo by BiP on real proteins is very limited. We have shown previously that newly synthesized monomers of the homotrimeric storage protein phaseolin associate with BiP and that phaseolin trimerization in the ER abolishes such interactions. Using different phaseolin constructs and green fluorescent protein (GFP) fusion proteins, we show here that one of the two alpha-helical regions of polypeptide contact in phaseolin trimers (35 amino acids located close to the C terminus and containing three potential BiP binding sites) effectively promotes BiP association with phaseolin and with secretory GFP fusions expressed in transgenic tobacco or in transfected protoplasts. We also show that overexpressed BiP transiently sequesters phaseolin polypeptides. We conclude that one of the regions of monomer contact is a BiP binding determinant and suggest that during the synthesis of phaseolin, the association with BiP and trimer formation are competing events. Finally, we show that the other, internal region of contact between monomers is necessary for phaseolin assembly in vivo and contains one potential BiP binding site.

We have assessed the ability of the plant secretory pathway to handle the expression of complex heterologous proteins by investigating the fate of a hybrid immunoglobulin A/G in tobacco cells. Although plant cells can express large amounts of the antibody, a relevant proportion is normally lost to vacuolar sorting and degradation. Here we show that the synthesis of high amounts of IgA/G does not impose stress on the plant secretory pathway. Plant cells can assemble antibody chains with high efficiency and vacuolar transport occurs only after the assembled immunoglobulins have traveled through the Golgi complex. We prove that vacuolar delivery of IgA/G depends on the presence of a cryptic sorting signal in the tailpiece of the IgA/G heavy chain. We also show that unassembled light chains are efficiently secreted as monomers by the plant secretory pathway.

Ricin is synthesised as an ER-targeted precursor containing an enzymatic A chain and a galactose-binding B chain separated by a 12-amino acid linker propeptide. This internal propeptide is known to contain a sequence-specific vacuolar sorting signal whose functionality depends on the presence of an isoleucine residue. Conversion of this isoleucine to glycine completely abolished vacuolar targeting of proricin and led to its secretion. However, when this mutated signal was positioned at the C-terminus of a normally secreted reporter, vacuolar targeting of a significant fraction still occurred. Likewise, when the corrupted linker was C-terminally exposed within its natural context following the mature ricin A chain, and then co-expressed with ricin B chain, toxin heterodimers were still partially transported to tobacco cell vacuoles. By contrast, when placed at the N-terminus of the secreted reporter, or at the N-terminus of ricin B chain for co-expression with ricin A chain, the propeptide behaved most strikingly as a sequence-specific vacuolar targeting signal that, when mutated, resulted in complete secretion of the proteins. It would appear that when sited C-terminally the ricin linker could act, with varying efficiencies, as a non sequence-specific vacuolar targeting signal.

Summary Background Results from observational studies suggest that caesarean-section delivery may reduce the risk of mother-to-child transmission of HIV-1 infection in comparison with vaginal delivery. We carried out a randomised clinical trial to address this issue and to assess the extent of postdelivery complications. Methods Eligible women were between 34 and 36 weeks of pregnancy, with a confirmed diagnosis of HIV-1 infection, and without an indication for caesarean-section delivery or a contraindication to this mode of delivery. Women were randomly assigned elective caesareansection delivery at 38 weeks of pregnancy or vaginal delivery. An infant was classified as uninfected if he or she became negative for antibody to HIV-1 by age 18 months or was negative for virus by PCR or culture on at least two occasions, with no clinical, immunological, or viral evidence of infection. From 1993, to March, 1998, 436 women were randomised. Findings We present the results of an analysis updated to November, 1998, with data on the infection status of 370 infants. Three (1·8%) of 170 infants born to women assigned caesarean-section delivery were infected, compared with 21 (10·5%) of 200 born to women assigned vaginal delivery (p

Complex karyotypes are often seen in primary surface epithelial ovarian tumors (SEOTs). Conventional cytogenetic as well as fluorescence in situ hybridization analyses coupled with loss of heterozygosity studies identified abnormalities of chromosome 6 as one of the most frequent lesions in these types of tumors. We performed cytogenetic analysis of direct preparations from 40 SEOTs, including borderline tumors and low-, intermediate-, and high-grade carcinomas to verify the frequency of chromosome 6 alterations. We also carried out fluorescence in situ hybridization analysis with a chromosome 6 library and yeast artificial chromosome clones from a region of the same chromosome (6q27). Chromosome 6 abnormalities were identified in 30 of 32 analyzable SEOTs. Twenty-five of 32 cases showed a deletion of 6q irrespective of their histological grade. We wish to underline that this is the first report proving that del(6q) was the most frequent chromosome anomaly in near-diploid SEOTs and that it was the sole anomaly observed in four SEOTs with diploid complement. Our findings suggest that abnormalities of the telomeric region of chromosome 6 (6q27) may be considered one of the earliest lesions in the pathogenesis of ovarian carcinomas.

Proliferative lesions, known as Von Brunn nests, cystitis cystica and glandularis, and squamous epithelium of vaginal type are not uncommon in the lamina propria of the vesical trigone. The former have been considered reactive to chronic irritants and may represent glandular metaplasia of the transitional epithelium; the latter looks like much more sensitive to hormones. These lesions have been thought to play a role in the pathogenesis of abacteric cystitis: but this has not been confirmed at all by our series of 27 cases. Nevertheless the extension of these lesions should be evaluated with both cystoscopy and biopsies in a large series of sintomatic and asintomatic women.

The purpose of this study was to investigate the presence of risk factors for node metastases and to estimate survival in patients with cervical cancer, stages IB and LIA. In a retrospective study of 103 patients with cervical cancer stages IB and IIA, all treated with radical hysterectomy and adjuvant radiotherapy, we estimated survival curves according to different prognostic parameters. Mean follow-up time was 97 months. A significant difference between clinical pre-operative assessment and histological determination of real extent of the disease was evidenced. Pelvic lymph node metastases (P = 0.0005) significantly correlated with survival. This study shows that only lymph node involvement is an independent prognostic factor. Stage acts through nodal status in its impact on survival. A surgical-pathological staging in early stage cervical cancers is found to be more appropriate to correctly estimate patients' survival and prognosis.

The records of patients treated for vulvar carcinoma at the University of Milan from January 1967 through December 1991 have been studied retrospectively, making an analysis of the results of surgical staging in terms of prognosis, morbidity and long-term survival. All cases have been reevaluated and restaged according to the 1988 FIGO classification of vulvar cancer, considering 196 cases of primary invasive vulvar squamous carcinoma. Surgical treatments have been divided according to radicality. Ninety-five per cent of patients underwent radical vulvectomy with different degrees of lymphadenectomy. Surgical mortality rate amounted to 2%. Surgical staging has not been related to increased early or late morbidity. Overall recurrence rate amounted to 19.9% without significant differences among FIGO stages. Five-year survivals amounted to 100%, 86.2%, 59.4%, 29.8%, and 20% for stages I, II, III, IVA and IVB respectively. Accurate surgical staging of vulvar carcinoma enables a precise prognosis and does not increase morbidity.