Search

Hormonal therapy is the preferred systemic treatment for recurrent or metastatic, post-menopausal hormone-receptor-positive breast cancer. Previous studies have shown that there is no cross-resistance between exemestane and reversible aromatase inhibitors. Exposure to hormonal therapy does not hamper later response to chemotherapy. Patients with locally advanced or metastatic, hormonal receptor positive or unknown, breast cancer were treated with oral anastrozole, until disease progression, followed by oral exemestane until new evidence of disease progression. The primary end point of the study was clinical benefit, defined as the sum of complete responses (CR), partial responses (PR) and > 24 weeks stable disease (SD). In all, 100 patients were enrolled in the study. Anastrozole produced eight CR and 19 PR for an overall response rate of 27% (95% CI: 18.6-36.8%). An additional 46 patients had long-term (> 24 weeks) SD for an overall clinical benefit of 73% (95% CI: 63.2-81.4). Median time to progression (TTP) was 11 months (95% CI: 10-12). A total of 50 patients were evaluated for the second-line treatment: exemestane produced one CR and three PR; 25 patients had SD which lasted > or = 6 months in 18 patients. Median TTP was 5 months. Toxicity of treatment was low. Our study confirms that treatment with sequential hormonal agents can extend the period of time during which endocrine therapy can be used, thereby deferring the decision to use chemotherapy. [ABSTRACT FROM AUTHOR]

In this paper, we present an approach to evaluate the hydrological alterations of a temporary river. In these rivers, it is expected that anthropogenic pressures largely modify low-flow components of the flow regime with consequences for aquatic habitat and diversity in invertebrate species. First, by using a simple hydrological index (IARI) river segments of the Celone stream (southern Italy) whose hydrological regime is significantly influenced by anthropogenic activities have been identified. Hydrological alteration has been further classified through the analysis of two metrics: the degree (Mf) and the predictability of dry flow conditions (Sd6). Measured streamflow data were used to calculate the metrics in present conditions (impacted). Given the lack of data from pristine conditions, simulated streamflow time series were used to calculate the metrics in reference conditions. The Soil and Water Assessment Tool (SWAT) model was used to estimate daily natural streamflow. Hydrological alterations associated with water abstractions, point discharges and the presence of a reservoir were assessed by comparing the metrics (Mf, Sd6) before and after the impacts. The results show that the hydrological regime of the river segment located in the upper part of the basin is slightly altered, while the regime of the river segment downstream of the reservoir is heavily altered. This approach is intended for use with ecological metrics in defining the water quality status and in planning streamflow management activities.

Abstract Background Ground waters are an important resource of water supply for human health and activities. Groundwater uses and applications are often related to its composition, which is increasingly influenced by human activities. In fact the water quality of groundwater is affected by many factors including precipitation, surface runoff, groundwater flow, and the characteristics of the catchment area. During the years 2004-2007 the Agricultural and Food Authority of Apulia Region has implemented the project “Expansion of regional agro-meteorological network” in order to assess, monitor and manage of regional groundwater quality. The total wells monitored during this activity amounted to 473, and the water samples analyzed were 1021. This resulted in a huge and complex data matrix comprised of a large number of physical-chemical parameters, which are often difficult to interpret and draw meaningful conclusions. The application of different multivariate statistical techniques such as Cluster Analysis (CA), Principal Component Analysis (PCA), Absolute Principal Component Scores (APCS) for interpretation of the complex databases offers a better understanding of water quality in the study region. Results Form results obtained by Principal Component and Cluster Analysis applied to data set of Foggia province it’s evident that some sampling sites investigated show dissimilarities, mostly due to the location of the site, the land use and management techniques and groundwater overuse. By APCS method it’s been possible to identify three pollutant sources: Agricultural pollution 1 due to fertilizer applications, Agricultural pollution 2 due to microelements for agriculture and groundwater overuse and a third source that can be identified as soil run off and rock tracer mining. Conclusions Multivariate statistical methods represent a valid tool to understand complex nature of groundwater quality issues, determine priorities in the use of ground waters as irrigation water and suggest interactions between land use and irrigation water quality.

Background: The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment., Methods: The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds., Results: Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions., Conclusions: The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

More than half of the world's rivers dry up periodically, but our understanding of the biological communities in dry riverbeds remains limited. Specifically, the roles of dispersal, environmental filtering and biotic interactions in driving biodiversity in dry rivers are poorly understood. Here, we conduct a large-scale coordinated survey of patterns and drivers of biodiversity in dry riverbeds. We focus on eight major taxa, including microorganisms, invertebrates and plants: Algae, Archaea, Bacteria, Fungi, Protozoa, Arthropods, Nematodes and Streptophyta. We use environmental DNA metabarcoding to assess biodiversity in dry sediments collected over a 1-year period from 84 non-perennial rivers across 19 countries on four continents. Both direct factors, such as nutrient and carbon availability, and indirect factors such as climate influence the local biodiversity of most taxa. Limited resource availability and prolonged dry phases favor oligotrophic microbial taxa. Co-variation among taxa, particularly Bacteria, Fungi, Algae and Protozoa, explain more spatial variation in community composition than dispersal or environmental gradients. This finding suggests that biotic interactions or unmeasured ecological and evolutionary factors may strongly influence communities during dry phases, altering biodiversity responses to global changes., (© 2024. The Author(s).)

Introduction: Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario)., Methods: Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts., Results: Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies., Discussion: While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease., Competing Interests: GLC has received speaker fees, research and educational grants from Abbott, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi and Pfizer. GNC has received speaker fees, research and educational grants from Janssen, Astellas, Bayer, Recordati, MSD, Astrazeneca, IPSEN. VB has received speakers fees from Janssen and Astellas. PB has received speaker fees, research and educational grants from Astellas, Astrazeneca, BeiGene, Dephaforum, EISAI, Eli Lilly, Excerptamedica, Gilead, Janssen-Cilag SpA, Merck Serono Spa, MSD, Novartis, PierreFabre, Pharmagenesis, Reithera srl, Roche, Rottapharm, Sanofi, Servier, Takeda, Takis, and Toscana Life Science. Outside of the submitted work, PZ reports personal fees for advisory roles, speaker engagements and travel and accommodation expenses from MSD, Merck Serono Spa, Astellas, Janssen-Cilag SpA, Sanofi, Ipsen, Pizer, Noartis, BMS, Amgen, AstraZeneca, Roche and Bayer. SB was advisory board or Steering Committee Member uncompensated for: Bayer, Astellas, Janssen, Pfizer, BMS, Roche, Ipsen, MSD, AAA, Sanofi, Merck, Astrazeneca. GP reports fees as advisory board and expertise dossier on clinical-epidemiological evaluations for Astellas, BMS, Merck, MSD. RI served as an advisory board member or consultant for Astellas, Pfizer, Janssen, Sanofi, IPSEN, MSD, BMS, Novartis, EISAI; received institutional support for research project from Pfizer and BMS. AG has received speakers fees from Amgen. MB received research grants and speaker fees from MSD, Leica and speaker fees from Pfizer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer SL declared a shared affiliation with the author EOS to the handling editor at the time of review., (Copyright © 2023 Bracarda, Iacovelli, Baldazzi, Zucali, Gernone, Conti, Pappagallo, Brunelli, Bruzzi, Fiorini, Magenta, Diomede, Mereta, D’Aria, Magliano, Liberatori, Cantù, Croce, Eandi, Colombo, Ferrante, Salè, Marinozzi, Lenzi, Remiddi and Remiddi.)

The recent approval of PARP inhibitors for the treatment of metastatic -castration-resistant prostate cancer (mCRPC) patients with BRCA mutations firstly introduced the possibility of proposing a targeted treatment in this disease. However, the availability of this therapeutic option raises a number of questions concerning the management of prostate cancer in everyday clinical practice: the timing and method of detecting BRCA mutations, the therapeutic implications of the detection, and the screening of the members of the family of a prostate cancer patient with a BRCA alteration. These challenging issues led the Italian Society for Uro-Oncology (SIUrO) to organise a Consensus Conference aimed to develop suggestions capable of supporting clinicians managing prostate cancer patients. The present paper described the development of the statements discussed during the consensus, which involved all of the most important Italian scientific societies engaged in the multi-disciplinary and multi-professional management of the disease., Competing Interests: Declaration of Competing Interest Alberto Lapini has received fees or honoraria for acting as an advisor to Medac, Bayer, MSD and Janssen, Orazio Caffo has received fees or honoraria for acting as speaker or as an advisor to AAA, Astellas, Astra Zeneca, Bayer, Ipsen, Janssen, MSD, Pfizer, Giario Natale Conti has received fees or honoraria for acting as an advisor to Janssen, Astellas, Bayer, Recordati, MSD, Astrazeneca and Ipsen, Giovanni Luigi Pappagallo has received fees or honoraria for acting as an advisor to AAA, Astellas, Astrazeneca, Janssen, Marzia Del Re has received fees from Astellas, AstraZeneca, Celgene, Novartis, Pfizer, BioRad, Janssen, Sanofi-Aventis, Roche, MSD, Lilly and Ipsen; and honoraria for acting as an advisor to Astra Zeneca, MSD, Ipsen, Janssen, Sanofi-Aventis, and Amgen, Francesca Castiglione has received fees from AstraZeneca, Novartis, Roche, MSD, GSK, and honoraria for acting as an advisor to Astra Zeneca, MSD, and Amgen, Matteo Brunelli has received fees from MSD, Janssen, Genactis, NTP, Oncotech, Roberto Iacovelli has received fees or honoraria for acting as an advisor to Astellas, BMS, EISAI, IPSEN, Janssen, MSD, Novartis, Pfizer, Sanofi. Consultant for Astellas, EISAI, MSD, Pfizer, Ugo De Giorgi received honoraria for advisory boards or speaker fees for Pfizer, BMS, MSD, PharmaMar, Astellas, Bayer, Ipsen, Roche, Novartis, Clovis, GSK, AstraZeneca, institutional research grants from AstraZeneca, Sanofi and Roche, Sergio Bracarda has received fees or honoraria for acting as an advisor from or steering committee member from AAA, Astellas, AstraZeneca, Bayer, BMS, Janssen, Ipsen, Merck, MSD, Pfizer, Roche, Sanofi. The other authors did not have conflicts of interest to be declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information re- garding their appropriate use and prescription that should be considered in clinical practice for impetigo management., Objective: A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information regarding their appropriate use and prescription that should be considered in clinical practice for impetigo management., Methods: A consensus on ideal features of antibiotic therapy for the treatment of impetigo was appraised by an online Delphi-based method, based on a panel of 61 infectious disease specialists, pediatricians, and dermatologists coordinated by a scientific committee of 5 experts specializing in impetigo management., Results: Full or very high consensus was reached on the 10 statements identified to describe the characteristics of the best hypothetic antibiotic therapy for impetigo together with indications for appropriate antibiotics use., Conclusions: Several criteria have to be considered when selecting topical antibacterial therapy for impetigo. Beyond efficacy and safety, antimicrobial susceptibility and pharmacological characteristics of the agent are essential points. Formulation of the antimicrobial product is fundamental, as well as patient and caregiver preference, to facilitate therapeutic adherence, to achieve the infection control, and to obtain the best benefit from treatment ( Curr Ther Res Clin Exp. 2023; 84:XXXXXX)., (© 2022 Published by Elsevier Inc.)

Metastatic hormone-sensitive prostate cancer (mHSPC) is usually categorized as high- or low-volume disease. This is relevant because low- and high-volume metastatic disease are associated with different outcomes, and thus management of the two forms should differ. Although some definitions have been reported, the concept of oligometastatic disease is not so clearly defined, giving rise to further variability in the choice of treatment, mainly between systemic agents and radiotherapy, especially in the era of metastasis-directed therapy. With the aim of providing clinicians with guidance on best practice, a group of medical and radiation oncologists, experts in prostate cancer, used the round robin method to generate a series of consensus statements on management of low-volume mHSPC. Consensus was obtained on three major areas of controversy: (1) with regard to clinical definitions of mHSPC, it was held that oligometastatic and low-volume disease refer to different concepts and should not be used interchangeably; (2) regarding therapy of de novo low-volume metastatic disease, androgen deprivation therapy alone can be considered undertreatment, and all patients should be evaluated for systemic treatment combinations; local therapy should not be denied in patients with mHSPC, regardless of the intensity of systemic therapy, and metastasis-directed therapy can be proposed in selected cases; (3) with regard to treatment of metachronous metastatic disease, patients should be evaluated for systemic treatment combinations. Metastasis-directed therapy can be proposed to delay systemic treatment in selected cases, especially if prostate-specific membrane antigen positron emission tomography staging has been performed and when indolent disease occurs. It is hoped that clinicians treating patients with mHSPC in daily practice will find this expert opinion of value.

Background: The goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients., Method: A consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF., Results: Full or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice., Conclusions: The consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient., Competing Interests: Dr. Blasi reports grants and personal fees from AstraZeneca, grants from Bayer, grants and personal fees from Chiesi, grants and personal fees from GSK, personal fees from Grifols, personal fees from Guidotti, personal fees from INSMED, grants and personal fees from Menarini, personal fees from Mylan, personal fees from Novartis, grants and personal fees from Pfizer, personal fees from Zambon, personal fees from Vertex, in the last 3 years outside the submitted work. Dr Volpi reports personal fees as a consultant for: Chiesi, Mylan, and Vertex in the last 3 years outside the submitted work. Giovanni Pappagallo, Vincenzo Carnovale, Carla Colombo, Valeria Raia, declare that they have no conflicts of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Many treatment approaches are now available for neuroendocrine neoplasms (NENs). While several societies have issued guidelines for diagnosis and treatment of NENs, there are still areas of controversy for which there is limited guidance. Expert opinion can thus be of support where firm recommendations are lacking. A group of experts met to formulate 14 statements relative to diagnosis and treatment of NENs and presented herein. The nominal group and estimate-talk-estimate techniques were used. The statements covered a broad range of topics from tools for diagnosis to follow-up, evaluation of response, treatment efficacy, therapeutic sequence, and watchful waiting. Initial prognostic characterization should be based on clinical information as well as histopathological analysis and morphological and functional imaging. It is also crucial to optimize RLT for patients with a NEN starting from accurate characterization of the patient and disease. Follow-up should be patient/tumor tailored with a shared plan about timing and type of imaging procedures to use to avoid safety issues. It is also stressed that patient-reported outcomes should receive greater attention, and that a multidisciplinary approach should be mandatory. Due to the clinical heterogeneity and relative lack of definitive evidence for NENs, personalization of diagnostic-therapeutic work-up is crucial.