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Background: Patients with muscle-invasive bladder cancer (MIBC) who receive radiotherapy with curative intent are followed by imaging, cystoscopy, and urine cytology. However, interpretation of cytology and cystoscopy is hampered by the impact of ionizing radiation on cells. Objective: To assess the diagnostic performance of a genomic urine assay to detect urinary tract recurrences in patients with MIBC treated by (chemo)radiation. Design, setting, and participants: Patients with nonmetastatic MIBC who underwent (chemo)radiation with curative intent from 2016 to 2020 were prospectively included. Follow-up consisted of cystoscopy and upper tract imaging. Prior to cystoscopy, a urine sample was analyzed to assess mutations in the genes FGFR3, HRAS, and TERT and methylation of OTX1, TWIST1, and ONECUT2. The treating physician was blinded for the assay result. Outcome measurements and statistical analysis: The primary endpoint was a urinary tract recurrence. Cross-sectional sensitivity, specificity, and negative predictive value (NPV) were analyzed using a previously developed logistic regression model for the detection of bladder cancer with this assay. The secondary endpoint was the risk of a future urinary tract recurrence following a positive test and negative cystoscopy/imaging, using a time-dependent Cox proportional hazard analysis. Results and limitations: A total of 143 patients were included, and 503 urine samples were analyzed. The median study duration was 20 mo (interquartile range [IQR] 10–33), and the median time to a recurrence was 16 mo (IQR 12–26). In 27 patients, 32 urinary tract recurrences were diagnosed, including three upper tract tumors. Of 32 recurrences, 18 (56%) had a concomitant urine test available. The diagnostic model had an area under the curve of 0.80 (95% confidence interval [CI] 0.69–0.90) with corresponding sensitivity, specificity, and NPV of 78 (95% CI 52–94), 77% (95% CI 73–81), and 99% (95% CI 97–100). When taking into account the anticipatory effect of the test, 28/32 (88%) recurrences were detected. A Cox regression analysis showed a hazard ratio of 14.8 for the development of a future recurrence (p < 0.001). A major limitation was the lack of a concomitant urine test result in 14/32 (44%) recurrences. Conclusions: A genomic urine assay detected urinary tract recurrences after (chemo)radiation in patients with MIBC, and a positive test was strongly associated with future recurrences. Although validation in a large cohort is warranted, the test has the potential to limit frequent cystoscopies. Patient summary: Radiotherapy is a bladder-sparing treatment in patients with bladder cancer. After treatment, these patients undergo visual inspection of the bladder by cystoscopy to detect possible recurrences. However, interpretation of cystoscopy is difficult due to the effects of radiation on the bladder lining. Hence, we analyzed the diagnostic value of a molecular urine test to detect recurrent disease in bladder cancer patients treated by radiotherapy, and we showed that the urine test has the potential to limit the number of cystoscopies.

Purpose: To develop a single NTCP model for grade ≥ 2 late rectal bleeding (G2 LRB) after conventional or hypofractionated radiotherapy for prostate cancer. Methods and Materials: The development dataset consisted of prostate cancer patients (n = 656) previously randomized to conventional (39 x 2 Gy) or hypofractionated (19 x 3.4 Gy) external beam radiotherapy with N = 89 G2 LRB cases. Candidate predictors were obtained from literature. We fitted five separate logistic regression models to the data, each with one of the following dose parameters as candidate predictors in biological effective dose (BED), assuming α/β = 3 Gy: Equivalent uniform dose (EUD) with n = 0.1, EUD with n = 0.2, the relative volume receiving ≥ 111.9 Gy in BED (V111.9, the equivalent of physical V70 for a conventional schedule), minimum BED to the hottest 0.1 cm3 (D0.1cm3) or 2 cm3 (D2cm3). Previous abdominal surgery was included in every model and fractionation schedule was tested as predictor in each model. A sensitivity analysis was performed by varying the α/β-ratio, n and dose-volume cutoff. Results: The pre-selected candidate dosimetric predictor and previous abdominal surgery were significantly associated with the outcome in all five models. Fractionation schedule was eliminated by the backward scheme in only the EUD (n = 0.1), D0.1cm3 and D2cm3-based models. In internal validation these models showed AUC’s of 0.64, 0.60 & 0.62, respectively. The sensitivity analyses showed that EUD models with n ≥ 0.15 and / or α/β ≥ 4 Gy failed, and EUD models based on α/β = 2 Gy with n = 0.05–0.2 showed good fits as well. Conclusions: Our trial data set with different fractionation schedules offered the unique possibility to generate unbiased BED-based models. EUD (n = 0.1), D0.1cm3 and D2cm3 performed overall best in predicting G2 LRB; with α/β = 2 Gy equally good models were obtained. External validation is required to confirm our results.

Purpose: In evaluating second primary cancers (SPCs) following External Beam Radiotherapy (EBRT), the role of lifestyle factors is frequently not considered due to data limitations. We investigated the association between smoking, comorbidities, and SPC risks within EBRT-treated patients for localized prostate cancer (PCa). Patients & Methods: The study included 1,883 PCa survivors aged 50–79, treated between 2006 and 2013, with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT). Clinical data were combined with SPC and survival data from the Netherlands Cancer Registry with a 12-month latency period. Standardized Incidence Ratios (SIRs) were calculated comparing the EBRT cohort with the general Dutch population. To explore the effect of patient and treatment characteristics on SPCs we conducted a Cox regression analysis. Lastly, we estimated cumulative incidences of developing solid SPC, pelvis SPC, and non-pelvis SPC using a competing risk analysis. Results: Significantly increased SIRs were observed for all SPC (SIR = 1.21, 95% confidence interval [CI]: 1.08–1.34), pelvis SPC (SIR = 1.46, 95% CI: 1.18–1.78), and non-pelvis SPC (SIR = 1.18, 95% CI [1.04–1.34]). Smoking status was significantly associated with pelvic and non-pelvic SPCs. Charlson comorbidity index (CCI) ≥ 1 (Hazard Ratio [HR] = 1.45, 95% CI: 1.10–1.91), cardiovascular disease (HR = 1.41, 95% CI: 1.05–1.88), and chronic obstructive pulmonary disease (COPD) (HR = 1.91, 95% CI: 1.30–2.79) were significantly associated with non-pelvis SPC. The proportion of active smoking numbers in the cohort was similar to the general population. Interpretation: We conclude that the presence of comorbidities in the EBRT population might be a relevant factor in observed excess non-pelvis SPC risk, but not for excess pelvis SPC risk.

Recently, there has been significant consumer demand for traditional tomato varieties due to their favourable organoleptic qualities; however, the cultivation of these ancient varieties is becoming more restricted due to inadequate shelf life and low productivity. The “Pisanello” is a Tuscany tomato variety mainly cultivated in the provinces of Pisa, Lucca, and Livorno, and the main producers of this ancient tomato are small local farmers. The purpose of this work was, firstly, to study the range of quality parameters of this landrace tomato grown using different cultivation techniques, both in soil and soilless systems. For this purpose, the physicochemical parameters of Pisanello tomatoes grown in six different farms in Tuscany using both soilless and soil methods were investigated. Secondly, Pisanello tomatoes grown using different soilless techniques (rockwool and aeroponics) and soil-grown tomatoes (Pisanello and Goldmar F1) were evaluated from organoleptic and nutraceutical points of view. The sensory profile evaluation of all types of tomatoes under investigation was carried out. The aeroponic cultivation of Pisanello induced higher organoleptic qualities than those of tomatoes cultivated in rockwool (+34% for titratable acidity and +18% for total soluble solids). On the other hand, soilless rockwool-grown tomatoes showed a better sensory profile with respect to aeroponic cultivation. Nevertheless, the Goldmar F1 tomato, morphologically similar to ‘Pisanello’, received lower scores from the sensory panel compared to the Tuscany landrace tomato. This indicates that ancient tomato varieties selected over decades remain the preferred choice for consumers. Therefore, from a long-term viewpoint, the valorisation of local tomato varieties such as Pisanello can promote the regional commercialization of novel niche products originating from ancient fruit thanks to their acceptability by consumers.

The influence of light downconversion films (red, pink and blue films) on leaf physiological features and fruit bioactive compound accumulation was studied in strawberry plants. Red, pink and blue films were able to convert light less utilised by plants into more efficient light wavebands with various possibilities depending on the film characteristics (blue film shifts UV into blue radiation; red film shifts green into red radiation, pink film shifts UV and green into blue and red radiation but to a lesser extent than red film). Indeed, by enhancing the quality of light available for photosynthesis, the utilization of these films holds the potential to improve agricultural productivity and sustainability. All of these light downconversion films resulted in higher plant fresh weight compared to a control colourless (Cnt) film, with plants grown under blue film (UV-to-blue light conversion) showing the most impressive results in terms of total leaf area (+25%), leaf thickness (+10%) and leaf mass per area (+15%). Simultaneously, during the flowering stage, plants under blue film had a higher net photosynthetic rate due to the increase in photosynthetically efficient wavelengths. Moreover, blue film resulted in the highest total phenolic (+40% and +28% than red and pink films, respectively) and flavonoid content (+54%, +84%, +70% than Cnt, red and pink films, respectively) in fruit, with specific effects on targeted phenols, i.e., quercetin, ellagic acid and its glycoside, ellagitannins, and procyanidins. In conclusion, the use of the UV-to-blue conversion light film tested herein represents an innovative solution to increase strawberry yield and promote fruit nutraceutical features, playing a pivotal role in ensuring food quality and security and sustainable agricultural practices.

Over two billion people worldwide suffer from micronutrient deficiencies. Biofortifying vegetables can enhance micronutrient intake through the diet. This study assessed the biofortification of indoor-grown baby-leaf lettuce using aeroponics. Four experiments, two each, were conducted by adding different concentrations of Zn (from 10 to 450 µM) or Cu (from 3 to 250 µM) into a nutrient solution. A fifth experiment was conducted by simultaneously adding to the nutrient solution the optimal concentration of I (5 µM) and Se (13 µM), chosen on the basis of previous works, and the optimal concentration of Zn (250 µM) and Cu (150 µM), chosen on the basis of the results obtained in the first four experiments. Leaf biomass, mineral concentrations, chlorophylls, carotenoids, phenols, flavonoids, nitrates, and antioxidant capacity were measured 21 days after transplanting. Higher concentrations of Cu, Zn, I, or Se in the nutrient solution led to an increase in their concentrations in lettuce leaves, without affecting the growth or leaf quality of lettuce plants. The simultaneous application of I with the other elements induced a higher accumulation in leaves compared to when I is applied alone. One hundred grams of lettuce leaves biofortified with Se, I, Cu, and Zn would provide the 6.1%, 35.3%, and 263.0% of Adequate Intake for Cu, Se, and I, respectively, and 4.5% of Population Reference Intake for Zn. Our results suggest that simultaneously biofortifying baby-leaf lettuce with these four minerals is a practical and convenient way to integrate these micronutrients into the diet without reducing the yield or quality of lettuce.

Tomatoes are globally renowned for their nutritional value and culinary versatility. However, environmental stresses, particularly salinity, present significant challenges to tomato production, impacting both yield and fruit quality. In light of these challenges, this study investigates the effect of salinity on yield and fruit quality of a local cultivar tomato named ‘Pisanello’ in a closed soilless rockwool cultivation system. Total yield, fruit size, and number were investigated in both control (10 mM of NaCl) and salinity-treated plants (salinity 1 (S1)~30 mM of NaCl and salinity 2 (S2)~60 mM of NaCl), alongside various physicochemical parameters in fully ripened tomato fruits. The results indicated a decrease in crop production with rising sodium chloride concentration in the nutrient solution (25% and 41% for S1 and S2 treatment, respectively). Conversely, salinity-treated fruits exhibited an increase in total phenolic content of +21.9% in S1 and +36.7% in S2 and in antioxidant capacity (+33.5% and +34.7%, for the S1 and S2 treatments, respectively). Salinity treatments registered in general higher quality parameters such as titratable acidity (+8.9 for S1 and +16.5% for S2), total soluble solids (+18.5% for S1 and +43.0% for S2) and fruit firmness (+30.7% for S1 and +60.3% for S2) in comparison with control tomato fruits. Sensory profile analysis further validated the preference for fresh consumption of tomato fruits grown with saline water. These findings suggests that salinity stress can enhance the nutritional quality and taste of the Pisanello tomato. Further investigation could explore the optimal NaCl concentration to balance tomato production and nutritional quality.

The foremost cause behind worldwide crop losses is attributed to abiotic stresses. Among them, salinity is a major concern for agriculture and is expected to play an increasingly important role as rising food demands and climate changes will inevitably lead to the greater use of marginal lands and poor-quality irrigation water. Tomato is a moderately salinity-sensitive crop which is widely used in the presence of poor-quality irrigation water without manifesting yield reduction. However, the excessive accumulation of salts can reduce photosynthetic efficiency, unbalance nutrient assimilation, reduce growth, and reduce product quality. This study was undertaken to explore the response of some varieties of Solanum lycopersicum that could be used as model systems to evaluate the performance of wild tomato ecotypes in future studies to identify genetic resources that respond adequately to climate change in the Mediterranean area. Tomato seedlings were raised in vitro on plates with sucrose-free agarized medium containing increasing concentrations of sea salt. The autotrophic conditions enabled a response resembling the plant’s behavior in vivo. The obtained results identified an interesting variety that can be used as a model for modern cultivars and concentrations, from which the behavior of some Solanum spp. can be further investigated.

PURPOSEThe COVID-19 pandemic has disrupted cancer care globally. There are limited data of its impact in Africa. This study aims to characterize COVID-19 response strategies and impact of COVID-19 on cancer care and explore misconceptions in Africa.METHODSWe conducted a web-based cross-sectional survey of oncology providers in Africa between June and August 2020. Descriptive statistics and comparative analysis by income groups were performed.RESULTSOne hundred twenty-two participants initiated the survey, of which 79 respondents from 18 African countries contributed data. Ninety-four percent (66 of 70) reported country mitigation and suppression strategies, similar across income groups. Unique strategies included courier service and drones for delivery of cancer medications (9 of 70 and 6 of 70, respectively). Most cancer centers remained open, but > 75% providers reported a decrease in patient volume. Not previously reported is the fear of infectivity leading to staff shortages and decrease in patient volumes. Approximately one third reported modifications of all cancer treatment modalities, resulting in treatment delays. A majority of participants reported ≤ 25 confirmed cases (44 of 68, 64%) and ≤ 5 deaths because of COVID-19 (26 of 45, 58%) among patients with cancer. Common misconceptions were that Africans were less susceptible to the virus (53 of 70, 75.7%) and decreased transmission of the virus in the African heat (44 of 70, 62.9%).CONCLUSIONFew COVID-19 cases and deaths were reported among patients with cancer. However, disruptions and delays in cancer care because of the pandemic were noted. The pandemic has inspired tailored innovative solutions in clinical care delivery for patients with cancer, which may serve as a blueprint for expanding care and preparing for future pandemics. Ongoing public education should address COVID-19 misconceptions. The results may not be generalizable to the entire African continent because of the small sample size.

Background: Testicular germ cell tumours (GCTs) are rare malignancies most prevalent in 15–40-year-old men. Incidence rates of testicular cancer on a global level show marked geographic variation with higher incidence rates reported in predominantly Caucasian populations. African data on GCT management show low incidence rates but an advanced stage at presentation and high mortality rates. Aim: The aim of the study was to explore patterns of practice in the management of testicual GCTs. Setting: The study was conducted in an African oncology care setting. Methods: A cross-sectional web-based survey was distributed to doctors or nurses providing oncology care for patients with testicular GCT in Africa. Data on staging procedures, chemotherapy and radiotherapy (RT) treatment schedules across institutions are reported and discussed in the context of international treatment guidelines and local resources. Results: Eleven African countries contributed data. Epidemiological estimates were received from 20 institutions and management and outcome data from 18 institutions. The estimated ratio of seminoma to non-seminoma was 1:1.3. The stage at presentation was tumour-node-metastases-serum marker (TNM-S) Stage III at half of the institutions surveyed. Chemotherapy regimens mostly followed international guidelines, but certain essential drugs were not consistently accessible at all centres. Radiotherapy services were available to all but one respondent, with three-dimensional planning being widely used. There was marked variation in RT doses and treatment fields. Conclusion: The resources to effectively manage testicular GCT appear to be accessible to most institutions surveyed. Regional management guidelines, sharing of clinical expertise within Africa through online platforms and centralised data collection on epidemiology, management and treatment efficacy are advocated to better allocate resources and improve the outcomes reported in this rare but potentially curable condition.

Heavy metals are environmental pollutants that cause toxicity in plants and represent a risk for human health, linked to bioaccumulation through the food chain. However, excess accumulation may not occur in young plants in the early stages of exposure to the toxic element. In the present work, rocket (Eruca sativa L.) plants grown in hydroponics were exposed for three weeks to excess concentrations (25, 50, or 100 µM) of Cu or Zn in the nutrient solution and were more sensitive to Cu than Zn toxicity. However, a significant decrease in the leaf biomass production as compared with the control was observed only after two or three weeks, and only minor signals of metal-induced adverse effects were evidenced concerning photosynthesis, oxidative stress indicators, antioxidant metabolites, and macronutrients. After two or three weeks, the leaf level of Cu occasionally approached the upper value associated with the recommended limits of dietary intake for human adults. However, as rocket leaves are commercialized when they achieve a 10–15 cm length, after one week of cultivation in perlite, the plants had an adequate size without metal contamination and could be considered suitable for the food market, even after exposure to Cu or Zn concentrations up to 100 µM.

PURPOSEHead and neck cancers are the third most common cancers treated with radiation in Ethiopia. There is, however, a lack of published data on clinical and pathological characteristics and treatment patterns of head and neck cancers in the country. The objective of the study was to assess clinical and pathological characteristics and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, which housed the only radiotherapy facility in Ethiopia during the study period.MATERIALS AND METHODSA retrospective cross-sectional study design with a simple random sampling of histologically confirmed head and neck cancers treated from 2014 to 2017 with analysis of descriptive data.RESULTSThree hundred twenty-one patient charts were analyzed in this study from a total population of 1,377 from the department cancer registry. The male to female ratio was 2:1. The median age was 45 years (interquartile range, 26-59). The most common primary site of head and neck cancers was nasopharynx (128 of 321, 40%), and the major histologic type was squamous cell carcinoma (285 of 321, 89%). Majority of the cases had advanced disease (stage III-IVC, 221 of 251, 88%), but 92% had potentially curable disease (231 of 321). Cobalt radiotherapy was used for 67% of all patients receiving treatment (184 of 273). Induction chemotherapy followed by radiotherapy was frequently used for curative intent patients (75 of 231, 32%). There was long duration between diagnosis and initiation of treatment, with 56% (148 of 264) waiting longer than 3 months.CONCLUSIONMajority of patients with head and neck cancers seen in Ethiopia presented at advanced stage of disease, received cobalt radiotherapy, and had protracted treatment initiation. These findings underscore the need for additional investments to improve research capacity and increase the availability of high-quality radiotherapy and supportive services to deliver optimal care for patients with head and neck cancer and other cancer patients in the country.

Background and purpose: External beam radiotherapy for prostate cancer deposits incidental dose to a region surrounding the target volume. Previously, an association was identified between tumor control and incidental dose for patients treated with conventional radiotherapy. We investigated whether such an association exists for patients treated using intensity modulated radiotherapy (IMRT) and tighter margins. Materials and methods: Computed tomography scans and three-dimensional treatment planning dose distributions were available from the Dutch randomized HYPRO trial for 397 patients in the standard fractionation arm (39 × 2 Gy) and 407 patients in the hypofractionation arm (19 × 3.4 Gy), mainly delivered using online image-guided IMRT. Endpoint was any treatment failure within 5 years. A mapping of 3D dose distributions between anatomies was performed based on distance to the surface of the prostate delineation. Mean mapped dose distributions were computed for patient groups with and without failure, obtaining dose difference distributions. Random patient permutations were performed to derive p values and to identify relevant regions. Results: For high-risk patients treated in the conventional arm, higher incidental dose was significantly associated with a higher probability of tumor control in both univariate and multivariate analysis. The locations of the excess dose mainly overlapped with the position of obturator internus muscles at about 2.5 cm from the prostate surface. No such relationship could be established for intermediate-risk patients. Conclusions: An association was established between reduced treatment failure and the delivery of incidental dose outside the prostate for high-risk patients treated using conventionally fractionated IMRT.

PURPOSEThe limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries.METHODSThe cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory.RESULTSThe estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively.CONCLUSIONThis investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

PUROSEEthiopia has one cobalt radiotherapy (RT) machine to serve a population of more than 100 million. The purpose of this study was to report on patterns of palliative RT of bone metastasis in a severely low-capacity setting.PATIENTS AND METHODSPatient and treatment characteristics of patients irradiated for palliation of symptomatic bone metastasis were extracted from a retrospective database of patients treated between May 2015 and January 2018. This database included a random sample of 1,823 of the estimated 4,000 patients who were treated with RT within in the study period. Associations between the applied RT schedule and patient and tumor characteristics were evaluated with the χ2 test. Hypothetical savings of RT sessions and time were compared in the case of a single-fraction policy.RESULTSFrom the database, 234 patients (13%) were treated for bone metastasis. Most patients were ≤ 65 years of age (n = 189; 80%) and female (n = 125; 53%). The most common primary sites were breast (n = 82; 35%) and prostate (n = 36; 15%). Fractionated regimens were preferred over single fraction: 20 Gy in 5 fractions (n = 192; 82.1%), 30 Gy in 10 fractions (n = 7; 3%), and 8 Gy in 1 fraction (n = 28; 12%). Factors associated with single-fraction RT included nonaxial sites of bone metastasis (P < .01) and an address outside Addis Ababa (P ≤ .01). If single-fraction RT would have been given uniformly for bone metastasis, this would have resulted in a 78% reduction in the number of RT sessions and 76% reduction in total RT time.CONCLUSIONThe pattern of palliative RT for bone metastasis in Ethiopia favors fractionated regimens over single fraction. Efforts should be made to adopt evidence-based and cost-effective guidelines.

Introduction: Unambiguous data on sexual dysfunction after Hodgkin lymphoma (HL) treatment are scarce. Aims: To form a baseline in this area, we compared patient-reported sexual function in sexually active male HL survivors in complete remission with a sexually active, age-matched, male Dutch sample population. Furthermore, we explored whether sociodemographic and clinical factors were associated with sexual dysfunction in HL survivors and investigated whether reporting to perceive sexual problems was indicative for sexual dysfunction. Methods: This cross-sectional study included male patients with HL who were treated with chemotherapy and age-matched sexually active males. Main outcome measures: Outcome measures included the internationally validated International Index of Erectile Function (IIEF) and self-reported sexual problems by adding 3 items to the study-specific questionnaire. Results: Erectile dysfunction (ED) occurred in 23.3% of the HL survivors vs in 23.0% of controls: respectively 13.3% and 12.3% had moderate to severe ED. However, more HL survivors positively answered the question whether they did perceive sexual problems than controls (20.0% vs 7.0%; P = .087). More patients treated with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procabazine, and prednisone (BEACOPP) had sexual problems 33.3% vs 8.3% who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (P = .057). Importantly, we found that the mean IIEF score for erectile function was 15.7 in HL survivors who reported to perceive sexual problems (moderate ED) vs 28.3 (normal) in those without perceiving sexual problems. Conclusion: In general, sexual function of male HL survivors is comparable to that of matched normal controls. Perceiving sexual problems was associated with lower sexual function measured by the IIEF. None of the HL survivors who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine perceived sexual problems. However, one-third of HL survivors who were treated with BEACOPP did, including ED in one-third of the cases. This is an important consideration for daily clinical practice as BEACOPP is increasingly used as standard therapy in advanced-stage HL.Eeltink CM, Lissenberg-Witte BI, Incrocci L, et al. Self-Reported Sexual Function in Sexually Active Male Hodgkin Lymphoma Survivors. Sex Med 2020;8:428–435.

Precision farming is one way of many to meet a 55 percent increase in global demand for agricultural products on current agricultural land by 2050 at reduced need of fertilizers and efficient use of water resources. The catalyst for the emergence of precision farming has been satellite positioning and navigation followed by Internet-of-Things, generating vast information that can be used to optimize farming processes in real-time. Statistical tools from data mining, predictive modeling, and machine learning analyze patterns in historical data, to make predictions about future events as well as intelligent actions. This special issue presents the latest development in statistical inference, machine learning, and optimum control for precision farming.

Introduction: The COVID-19 outbreak has affected care for non-COVID diseases like cancer. We evaluated the impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. Methods: Prostate cancer diagnoses per month in 2020–2021 versus 2018–2019 were compared based on preliminary data of the Netherlands Cancer Registry (NCR) and nationwide pathology network. Detailed data was retrieved from the NCR for the cohorts diagnosed from March-May 2020 (first COVID-19 wave) and March-May 2018–2019 (reference). Changes in number of diagnoses, age, disease stage and first-line treatment were compared. Results: An initial decline of 17% in prostate cancer diagnoses during the first COVID-19 wave was observed. From May onwards the number of diagnoses started to restore to approximately 95% of the expected number by the end of 2020. Stage at diagnosis remainedstable over time. In low-risk localised prostate cancer radical prostatectomy was conducted more often in week 9–12 (21% versus 12% in the reference period; OR=1.9, 95% CI; 1.2–3.1) and less active surveillance was applied (67% versus 78%; OR=0.6, 95% CI; 0.4–0.9). In the intermediate-risk group, a similar change was observed in week 13–16. Radical prostatectomy volumes in 2020 were comparable to 2018–2019. Conclusion: During the first COVID-19 wave the number of prostate cancer diagnoses declined. In the second half of 2020 this largely restored although the number remained lower than expected. Changes in treatment were temporary and compliant with adapted guidelines. Although delayed diagnoses could result in a less favourable stage distribution, possibly affecting survival, this seems not very likely.

PURPOSE: Radiotherapy (RT) is an essential component of cancer treatment. There is a lack of RT services in sub-Saharan Africa as well as limited knowledge regarding clinical practices. The purpose of this study was to identify and describe the patterns for RT treatment in Ethiopia. METHODS AND MATERIALS: We performed a retrospective analysis of 1,823 patients treated with cobalt RT at a large referral hospital in Addis Ababa, Ethiopia, from May 2015 through January 2018. Paper charts were reviewed for patient and treatment characteristics. Descriptive statistics were computed using SPSS (IBM, Armonk, NY). RESULTS: Among patients treated for cancer, 98% (n = 1,784) were adults, 78% (n = 1,426) were female, 5% (n = 85) were HIV positive, 30% (n = 555) were from Addis Ababa, and the median age was 48 years (interquartile range [IQR], 38-58 years). Cervical cancer was the most frequent cancer treated (47%, n = 851), followed by breast cancer (15%, n = 274) and head and neck cancer (10%, n = 184). Seventy-three percent of patients (n = 1,339) presented at a late stage, and 62% (n = 1,138) received palliative RT. The wait times were the shortest for patients receiving palliative treatment (median, 0 days; IQR, 0-15 days; n = 1,138), whereas wait times were longer for patients receiving curative treatment (median, 150 days; IQR, 60-210 days; n = 685). Three percent of patients (n = 56) had documented grade 3 or 4 acute toxicity; of these, 59% (n = 33) were patients with head and neck cancer. CONCLUSION: Cervical cancer accounted for half of patients treated; thus, a majority of patients were adult females. Most patients had advanced-stage cancer, and goals of care were palliative. Wait times were long for patients with curative-intent cancer as a result of low capacity for RT services.

Among a growing body of literature in global oncology, several articles project increased cost savings and radiotherapy access by adopting hypofractionated radiotherapy (HFRT) in low- and middle-income countries (LMICs) like those in Africa. Clinical trials in Europe and the USA have demonstrated HFRT to be non-inferior to conventional radiotherapy for eligible patients with several cancers, including prostate cancer. This could be a highly recommended option to battle a severely large and growing cancer burden in resource-limited regions. However, a level of implementation research may be needed in limited resource-settings like in Africa. In this article, we present a list of evidence-based recommendations to practice HFRT on eligible prostate cancer patients. As literature on HFRT is still developing, these guidelines were compiled from review of several clinical trials and professionally accredited material with minimal resource requirements in mind. HFRT guidelines presented here include patient eligibility, prescription dose schedules, treatment planning and delivery techniques, and quality assurance procedures. The article provides recommendations for both moderately hypofractionated (2.4-3.4Gy per fraction) and ultrahypofractionated (5Gy or more per fraction) radiation therapy when administered by 3D-Conformal Radiotherapy, Intensity Modulated Radiation Therapy, or Image-Guided Radiotherapy. In each case radiation oncology health professionals must make the ultimate judgment to ensure safety as more LMIC centers adopt HFRT to combat the growing scourge of cancer.

PurposeExternal Beam Radiotherapy (EBRT) techniques dramatically changed over the years. This may have affected the risk of radiation-induced second primary cancers (SPC), due to increased irradiated low dose volumes and scatter radiation. We investigated whether patterns of SPC after EBRT have changed over the years in prostate cancer (PCa) survivors.Materials and MethodsPCa survivors diagnosed between 1990-2014 were selected from the Netherlands Cancer Registry. Patients treated with EBRT were divided in three time periods, representing 2-dimensional Radiotherapy (RT), 3-dimensional conformal RT (3D-CRT), and the advanced RT (AdvRT) era. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated to estimate relative and excess absolute SPC risks. Sub-hazard ratios (sHRs) were calculated to compare SPC rates between the EBRT and prostatectomy cohort. SPCs were categorized by subsite and anatomic region.ResultsPCa survivors who received EBRT had an increased risk of developing a solid SPC (SIR=1.08; 1.05-1.11), especially in patients aged

Lettuce is widely used for its healthy properties, and it is of interest to increase them with minimal environmental impact. The purpose of this work was to evaluate the effect of the arbuscular mycorrhizal fungus (AMF) Funneliformis mosseae in lettuce plants (Lactuca sativa L. cv. Salinas) cultivated in a soilless system with sub-optimal phosphorus (P) compared with non-inoculated controls at two different P concentrations. Results show that lettuce inoculation with the selected AMF can improve the growth and the nutritional quality of lettuce even at sub-optimal P. Leaf content of chlorophylls, carotenoids, and phenols, known as important bioactive compounds for human health, was higher in mycorrhizal lettuce plants compared with non-mycorrhizal plants. The antioxidant capacity in AMF plants showed higher values compared with control plants grown at optimal P nutrition level. Moreover, leaf gas exchanges were higher in inoculated plants than in non-inoculated ones. Nitrogen, P, and magnesium leaf content was significantly higher in mycorrhizal plants compared with non-mycorrhizal plants grown with the same P level. These findings suggest that F. mosseae can stimulate plants growth, improving the nutritional quality of lettuce leaves even when grown with sub-optimal P concentration.

Saltwater aquaponics is a sustainable alternative system for food production. The success of this system largely depends on the selection of both fish and plant species, for which several features and criteria must be considered. This paper aims to identify the most suitable plant species for saltwater aquaponics by using a multi-criteria decision-making method also based on current literature. One simple model that contained one root criterion, four aggregated criteria, and four sub-criteria was created using DEXi software. The same model was evaluated considering two different salinity levels in the recirculating water: 10 (brackish water) and 35 (sea water) g L−1. The relevance of the model structure was evaluated by the sensitivity analysis, through the ‘plus/minus-1′ analysis. Our results suggest that Salicornia europaea L. and Portulaca oleracea L. were suitable species for saltwater aquaponics at 35 g L−1. Moreover, at 10 g L−1, the suitable candidates were: Salicornia bigelovii Torr, S. europaea L., Beta vulgaris ssp. maritima (L.) Arcang, Atriplex hortensis L., and P. oleracea L. The DEXi analysis resulted in being an easy and effective tool to select proper species in similar contexts. DEXi can help to identify the hotspots of production processes, according to our results. Since the selected species are wild edible species or minor crops, the availability of their seeds is one of the main constraints of their cultivation in saltwater aquaponics.

Cardoon (C. cardunculus var. altilis DC) is commonly cultivated in the Mediterranean area to produce stalks that are consumed once cooked. Before cooking, stalks are usually subjected to blanching, which means they are exposed to darkness for a few weeks. The present work analyzed the effect of field blanching carried out for 40 days in different ways (burying the stalks under soil or covering them with plastic sheet) on the total phenolic content (TPC), phenolic profile, cynaropicrin content (a bitter compound), and antioxidant activity (AA) of two cardoon cultivars. The nutraceutical quality of blanched cardoons was also investigated following boiling. The phenolic profile revealed a higher number of compounds in blanched stalks than in raw ones. The cynaropicrin content decreased in both cultivars after blanching, indicating a sensitivity to dark conditions and the effectiveness of blanching method in reducing its bitterness. The data presented contribute to improving the knowledge about the effect of blanching and boiling on the quality of cardoon stalks.

There is an increasing interest in the use of seawater in horticulture. The objective of this study was to evaluate Beta vulgaris var. cicla (Swiss chard) and its wild ancestor B. vulgaris spp. maritima (sea beet) as potential crop species for seawater hydroponics or aquaponics. Both species were grown in a floating system for leaf production with recurrent harvests. The nutrient solutions contained different concentrations of nitrate (1 and 10 mM) and a synthetic sea salt (0 and 10 g L−1), in a factorial design, where the saline solution with a low nitrate level intended to mimic the typical nutritional conditions of saltwater aquaponics. In both species, increasing the salinity or reducing the N level in the nutrient solution reduced the crop yield and total dry biomass. In both Swiss chard and sea beet, the use of saline water resulted in a lower leaf concentration of K, Ca, Cu, and Mn, and a greater content of Na and Cl. In Swiss chard, an increase in Na and Cl and a decrease in K leaf content were found in successive harvests. On average, sea beet showed a higher leaf production and accumulation of nitrate than Swiss chard.

In the advent of the coronavirus disease (COVID-19) pandemic, professional societies including the American Society for Radiation Oncology and the National Comprehensive Cancer Network recommended adopting evidence-based hypofractionated radiotherapy (HFRT). HFRT benefits include reduction in the number of clinical visits for each patient, minimizing potential exposure, and reducing stress on the limited workforce, especially in resource-limited settings as in Low-and-Middle-Income Countries (LMICs). Recent studies for LMICs in Africa have also shown that adopting HFRT can lead to significant cost reductions and increased access to radiotherapy. We assessed the readiness of 18 clinics in African LMICs to adopting HFRT. An IRB-approved survey was conducted at 18 RT clinics across 8 African countries. The survey requested information regarding the clinic’s existing equipment and human infrastructure and current practices. Amongst the surveyed clinics, all reported to already practicing HFRT, but only 44% of participating clinics reported adopting HFRT as a common practice. Additionally, most participating clinical staff reported to have received formal training appropriate for their role. However, the survey data on treatment planning and other experience with contouring highlighted need for additional training for radiation oncologists. Although the surveyed clinics in African LMICs are familiar with HFRT, there is need for additional investment in infrastructure and training as well as better education of oncology leaders on the benefits of increased adoption of evidence-based HFRT during and beyond the COVID-19 era.

Microgreens are edible seedlings of vegetables and flowers species which are currently considered among the five most profitable crops globally. Light-emitting diodes (LEDs) have shown great potential for plant growth, development, and synthesis of health-promoting phytochemicals with a more flexible and feasible spectral manipulation for microgreen production in indoor farms. However, research on LED lighting spectral manipulation specific to microgreen production, has shown high variability in how these edible seedlings behave regarding their light environmental conditions. Hence, developing species-specific LED light recipes for enhancement of growth and valuable functional compounds is fundamental to improve their production system. In this study, various irradiance levels and wavelengths of light spectrum produced by LEDs were investigated for their effect on growth, yield, and nutritional quality in four vegetables (chicory, green mizuna, china rose radish, and alfalfa) and two flowers (french marigold and celosia) of microgreens species. Microgreens were grown in a controlled environment using sole-source light with different photosynthetic photon flux density (110, 220, 340 µmol m−2 s−1) and two different spectra (RB: 65% red, 35% blue; RGB: 47% red, 19% green, 34% blue). At harvest, the lowest level of photosynthetically active photon flux (110 µmol m−2 s−1) reduced growth and decreased the phenolic contents in almost all species. The inclusion of green wavelengths under the highest intensity showed positive effects on phenolic accumulation. Total carotenoid content and antioxidant capacity were in general enhanced by the middle intensity, regardless of spectral combination. Thus, this study indicates that the inclusion of green light at an irradiance level of 340 µmol m−2 s−1 in the RB light environment promotes the growth (dry weight biomass) and the accumulation of bioactive phytochemicals in the majority of the microgreen species tested.

The interest for wild edible plants as functional food is increasing among consumers in the Mediterranean countries because of their high content of antioxidants. However, a critical point is the seasonality of wild edible species due to their spontaneity and the cultivation results necessary to satisfy market requests. Moreover, cooking may be necessary for most wild edible species to enhance their palatability. In the present experiment, the crop yield, total phenolic content (TPC) and antioxidant activity (AA) of leaves were determined in three wild edible species (Borago officinalis L., Malva sylvestris L. and Plantago coronopus L.), which were hydroponically cultivated in winter and in spring. Plants were recurrently harvested three times and the leaves were analyzed raw or after boiling in water for different times based on their palatability as evaluated by a hedonic test (2 min for B. officinalis, 2.5 min for M. sylvestris and 8 min for P. coronopus). The total crop yield was promising, especially for P. coronopus, with small differences between winter and spring (9.3 and 13.8 kg m−2, respectively). The boiling treatment caused a loss of TPC and, in some cases, of the AA in B. officinalis and M. sylvestris due to the solubilization of phenolic and other antioxidant compounds in boiling water. Conversely, in P. coronopus, TPC and AA were higher in boiled leaves than in fresh leaves, likely due to the strong binding of phenolic compounds to the cell wall. This binding might lead to the inefficient extraction of these compounds through the boiling treatment.

The aim of this research was to develop an effective protocol for the application of nonthermal plasma (NTP) technology to the hydroponic nutrient solution, and to investigate its effects on the growth and quality of baby leaf lettuce (Lactuca sativa var. acephala Alef.) grown in a hydroponic growing system (HGS) specifically designed for indoor home cultivation. Four HGSs were placed in separate growth chambers with temperature of 24 ± 1 °C and relative humidity of 70 ± 5%). Lettuce plants were grown for nine days in nutrient solutions treated with NTP for 0 (control) to 120 s every hour. Results of the first experiments showed that the optimal operating time of NTP was 120 s h−1. Fresh leaf biomass was increased by the 60 and 120 s NTP treatments compared to the control. Treating the nutrient solution with NTP also resulted in greater leaf content of total chlorophylls, carotenoids, total phenols, and total antioxidant capacity. NTP also positively influenced chlorophyll a fluorescence in Photosystem I (PSI) and photosynthetic electron transport. These results revealed that the NTP treatment of the nutrient solution could improve the production and quality of hydroponically grown baby leaf lettuce.

PurposeConcerns have been raised that modern intensity modulated radiotherapy (IMRT) may be associated with increased second primary cancer risks (SPC) compared to previous three-dimensional conformal radiation techniques (3DCRT), due to increased low dose volumes and more out-of-field ionizing dose to peripheral tissue further away from the target. We assessed the impact of treatment technique on SPC risks in a cohort of prostate cancer (PCa) survivors.Material and MethodsThe study cohort comprised 1,561 PCa survivors aged 50–79 years at time of radiotherapy, treated between 2006–2013 (N=707 IMRT, N=854 3DCRT). Treatment details were extracted from radiotherapy systems and merged with longitudinal data of the Netherlands Cancer Registry to identify SPCs. Primary endpoint was the development of a solid SPC (excluding skin cancer) in peripheral anatomical regions, i.e. non-pelvic. Applied latency period was 12 months. SPC rates in the IMRT cohort (total cohort and age subgroups) were compared to 1) the 3DCRT cohort by calculating Sub-Hazard Ratios (sHR) using a competing risk model, and 2) to the general male population by calculating Standardized Incidence Ratios (SIR). Models were adjusted for calendar period and age.ResultsMedian follow-up was 8.0 years (accumulated 11,664 person-years at-risk) with 159 cases developing ≥1 non-pelvic SPC. For IMRT vs 3DCRT we observed a significantly (p=0.03) increased risk (sHR=1.56, 95% Confidence Interval (CI) 1.03–2.36, corresponding estimated excess absolute risk (EAR) of +7 cases per 10,000 person-years). At explorative analysis, IMRT was in particular associated with increased risks within the subgroup of active smokers (sHR 2.94, p=0.01). Within the age subgroups 50–69 and 70–79 years, the sHR for non-pelvic SPC was 3.27 (p=0.001) and 0.96 (p=0.9), respectively. For pelvic SPC no increase was observed (sHR=0.8, p=0.4). Compared to the general population, IMRT was associated with significantly increased risks for non-pelvic SPC in the 50–69 year age group (SIR=1.90, p

Background: Currently, radiation-oncologists generally evaluate a single treatment plan for each patient that is possibly adapted by the planner prior to final approval. There is no systematic exploration of patient-specific trade-offs between planning aims, using a set of treatment plans with a-priori defined (slightly) different balances. To this purpose, we developed an automated workflow and explored its use for prostate cancer.Materials and Methods: For each of the 50 study patients, seven plans were generated, including the so-called clinical plan, with currently clinically desired ≥99% dose coverage for the low-dose planning target volume (PTVLow). The six other plans were generated with different, reduced levels of PTVLow coverage, aiming at reductions in rectum dose and consequently in predicted grade≥2 late gastro-intestinal (GI) normal tissue complication probabilities (NTCPs), while keeping other dosimetric differences small. The applied NTCP model included diabetes as a non-dosimetric predictor. All plans were generated with a clinically applied, in-house developed algorithm for automated multi-criterial plan generation.Results: With diabetes, the average NTCP reduced from 24.9 ± 4.5% for ≥99% PTVLow coverage to 17.3 ± 2.6% for 90%, approaching the NTCP (15.4 ± 3.0%) without diabetes and full PTVLow coverage. Apart from intended differences in PTVLow coverage and rectum dose, other differences between the clinical plan and the six alternatives were indeed minor. Obtained NTCP reductions were highly patient-specific (ranging from 14.4 to 0.1%), depending on patient anatomy. Even for patients with equal NTCPs in the clinical plan, large differences were found in NTCP reductions.Conclusions: A clinically feasible workflow has been proposed for systematic exploration of patient-specific trade-offs between various treatment aims. For each patient, automated planning is used to generate a limited set of treatment plans with well-defined variations in the balances between the aims. For prostate cancer, trade-offs between PTVLow coverage and predicted GI NTCP were explored. With relatively small coverage reductions, significant NTCP reductions could be obtained, strongly depending on patient anatomy. Coverage reductions could also make up for enhanced NTCPs related to diabetes as co-morbidity, again dependent on the patient. The proposed system can play an important role in further personalization of patient care.

Purpose: Late gastrointestinal (GI) toxicity after radiotherapy for prostate cancer may have significant impact on the cancer survivor's quality of life. To date, little is known about local dose-effects after modern radiotherapy including hypofractionation. In the current study we related the local spatial distribution of radiation dose in the rectum to late patient-reported gastrointestinal (GI) toxicities for conventionally fractionated (CF) and hypofractionated (HF) modern radiotherapy in the randomized HYPRO trial.Material and Methods: Patients treated to 78 Gy in 2 Gy fractions (n = 298) or 64.6 Gy in 3.4 Gy fractions (n = 295) with available late toxicity questionnaires (n ≥ 2 within 1–5 years post-treatment) and available 3D planning data were eligible for this study. The majority received intensity modulated radiotherapy (IMRT). We calculated two types of dose surface maps: (1) the total delineated rectum with its central axis scaled to unity, and (2) the delineated rectum with a length of 7 cm along its central axis aligned on the prostate's half-height point (prostate-half). For each patient-reported GI symptom, dose difference maps were constructed by subtracting average co-registered EQD2 (equivalent dose in 2 Gy) dose maps of patients with and without the symptom of interest, separately for HF and CF. P-values were derived from permutation tests. We evaluated patient-reported moderate to severe GI symptoms.Results: Observed incidences of rectal bleeding and increased stool frequency were significantly higher in the HF group. For rectal bleeding (p = 0.016), mucus discharge (p = 0.015), and fecal incontinence (p = 0.001), significant local dose-effects were observed in HF patients but not in CF patients. For rectal pain, similar local dose-effects (p < 0.05) were observed in both groups. No significant local dose-effects were observed for increased stool frequency. Total rectum mapping vs. prostate-half mapping showed similar results.Conclusion: We demonstrated significant local dose-effect relationships for patient-reported late GI toxicity in patients treated with modern RT. HF patients were at higher risk for increased stool frequency and rectal bleeding, and showed the most pronounced local dose-effects in intermediate-high dose regions. These findings suggest that improvement of current treatment optimization protocols could lead to clinical benefit, in particular for HF treatment.

The interest in the pre-harvest ultraviolet-B (UV-B) exposure of crops in indoor cultivation has grown consistently, though very little is known about its influence on the nutraceutical quality of microgreens. Flaxseeds constitute a valuable oilseed species, mostly appreciated for their nutritional properties and the presence of health-promoting compounds. Therefore, although scarcely studied, flaxseed sprouts and microgreens might constitute a high-quality food product to be included in a healthy diet. This study aims to unravel the effects of pre-harvest ultraviolet-B irradiation on the nutritional and nutraceutical quality of flaxseed sprouts and microgreens grown under artificial conditions. The UV-B irradiation decreased the biomass and stem length of microgreens. However, the content of total phenolics and flavonoids and the antioxidant capacity were strongly enhanced by the UV-B treatment in both sprouts and microgreens. Among photosynthetic pigments, chlorophyll a, violaxanthin, antheraxanthin, and lutein in sprouts were reduced by the treatment, while chlorophyll b increased in microgreens. In conclusion, our results showed that growing flaxseed sprouts and microgreens in controlled conditions with supplemental UV-B exposure might increase their nutritional and nutraceutical quality, as well as their antioxidant capacity, making them high-quality functional foods.

Flaxseed could be suitable for obtaining high-quality sprouts and microgreens thanks to high amounts of nutrients and antioxidant, antidiabetic, and anticancer compound content in its seeds. Recent studies highlighted that seedling growth, nutritional compound, and secondary metabolite content can be strongly managed by regulation of the light spectrum used during germination. The present study intended to shed light on flaxseed as emerging and novel species for sprouts and microgreens and to evaluate the effect of light, with different spectrum compositions (100% blue, 100% red, 100% green, and red:green:blue—1:1:1) on the performance of flax microgreens and sprouts grown indoors under controlled conditions. Microgreens showed, compared to sprouts, a higher chlorophyll (+62.6%), carotenoid (+24.4%), and phenol content (+37.8%), antioxidant capacity (+25.1%) and a lower dry matter content (−30.7%). Besides, microgreens treated with 100% blue light were characterized by the highest content of flavonoids (2.48 mg CAE g−1 FW), total phenols (3.76 mg GAE g−1 FW), chlorogenic acid (1.10 mg g−1 FW), and antioxidant capacity (8.06 µmol TEAC g−1 FW). The paper demonstrates the feasibility of obtaining flax sprouts and microgreens indoors with a considerable antioxidant capacity and health-promoting compounds by modulating the light spectrum.

Iodine deficiency is a serious world-wide public health problem, as it is responsible for mental retardation and other diseases. The use of iodine-biofortified vegetables represents a strategic alternative to iodine enriched salt for people with a low sodium diet. However, at high concentrations iodine can be toxic to plants. Therefore, research on plant iodine toxicity is fundamental for the development of appropriate biofortification protocols. In this work, we compared two cultivars of sweet basil (Ocimum basilicum L.) with different iodine tolerance: “Tigullio,” less tolerant, with green leaves, and “Red Rubin,” more tolerant and with purple leaves. Four greenhouse hydroponic experiments were conducted in spring and in summer with different concentrations of iodine in the nutrient solution (0.1, 10, 50, 100, and 200 μM), supplied as potassium iodide (KI) or potassium iodate (KIO3). Plant growth was not affected either by 10 μM KI or by 100 μM KIO3, while KI concentrations higher than 50 μM significantly reduced leaf area, total plant dry matter and plant height. The severity of symptoms increased with time depending on the cultivar and the form of iodine applied. Growth inhibition by toxic iodine concentrations was more severe in “Tigullio” than in “Red Rubin,” and KI was much more phytotoxic than KIO3. Leaf iodine concentration increased with the iodine concentration in the nutrient solution in both varieties, while the total antioxidant power was generally higher in the purple variety. In both basil cultivars, a strong negative correlation was found between the photosynthesis and the leaf iodine content, with significant differences between the regression lines for “Tigullio” and “Red Rubin.” In conclusion, the greater tolerance to iodine of the “Red Rubin” variety was associated with the ability to withstand higher concentrations of iodine in leaf tissues, rather than to a reduced accumulation of this element in the leaves. The high phenolic content of “Red Rubin” could contribute to the iodine tolerance of this purple cultivar.

The iodine (I) and selenium (Se) deficiencies affect approximately 30% and 15%, respectively, of the global population. The biofortification of vegetables is a valid way to increase the intake of iodine and selenium through the diet. This study was carried out on baby-leaf lettuce to investigate the effects on plant growth, leaf quality, and leaf I and Se accumulation of adding potassium iodide and sodium selenate, separately and simultaneously, to the nutrient solution in a floating system and aeroponics. The effect of I and Se biofortification on post-harvest quality of lettuce leaves was also evaluated. Our results evidenced that the Se and I treatments increased the content of the two microelements in lettuce leaves without any negative interactions in the plants, when applied either separately or simultaneously. Both hydroponic systems proved to be suitable for producing Se and/or I enriched lettuce. Biofortification with Se was more effective when performed in aeroponics, whereas I biofortification was more effective in the floating system. Quality of leaves during post-harvest storage was not affected by neither of the treatments. Lettuce leaves enriched with 13 µM Se and 5 µMI could be good dietary sources of Se and I without inducing toxic effects in humans.

Wild edible plant species are often more tolerant to salinity than many crop plants. Considering the salinization of irrigation water that is progressively affecting the Mediterranean region and the market demand for new plant foods, the cultivation of wild edible species could represent a valid alternative to conventional vegetable crops. In this study, Reichardia picroides (L.) Roth, a widespread spontaneous herb of ethnobotanical tradition, was grown for four or six weeks under a greenhouse in a floating system for the production of baby leaves. In order to improve the nutraceutical quality of the tissues, the plants were exposed to the following NaCl concentrations in the nutrient solution: 1.7 (control), 25, 50, and 100 mM. The results showed that a 4-week growing period in a floating system with 50 mM NaCl in the nutrient solution increased the content of bioactive molecules without affecting the fresh yield. After six weeks of cultivation, despite a decrease in biomass production as compared with the control, the leaves of salt-treated plants contained higher levels of bioactive molecules along with lower amounts of nitrate ion.

Heavy metal contamination is a major health issue concerning the commercial production of medicinal and aromatic plants (MAPs) that are used for the extraction of bioactive molecules. Copper (Cu) is an anthropogenic contaminant that, at toxic levels, can accumulate in plant tissues, affecting plant growth and development. On the other hand, plant response to metal-induced stress may involve the synthesis and accumulation of beneficial secondary metabolites. In this study, hydroponically grown Pelargonium graveolens plants were exposed to different Cu concentrations in a nutrient solution (4, 25, 50, 100 μM) to evaluate the effects Cu toxicity on plant growth, mineral uptake and distribution in plants, some stress indicators, and the accumulation of bioactive secondary metabolites in leaf tissues. P. graveolens resulted in moderately tolerant Cu toxicity. At Cu concentrations up to 100 μM, biomass production was preserved and was accompanied by an increase in phenolics and antioxidant capacity. The metal contaminant was accumulated mainly in the roots. The leaf tissues of Cu-treated P. graveolens may be safely used for the extraction of bioactive molecules.

Tomato landraces, originated by adaptive responses to local habitats, are considered a valuable resource for many traits of agronomic interest, including fruit nutritional quality. Primary and secondary metabolites are essential determinants of fruit organoleptic quality, and some of them, such as carotenoids and phenolics, have been associated with beneficial proprieties for human health. Landraces’ fruit taste and flavour are often preferred by consumers compared to the commercial varieties’ ones. In an autumn-winter greenhouse hydroponic experiment, the response of three Southern-Italy tomato landraces (Ciettaicale, Linosa and Corleone) and one commercial cultivar (UC-82B) to different concentrations of sodium chloride (0 mM, 60 mM or 120 mM NaCl) were evaluated. At harvest, no losses in marketable yield were noticed in any of the tested genotypes. However, under salt stress, fresh fruit yield as well as fruit calcium concentration were higher affected in the commercial cultivar than in the landraces. Furthermore, UC-82B showed a trend of decreasing lycopene and total antioxidant capacity with increasing salt concentration, whereas no changes in these parameters were observed in the landraces under 60 mM NaCl. Landraces under 120 mM NaCl accumulated more fructose and glucose in the fruits, while salt did not affect hexoses levels in UC-82B. Ultra-performance liquid chromatography–tandem mass spectrometry analysis revealed differential accumulation of glycoalkaloids, phenolic acids, flavonoids and their derivatives in the fruits of all genotypes under stress. Overall, the investigated Italian landraces showed a different behaviour compared to the commercial variety UC-82B under moderate salinity stress, showing a tolerable compromise between yield and quality attributes. Our results point to the feasible use of tomato landraces as a target to select interesting genetic traits to improve fruit quality under stress conditions.

Elevated UV-B radiation (UV-B) has been previously reported to affect plant development, physiology, and promote the biosynthesis of UV-absorbing compounds. Sweet basil (Ocimum basilicum L.) is an aromatic herb, widely cultivated worldwide for its use in the food, pharmaceuticals, and cosmetics industry. This species exhibits high diversity among different ecotypes based on their geographical locations. There has been little research on intra-specific photosynthetic and metabolic differences in UV-B tolerance across ecotypes from different geographical areas. This study evaluated the protection responses to high UV-B radiation of nine O. basilicum accessions with different geographic origins. Specifically, the changes in chlorophyll a fluorescence parameters and the leaf rosmarinic acid (RA) compound were assessed using an “in vivo-vitro system” in a closed-type plant production system. Our results revealed a significant variation in UV-B protection mechanisms among accessions when plants were treated with high UV-B doses. The accumulation of RA increased significantly by UV-B light treatment in OCI142, OCI148, OCI30, OCI160, and OCI102, with the highest concentration measured in OCI160 plants. This ecotype showed the highest value of the Fv/Fm ratio, 0.70, after 48 h. Recovery of leaf functionality was more rapid in OCI160 than in other sweet basil accessions, which may indicate better photosynthetic capacity associated with enhanced biosynthesis of UV absorbing compounds. This study shows that the biosynthesis of the UV-absorbing compound (RA) represents an effective mechanism to reduce the photoinhibitory and photooxidative damage caused by high UV stress.

Stinging nettle (Urtica dioica) is a plant well known in traditional medicine for its many beneficial properties, but the lack of standardization regarding the product to offer to consumers limits its diffusion. To this end, drying appears to be a useful technique to offer a low-cost product that can be stored for long time, but the different drying procedures may give rise to end-products of very different quality as nutraceutical and antioxidant compounds. Nettle leaves have been dehydrated employing freeze-drying (FD), oven-drying (OD) or heat pump drying (HPD) and compared with fresh leaves following water extraction to emulate the use by final consumers. Results indicate that the best dehydration technique is HPD, which apparently gives rise to more than a doubling of total phenols and antioxidant activity in the extract compared to the water extract obtained from fresh leaves but a reduction in the level of ascorbic acid of about 39%. In addition, the content of some phenolic compounds is 10 to over a hundred times higher in the extract after HPD than that obtained from fresh samples. This confirms that the dehydration technique should be tuned in relation to the compounds of greatest interest or value.

Large amounts of fertilizers are being used in agriculture to sustain growing demands for food, especially in vegetable production systems. Soluble fertilizers can generally ensure high crop yields, but excessive leaching of nutrients, mainly as nitrate, can be a major cause of water pollution. Controlled-release fertilizers improve the nutrient use efficiency and lower the environmental hazard, usually without affecting the production. In this study, an innovative controlled-release coated urea fertilizer was compared to conventional nitrogen (N) fertilizers and a soluble ammonium-based fertilizer containing a nitrification inhibitor, in a round table tomato cultivation. Both the water and N balance were evaluated for each treatment, along with the yield and quality of the production. The experiment was repeated in three different seasons (spring, autumn and summer-autumn) in a glasshouse to prevent the effect of uncontrolled rainfall. The results indicated that N leaching decreased by increasing the percentage of coated urea. The application of at least 50% total N as coated urea strongly reduced N leaching and improved N agronomic efficiency in comparison with traditional fertilizers, ensuring at the same time a similar fruit production. Due to reduced leaching, the total N amount commonly applied by growers could be lowered by 25% without detrimental effects on commercial production.

In this study, five wild edible herbs traditionally consumed in the Tuscany region (Italy) were evaluated for their potential in human nutrition. The nutraceutical characterization of Rumex acetosa, Cichorium intybus, Picris hieracioides, Sanguisorba minor, and Plantago coronopus, as well as their sensory profile were reported. Additionally, a preliminary assessment of completely different domestication of the wild species (named “soilless”, pot, and open field) was conducted to verify the possibility of their marketability, which is impossible if the plants are only gathered as wild. The open field domestication allowed to obtain plants with nutraceutical and sensory profiles similar to those of the wild species, especially in C. intybus, P. hieracioides, and S. minor. The pot domestication allow to obtain plants with chlorophyll and carotenoid contents close to those of the wild species, as well as a lower total phenolic and flavonoid content and ascorbic acid content than wild species. In the “soilless” method, R. acetosa and P. coronopus exhibited a high quality in terms of phytochemicals and antioxidant activity. Afterward, the sensory profile was strongly affected by the domestication in terms of the palatability, except for R. acetosa and P. coronopus, which displayed Hedonic Index (HI) values close to the consumer acceptability limit (HI = 6). A sensory profile similar to that of wild species was reported in open field domestication, whereas a worse sensory profile was reported in P. hieracioides and C. intybus domesticated using the soilless method. Finally, according to the preliminary assessment carried out in this study through an analysis of the general nutraceutical properties, S. minor was shown to be the most promising species thanks to its intrinsically highest nutraceutical properties considering the marketability of wild edible herbs as “new” functional food. However, further research on the bioavailability and bioactivity tests of nutraceutical compounds present in this species are required to confirm the findings of this study.

While the ongoing global warming and the economic crisis threaten horticultural and ornamental products production in the Mediterranean region, new challenges and opportunities for renewing plant material occur. Pitaya has great potential as a new crop for Mediterranean growers: it consumes little water and it adapts well to the high temperatures present in the greenhouse. Moreover, the market shows increasing demand of new, healthy exotic fruits and the fruit of these crops are worldwide appreciated as a super fruits. The aim of this study was to investigate the potential of introducing a new type of product that in addition to the aesthetic value can combine functional nutritional characteristics, through a whole chain approach, in order to develop basic knowledges and technical information that may lead to the commercial production of pitaya by small-scale farmers in Italy. The results of this study report and discuss various aspects to support the establishment of pitaya cultivation, such as its propagation by cuttings and micropropagation, greenhouse cultivation practices (through the clarification of the sprouting and flowering phenology as well as the fruit maturation period), while providing also information on the sensory properties and the antioxidant levels which naturally occurring in these fruits.

This paper follows an integrated approach of Internet of Things based sensing and machine learning for crop growth prediction in agriculture. A Dynamic Bayesian Network (DBN) relates crop growth associated measurement data to environmental control data via hidden states. The measurement data, having (non-linear) sigmoid-type dynamics, are instances of the two classes observed and missing, respectively. Considering that the time series of the logistic sigmoid function is the solution to a reciprocal linear dynamic model, the exact expectation-maximization algorithm can be applied to infer the hidden states and to learn the parameters of the model. At iterative convergence, the parameter estimates are then used to derive a predictor of the measurement data several days ahead. To evaluate the performance of the proposed DBN, we followed three cultivation cycles of micro-tomatoes (MicroTom) in a mini-greenhouse. The environmental parameters were temperature, converted into Growing Degree Days (GDD), and the solar irradiance, both at a daily granularity. The measurement data were Leaf Area Index (LAI) and Evapotranspiration (ET). Although measurement data were only available scarcely, it turned out that high quality measurement data predictions were possible up to three weeks ahead.

Sorrel (Rumex acetosa L.) is a perennial wild herb appreciated as a folk medicine and for use in folk-traditional cuisines, and its nutraceutical properties are increasingly known and studied. Nowadays, there is a lack of knowledge about the possibility of using this species as fresh-cut produce, and no reports have investigated the physiological/biochemical changes of sorrel leaves upon storage. To test the aforementioned, sorrel seedlings were cultivated in a floating system and two consecutive harvests took place: The first cut at 15 days (C1) and second cut at 30 days (C2) after sowing. Fresh-cut sorrel leaves from C1 and C2 were stored in plastic boxes at 4 °C for 15 days and chlorophylls, carotenoids, total phenols, flavonoids, ascorbic acid, and antioxidant capacity were evaluated during the storage period. During storage, sorrel leaves from the same cut did not show significant changes in total phenolic content and antioxidant capacity, which represents a positive outcome for the maintenance of the nutraceutical value of this species. For this reason, sorrel may be a very promising species as a “new” fresh-cut leafy vegetable. However, some differences were observed between the two cuts, especially in the total flavonoid and the total ascorbic acid contents. While promising, further research will be necessary to standardize the yield and the nutraceutical content of this species in different cuts, which will be necessary to introduce and promote sorrel to consumers.

Spinach is one of the most important green-leafy vegetables, consumed worldwide, and its intake is beneficial for human beings. In this crop, produce yield and quality are closely related to plant nitrogen (N) nutrition. A precise supply of N is also essential for high environmental and economic sustainability. Main aims of the work were: i) to establish relationships between produce yield or quality and mineral N availability in the root zone; and ii) to define an optimal mineral N level to be maintained in the root zone for spinach. Eight experiments were carried out during a four-year-long period under typical Mediterranean climate conditions. Different amounts of N fertilisers were supplied leading to twenty different levels of mineral N in the root zone. Experimental measurements included climate parameters, plant growth, tissue and soil analyses, produce yield and quality indicators. A segmented linear model significantly represented the relationship between crop yield (1.7 to 21.7 t ha–1) and soil mineral N concentration (7.6 to 41.0 mg kg–1). Basing on this model, an optimal mineral N threshold was fixed at 23.4 mg kg–1. Above this threshold, crop yield did not show any significant variations as well as tissue characteristics and produce quality. Plants grown under suboptimal N levels showed reduction in growth, tissue mineral (nutrients) content, and SPAD index. The proposed models could be implemented in fertilisation protocols for the optimization of N supply and the estimation of spinach growth and yield.

Cancer is an emerging public health problem in Africa. According to the World Health Organization, the numbers will be doubled by 2030 because of the ageing and the growth of the population. Prostate cancer is the most common cancer among men in most African countries. Radiotherapy machines are extremely limited in Africa and therefore prostate cancer in Africa is mostly managed by urologists. However, for a large proportion of prostate cancer patients, external-beam radiotherapy (EBRT) will be the treatment of choice in Africa because of limitations of surgical expertise in many countries. The disparity between the α/β ratio for late complications and the low α/β ratio for prostate cancer widens the therapeutic window when treating prostate cancer with hypofractionation. Because of the reduced number of treatment days, hypofractionation offers economic and logistic advantages, reducing the burden of the very limited radiotherapy resources in most African countries. It also increases patient convenience. A misleading assumption is that high-level radiotherapy is not feasible in low-income countries. The gold standard option for hypofractionation includes daily image-guided radiotherapy with 3–4 implanted gold fiducials. Acceptable methods for image guidance include ultrasound and cone-beam computed tomography (CT). CT-based treatment planning with magnetic resonance imaging fusion allows for accurate volume delineation. Volumetric modulated arc therapy or inversely planned intensity modulated radiotherapy is the ideal for treatment delivery. The most vital component is safe delivery, which necessitates accurate quality assurance measures and on-board imaging. We will review the evidence and potential utilisation of hypofractionated EBRT in Africa.

Introduction: The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. Aim: The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. Methods: In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. Results: The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. Conclusion: The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41–59.

Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim: The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method: A comprehensive literature review was performed. Results: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90.