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Oncologists continue to prefer traditional low molecular weight heparins over direct oral anticoagulants (DOAC) for the treatment of venous thromboembolism (VTE) cancer-related. Recently published studies supporting the use DOACs in this patient setting confirm the safety and efficacy of the treatment, but this still does not seem to be enough. The major obstacles to their use are interaction with chemotherapeutic agents, fear of haemorrhage, poor habit of using DOACs for VTE prophylaxis. But what if the haemostasis and thrombosis laboratory reassured oncologists? In this short report we talk about this topic in order to stimulate a fruitful discussion between expert.

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/heightˆ2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.

Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor because compared to other cancers it usually presents a well-expressed lymphoid infiltration. The aim of this paper is to perform a multidisciplinary comprehensive review of the evidence available about the combination of radiotherapy and immunotherapy for melanoma. Radiation, in fact, can increase tumor antigens visibility and promote priming of T cells but can also exert immunosuppressive action on tumor microenvironment. Combining radiotherapy with immunotherapy provides an opportunity to increase immunostimulatory potential of radiation. We therefore provide the latest clinical evidence about radiobiological rationale, radiotherapy techniques, timing, and role both in advanced and systemic disease (with a special focus on ocular melanoma and brain, liver, and bone metastases) with a particular attention also in geriatric patients. The combination of immunotherapy and radiotherapy seems to be a safe therapeutic option, supported by a clear biological rationale, even though the available data confirm that radiotherapy is employed more for metastatic than for non-metastatic disease. Such a combination shows promising results in terms of survival outcomes; however, further studies, hopefully prospective, are needed to confirm such evidence.

Neoadjuvant chemotherapy is increasingly being employed in the management of breast cancer patients. Efforts and resources have been devoted over the years to the search for an optimal strategy that can improve outcomes in the neoadjuvant setting. Today, a multidisciplinary approach with the application of evidence-based medicine is considered the gold standard for the improvement of oncological results and patient satisfaction. However, several clinical complications and psychological issues due to various factors can arise during neoadjuvant therapy and undermine outcomes. To ensure that health care needs are adequately addressed, clinicians must consider that women with breast cancer have a high risk of developing “unmet needs” during treatment, and often require a clinical intervention or additional care resources to limit possible complications and psychological issues that can occur during neoadjuvant treatment. This work describes a multidisciplinary model developed at “Fondazione Policlinico Universitario Agostino Gemelli” (FPG) in Rome in an effort to optimize treatment, ease the application of evidence-based medicine, and improve patient quality of life in the neoadjuvant setting. In developing our model, our main goal was to adequately meet patient needs while preventing high levels of distress.

Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of -1.97 (95% CI: -3.12, -0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women befo

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/heightˆ2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.

Background: During the 2016 Assisi Think Tank Meeting (ATTM) on breast cancer, the panel of experts proposed developing a validated system, based on rapid learning health care (RLHC) principles, to standardize inter-center data collection and promote personalized treatments for breast cancer. Material and Methods: The seven-step Breast LArge DatabasE (BLADE) project included data collection, analysis, application, and evaluation on a data-sharing platform. The multidisciplinary team developed a consensus-based ontology of validated variables with over 80% agreement. This English-language ontology constituted a breast cancer library with seven knowledge domains: baseline, primary systemic therapy, surgery, adjuvant systemic therapies, radiation therapy, followup, and toxicity. The library was uploaded to the BLADE domain. The safety of data encryption and preservation was tested according to General Data Protection Regulation (GDPR) guidelines on data from 15 clinical charts. The system was validated on 64 patients who had undergone post-mastectomy radiation therapy. In October 2018, the BLADE system was approved by the Ethical Committee of Fondazione Policlinico Gemelli IRCCS, Rome, Italy (Protocol No. 0043996/18). Results: From June 2016 to July 2019, the multidisciplinary team completed the work plan. An ontology of 218 validated variables was uploaded to the BLADE domain. The GDPR safety test confirmed encryption and data preservation (on 5000 random cases). All validation benchmarks were met. Conclusion: BLADE is a support system for follow-up and assessment of breast cancer care. To successfully develop and validate it as the first standardized data collection system, multidisciplinary collaboration was crucial in selecting its ontology and knowledge domains. BLADE is suitable for multi-center uploading of retrospective and prospective clinical data, as it ensures anonymity and data privacy.

Background: Artificial Intelligence (AI) is increasingly used for process management in daily life. In the medical field AI is becoming part of computerized systems to manage information and encourage the generation of evidence. Here we present the development of the application of AI to IT systems present in the hospital, for the creation of a DataMart for the management of clinical and research processes in the field of breast cancer. Materials and methods: A multidisciplinary team of radiation oncologists, epidemiologists, medical oncologists, breast surgeons, data scientists, and data management experts worked together to identify relevant data and sources located inside the hospital system. Combinations of open-source data science packages and industry solutions were used to design the target framework. To validate the DataMart directly on real-life cases, the working team defined tumoral pathology and clinical purposes of proof of concepts (PoCs). Results: Data were classified into “Not organized, not ‘ontologized’ data”, “Organized, not ‘ontologized’ data”, and “Organized and ‘ontologized’ data”. Archives of real-world data (RWD) identified were platform based on ontology, hospital data warehouse, PDF documents, and electronic reports. Data extraction was performed by direct connection with structured data or text-mining technology. Two PoCs were performed, by which waiting time interval for radiotherapy and performance index of breast unit were tested and resulted available. Conclusions: GENERATOR Breast DataMart was created for supporting breast cancer pathways of care. An AI-based process automatically extracts data from different sources and uses them for generating trend studies and clinical evidence. Further studies and more proof of concepts are needed to exploit all the potentials of this system.

Milk whey processing wastewaters (MWPWs) are characterized by high COD and organic nitrogen content; the concentrations of phosphorus are also relevant. A microalgal-based process was tested at lab scale in order to assess the feasibility of treating MWPW without any dilution or pre-treatment. Different microalgal strains and populations were tested. Based on the obtained results, Scenedesmus acuminatus (SA) and a mixed population (PM) chiefly made of Chlorella, Scenedesmus, and Chlamydomonas spp. were grown in duplicate for 70 days in Plexiglas column photobioreactors (PBRs), fed continuously (2.5 L culture volume, 7 days hydraulic retention time). Nutrient removal, microalgae growth, photosynthetic efficiency, and the composition of microalgal populations in the columns were monitored. At steady state, the microalgal growth was similar for SA and PM. The average removal efficiencies for the main pollutants were: 93% (SA), 94% (PM) for COD; 88% (SA) and 90% (PM) for total N; and 69% (SA) and 73% (PM) for total P. The residual pollution levels in the effluent from the PBRs were low enough to allow their discharge into surface waters; such good results were achieved thanks to the synergy between the microalgae and bacteria in the CO2 and oxygen production/consumption and in the nitrogen mineralization.

No abstract available

Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results. Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%-100%, the grade 3-4 toxicity range was 0%-6.6%, the cancer-specific survival (CSS) range was 97.9%-100%, and the overall survival (OS) range was 87%-100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%. Conclusion. Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5-10 years.

A correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) from Oncotype DX results was used to develop a decision supporting system for clinical use. We created a freely available nomogram based on quantitative IHC results that allows prediction of RS ≤ 25 or ≤ 20. Prospective studies will test this application in clinical practice.

Tetraselmis suecica was cultivated in a semi-continuously operated tubular photobioreactor fed on aquaculture wastewater (AW) testing two hydraulic retention times (HRT): 10 and 7 days (RUN_1 and RUN_2, respectively). The integrated mechanistic model BIO_ALGAE was validated with experimental data in order to simulate the biomass production and nutrient uptake of T. suecica. Moreover, AW was used as substitute synthetic cultivation medium to test the production of lipids, proteins, and carbohydrates in the microalgal biomass. Preliminary photo-respirometric tests were carried out on the AW suspension containing microalgae and bacteria. Dissolved Inorganic Nitrogen (DIN) and Dissolved Inorganic Phosphorus (DIP) were analyzed for the two RUNs, and no significant difference was highlighted (p > 0.05). On the contrary, the productivity of the Total suspended solids (TSS) was significantly higher (p < 0.05) for RUN_1 (900 mg TSS/L) than for RUN_2 (550 mg TSS/L). The analysis of the biochemical composition of biomass has demonstrated a higher content of proteins than of lipids and carbohydrates for the two RUNs. BIO_ALGAE model was validated by comparing simulated results to experimental data. The model was able to reproduce the pattern of these experimental data quite well, for both nutrient uptake and biomass production. The simulated curve follows the same pattern as the experimental data for both RUNs. The wavelike trend indicates the good accuracy of the simulated curves to reproduce the microalgae growth and nutrient uptake that occurring during daytime and at night. With this study, BIO_ALGAE Model was demonstrated to be useful to simulate bioremediation and microalgae production in aquaculture wastewater in a semi-continuous system with different environmental factors. The photo-respirometric outputs were compared with the process rates affecting dissolved oxygen dynamics computed by the mathematical model.

The definition of relationships among the attributes of macroinvertebrate communities and environmental gradients is fundamental to understand ecological dynamics. Testing the response of macroinvertebrate communities and the related metrics to the action of multiple drivers is crucial to provide reliable tools for the management and conservation of freshwater ecosystems. In this study habitat conditions, seasons and physical–chemical water characteristics were evaluated as potential limiting factors for macroinvertebrate communities. 42 sites, along 11 pre-Alpine rivers and streams, were surveyed for macroinvertebrate communities and water chemistry, collecting a total of 387 samples. Hydromorphological characteristics and habitat availability in each sampling site were assessed to describe different features of channel, banks and vegetation that can be relevant for management purposes. Macroinvertebrate community characteristics were summarized by both structural metrics (i.e. density, diversity and taxonomy-based) and ecosystem attributes derived from functional trait analysis. Functional traits are based on morphological and behavioural attributes associated with feeding, modes of attachment, concealment and locomotion, together with voltinism and drift propensity. In this framework, quantitative models have been developed to predict the potential characteristics of macroinvertebrate communities as a function of selected environmental variables. These relationships can be used to predict the effects of river restoration programs on macroinvertebrate diversity and ecosystem processes.The various metrics considered in this study may help to raise a better awareness in the natural functioning of river ecosystems, the selection of effective strategies for the conservation of biological communities, and the evaluation of river restoration success, thus supporting decision-making processes.

This study aims at demonstrating the feasibility of using microalgae-bacteria consortia for the treatment of the sidestream flow of the supernatant from blackwater dewatering (centrate) in an urban wastewater treatment plant in Northern Italy. A 1200 L raceway reactor was used for the outdoor cultivation of a diverse community of Chlorella spp., Scenedesmus spp. and Chlamydomonas spp. in continuous operation mode with 10 days hydraulic retention time. During the trial, an average daily areal productivity of 5.5 ± 7.4 g TSS m−2 day−1 was achieved while average nutrient removal efficiencies were 86% ± 7% and 71% ± 10% for NH4-N and PO4-P, respectively. The microalgal nitrogen assimilation accounted for 10% of the nitrogen in the centrate while 34% was oxidized to nitrite and nitrate. The oxygen produced by microalgae fully covert the oxygen demand for nitrification. This suggests that the proposed process would reduce the aeration demand for nitrification in the water line of the plant, while producing algal biomass to be further valorized for energy or material recovery.

BACKGROUND: Secondary effluent wastewaters still contain resources including water and nutrients that must be safely reused and recovered. In this study, the combined role of microalgae as disinfectant and nutrient removal agent was evaluated for the potential application of a microalgae-based process as a cost-effective tertiary treatment. Nutrient removal, biomass productivity and disinfection performances were monitored in laboratory-scale photobioreactors (batch and continuous) fed on a secondary effluent mixed with a 10% on influent collected at a large municipal wastewater treatment plant where tertiary disinfection is performed by UV treatment. RESULTS: In microalgae-based batch disinfection tests, Escherichia coli counts (0.5 ± 0.7 log CFU 100 mL−1) were comparable to those after traditional UV process (0.7 ± 0.84 log CFU 100 mL−1) and lower than in tests where light was applied without microalgae. In the following continuous test, E. coli counts were reduced by one order of magnitude and the pathogenic strain of E. coli O157:H7/H−, Salmonella spp. and indicators such as Bacteroides spp. and Enterococcus spp. were never detectable in the effluents by molecular tools. Total nitrogen and phosphorus removals reached 93 and 100%, respectively, while the algal biomass productivity of the system averaged 50 ± 30 mg TSS L−1 day−1. CONCLUSIONS: The effluents of the photobioreactors reached quality standards appropriate for water reuse. Moreover, nutrients could be recovered through the generation of algal biomass suitable for further valorization. © 2019 The Authors. Journal of Chemical Technology & Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

BACKGROUND: Microalgae–bacteria-based processes are among the most promising low-cost technologies to treat livestock wastewaters. The current literature reports the need for pretreatment or dilution of piggery wastewater for adequate microalgal growth. The aim of this study is to optimize the potential of microalgal–bacterial communities to treat undiluted and untreated piggery wastewater by investigating the influence of some operational parameters such as phosphorus and CO 2 availability and hydraulic retention time on the nitrogen removal efficiency and biomass productivity. RESULTS: The microalgal community (dominated by Chlorella spp.) developed quickly and remained quite stable. The rates of biomass production and NH 4 -N removal were 55 ± 30 mg TSS L −1 day −1 and 13 ± 3 mg NH 4 -N L −1 day −1 respectively. CO 2 adjustment had a positive effect on microalgal growth and NH 4 -N removal. CONCLUSION: Data confirm the ability of the microalgal–bacterial consortium to grow on undiluted and untreated piggery wastewater under semi-continuous conditions. Synergy between algae and bacteria seems positive since photosynthesis produces the oxygen needed for ammonia oxidation

No abstract available

Aim: This manuscript focuses on the first experience in literature of a patient with a complicated Adult Onset Still's Disease-related heart failure who thereafter underwent adjuvant radiotherapy for left breast cancer. Background: AOSD is a rare autoimmune inflammation-related disease, in which life-threatening pulmonary and cardiac complications can occur. In literature, AOSD is often associated with cancer, as paraneoplastic syndrome, but there are few data about primary AOSD and management of oncological therapies. Materials and Methods: A patient who needed adjuvant breast cancer radiotherapy underwent tumour board evaluation to define feasibility of an RT in a patient with of a history of a heart life-threatening complication 2 years before AOSD. Results of the review were discussed by a multidisciplinary panel of experts that chose the type of surgery, radiotherapy and monitoring of patient. Results: Literature review confirmed association of AOSD with BC in some pts and uniqueness of this treatment management experience. Patient underwent RT according to schedule of 40.05/2.67 Gy/fx on residual left breast and 10/2 Gy/fx on tumour bed with the gating technique. The panel chose to keep immunosuppressive therapy with anakinra. No complications were observed at clinical, ECG and laboratory examinations. Maximum toxicity was G2 skin. At first follow up AOSD signs of flare were negative. Conclusion: In conclusion, when oncological treatments, especially radiotherapy, are mandatory for AOSD pts, multidisciplinary management and tailored monitoring are necessary to avoid acute adverse effects and allow pts to complete therapies.

The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common—paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyze available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.

The thermal regime of Alpine streams: natural controls and effect of hydroelectric power production Riccardo Fornaroli, Luca Bonacina, Francesca Marazzi, and Valeria Mezzanotte University of Milano-Bicocca, Department of Earth and Environmental Sciences, Milan, Italy (riccardofornaroli@gmail.com) Since the earliest studies water temperature was recognized as one of the most important drivers in stream ecosystems, shaping both biodiversity and ecosystem functioning. So, it was often included as a factor in stream classification systems. The temperature is critical to aquatic organisms through its effects on metabolic rates and thus on growth. Moreover, water temperature relates to the outbreaks of disease, to the toxicity of numerous substances, to the ability of fish to migrate and to many other ecosystem attributes. Despite the recognized biological importance of water temperature, stream thermal regime alterations were rarely quantified in bioassessment programs and few quantitative information about the natural thermic conditions of Alpine streams are available. Besides, the ecological consequences of differences in the thermal regimes were highlighted to be important for many species of fish and invertebrates, but few studies focus on their consequences at community or ecosystem level which are the subject of bioassessment. In the present study we monitored water temperature of streams belonging to the Alpine catchment of Serio River (Italy), in reaches selected as representative of different natural conditions and human alterations. The collected data, with air temperature, flow estimates and diversion rates of hydroelectric power plants, were used to produce quantitative models able to predict the temperature of stream water. Those models describe the effects of meteorological conditions on thermal regime for snow-melt/storm-water and groundwater fed streams. This is the basis for the evaluation of natural thermal regime, allowing to reconstruct temperature ti

This study investigates and compares the uptake of nutrients (nitrogen, phosphorus) and the growth of Tetraselmis suecica and Dunaliella tertiolecta in aquaculture wastewater. The obtained data were used to implement and calibrate the microalgae-bacteria model BIO_ALGAE to simulate the bioremediation and the biomass production of these species. The microalgae were cultivated in batch conditions for 7 days using 120-L vertical column photobioreactors. In the first 4 days, after which the algal density reached a steady state, the average biomass production was 83.7 ± 4.4 mg/L/day for T. suecica and 56.4 ± 5.1 mg/L/day for D. tertiolecta. The two species were able to remove more than 96% of dissolved inorganic nitrogen (DIN) and dissolved inorganic phosphorus (DIP). The total lipid content was analyzed at the end of the 7 days; T. suecica and D. tertiolecta had different lipid content: 75.8 ± 1.6% and 23.2 ± 2.0%, respectively. The BIO_ALGAE model fits very well the experimental data of both species in terms of biomass and nutrient uptake and could be an effective tool to predict the production of microalgae using aquaculture wastewater as growth media, obtaining at the same time the removal of nutrients from wastewater and the production of biomass to be used as feed. In particular, this mathematical model can be applied to forecast the performance under different operating conditions, for the design, optimization, and control of the process in aquaculture systems.

This study was carried out to assess the efficiency of a pilot-scale bubble-column reactor to remove nitrogen in centrate from the biosolid dewatering of a municipal wastewater treatment plant whilst producing biomass for agricultural purposes. The column was inoculated with a mixed community of Scenedesmus and Chlorella spp. and operated outdoor in batch for 55 days and in continuous for further 130 days. In continuous, the average daily biomass productivity was 40 ± 62 mg TSS L −1 d−1 and the average NH4+-N removal was 20 ± 10 mg L −1 d−1. Nitrification was fostered by photo‐oxygenation leading to the oxidation of 34 ± 27% of the incoming ammonia nitrogen. Microalgal and bacterial activity inside the column was analyzed by the Generalized Linear Models in order to understand the main factors affecting the process performances. Microalgal growth was affected positively by the NH4+-N content in the influent and negatively by the amount of TSS entering the system, probably due to the competition between microalgae and bacteria for phosphorus and other nutrients. The removal rate of NH4+-N was positively affected by NH4+-Nin (influent concentration) and by pH, whose increase fosters stripping, and decreased for increasing NH3-N concentrations, responsible for inhibiting nitrifying bacteria. NH4+-N oxidation was the result of complex interactions between algae and bacteria and was also affected by flow and solar radiation. No other specific limiting factors have been highlighted. The possibility of improving the process performance by controlling pH, by supplying off-gas as CO2 additional source, appears as an interesting option. In view of a scale-up, the most relevant expected result would be the energy saving due to the decrease in the oxygen demand for nitrification in the water line. The microalgal biomass grown on centrate was suitable for agricultural use due to its low contamination by heavy metals.

This paper addresses the efficiency of a microalgae-based agricultural digestate treatment at pilot-scale in an outdoor raceway pond (880 L, pH-dependent CO2 dosage) and in a bubble column (74.5 L, air-bubbling). Specifically, nitrogen removal, evolution of the algae-bacteria consortium, and the actual process applicability in the Po Valley climate are discussed. The performance of the two reactors varied seasonally. The average algal productivity in the raceway was 32.4 ± 33.1 mg TSS·L−1·d−1 (8.2 ± 8.5 g TSS·m−2·d−1) while in the PBR it was 25.6 ± 26.8 mg TSS·L−1·d−1; the average nitrogen removal was 20 ± 29% (maximum 78%) and 22 ± 29% (maximum 71%) in the raceway and in the column, respectively. Nevertheless, nitrification had a key role as 61 ± 24% and 52 ± 32% of the nitrogen load was oxidized in the raceway and in the column, respectively.

Objective: Palbociclib is a cyclin-dependent kinase 4/6 inhibitor recently approved for treatment in advanced or metastatic breast cancer (BC) patients. The use of 18 F-FDG PET/CT for chemo/endocrine therapy response assessment in BC patients is well reported in the literature, but no studies have evaluated its role for assessing Palbociclib efficacy in clinical practice. Our study aimed to evaluate the potential role of 18 F-FDG PET/CT in this setting. Methods: In 12 metastatic BC patients (mean age = 62 ± 10 years) treated with Palbociclib plus endocrine therapy and who underwent a baseline and post-therapy 18 F-FDG PET/CT, we retrospectively compared the Metabolic Response Evaluation (MRE, based on PET/CT) to the Standard Response Evaluation (SRE, based on clinico-laboratory and morphological data); we also assessed the influence of additional PET/CT information on the patients’ management. Results: Compared to SRE, MRE increased the proportion of patients classified with progressive disease from 25 to 50% and differed from SRE in 8/12 patients: 3/8 shifted from stable disease or undetermined response to metabolic progression (more unfavorable category), 4/8 from stable disease to partial or complete metabolic response, and 1/8 from partial response to complete metabolic response (more favorable category). Additional PET/CT information led to a change in patients’ management in 3/12 (25%) patients. Conclusion: In BC patients treated with Palbociclib, additional 18 F-FDG PET/CT information seems clinically useful, with respect to personalized management, to early intercept patients who should discontinue Palbociclib because of progressive disease and to select patients requiring a strict monitoring of additional metabolic findings. Further studies are needed to confirm these preliminary results.

No abstract availablle

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© 2019 Elsevier B.V. Background: Risk factors for local recurrence after mastectomy in ductal carcinoma in situ (DCIS) emerged as a grey area during the second “Assisi Think Tank Meeting” (ATTM) on Breast Cancer. Aim: To review practice patterns of post-mastectomy radiation therapy (PMRT) in DCIS, identify risk factors for recurrence and select suitable candidates for PMRT. Methods: A questionnaire concerning DCIS management, focusing on PMRT, was distributed online via SurveyMonkey. Results: 142 responses were received from 15 countries. The majority worked in academic institutions, had 5–20 years work-experience and irradiated <5 DCIS patients/year. PMRT was more given if: surgical margins <1 mm, high-grade, multicentricity, young age, tumour size >5 cm, skin- or nipple- sparing mastectomy. Moderate hypofractionation was the most common schedule, except after immediate breast reconstruction (57% conventional fractionation). Conclusions: The present survey highlighted risk factors for PMRT administration, which should be further evaluated.