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Background: Surgical rib fixation (SRF) is being used increasingly in trauma centers for stabilization of chest wall injuries, in line with new and evolving surgical techniques. Our institution has developed a pathway for the management of chest wall injuries and SRF, which includes a follow-up low-volume, noncontrast computed tomography (CT) scan at 12 months., Methods: This study was a single-center retrospective study conducted on 25 consecutive patients who underwent SRF between February 2019 and February 2020. All CT measurements were done by a CT radiographer under the supervision of a board-certified radiologist and included the use of three-dimensional volume-rendered images., Results: There were no patients with SRF who experienced hardware failure at 12 months in either flail or nonflail groups. For fractured ribs treated with SRF, complete or partial union occurred in 75 of 76 ribs plated (98.7%). The median ratio for improvement in lung volumes was 1.71 for flail SRF and 1.69 for nonflail SRF in our study., Conclusion: Three-dimensional volume-rendered CT at 12 months post-SRF showed good alignment (no hardware failure) and fracture healing of fixed ribs in both flail and nonflail groups. Lung volumes also improved pre-SRF and post-SRF for both flail and nonflail patients. More studies are needed to define how the pattern of rib fracture healing of fixed and nonfixed ribs affects lung volumes., Level of Evidence: Therapeutic, Level V., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population's awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.

We obtained data from Google Trends and Wikipedia in order to assess whether an analysis of Internet searches could provide information on the Internet users' behaviour/interest in diets. Differences in seasonality, year and before/during COVID-19 pandemic were assessed. From Wikipedia, we extracted the number of times a page is viewed by users, aggregated on monthly and seasonal bases. We also used Google Trends to evaluate the frequency of the users' web searches. The Mediterranean diet was the most frequently (33.9%), followed by the pescatarian diet (9.0%). Statistically, significant seasonal differences were found for the Mediterranean, vegetarian, Atkins, Scarsdale, and zone diets and pescetarianism. The most commonly searched diet and consequent diet-related queries on Google resulted to be: Dukan diet, Dukan and weight loss. Ketogenic, FODMAP and intermittent fasting diets were statistically more frequently searched during the pandemic compared with before. Our data show a different trend of searches based on the seasonality, year and the pandemic. These data could be useful for scientists, practitioners and policy makers because they can inform educational campaigns via the Internet, especially in periods when the population is more receptive.

Introduction: The aim of the current study was to assess if the frequency of internet searches for influenza are aligned with Italian National Institute of Health (ISS) cases and deaths. Also, we evaluate the distribution over time and the correlation between search volume of flu and flu symptoms with reported new cases of SARS-CoV-2., Materials and Methods: The reported cases and deaths of flu and the reported cases of SARS-CoV-2 were selected from the reports of ISS, the data have been aggregated by week. The search volume provided by Google Trends (GT) has a relative nature and is calculated as a percentage of query related to a specific term in connection with a determined place and time-frame., Results: The strongest correlation between GT search and influenza cases was found at a lag of +1 week particularly for the period 2015-2019. A strong correlation was also found at a lag of +1 week between influenza death and GT search. About the correlation between GT search and SARS-CoV-2 new cases the strongest correlation was found at a lag of +3 weeks for the term flu., Conclusion: In the last years research in health care has used GT data to explore public interest in various fields of medicine. Caution should be used when interpreting the findings of digital surveillance., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Objectives: At the end of 2019, an acute infectious pneumonia (coronavirus disease 2019 [COVID-19]) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, and subsequently spread around the world starting a pandemic. Globally, to date, there have been >118 million confirmed cases, including >2 million deaths. In this context, it has been shown that the psychological impact of the pandemic is important and that it can be associated with an increase in internet searches related to fear, anxiety, depression, as well as protective behaviours, health knowledge and even maladaptive behaviours., Study Design: This is a systematic review., Methods: This review aims to collect, analyse and synthesise available evidence on novel data streams for surveillance purposes and/or their potential for capturing the public reaction to epidemic outbreaks, particularly focusing on mental health effects and emotions., Results: At the end of the screening process, 19 articles were included in this systematic review. Our results show that the COVID-19 pandemic had a great impact on internet searches for mental health of entire populations, which manifests itself in a significant increase of depressed, anxious and stressed internet users' emotions., Conclusions: Novel data streams can support public health experts and policymakers in establishing priorities and setting up long-term strategies to mitigate symptoms and tackle mental health disorders., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Introduction: The aim of the study was to evaluate the knowledge, attitude and practices towards SARS-CoV-2 among nursing students of University of Palermo during the rapid rise period of the COVID-19 pandemic., Materials and Methods: This is cross-sectional study. A survey was provided to all nursing students and consisted of two parts: demographics and Knowledge, Attitude and Practices (KAP) survey. A multivariate linear regression model was used and adjusted Odds Ratios (aOR) are presented., Results: 575 students were interviewed, and their mean age was 22.29 ± 4.2. The overall score indicates good knowledge (p=0.046) and good practices among the four courses of study (p=0.038). Multivariate linear regression showed that Attitude score (b = -0.29; p = 0.024) and Knowledge score (b = 0.10; p = 0.026) adjusted for age, gender, year of study, perceived economic status, perceived health status were significantly associated with Practice score., Conclusion: Our results suggest that proper health education is useful for encouraging optimistic attitudes and maintaining safe practices among future category of nurses., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Background: We aimed to investigate changes in volume and MRI T2-weighted intensity in desmoid-type fibromatosis (DF) receiving methotrexate plus vinca-alkaloids (MTX-VA) at Istituto Nazionale dei Tumori, Milan., Methods: All cases of sporadic DF treated with MTX-VA from 1999 to 2019 were reviewed. MRIs at baseline, 6 and 12 months of chemotherapy and at treatment withdrawal were retrospectively reviewed, contouring the tumor lesion and measuring diameters, volume, and mean T2-signal intensity (normalized to muscle) changes. These parameters were also evaluated according to clinical variables., Results: Thirty-two DF patients were identified. Best RECIST response was: 25% partial response, 69% stable disease, 6% progression. A ≥65% tumor volume reduction was observed in 38%, <65% reduction in 53%, an increase in 9%. 22% had RECIST stable disease with a ≥65% tumor volume reduction. T2-signal intensity decreased by ≥50% in 47%, <50% in 41% and increased in 12%. In patients with symptomatic improvement while on therapy and in patients maintaining symptomatic improvement during follow-up, median T2-signal intensity showed a reduction along the time points (3.0, 1.9, 1.2, 1.1; 2.9, 2.0, 1.2, 1.2, respectively); in patients without symptomatic improvement and in those clinically progressing during follow-up, a reduction was not observed. High T2-signal intensity at baseline was observed in patients showing RECIST progression during follow-up., Conclusions: In this series, RECIST detected a lower proportion of responses as compared to volumetric and T2-signal changes. T2-signal reduction seemed to better reflect symptomatic improvement. High T2-signal intensity at baseline was related to a higher proportion of further progression., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

The flu vaccination rate is still too low, both among healthcare providers (HCPs) and among health sciences university students. This study aims to assess the reasons of past and future flu vaccination acceptance among health sciences university students, and second, to identify what interventions would be helpful to foster acceptance of the flu vaccination among HCPs. A multicentre cross-sectional study was performed, using a validated questionnaire administered to health sciences students enrolled in 14 Italian universities. A multivariable logistic regression model was used. A total of 3131 questionnaires were collected. The statement that mandatory vaccination is required to increase adhesions to vaccinations (adjusted odds ratio [aOR] = 1.57; 95% confidence interval [CI] = 1.25-1.97), being in favour of this obligation (aOR = 7.91; 95% CI = 2.50-25.02) and considering themselves as people at risk of infection (aOR = 1.96; 95% CI = 1.46-2.64), are associated with having received the vaccination in the past flu season; on the other hand, planning to be vaccinated for the next season to avoid infecting patients is protective (aOR = 0.51; 95% CI = 0.38-0.70). This study shows which beliefs are associated with having joined the previous vaccination campaign in a large sample of HCPs. The acceptance of vaccination is an outcome behaviour resulting from a complex decision-making process. In order to implement coverage of the influenza vaccination in HCPs, it is necessary to implement awareness campaigns and provide specific information for this category of workers., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Objectives: The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for Chikungunya, Dengue, Zika, and West Nile Virus infection reported by bulletin of Italian National Institute of Health (Istituto Superiore di Sanità in italian, ISS)., Study Design: A cross-sectional study design was used., Methods: The reported cases of Dengue and Chikungunya were selected from July 2015 to December 2019. For West Nile Virus, the bulletins are issued in the period June-November (6 months) of the years 2015-2019, and for Zika virus, the data reported in the ISS bulletin start from January 2016. From Wikipedia Trends, we extracted the number of monthly views by users from the July 2015 to December 2019 of the pages Chikungunya, Dengue, Zika virus, and West Nile Virus., Results: A correlation was observed between the bulletin of ISS and Wikipedia Wikitrends, the correlation was strong for Chikungunya and West Nile Virus (r = 0.9605; r = 0.9556, respectively), and highly statistically significant with P-values <0.001. The correlation was moderate for Dengue and Zika virus (r = 0.6053; r = 0.5888, respectively), but highly statistically significant with P-values <0.001., Conclusions: Classical surveillance system should be integrated with the tools of digital epidemiology that have potential role in public health for the dynamic information and provide near real-time indicators of the spread of infectious disease., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Transcatheter aortic valve implantation (TAVI) is relatively contraindicated in the bicuspid aortic valve, and to our knowledge has not been tried where the true native annulus is of a size far in excess of current device capabilities. We present here a case of a successful emergency TAVI of a 73-year-old previously healthy man, who presented with cardiogenic shock, ventricular tachycardia storm and severe left ventricular dysfunction because of the underlying critical bicuspid aortic stenosis with aortic annulus area of 991.9 mm 2 and associated moderate aortic incompetence (the Society of Thoracic Surgeons (STS) risk score; score mortality of 40.9%). Despite the critical condition of the patient and technically challenging anatomy, successful TAVI was performed and the patient remains well with near-normal left ventricle (LV) function at 6 months follow-up.

Introduction: This study aimed to assess if the frequency of the Italian general public searches for influenza, using the Wikipedia web-page, are aligned with Istituto Superiore di Sanità (ISS) influenza cases., Materials and Methods: The reported cases of flu were selected from October 2015 to May 2019. Wikipedia Trends was used to assess how many times a specific page was read by users; data were extracted as daily data and aggregated on a weekly basis. The following data were extracted: number of weekly views by users from the October 2015 to May 2019 of the pages: Influenza, Febbre and Tosse (Flu, Fever and Cough, in English). Cross-correlation results are obtained as product-moment correlations between the two times series., Results: Regarding the database with weekly data, temporal correlation was observed between the bulletin of ISS and Wikipedia search trends. The strongest correlation was at a lag of 0 for number of cases and Flu (r=0.7571), Fever and Cough (r=0.7501). The strongest correlation was at a lag of -1 for Fever and Cough (r=0.7501). The strongest correlation was at a lag of 1 for number of cases and Flu (r=0.7559), Fever and Cough (r=0.7501)., Conclusions: A possible future application for programming and management interventions of Public Health is proposed.

Background: The outcome of patients with retroperitoneal sarcomas (RPS) depends mainly on tumor biology and completeness of surgical resection. However, some patients are deemed not resectable for various reasons. This study analyzed a series of primary RPS patients to describe rate and reasons of primary inoperability at a large referral center., Methods: All consecutive patients affected by primary localized RPS referred for surgical treatment at our institution between January 1, 2013 and December 31, 2017 were analyzed. Patients were split in two groups: those who underwent surgical resection with curative intent, and those who were not resected., Results: A total of 322 patients were available for the current analysis: 285 (88.5%) underwent resection with curative intent, and 37 (11.5%) did not. Twenty of 322 (6.2%) patients who did not undergo resection had a technically unresectable tumor, whereas the remaining 18 of 322 (5.6%) were not amenable to a major surgical procedure due to comorbidities/poor performance status. The dominant technical reason was involvement of the celiaco-mesenteric vessels. At a median follow-up from the diagnosis of 34 months, 24 of 37 (64.9%) nonoperated and 48 of 285 (16.8%) operated patients died. The corresponding 4-year overall survival were 10.3% and 83.4%, respectively (p < 0.001)., Conclusions: Roughly, 10% of patients who presented with localized primary RPS at a large referral institution were not resected. An attempt to standardize the definition of resectability for primary localized RPS should be made considering anatomic, biologic, and patient-related factors.

Introduction: The purpose of this study was to ascertain the determinants of nursing students' compliance with flu vaccination., Methods: In this cross-sectional study, an anonymous paper questionnaire was administered to students attending the 3-year nursing course at the University of Palermo. Adjusted Odds Ratios (aOR) are presented., Results: 403 nursing students (65% female) completed the questionnaire (response rate 98.5%). The average age of the respondents was 22.0 years (SD ± 3.04). The dependent variable: "In the next season, do you intend to be vaccinated against flu? Yes", displayed a statistically significant association with the following independent variables: "year of study: second" (aOR 2.66), "year of study: third" (aOR 1.72), "Perceived health status: medium-high" (aOR 6.61), "Did you get vaccinated against seasonal flu last year? Yes" (aOR 22.47)., Conclusions: Although nursing students are not yet health professionals, they spend part of their time in health facilities for their clinical training and will be the health workers of the future. Involving nursing students in influenza vaccination campaigns can also help them take better care of themselves and their patients., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2020 Pacini Editore SRL, Pisa, Italy.)

Background: SARS-CoV-2 infection is a global health problem that is primarily detected in Italy with progressive increase in cases and deaths. To facilitate the management of the pandemic in Italy, it is essential to understand the level of attention on COVID-19. The aim of the study was to evaluate the knowledge, attitude and practices towards SARS-CoV-2 among the nursing students of University of Palermo during the rapid rise period of the COVID-19 pandemic., Methods: The current study was a cross-sectional study. On-line questionnaires were used for the collection of the data by providing a survey in all nursing students. The questionnaire consisted of two parts: demographics and Knowledge, Attitude and Practices (KAP) survey. A multivariate linear regression model was used and adjusted Odds Ratios (aOR) are presented., Results: 525 students were interviewed and their mean age was 21.8. The overall score indicates good practices among the three courses of study (p=0.025). The Multivariable logistic regression showed that the dependent variable "Practice poor score" is statistically significant associated with these independent variables: "Other country of birth" (aOR 17.7, 95% CI 2.31-136.03), "second" (aOR 2.65, 95% CI 1.21-7.80) and "third" (aOR 2.96, 95% CI 1.31-6.72) year of study, "low perceived health status"(aOR 2.35, 95% CI 1.04-5.30) and "Knowledge poor score (aOR 3.05, 95% CI 1.06-8.77)., Conclusion: Our results suggest that health education programs aimed at improving COVID-19 knowledge are helpful for nursing students to hold optimistic attitudes and maintain appropriate practices.

Introduction: Cases of measles in some European countries are increasing. The aim of this study is to find the correlation between Google Trends and Wikipedia searches and the real number of cases notified., Materials and Methods: The data on Internet searches have been obtained from Google Trends and Wikipedia. The reported cases of measles were selected from January 2013 until December 2018 for Google Trends and July 2015 until December 2018  from for Wikipedia. We have selected data from four European Countries: Italy, France, Germany and Romania. The data extracted from Wikipedia and Google Trends have been moved over time (Lag), one month in the future and one month in the past. Cross-correlation results are obtained as product-moment correlations between the two time series. The statistical analyses have been performed by using the Spearman's rank correlation coefficient or Pearson correlation coefficient., Results: A temporal correlation was observed between the bulletin of ECDC and Wikipedia search trends. For Wikipedia the strongest correlation is at a lag of +1 for rougeole (r=0.9006) and masern (r=0.7023) and at lag 0 for morbillo (r=0.8892) and rujeola (r=0.5462); for Google Trends the strongest correlation at a lag 0 for rougeole (rho=0.7398), symptômes rougeole (rho=0.3399), masern (rho=0.6484), sintomi morbillo (rho=0.6029), rujeola (rho=0.7209), simptome rujeola (rho=0.5297) and at lag -1 for masern symptom (rho=0.4536) and morbillo (rho=0.5804)., Conclusions: Google and Wikipedia could play an important role in surveillance, although these tools need to be combined with traditional surveillance systems.

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren't any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting., (©2020 Pacini Editore SRL, Pisa, Italy.)

This abstract from abstract [Pathology 2020; 52(S1): S82] has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This abstract has been removed at the request of the Authors and the Editor in Chief due to patient consent issues., (Copyright © 2020. Published by Elsevier B.V.)

Summary: Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, therefore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (χ2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Background: Despite the free-of-charge offer of influenza vaccines to at-risk subgroups, vaccine coverage remains low and far from the target, probably due to the false myths and misperceptions. We aimed to explore the healthcare students' vaccination behavior and beliefs to find any association between vaccination uptake during the last 5 years and future vaccination acceptance., Study Design: A multicentre cross-sectional study., Methods: From Oct 2017 to Nov 2018, the Italian healthcare students from 14 different universities in 2017/2018 were enrolled, through an online and anonymous questionnaire previously validated. Absolute and relative frequencies were calculated and Pearson's Chi-square test was used. A multinomial logistic regression model was performed. Results are expressed as relative Risk Ratio (RR) with 95% Confidence Intervals (95% CI). The level of significance chosen was P-value <0.05., Results: A total of 3137 students were enrolled and 3131 questionnaires were analysed. 82.7% of the sample declared they had not received any flu vaccination during the last 5 years. Students who received flu vaccination 4 times or more during the last 5 years were more likely to do it again next year as well (95.1% vs 4.9%). The regression model showed that having received flu vaccination over the last 5 years was statistically associated with the intention of getting vaccinated during next season., Conclusion: Frequency of flu vaccination is predictive for future acceptance among healthcare students. This association could have both implications for the organization of vaccination campaigns and improve educational strategies for this category of students.

Introduction: Sexually transmitted diseases are an emerging problem especially among young people, increasing the burden of disease in this population. The aim of the study was to evaluate sexual habits, sexual relations and knowledge of STIs among the students in the nursing science course of the University of Palermo., Materials and Methods: In April 2019, a survey was provided to students that investigate on: personal information and habits, knowledge of sexually transmitted diseases, anti-HPV vaccination. Multivariable logistic regression was performed, considering it as a dependent variable "Have you occasionally had unprotected sex (without a condom)? Yes", in order to evaluate the role of the variables of the questionnaire. Results are expressed as adjusted Odds Ratio (aOR)., Results: 405 students completed the questionnaire. The mean age of the sample is 21.65 years, 69.63% of the interviewees are women. The multivariable logistic regression shows that the risk of having occasional unprotected sex (without condom) is significantly associated with "Do you permanently have unprotected sex (without a condom)? Yes" (aOR 4.46); "Have you ever received information on sex education and/or sexually transmitted diseases? No" (aOR 6.02); "Age Class <22 years old (aOR 2.03); "Number of sexual partners: As the unit increase" (aOR 1.18)., Conclusions: Too many young people receive confusing and conflicting information about relationships and sex, as they make the transition from childhood to adulthood. Nurses play an important role in promoting public health. The study showed that young students are not still enough sensitized on sexually transmitted infections and preconception care.(www.actabiomedica.it).

Background: Violence in the workplace is now universally recognized as a significant global public health issue and is one of the most serious issues affecting the healthcare sector., Objectives: To assess the prevalence of workplace violence., Methods: We performed a multicenter cross-sectional study using an anonymous questionnaire submitted to doctors from Northern Italy. The survey investigates socio-demographic information, the number of years of work in the health sector and the physical and verbal aggressions that occurred in the workplace in the last 12 months., Results: The sample consists of 4545 healthcare workers, of whom 2603 (57.27%) are females. The mean age of the sample is 49.79 years (SD ± 12.63). The risk of being victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (aOR 2.09, 95% CI 1.51-2.88), work in the public sector (aOR 2.57, 95% CI 1.72-3.85), being victim of verbal aggression at work in the last 12 months (aOR 22.52, 95% CI 10.97-46.20), work in the operational units of the Medical area (aOR 2.36, 95% CI 1.33-4.21) and the Territorial area (aOR 1.97, 95% CI 1.04-3.74)., Discussion: The prevalence of violent behaviour is difficult to assess, because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is necessary to develop effective control strategies at individual, hospital and national levels.

This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Authors and the Editor in Chief due to patient consent issues.

Introduction: Desmoid tumour (DT) is a locally aggressive fibroblastic proliferative disease representing the most common extraintestinal manifestation of familial adenomatosis polyposis (FAP). As data on the activity of chemotherapy in these patients are limited, we examined the outcomes of patients treated with low-dose methotrexate (MTX)+vinca alkaloids (vinorelbine or vinblastine)., Patients and Methods: We retrospectively reviewed clinical and outcome data from all patients with confirmed FAP-associated DTs treated with weekly MTX+vinca alkaloids in seven European sarcoma reference centres between January 2000 and December 2018. Radiological responses were assessed using RECIST V.1.0 and V.1.1. The Kaplan-Meier method associated to the log-rank test was used to estimate and compare survival curves., Results: We identified 37 patients (median age 29 years, range 7-44). According to RECIST, 20/37 (54.1%) patients achieved partial response (PR), 15/37 (40.5%) patients had stable disease and 2/37 (5.4%) had progressive disease as best response. Overall, the median progression-free survival (PFS) was 6.5 years (range, 0.3-12.1 years). In the subset of patients achieving PR as best response, the median PFS was not reached. In a subset of 11 patients with progressive disease offered MTX+vinca alkaloids rechallenge (after chemotherapy withdrawal following prolonged disease control), the disease control rate was 100%, resulting in a median PFS after rechallenge of 5.8 years., Conclusions: This is the largest series on the activity of low-dose chemotherapy in patients with FAP-related DT. In this population, MTX+vinca alkaloids is an active combination, as already reported in patients with sporadic DT., Competing Interests: Competing interests: None declared., (© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.)

Introduction: The purpose of the study was to assess tobacco smoking habits among nursing students and how these are influenced by family members and cohabitants., Methods: Cross-sectional study. An anonymous paper questionnaire was administered to nursing students of the three-year course of the University of Palermo. Adjusted Odds Ratio (aOR) are presented., Results: 301 nursing students (63.12 % female) completed the questionnaire (response rate 61.17%). The average age of the sample is 21.88 years (SD ± 2.80). Considering as a dependent variable: "I currently smoke", the statistically significant independent variables associated are: "Male gender" (aOR 2.09), "Single" (aOR 2.06), "Second year of study of the degree course in nursing" (aOR 0.46), "Third year of study of the degree course in nursing" (aOR 0.43), "Don't think that warnings and pictures on cigarette packs can help stop smoking" (aOR 6.38), "Mother smoked in the past" (aOR 2.25) and "Brother or sister smoked in the past" (aOR 5.50)., Conclusions: Students and graduate nurses need to be aware of current knowledge in the smoking cessation field and they have an influential role in modifying patient behavior in order to assist them to smoking cessation., (©2019 Pacini Editore SRL, Pisa, Italy.)

Purpose: Perivascular epitheliod cell tumors (PEComas) are rare mesenchymal neoplasms for which the role of systemic treatments is not established as there are no published prospective clinical trials or sufficiently large retrospective case series. The aim of this study is to clarify the activity of conventional chemotherapy and biological agents in advanced/metastatic PEComas., Experimental Design: This was an observational, retrospective, international study that included patients with advanced/metastatic PEComa treated with systemic therapy at 5 European sarcoma reference centers and within the Italian Rare Cancer Network. Survival analyses were performed using the Kaplan-Meier method and the Cox hazards regression models., Results: A total of 53 patients were included. Cytotoxic chemotherapy regimens were active only in a small proportion of PEComas. Gemcitabine-based regimens [objective response rate (ORR): 20%, median progression-free survival (PFS): 3.4 months] seemed to have the same activity of anthracycline-based regimens (ORR: 13%, median PFS: 3.2 months). Antiangiogenic agents resulted in disease stabilization in some patients, with a number having density changes/tissue response on imaging, with an ORR of 8.3% and a median PFS of 5.4 months. mTOR inhibitors were the most active agents, with an ORR of 41% and a median PFS of 9 months., Conclusions: Our study provides data for the selection of systemic therapy in patients with advanced/metastatic PEComa: mTOR inhibitors are the most active agents. Antiangiogenics and chemotherapy with gemcitabine-based regimens or anthracycline-based regimens are options in further line, but with a lower response rate and PFS., (©2019 American Association for Cancer Research.)

Introduction: Influenza is an infectious disease with a high burden, for which a safe and efficacy vaccine is available. However, vaccination coverage is generally low, also among Health Care Workers (HCW). Health Professions students are comparable to HCW in terms of workplace exposure., Aim: The study aim was to identify predictive factors of flu vaccination acceptance among Italian students of Health Professions., Methods: A cross-sectional study was performed using a validated, on-line, anonymous questionnaire. Data were analyzed performing both univariable and multivariable logistic analysis., Results: The results showed a statistically significant association between intention to vaccinate next year and: geographical distribution, considering themselves at higher risk due to their profession, having been vaccinated last year, having recommended the vaccination last year, and being willing to recommend it next year and being favorable to mandatory vaccination. In conclusion, identifying an effective vaccination strategy and including students in flu vaccination campaigns might have positive effect on vaccination acceptance.

Background: The role of vaccination in reducing the incidence, morbidity and mortality of vaccine preventable diseases is well-known; however, vaccination uptake for some vaccine-preventable diseases remains low among Italian healthcare workers. The aim of this study was to evaluate knowledge attitudes and practice regarding mandatory vaccinations among Italian health science university students., Methods: A multi-center study was conducted in 14 Italian universities. A standardized, previously validated and anonymous questionnaire consisting of 21 questions was administered to health science students. The students were informed on the questionnaire during a Hygiene and Preventive Medicine lesson of their degree course, so they were asked to fill it out. A multivariable logistic regression model was used, the results are expressed as adjusted Odds Ratio (aOR)., Results: A total of 3131 students completed the questionnaire, of whom 90% were found to be in agreement with the introduction of a mandatory vaccination law for children and 87% with the potential introduction of mandatory vaccination for health care workers. Having an insufficient/sufficient/fair level of knowledge related to vaccine preventable diseases and vaccinations, compared with having a good/excellent level of knowledge, was associated with being less supportive towards the mandatory childhood vaccination law (OR 0,64; IC 95% 0.44-0.93)., Conclusions: We found that having good/excellent knowledge regarding vaccine preventable diseases and their related vaccinations is associated in a statistically significant manner to the propensity towards supporting mandatory vaccinations. This is probably due to a greater awareness of the importance of immunization and its value.

Rhabdomyosarcoma (RMS) is rare in adults and it is generally characterized by poor outcome. In a previous retrospective study, we demonstrated a better prognosis in adults treated with multimodality approach resembling pediatric protocols. Thereafter, we developed specific recommendations based on the principles adopted in pediatric oncology. The present analysis reports the results in a subsequent prospective series. The study included 95 consecutive patients (age 18-77 years) treated from 2002 to 2015 for embryonal and alveolar RMS. As in the previous series, patients were stratified by the appropriateness of their treatment according to therapeutic guidelines for childhood RMS. The 5-year event-free survival (EFS) and overall survival (OS) rates were 33.6% and 40.3%, respectively. The 5-year EFS was 40.8% for patients with the highest treatment score, and 15% for those with lower score, while OS was 44.4% and 24.5%, respectively. The developing of specific recommendations enabled an increase in the number of patients treated with intensive multimodal treatment resembling pediatric strategy (69.7% vs. 39.1% in the retrospective series). This study reinforced the idea that adherence to the principles of pediatric protocols, improves adult RMS outcomes. However, treating adults with pediatric-type strategy is not enough to achieve the results obtained in children. Issues in compliance and a more aggressive biology of adult RMS might have a role in the different outcome according to age. Improving the collaboration between pediatric and adult oncologists in promoting specific clinical and biological research is crucial to improve the outcome for this patient population.

Introduction: We aimed at carrying out a quantitative and qualitative analysis of claims for adverse events addressed to Palermo University Hospital Policlinico “Paolo Giaccone” in order to promote evidence-based interventions and increase patient safety., Methods: A retrospective study of 296 claims collected between 1st of January, 2014 and 31st of December, 2017 by Quality and Clinical Risk Management staff unit was performed along with descriptive analysis of any associated determinant factors., Results: The most frequent causes of claims consisted of wrong surgical procedures (33.8%), mistaken diagnoses (18.6%), falls (17.6%), infections (6.4%), postoperative complications (5.4%) and wrong therapies (3.1%). At the end of the survey, the judicial process was not concluded in the majority of cases (82.8%). Claims were closed by receipt payment in 12.2% of cases, without any payment in 5.1%., Conclusions: Clinical risk management plays a pivotal role in providing information and tools to prevent medical adverse events, avoid claims addressed to hospitals and improve the quality of health care.

Background: The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products., Methods: A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases., Results: 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2)., Conclusion: Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

Background: Malnutrition is a frequent condition in the elderly, and is associated with prolonged hospitalization and increased mortality. However, the impacts of malnutrition among elderly patients with acute myocardial infarction have not been clarified yet., Methods and Results: We enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI), who underwent evaluation of nutritional status by Mini Nutritional Assessment (MNA) and evaluation of mortality risk by GRACE Score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse glomerular filtration rate, lower systolic blood pressure, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that GRACE Score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95%, CI = 1.34⁻2.32, and HR = 0.56, 95% CI = 0.42⁻0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included, compared to the partial models without MNA., Conclusion: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with, or at risk of, malnutrition in order to apply interventions to improve nutritional status, and maybe survival in this population.

Introduction: In Italy, as in the rest of the world, the number of homeless people is increasing considerably. Many of them suffer from chronic conditions, mental health problems and addiction to alcohol, drugs or smoking, and need complex medical care. Their health status is often exacerbated by greater difficulty in accessing primary care. The aim of the present study was to assess health conditions of homeless people living in Palermo, Southern Italy, and to find ways to limit the spread of common infectious diseases that can be prevented by vaccination., Material and Methods: A self-administered questionnaire was distributed. The questionnaire was structured into two parts including an introduction with socio-demographic information, and a second part investigating health status, chronic diseases and vaccinations. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented., Results: The sample consisted of 52 homeless, 35 (67.3%) of whom were male and the most represented age class (55.8%) was < 50 years of age. The average age of the sample was 49.6 years (SD ± 15.2) and 88.5% were born in Italy. A multivariable logistic regression model based on 52 observations was used. The analysis showed that the female gender was significantly associated with: not performing regular physical activity (aOR 4.14, 95% C.I. 1.20 - 14.32, p = 0.025), suffering from chronic diseases (aOR 3.52, 95% C.I. 1.02 - 12.11, p = 0.046) and taking medicines (aOR 3.95, 95% C.I. 1.14 - 13.64, p = 0.030)., Conclusions: This particularly fragile population is exposed to diseases that are largely preventable or curable through a wider and more early access to care by local health facilities with a subsequent reduction in the worsening of clinical outcomes and related social costs.

Purpose: Depression is a common and serious medical illness, considered as a public health issue because it interferes with the interpersonal, social and professional functioning of the individual, and its frequency is constantly increasing. According to a recent review, approximately 34 per cent of nursing students had experienced depression worldwide. The university period may represent a moment in which the mental well-being of students is subjected to stress with a relative predisposition to the development of diseases related to mood disorders. The purpose of this study is to estimate the prevalence and examine the socio-demographic correlates of depressive symptomatology., Design/methodology/approach: In April 2019, a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. The statistical significance level chosen for all analyses was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted odds ratio (aOR) with 95 per cent confidence intervals., Findings: The sample consists of 493 students who completed the questionnaire, and the average age of the sample participants is 21.88 years. The multivariable logistic regression model shows that the risk to have depressive symptomatology is significantly associated with the following independent variables: female gender (aOR 1.91), being single (aOR 1.87), second year of study (aOR 1.94), third year of study (aOR 1.92), not performing regular physical activity (aOR 1.78) and perceived low health status (aOR 3.08)., Originality/value: This study shows that belonging to the female gender, being further along in the years of study, having a chronic illness and perceiving a low state of health are all factors that can increase the risk of developing the symptoms of depression; rather, regular physical activity, friendship and romantic relationships can be considered factors protecting them from the risk of falling into depression that can undermine both the study and work performance. Certainly, it is important to analyze all the involved variables to improve the global health not only of the nursing students but of all the students., Competing Interests: Competing interests: None declared., (© Omar Enzo Santangelo, Sandro Provenzano, Domiziana Giordano, Enrico Alagna, Francesco Armetta, Claudia Gliubizzi, Antonio Terranova, Giuseppe D’Anna, Dalila Barresi, Dimple Grigis, Cristina Genovese, Raffaele Squeri and Alberto Firenze.)

Introduction: During the university period, student wellbeing is exposed to the negative effects of many stressful factors, including the use and abuse of alcoholic beverages. The aim of this study is to estimate the risky alcohol consumption within the student population of the University of Palermo., Material and Methods: An anonymous online questionnaire was provided to students enrolled in the mailing list of the Regional Agency for the Right to University Study (ERSU) of the University of Palermo. the first section investigated demographic and social data, while in the second section the A.U.D.I.T. C (Alcohol Use Disorders Identification Test-Consumption) test was administered., Results: 539 subjects agreed to the informed consent and completed the questionnaire. The average age of the sample is 22.65 years (SD ± 2.95). Considering as dependent variable "students with risky consumption of alcohol", the statistically significant independent variables associated were: "age class ≤22 years old" (aOR 2.02, 95% CI 1.18-3.44, p=0.019), "don't live with own family" (aOR 3.21, 95% CI 1.81-5.69, p&0.001) and "I currently smoke" (aOR 6.44, 95% CI 3.85-10.79, p&0.001)., Conclusions: The results of the study show that about 19% of students experience risky alcohol consumption. This percentage seems not to be gender related. Information and training campaigns focused on alcoholism and related risks are of great importance in order to educate students on the socio-economic costs of alcohol related diseases to public health; parents can play a crucial role in minimising the use of alcohol in their sons/children through dialogue if properly trained to address these issues. In fact, our study seems to show that those who no longer live in the household have a higher risk of alcohol consumption.

Previous studies empirically support the existence of a distinctive association between deontological (but not altruistic) guilt and both disgust and obsessive-compulsive (OC) symptoms. Given that the neural substrate underlying deontological guilt comprises brain regions strictly implicated in the emotion of disgust (i.e. the insula), the present study aimed to test the hypothesis that indirect stimulation of the insula via transcranial direct current stimulation (tDCS) would enhance disgust and morality in the deontological domain. A randomized, sham-controlled, within-subject design was used. Thirty-seven healthy individuals (25 women) underwent 15-min anodal and sham tDCS over T3 in two different days, while their heart rate (HR) was recorded to derive measures of parasympathetic nervous system activity (HR variability; HRV). After the first 10-min of sham or active tDCS stimulation, participants were asked to 1) complete a series of 6-item words that could be completed with either a disgust-related word (cleaning/dirtiness) or neutral alternatives; 2) rate how much a series of vignettes, each depicting a behavior that violated a specific moral foundation, were morally wrong. Levels of trait anxiety, depression, disgust sensitivity, scrupulosity, and altruism as well as pre- and post- stimulation momentary emotional states were assessed. Compared to the sham condition, after active stimulation of T3 a) HRV significantly increased and participants b) completed more words in terms of cleaning/dirtiness and c) reported greater subjective levels of disgust, all suggesting the elicitation of the emotion of disgust. Although the results are only marginally significant, they point to the absence of difference between the two experimental conditions for moral vignettes in the altruistic domain (i.e., animal care, emotional and physical human care), but not in the deontological domain (i.e., authority, fairness, liberty, and sacrality), where vignettes were judged as more morally wrong in the active compared to the sham condition. Moreover, scores on the OCI-R correlated with how much vignettes were evaluated as morally wrong in the deontological domain only. Results preliminarily support the association between disgust and morality in the deontological domain, with important implications for OC disorder (OCD). Future studies should explore the possibility of decreasing both disgust and morality in patients with OCD by the use of non-invasive brain stimulation techniques., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: The internationally adopted child is a fragile subject who often shows an incomplete health documentation, which hinders the complete assessment of health status., Materials and Methods: Between January 2010 and June 2016, at the University Hospital "AOUP P. Giaccone" of Palermo, we reviewed the health documentations of 111 children recently arrived in Italy following the conclusion of the international adoption procedure. 62.2% of the children were male, of various nationalities and with an average age of 7 years (± 3.4). This study aims to detect, in the observed sample, the reliability of the vaccinal documentation and the real acquired immunization. We intend to estimate the presence of IgG against Measles, Mumps, Rubella and Hepatitis B viruses., Results: Percentages of subjects with a complete correspondence between documentation attesting the successful vaccination and the effective immunization were: 78% for measles, 66% for mumps, 84% for rubella, 71% for hepatitis B. Percentages of subjects without vaccinal documentation but with positive evidence of IgG were: 50% for measles, 38% for mumps, 71% for rubella, 50% for hepatitis B., Conclusions: The partial correspondence found between vaccinations performed and real immune status can be attributed to several reasons: poor reliability of the received health documentation, the complex economic situation of the health services in the countries of origin, the incorrect vaccines storage or the administration beyond the expiration date, the poor immunological response due to concomitant diseases or severe malnutrition, the probable non-administration of the expected booster dose. Particular attention needs to be paid to this population, which may represent a risk group susceptible to vaccine-preventable diseases.

Perivascular epithelioid cell tumor (PEComa) is a family of mesenchymal tumors. Conventional chemotherapy has little activity in this disease, but case reports are available on the activity of mammalian target of rapamycin inhibitors (e.g. sirolimus and temsirolimus). Pharmacokinetic assays of sirolimus are available as this drug has a precise therapeutic window and blood levels might be influenced by CYP3A4 polymorphisms and drug interactions. We report on a case of a patient with metastatic, progressive PEComa who started sirolimus at a dose of 5 mg/day with evidence of grade (G) 3 mucositis, G2 thrombocytopenia, and G1 leucopenia 10 days after the treatment started, in absence of concomitant medications or prohibited food assumption. Elevated sirolimus blood levels were detected (156.8 ng/ml). Sirolimus was stopped, and toxicity resolved in 5 weeks. Computed tomography scan 2 months after the treatment started showed a partial response (RECIST). After toxicity resolution, the patient restarted sirolimus at a dose of 1 mg/day, with blood levels in the range of 10-20 ng/ml. Tumor response was confirmed and maintained, and the patient is still under treatment 18 months later, with no additional adverse effects. Genetic analysis of five selected polymorphisms (rs2740574, rs776746, rs1128503, rs2032582, and rs1045642) in drug metabolism enzymes and transporters did not provide a clear explanation of the observed unusual pharmacokinetic. This case confirms the activity of mammalian target of rapamycin inhibitors in PEComa and strengthens the importance of pharmacokinetic drug blood levels monitoring in patients treated with sirolimus. In our patient, after dose adjustment, sirolimus could be restarted with a prolonged clinical benefit and no additional toxicity.

The aim of the study was to evaluate depressive symptomatology within the student population of the University of Palermo (Italy). An anonymous online questionnaire was provided to the students of the University of Palermo. The first section investigated demographic and social data, while in the second section the QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report) test was administered. 539 students (68.3% female) gave informed consent and completed the questionnaire. Considering as a dependent variable: Depressive symptomatology moderate-severe-very severe , the statistically significant independent variables associated are I don't live with my family (aOR 1.63, 95% CI 1.01-2.63, P=0.043), I currently smoke (aOR 1.55, 95% CI 1.01-2.39, P=0.048) and Low perceived health status (aOR 4.14, 95% CI 2.73-6.28, P<0.001). Smoking is associated with an increased risk of developing a high-grade depressive symptomatology. Family plays a crucial role in decreasing the risk of moderate, severe or very severe symptoms., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest.

Aim: The university student is vulnerable to the adverse effects of many stress factors that can lead to depressive symptoms, anxiety and alcohol abuse, causing an increase in the burden of illness in young people. The aim of the study was to measure depressive symptoms, anxiety levels, and harmful alcohol consumption within the student population of the University of Palermo., Methods: An online questionnaire was sent by e-mail to the 8500 students enrolled in the (ERSU) Regional Office for the Right to University Study's mailing list in Palermo. It was evaluated the severity of depressive symptoms through the Quick Inventory of Depressive Symptomatology-Self Report, anxiety symptoms using the Beck Anxiety Inventory and risky consumption of alcohol by using the Alcohol Use Disorders Identification Test-Consumption test. From the test it was possible to get individual scores that allow you to evaluate the risk by associating each individual with a category. The obtained variables were analyzed by Pearson square test (χ 2)., Results: The questionnaire answered 1102 individuals, 756 females (68.60%), with an average age of 22 years (± 3.28). 13.52% of the sample have a risky consumption of alcohol. 22.14% showed moderate depressive symptoms and 12.16% had serious and very serious symptoms. Respectively, 19.69% and 7.53% have moderate and high levels of anxiety. As for depressive symptoms (χ2 (4)=31.58, p<0.001) and anxiety (χ2 (2)=20.71; p<0.001), the female gender is assigned to more relevant reference categories than males., Discussion and Conclusions: There are no statistically significant differences of risky consumption of alcohol in terms of gender or type or length of course. An analysis of the data shows that anxiety, depression and alcoholism risk have a similar distribution in all degree courses. Female students are more vulnerable to anxiety and depression. Active public health planning and implementation of structural and organizational measures would be very effective in reducing alcohol consumption and promoting health.

Background: Clinical characteristics combined with new biomarkers help discriminate between atypical uterine smooth muscle tumors (AUSMT) and leiomyosarcomas (LMS)., Patients and Methods: We retrospectively collected a series of leiomyomas (LM), AUSMT, and LMS. Estrogen receptors (ER), progesterone receptors (PR), p16, Ki-67, and p53 expression were assessed by immunohistochemistry. For AUSMT patients, immunohistochemistry evaluations were performed at the time of diagnosis and at recurrences., Results: A total of 27 cases of AUSMT, 22 LM, and 31 LMS were identified. The expression of ER and PR decreased from LM to LMS (ER+: LM 95.5%, AUSMT 88.9%, LMS 41.9%, p < 0.001; PR+: LM 100%, AUSMT 88.9%, LMS 38.2%, p = 0.002). By contrast, p16 and p53 expression increased (p16+: LM 4.5%, AUSMT 40.7%, LMS 45.2%, p = 0.004; p53: LM 9.1%, AUSMT 33.3%, LMS 58.1%, p = 0.001). At a median follow-up of 33.47 months, 40.7% of patients with AUSMT experienced recurrent disease, 6 patients relapsed as AUSMT and 5 as LMS. In univariate analysis was observed that ER status (p = 0.027) and p53 expression (p = 0.015) predicted risk of relapse., Conclusions: Treatment of AUSMT should be centralized in dedicated centers. International collaborations are needed to optimize research strategy, which may lead to the identification of new useful biomarkers and to improvement in the clinical management of this rare disease., (© 2017 S. Karger AG, Basel.)

Background: Alveolar soft part sarcoma (ASPS) is an exceedingly rare and orphan disease, without active drugs approved in the front line. Pazopanib and trabectedin are licensed for sarcoma treatment from second-line, but very little and contradictory data are available on their activity in ASPS. Lacking ongoing and/or planned clinical trials, we conducted a multi-institutional study involving the reference sites for sarcoma in Europe, U.S., and Japan, within the World Sarcoma Network, to investigate the efficacy of pazopanib and trabectedin., Materials and Methods: From May 2007, 14 of the 27 centers that were asked to retrospectively review their databases had identified 44 advanced ASPS patients treated with pazopanib and/or trabectedin. Response was evaluated by Response Evaluation Criteria in Solid Tumors 1.1. Progression-free survival (PFS) and overall survival (OS) were computed by Kaplan-Meier method., Results: Among 30 patients who received pazopanib, 18 were pretreated (13 with other antiangiogenics). Response was evaluable in 29/30 patients. Best responses were 1 complete response, 7 partial response (PR), 17 stable disease (SD), and 4 progressions. At a 19-month median follow-up, median PFS was 13.6 months (range: 1.6-32.2+), with 59% of patients progression-free at 1 year. Median OS was not reached.Among 23 patients treated with trabectedin, all were pretreated and evaluable for response. Best responses were 1 PR, 13 SD, and 9 progressions. At a 27-month median follow-up, median PFS was 3.7 months (range: 0.7-109), with 13% of patients progression-free at 1 year. Median OS was 9.1 months., Conclusion: The value of pazopanib in advanced ASPS is confirmed, with durable responses, whereas the value of trabectedin appears limited. These results are relevant to defining the best approach to advanced ASPS., Implications for Practice: This retrospective study, conducted among the world reference centers for treatment of sarcoma, confirms the value of pazopanib in patients with advanced alveolar soft part sarcoma (ASPS), with dimensional and durable responses, whereas trabectedin shows a limited activity. Alveolar soft part sarcoma is resistant to conventional cytotoxic chemotherapy. Pazopanib and trabectedin are licensed for treatment of sarcoma from second line; in the lack of prospective clinical trials, these results are relevant to defining ASPS best management and strongly support initiatives aimed at obtaining the approval of pazopanib in the front line of the disease., Competing Interests: Disclosures of potential conflicts of interest may be found at the end of this article., (© AlphaMed Press 2017.)

Background: It is necessary to implement current teaching in the healthcare and university sector by promoting new tools for the enhancement of public health, bearing in mind that some health determinants seek to create a context in which to present their own idea of innovative Startup, can represent the opportunity to give your professional contribution to the development of another's idea or to propose an improved solution to the private business. On the other hand, networking with companies and networking between training participants will allow us to recognize the importance of demonstrating their diverse skills as a key element to create a successful Startup or to implement the activities of a reality already consolidated., Methods: This paper describes the research protocol of a Hackathon Public Health (HPH) teaching methodology aimed at: a) increasing public health knowledge; b) changing the proactive approach of the healthcare provider, especially by increasing the sectoral training activity; c) to promote educational and training activities in Italian regions. The subjects involved will be healthcare professionals (doctors, nurses, health professions, psychologists, biologists, assistants in training) who are selected to receive or not the intervention through the implementation of a HPH which also includes training activity., Conclusions: HPH is an innovation in the national health landscape, with the aim of creating environments and training policies aimed at promoting proper clinical risk management as part of the continuous improvement of the quality of healthcare organizations and proper training activities.

Background: We report on the activity of anthracycline-based and high-dose prolonged-infusion ifosfamide chemotherapy in a retrospective series of patients affected by advanced myxofibrosarcoma treated at Istituto Nazionale Tumori in Milan, Italy, and within the Italian Rare Cancer Network (RTR)., Methods: Advanced myxofibrosarcoma patients treated with anthracycline + ifosfamide and high-dose prolonged-infusion ifosfamide as a single agent from November 2001 to December 2016 were retrospectively reviewed. All pathological diagnosis were centrally reviewed by at least two expert pathologists. Response was evaluated by RECIST, and survival functions were computed., Results: Among 34 advanced myxofibrosarcoma patients, 13 were treated with front-line anthracycline + ifosfamide chemotherapy (male/female = 6/7, median age 54 years, range 33-72). Overall best response was: 4 partial responses, 3 stable diseases and 6 progressive diseases, with a median progression-free survival of 4 months. Twenty-eight patients received second/further line high-dose prolonged-infusion ifosfamide (male/female = 17/11, median age 55 years, range 27-75 years). We observed 10 partial responses, 4 stable diseases and 14 progressive diseases, with a median progression-free survival of 4 months. Median overall survival was 12 months., Conclusions: This retrospective analysis suggests that the combination of anthracyclines and ifosfamide is active in myxofibrosarcoma. In patients already treated with a combination of anthracyclines and ifosfamide, high-dose prolonged-infusion ifosfamide showed activity as well.

Background: To report on the activity of high-dose prolonged-infusion ifosfamide (HDIFX) chemotherapy in a retrospective series of patients affected by myxoid liposarcoma treated at Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy., Patients and Methods: Patients with an advanced myxoid liposarcoma treated with HDIFX (14 g/sqm, i.v., prolonged infusion of 14 days every 28 days) as a single agent between May 2002 and April 2017 were retrospectively reviewed. All pathologic diagnoses were centrally reviewed and molecularly confirmed. Response was evaluated by RECIST, and survival functions were computed by the Kaplan-Meier method., Results: Eleven patients with advanced myxoid liposarcoma were treated with HDIFX (male/female = 9/2, median age 33 years, range 31-75). Among these, 1/11 received HDIFX in first line, 5/11 in second line, 3/11 in third line, and 2/11 in fourth line for a median course number of 3 (range 2-7). No RECIST objective responses were observed. Overall median progression-free survival was 1,9 months. Median overall survival was 37 months. At a median follow-up of 115 months, 1 patient is alive., Conclusions: In this series of patients affected by advanced myxoid liposarcoma, chemotherapy with HDIFX was essentially inactive.

Aims: This work evaluated the post-implant biomechanical properties of light-weight (LW) and heavy-weight (HW) monofilament polypropylene (PP) meshes with different knitting patterns in an animal model in vivo., Methods: Forty-five adult female Wistar rats were divided into three groups and randomly implanted with 32 × 32 mm HW-PP (62 gm -2 ) orLW-PP (16 gm -2 ) in the lower abdomen. LW-PPwas tested orthogonally (called LWL and LWT) to reproduce the longitudinal and transverse planes of the vaginal wall, respectively. Abdominal walls were removed at 7, 30, and 60 days, and then tested for tensile load (maximum load until avulsion from the tissue), deflection, and stiffness to maximum load. Explants were compared over time and between groups., Results: LW-PP meshes implanted in the LWT fashion (vaginal transverse plane) showed comparable maximum load and stiffness to HW-PP meshes, and LW-PP meshes implanted in the LWL fashion (vaginal longitudinal plane) presented lower maximum load and stiffness than the HW-PP meshes. There were no significant differences in the values of deflection at maximum load between the studied meshes as a function of time., Conclusions: The final mechanical behavior of PP mesh can be changed by its weight and knitting pattern. These properties may be useful in making more biocompatible prostheses for pelvic organ prolapse (POP) with less foreign material to maintain longitudinal vaginal elasticity and minimize sexual symptoms while maintaining transverse resistance (i.e., between vaginal fornixes) to prevent POP recurrence. Neurourol. Urodynam. 36:73-79, 2017. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)