Search

The management of an endograft infection with Coxiella burnetti (Q fever) is presented. In this case report, we describe a unique case of an endovascular aneurysm repair (EVAR) that was originally placed for a 6.4-cm abdominal aortic aneurysm with an aorto-left renal vein fistula. In retrospect, the abdominal aortic aneurysm was most likely infected at the time of EVAR. The patient presented 2 years later with a virulent infection of the stent graft requiring explantation and reconstruction. This case highlights surgical management of an infected EVAR with homograft reconstruction and subsequent antibiotic management.

Perineal seeding is an extremely rare complication after prostate biopsy. We found a perineal localization of prostatic adenocarcinoma 5 years after the transperineal biopsy in a patient with metastatic castration resistant prostate cancer. The tumor was identified by a18F-Fluorocholin positron emission tomography-computed tomography (18F-FCH PET-CT) performed after a sudden rise of PSA levels during androgen deprivation therapy and after a negative CT scan. This case report underscores the challenge one may encounter in detecting perineal prostate cancer metastasis after a biopsy when using traditional imaging with CT scan alone or MRI, and the added diagnostic value of PET-CT imaging.

BackgroundPain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. ObjectiveThis research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children’s Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. MethodsThe adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. ResultsPreliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P

We herein present a video of a robotic-assisted uretero-ileal reimplantation in an ileal conduit. The patient was a 74 year old male who had undergone robotic assisted radical cystectomy with intracorporeal ileal conduit in 2022. Pathology showed urothelial cell carcinoma pT2N0. In amrch 2023 the patient was admitted in our clinic with left side flank pain and sepsis. A CT scan showed severe lefthydronephrosis on a left sided uretero-ileal stricture. A nephrostomy tube was patient and, after management of sepsis, an endoscopic balloon dilatation of the stricture was performed in may 2023. Patient experienced a stricture recurrence in September 2023. We thus decided to perform robotic assisted uretero-ilal reimplantation.Patient was positions in dorsal decubitus and robotic trocarts were positioned as for radical cystectomy. Extensive adhesiolysis was performed. A stay suture was then positioned on the ileal conduit to traction it towards the abdominal wall. Dissection of the retroperitoneum was then performed medial to the ileal conduit, in order to identify the left ureter. The right ilac vessels are exposed to avois inadvertent injury. ICG is instilled via the left nephrostomy, helping the surgeon to identify the left ureter. Gven the massive fibrosis of the ureter, this structure is not mobilized and the ileal loop is brought down to the ureter. A side to side anastomosis is performed using 4/0 vycril. A 7F monoJ catheter is positioned and externalized using a foley catheter as carrier. OR time was 155 minuted and estimated blood loss 50cc. Post operative course was uneventful and patient was discharged on POD 2.

Abstract Background Paucity and low evidence-level data on proton therapy (PT) represent one of the main issues for the establishment of solid indications in the PT setting. Aim of the present registry, the POWER registry, is to provide a tool for systematic, prospective, harmonized, and multidimensional high-quality data collection to promote knowledge in the field of PT with a particular focus on the use of hypofractionation. Methods All patients with any type of oncologic disease (benign and malignant disease) eligible for PT at the European Institute of Oncology (IEO), Milan, Italy, will be included in the present registry. Three levels of data collection will be implemented: Level (1) clinical research (patients outcome and toxicity, quality of life, and cost/effectiveness analysis); Level (2) radiological and radiobiological research (radiomic and dosiomic analysis, as well as biological modeling); Level (3) biological and translational research (biological biomarkers and genomic data analysis). Endpoints and outcome measures of hypofractionation schedules will be evaluated in terms of either Treatment Efficacy (tumor response rate, time to progression/percentages of survivors/median survival, clinical, biological, and radiological biomarkers changes, identified as surrogate endpoints of cancer survival/response to treatment) and Toxicity. The study protocol has been approved by the IEO Ethical Committee (IEO 1885). Other than patients treated at IEO, additional PT facilities (equipped with Proteus®ONE or Proteus®PLUS technologies by IBA, Ion Beam Applications, Louvain-la-Neuve, Belgium) are planned to join the registry data collection. Moreover, the registry will be also fully integrated into international PT data collection networks.

Abstract Introduction Biomarker testing is mandatory for the clinical management of patients with advanced non-small cell lung cancer (NSCLC). Myriads of technical platforms are now available for biomarker analysis with differences in terms of multiplexing capability, analytical sensitivity, and turnaround time (TAT). We evaluated the technical performance of the diagnostic workflows of 24 representative Italian institutions performing molecular tests on a series of artificial reference specimens built to mimic routine diagnostic samples. Methods Sample sets of eight slides from cell blocks of artificial reference specimens harboring exon 19 EGFR (epidermal growth factor receptor) p.E746_AT50del, exon 2 KRAS (Kirsten rat sarcoma viral oncogene homologue) p.G12C, ROS1 (c-ros oncogene 1)-unknown gene fusion, and MET (MET proto-oncogene, receptor tyrosine kinase) Δ exon 14 skipping were distributed to each participating institution. Two independent cell block specimens were validated by the University of Naples Federico II before shipment. Methodological and molecular data from reference specimens were annotated. Results Overall, a median DNA concentration of 3.3 ng/µL (range 0.1–10.0 ng/µL) and 13.4 ng/µL (range 2.0–45.8 ng/µL) were obtained with automated and manual technical procedures, respectively. RNA concentrations of 5.7 ng/µL (range 0.2–11.9 ng/µL) and 9.3 ng/µL (range 0.5–18.0 ng/µL) were also detected. KRAS exon 2 p.G12C, EGFR exon 19 p.E736_A750del hotspot mutations, and ROS1 aberrant transcripts were identified in all tested cases, whereas 15 out of 16 (93.7%) centers detected MET exon 14 skipping mutation. Conclusions Optimized technical workflows are crucial in the decision-making strategy of patients with NSCLC. Artificial reference specimens enable optimization of diagnostic workflows for predictive molecular analysis in routine clinical practice.

Nanofoam materials are gaining increasing interest in the scientific community, thanks to their unique properties such as ultralow density, complex nano‐ and microstructure, and high surface area. Nanofoams are attractive for multiple applications, ranging from advanced catalysis and energy storage to nuclear fusion and particle acceleration. The main issues hindering the widespread use of nanofoams are related to the choice of synthesis technique, highly dependent on the desired elemental composition and leading to a limited control over the main material properties. Herein, femtosecond pulsed laser deposition is proposed as a universal tool for the synthesis of nanofoams with tailored characteristics. Nanofoams made by elements with significantly different properties—namely, boron, silicon, copper, tungsten, and gold—can be produced by suitably tuning the deposition parameters. The effect of the background pressure is studied in detail, in relation to the morphological features and density of the resulting nanofoams and nanostructured films. This, together with the analysis of the specific features shown by nanofoams made of different elements, offers fresh insights into the aggregation process and its relation to the corresponding nanofoam properties down to the nanoscale, opening new perspectives toward the application of nanofoam‐based materials.

Abstract Background Currently, main treatment strategies for early-stage non-small cell lung cancer (ES-NSCLC) disease are surgery or stereotactic body radiation therapy (SBRT), with successful local control rates for both approaches. However, regional and distant failure remain critical in SBRT, and it is paramount to identify predictive factors of response to identify high-risk patients who may benefit from more aggressive approaches. The main endpoint of the MONDRIAN trial is to identify multi-omic biomarkers of SBRT response integrating information from the individual fields of radiomics, genomics and proteomics. Methods MONDRIAN is a prospective observational explorative cohort clinical study, with a data-driven, bottom-up approach. It is expected to enroll 100 ES-NSCLC SBRT candidates treated at an Italian tertiary cancer center with well-recognized expertise in SBRT and thoracic surgery. To identify predictors specific to SBRT, MONDRIAN will include data from 200 patients treated with surgery, in a 1:2 ratio, with comparable clinical characteristics. The project will have an overall expected duration of 60 months, and will be structured into five main tasks: (i) Clinical Study; (ii) Imaging/ Radiomic Study, (iii) Gene Expression Study, (iv) Proteomic Study, (v) Integrative Model Building. Discussion Thanks to its multi-disciplinary nature, MONDRIAN is expected to provide the opportunity to characterize ES-NSCLC from a multi-omic perspective, with a Radiation Oncology-oriented focus. Other than contributing to a mechanistic understanding of the disease, the study will assist the identification of high-risk patients in a largely unexplored clinical setting. Ultimately, this would orient further clinical research efforts on the combination of SBRT and systemic treatments, such as immunotherapy, with the perspective of improving oncological outcomes in this subset of patients. Trial registration The study was prospectively registered at clinicaltrials.gov (NCT05974475).

A single strain of yeast was isolated from industrial gluten bread (GB) purchased from a local supermarket. This strain is responsible for spoilage consisting of white powdery and filamentous colonies due to the fragmentation of hyphae into short lengths (dust-type spots), similar to the spoilage produced by chalk yeasts such as Hyphopichia burtonii, Wickerhamomyces anomalus and Saccharomycopsis fibuligera. The isolated strains were identified initially by traditional methods as Wickerhamomyces anomalus, but with genomic analysis, they were definitively identified as Cyberlindnera fabianii, a rare ascomycetous opportunistic yeast species with low virulence attributes, uncommonly implicated in bread spoilage. However, these results demonstrate that this strain is phenotypically similar to Wi. anomalus. Cy. fabianii grew in GB because of its physicochemical characteristics which included pH 5.34, Aw 0.97 and a moisture of about 50.36. This spoilage was also confirmed by the presence of various compounds typical of yeasts, derived from sugar fermentation and amino acid degradation. These compounds included alcohols (ethanol, 1-propanol, isobutyl alcohol, isoamyl alcohol and n-amyl alcohol), organic acids (acetic and pentanoic acids) and esters (Ethylacetate, n-propil acetate, Ethylbutirrate, Isoamylacetate and Ethylpentanoate), identified in higher concentrations in the spoiled samples than in the unspoiled samples. The concentration of acetic acid was lower only in the spoiled samples, but this effect may be due to the consumption of this compound to produce acetate esters, which predominate in the spoiled samples.

The ICI–RS has proposed the definition of COUB (Coexistent Overactive-Underactive Bladder) as a syndrome characterized by voiding and filling LUTS in the same patient. The aim of this study is to explore whether the presence of DO can lead to DU, because of muscle asthenia and fatigue of the smooth muscle cells.Retrospectively, we included all consecutive male patients with LUTS who underwent an invasive UDS (January 2011–December 2022). Patients with neurologic diseases or with previous LUT surgery were excluded. They were divided into normal detrusor function, Group A and Detrusor Overactivity, Group B during the filling phase. BOOI, BCI, PVR and BVE were compared in the two groups. DO patients were divided according to the phasic or terminal DO contractions and mean BCI was calculated in these subgroups.We analysed 425 male patients with LUTS. During filling phase, 167 patients (39.3%, Group A) showed NDF and 258 patients (60.7% Group B) DO. 207 of them (80.2%) had phasic detrusor contractions and 51 (20.8%) had terminal DO. MCC was 409.8 mL and 308.7 mL (p100. 207 (80.2%) patients of the group B showed phasic, while 51 (19.8%) terminal DO; in these subgroups, mean BCI was 118.8 and 112.0 respectively (p 0.806658).

Background Epithelial to mesenchymal transition (EMT) endows cancer cells with pro-metastatic properties, which appear most effective when cells enter an intermediate hybrid (H) state, characterized by integrated mesenchymal (M) and epithelial (E) traits. The reasons for this advantage are poorly known and, especially, it is totally unexplored whether the interplay between H-cells and NK cells could have a role. Here we characterize the pro-metastatic mechanics of non-small cell lung cancer (NSCLC) H-cells and their subset of cancer-initiating cells (CICs), dissecting crucial interactions with NK cells.Methods Human lung cancer cell lines and sublines representative of E, M, or H states, assessed by proteomics, were analyzed in vivo for their tumor-forming and disseminating capabilities. Interactions with NK cells were investigated in vitro using migration assays, cytotoxic degranulation assays, and evaluation of CD133+ CICs modulation after coculture, and validated in vivo through NK cell neutralization assays. Correlation between EMT status, NK cell infiltration, and survival data, was evaluated in a cohort of surgically resected NSCLC cases (n=79).Results We demonstrated that H-cells, have limited dissemination capability but show the highest potential to initiate metastases in vivo. This property was related to their ability to escape NK cell surveillance. Mechanistically, H-cells expressed low levels of NK-attracting chemokines (CXCL1 and CXCL8), generating poorly infiltrated metastases. Accordingly, proteomics and GO enrichment analysis of E, H, M cell lines showed that the related secretory processes could change during EMT.Furthermore, H-CICs uniquely expressed high levels of the inhibitory ligand B7-H3, which protected H-CIC from NK cell-mediated clearance. In vivo neutralization assays confirmed that, indeed, the pro-metastatic properties of H-cells are poorly controlled by NK cells.Finally, the analysis of patients revealed that detection of hybrid phenotypes associated with low NK infiltration in NSCLC clinical specimens could identify a subset of patients with poor prognosis.Conclusions Our study demonstrates that H-cells play a central role in the metastatic spread in NSCLC. Such pro-metastatic advantage of H-cells is supported by their altered interaction with NK cells and by the critical role of B7-H3 in preserving their H-CIC component, indicating B7-H3 as a potential target in combined NK-based therapies.

Whether Clonal Hematopoiesis (CH) represents a risk factor for severity of the COVID-19 disease remains a controversial issue. We report the first high- sensitivity analysis of CH in COVID-19 patients (threshold of detection at 0.5% vs 1 or 2% in previous studies). We analyzed 24 patients admitted to ICU for COVID-19 (COV-ICU) and 19 controls, including healthy subjects and asymptomatic SARS-CoV2-positive individuals. Despite the significantly higher numbers of CH mutations identified (80% mutations with