ABSTRACT
With its long coastline, vast exclusive economic zone (EEZ), skilled labor force, advanced technology, and one of the largest seafood markets in the world, the United States could be a major marine aquaculture producer of fish, mollusks, crustaceans, and marine algae. Despite all its promise, U.S. marine aquaculture production is tiny relative to its potential. The constraints often cited are lack of social license, an inefficient and uncoordinated permitting system, and the absence of supportive government programs similar to those enjoyed by terrestrial agriculture. National commissions have noted these constraints for more than 30 years. The paper first outlines key policy drivers prompting a reevaluation of US marine aquaculture policy (human health and nutrition, climate change, and market disruptions caused by the coronavirus) and then focuses on three critical policy goals that could contribute to expanding U.S. seafood farming: improve public understanding and acceptance, enhance the efficiency and timeliness of the aquaculture permitting process, and expand economic incentives to foster aquaculture development. © 2022 Taylor & Francis Group, LLC.
ABSTRACT
Background: Studies evaluating COVID-19 in cancer patients beyond the effects of the infection itself are generally from single institutions, voluntary surveillance registries, or surveys. To extend the limited evidence available, we analyzed both the incidence and one-year mortality of breast cancer (BC) female patients at a population level in Lombardy, the first Italian region affected by the pandemic and the most populous one. Method(s): The regional COVID-19 database, including all SARS-CoV2 cases based on a positive swab result, was integrated with the Regional Health Information System, collecting data from 10 million habitants on primary medical care;hospitalization;pharmaceuticals;and survival status. From the database, we extracted data of newly-diagnosed not previously treated BC patients, including patient characteristics and comorbidities (respiratory insufficiency, diabetes, chronic kidney disease, cerebral vasculopathy, hypertension and cardiovascular disease), BC stage, and treatment. Result(s): The study population consisted of 12912 newlydiagnosed/ not previously treated BC patients, 7349 in 2019 and 5563 in 2020. There were two drops of newly diagnosed cases, one in the first wave (March-May 2020;-37.2%), the other in the second wave (October-December 2020;-15.8%). No major differences were found between characteristics of cases occurring in 2019 and 2020;with the exception of a reduced use of both chemotherapy (86.2% vs 53.4%) and radiotherapy (65.7% vs 42.1%) in 2020. One-year overall survival was 97.6% in 2020 vs 98.3% in 2019, Hazard Ratio [HR] (95% Confidence Interval [95%CI]): 1.51 (1.18-1.93);p=0.0010 at univariate analysis;HR 0.91 (0.71-1.17), p= 0.47, after adjusting for age, stage, BC treatment and comorbidities at multivariable analysis. COVID-19 occurred in 250 of 5563 (4.5%) newly-diagnosed BC cases in 2020. Notably, the time-dependent COVID-19 effect was significantly associated with mortality (multivariable Cox analysis HR 2.25 (1.35-3.74);p=0.0018) even after adjusting for age, stage, treatment and comorbidities. Conclusion(s): Breast cancer incidence and survival were both reduced in 2020, and COVID-19 was an independent predictor of death in BC patients. While follow-up is ongoing to assess long sequelae of COVID-19, these results encourage prevention of infection regardless of BC stage;and at the same time warn against suboptimal treatment and overlooking new diagnoses to ensure a favourable prognostic outcome.
ABSTRACT
With its long coastline, vast exclusive economic zone (EEZ), skilled labor force, advanced technology, and one of the largest seafood markets in the world, the United States could be a major marine aquaculture producer of fish, mollusks, crustaceans, and marine algae. Despite all its promise, U.S. marine aquaculture production is tiny relative to its potential. The constraints often cited are lack of social license, an inefficient and uncoordinated permitting system, and the absence of supportive government programs similar to those enjoyed by terrestrial agriculture. National commissions have noted these constraints for more than 30 years. The paper first outlines key policy drivers prompting a reevaluation of US marine aquaculture policy (human health and nutrition, climate change, and market disruptions caused by the coronavirus) and then focuses on three critical policy goals that could contribute to expanding U.S. seafood farming: improve public understanding and acceptance, enhance the efficiency and timeliness of the aquaculture permitting process, and expand economic incentives to foster aquaculture development. © 2022 Taylor & Francis Group, LLC.
ABSTRACT
Background-Aim: The importance of timely assistance in oncological patients is undeniable;however it is well known that these patients could have important clinical problems if they were infected by COVID-19, with an increased risk of severe illness and mortality. A recent multicenter Italian study reported a delay both in the beginning of PRRT for new patients (about 45.5% of centers) and in those ones who had already started the treatment (15%), as a direct consequence of COVID-19. The aim of this study was to understand if SARS-CoV2 infection has modified our clinical management, with particular attention to PRRT. Methods: In our ENETS Center of Excellence, the weekly multidisciplinary tumor board never stopped, also during the pandemic period. During these periods, the patients were treated with PRRT in the same way of previous years, remaining one night in Radiometabolic Therapy Unit, according to local laws. During COVID-19 pandemic, the patients received the PCR test the day before the treatment, while the day of PRRT they received a particular triage for avoid admitting patients with Sars-CoV-2 infection. We made a comparison between the number of PRRT cycles (either in clinical practice or in clinical trials) performed at European Institute of Oncology (IEO) from February 2020 to July 2021, with those performed in the previous year (February 2019-January 2020). Results: From February 2019 to January 2020, we performed 10 PRRT cycles, instead in the following months, during and despite of COVID-19 pandemic, from February 2020 to July 2021, we increased the number of patients treated. In fact 126 PRRT cycles were performed without any delay (either in clinical practice or in clinical trials). Only one Italian patient was unable to receive the treatment at IEO because he couldn't travel during lockdown period, so he performed PRRT near home. On the contrary, another patient coming from a different Nation, received PRRT on time. During this period, only two patients were affected by COVID-19 at the end of the treatment even if they were not yet vaccinated and, fortunately, the disease was mild, without consequences. These patients didn't stopped the therapy with SSA during COVID-19 disease. Moreover we performed a dosimetric study in almost all the patients during the first cycle of PRRT. Conclusions: These results focusing on PRRT treatments and COVID-19 pandemic, show that centers with more experience are able to adapt to the new global situation and to the new rules imposed by governments, providing continuity in care without any delay and even to increase the number of treatments.
ABSTRACT
Eosinophilic pancarditis (EP) is a rare, often unrecognized condition caused by endomyocardial infiltration of eosinophil granulocytes (referred as eosinophilic myocarditis, EM) associated with pericardial involvement. EM has a variable clinical presentation, ranging from asymptomatic cases to acute cardiogenic shock requiring mechanical circulatory support (MCS) or chronic restrictive cardiomyopathy at high risk of progression to dilated cardiomyopathy (DCM). EP is associated with high in‐hospital mortality, particularly when associated to endomyocardial thrombosis, coronary arteries vasculitis or severe left ventricular systolic dysfunction. To date, there is a lack of consensus about the optimal diagnostic algorithm and clinical management of patients with biopsy‐proven EP. The differential diagnosis includes hypersensitivity myocarditis, eosinophil granulomatosis with polyangiitis (EGPA), hypereosinophilic syndrome, parasitic infections, pregnancy‐related hypereosinophilia, malignancies, drug overdose (particularly clozapine) and Omenn syndrome (OMIM 603554). To our knowledge, we report the first case of pancarditis associated to eosinophilic granulomatosis with polyangiitis (EGPA) with negative anti‐neutrophil cytoplasmic antibodies (ANCA). Treatment with steroids and azathioprine was promptly started. Six months later, the patient developed a relapse: treatment with subcutaneous mepolizumab was added on the top of standard therapy, with prompt disease activity remission. This case highlights the role of a multimodality approach for the diagnosis of cardiac involvement associated to systemic immune disorders.
ABSTRACT
Background: Data about neuroendocrine neoplasms (NENs) patients with SARS-CoV-2 are scanty and specific indications for clinical practice are missing. Our aim is to create an international registry about NENs patients affected by SARS-CoV-2 positivity to give a worldwide representation of the situation. Methods: This is an observational retrospective/prospective multicenter survey based on a direct email invitation. All types of NEN are eligible except SCLC and MiNEN. Patients fulfilling the inclusion criteria from March 1st, 2020 up to the end pf pandemic will be recruited. Electronic CRFs are filled out using the REDCap database. Local Institutional Review Board approval is required before data entry. Results: Eighty-one centers, 24 in and 57 outside Italy, representing 39 countries and 5 continents, were contacted. Fourteen centers did not respond and 15 declined the invitation. Among the remaining 52, 6 centers are currently recruiting and 8 are active but not recruiting yet. As of the current abstract submission deadline, 67 patients have been included, mostly GEP-NET (75%), nonfunctioning (86%), metastatic (85%) and on active treatment [47% somatostatin analogs (SSAs), 10% everolimus, 12% tirosin-kinase inhibitors (TKIs), 10% peptide receptor radionuclide therapy (PRRT), 15% chemotherapy]. Median age at NEN diagnosis was 57 years whilst the median age at SARSCoV-2 diagnosis was 62 years. Almost all patients reported COVID-19-related symptoms, more commonly fever (67% of patients), cough (55%) and dyspnea (51%), in 28% of cases exertional and in 22% at rest. More than one third of patients (n, 24) had a pneumonia. The most common therapies for COVID-19 were antibiotics, steroids and hydroxychloroquine. Eleven patients (16%) needed oxygen therapy, three (4%) sub-intensive care and none intensive care. Fifty-six patients (84%) clinically recovered, six (9%) with sequelae, whereas five (7%) died. Among these latter 4 had a NET and 1 a NEC, and no patients have been receiving chemotherapy. With regard to the anti-tumor therapy no change occurred in 66% of patients, temporary interruption in 30%, and definitive discontinuation in 3%, 2% missing. Conclusions: Most of the NEN patients completely recovered from COVID-19, in many cases without any antitumor therapy adjustment. No clear correlations were observed with type, primary site and treatment of NEN. The recruitment is ongoing.
ABSTRACT
Primary neuroendocrine tumors of the thymus are extremely rare. In patients with advanced disease, tumor growth control, and sometimes also syndrome control are the main goals of systemic therapy. Unfortunately, no standard therapies are available in clinical practice; therefore, clinical studies are strongly recommended. Axitinib (AXI) is a tyrosine kinase inhibitor, currently under investigation in an international phase II/III trial including thymic neuroendocrine tumors. Over the past 5 months, the entire world has been facing a devastating medical emergency brought about by a pandemic due to a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, in late 2019. Since then, health professionals have been expending all their efforts on trying to provide the best available treatments for patients involved. Patients with cancer, especially those with thoracic involvement, are at higher risk of coronavirus disease 19 (COVID-19) and its complications because of their immunosuppressive status caused by the cancer and the anticancer therapies. As it remains unclear how to optimally manage such patients, we wished to report our experience with a patient with a metastatic neuroendocrine tumor of the thymus infected with SARS-CoV-2 in the hope that it may provide some insights and reflections on the management of cancer patients during this challenging time in our history.