Radiation Therapy in Non-Melanoma Skin Cancers: An Italian Survey on Behalf of the Italian Association of Radiotherapy and Clinical Oncology.

AIMS: The National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a "snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy. MATERIALS AND METHODS: The survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists. RESULTS: Fifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50-70.95/22-35 fractions (fx) and 50-70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20-35Gy/5fx. For IRT, the most popular curative options were 32-50Gy/8-10fx and 30-54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11-20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20-40Gy in 10fx and 20-25Gy in 5fx were the recommended fractionations. CONCLUSION: The survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes.

Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer.

OBJECTIVE: To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS: 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS: Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION: re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE: Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.

Invasive crayfish and freshwater fishes of the world.

After habitat destruction, invasive alien species are the second leading cause of biodiversity loss, particularly in freshwater ecosystems. They also alter the structure and functioning of ecosystems, lead to biotic homogenisation, and eventually threaten human economies and health. This review aims to synthesise some of the existing information about the world distribution, vectors of spread, and impacts of two important components of freshwater ecosystems, crayfish and fishes. Analysis of the available literature shows that crayfish and fish species, once moved outside their native range, are likely to establish self-reproducing populations, spread from the point of introduction and become invasive. Efforts to manage these populations are difficult and expensive, which warrants the provision of effective preventative measures. Unfortunately, the state of our knowledge of the mechanisms in play in crayfish and fish invasions is still limited, which suggests that much greater attention and investment should be directed to studies in this field.

Phylogeography of the threatened crayfish (genus Austropotamobius) in Italy: implications for its taxonomy and conservation.

A nucleotide sequence analysis of a portion of the mitochondrial large ribosomal subunit was performed to define the phylogeography of the threatened crayfish Austropotamobius (Decapoda; Astacidae) in Italy. We collected 61 specimens from 31 localities across the Italian peninsula. For the phylogenetic inference, we combined the 61 Austropotamobius spp sequences obtained from this study with 18 sequences deposited in GenBank and corresponding to Italian, French, Irish, Swiss, and Slovenian locations. Among the analysed sequences, 34 distinct haplotypes were detected. Our results confirmed the presence of both A. pallipes and A. italicus in the Italian peninsula and the existence within the latter species of a strong intraspecific genetic variation, due to the occurrence of four subspecies with a well-defined geographic distribution. From a conservation viewpoint, Italy, with its high haplotype variability, may be considered a 'hot spot' for the genetic diversity of the European native crayfish Austropotamobius. We suggest that re-introduction programs should be conducted with extreme caution in Italy, since not only the two Austropotamobius species but also the four A. italicus subspecies are genetically and taxonomically separate units and require independent conservation plans.

Endogenous ABA maintains shoot growth in tomato independently of effects on plant water balance: evidence for an interaction with ethylene.

To examine whether the reduced shoot growth of abscisic acid (ABA)-deficient mutants of tomato is independent of effects on plant water balance, flacca and notabilis were grown under controlled-humidity conditions so that their leaf water potentials were equal to or higher than those of well-watered wild-type plants throughout development. Most parameters of shoot growth remained markedly impaired and root growth was also greatly reduced. Additional experiments with flacca showed that shoot growth substantially recovered when wild-type levels of ABA were restored by treatment with exogenous ABA, even though improvement in leaf water potential was prevented. The ability of applied ABA to increase growth was greatest for leaf expansion, which was restored by 75%. The ethylene evolution rate of growing leaves was doubled in flacca compared to the wild type and treatment with silver thiosulphate to inhibit ethylene action partially restored shoot growth. The results demonstrate that normal levels of endogenous ABA are required to maintain shoot development, particularly leaf expansion, in well-watered tomato plants, independently of effects on plant water balance. The impairment of shoot growth caused by ABA deficiency is at least partly attributable to ethylene.

Prey-handling behaviour of Octopus vulgaris (Mollusca, Cephalopoda) on Bivalve preys.

This study examines the ability of Octopus vulgaris to prey on bivalve molluscs showing that octopuses exhibited the same behavioural pattern irrespective of the prey species. When the initial pulling method did not result efficient octopuses skipped to drilling accompanied by an increase in the handling time. A complete behavioural repertoire of O. vulgaris in handling bivalve preys is also given.

Catecholaminergic nerve fibres in normal and alkali-burned rabbit cornea.

BACKGROUND: In recent years anatomic research has demonstrated the presence of various types of nerve fibre in the cornea. The purpose of this study was to investigate the distribution of catecholaminergic fibres in various corneal layers and to study the effects of an experimental superficial corneal lesion on the pattern of catecholaminergic nerve fibre distribution in the various corneal layers. METHODS: Three weeks after the creation of an alkali burn in the centre of the right cornea of five albino rabbits, the animals were killed, and histologic sections from the cornea of both eyes were stained for observation of catecholaminergic nerve fibres and photographed on black-and-white film. The photographs were examined using the Quantimet image analyser (Leica). RESULTS: Catecholaminergic nerve fibres were observed in the corneal epithelium and the deep stromal layers. Sections from injured cornea showed a drastic reduction in epithelial and superficial stromal catecholaminergic nerve fibres, whereas the nerve fibres in the endothelium and deep stroma were not damaged. INTERPRETATION: Although catecholaminergic nerve fibres were observed in all corneal layers, the pattern of catecholaminergic fibres following the creation of a superficial lesion of the cornea seems to suggest that the superficial and deep nerve fibres may have a different distribution.

Occurrence of cholinergic nerve fibers in the human uveoscleral tissue.

We have studied the cholinergic nerve fibers (CNF) of human uveoscleral tissue in normal and pathological conditions (intraocular pressure: (IOP) of various degrees ) and have performed a quantitative image analysis of CNF with the aim of studying an hypothetical association between IOP and the uveoscleral level of cholinergic neurotransmitter in nerve fiber of the enucleated human eyes. Eleven patients, previously enrolled in our medical protocols are affected by an increase of IOP of various degrees, were subjected to surgical enucleation of one eyeball for traumatic or neoplastic reasons and were the donors of samples of the uveoscleral tissue for CNF demonstration. The samples were also submitted to quantitative image analysis. An enzymatic activity, Acetylcholinesterase (AChe), is present in nerve fibers that innervate the human uveoscleral tissue. The AChe-positive nerve fibers represent about 7.2% of the observed area in normal conditions, while in patients with elevated IOP AChe activity is about 20.3% of the total observed area. The increase of AChe activity in our experiments, all performed under the same conditions, and therefore, with comparable results, may be related with the increase of IOP.

'Minimal-change hypertensive retinopathy' and 'arterial pre-hypertension', illustrated via ambulatory blood-pressure monitoring in putatively normotensive subjects.

PURPOSE: To investigate the 24 h blood-pressure (BP) pattern in subjects who were found to show some incipient signs of hypertensive retinopathy but had been diagnosed as normotensives by means of casual sphygmomanometry. METHODS: Non-invasive ambulatory BP monitoring was performed in 25 caucasian subjects (16 M, 9 F; mean age 46 +/- 16 years) showing this type of retinal problem. A comparable number of controlled normotensive Caucasian subjects (15 M, 10 F; mean age: 48 +/- 15 years) without funduscopic signs of hypertensive retinopathy were investigated as a reference group. A series of BP tests over time was analysed by means of conventional biometry and chronobiological methods. RESULTS: The biometric estimates suggest that the investigated subjects with incipient hypertensive retinopathy, although characterized by BP values below 140/90 mmHg, show a significantly higher daily systolic BP. The increase, however, is within WHO reference limits and is not associated with the abolition of the circadian BP rhythm. CONCLUSIONS: The results suggest that the initial signs of hypertensive retinopathy may appear before BP elevation above WHO reference limits occurs. Because of this, it can be assumed that there is such a condition as 'minimal-change hypertensive retinopathy' associated with a haemodynamic picture of 'arterial pre-hypertension'.

The role of stimulus preexposure in problem solving by Octopus vulgaris.

Octopus vulgaris is able to open transparent glass jars closed with plastic plugs and containing live crabs. The decrease in performance times for removing the plug and seizing the prey with increasing experience of the task has been taken to indicate learning. However, octopuses' attack behaviors are typically slow and variable in novel environmental situations. In this study the role of preexposure to selected features of the problem-solving context was investigated. Although octopuses failed to benefit from greater familiarity with the training context or with selected elements of the task of solving the jar problem, the methodological strategies used are instructive in potentially clarifying the role of complex problem-solving behaviors in this species including stimulus preexposure and social learning.

[Minimal lesion hypertensive retinopathy and arterial pre-hypertension: evidence of arterial pressure monitoring in presumed normotensive subjects at zero risk]. / Retinopatia tensiva a lesioni minime e pre-ipertensione arteriosa: evidenze dal monitoraggio della pressione arteriosa in soggetti reputati normotesi a rischio zero.

The present study investigates the blood pressure (BP) 24 h pattern in 25 subjects who were found to show some incipient signs of hypertensive retinopathy, although they were diagnosed as normotensive by means of casual sphygmomanometry. BP was controlled by means of non invasive ambulatory monitoring. A comparable number of normotensive subjects without fundoscopic signs of hypertensive retinopathy was investigated as a control group. BP times series were analyzed by means of conventional and rhythmometric biometry. The biometric estimates suggest that the subjects with incipient hypertensive retinopathy show a significantly higher level of daily systolic BP even though their BP values remain below the reference limits. This finding suggests that the hypertensive retinopathy may exist in a non-zero stage characterizable as minimal change tensive retinopathy. This retinal picture occurs in subjects who show a pre-hypertensive stage in their BP 24 h pattern.

Life History Patterns of Discorsopagurus schmitti, a Hermit Crab Inhabiting Polychaete Tubes.

Discorsopagurus schmitti is a hermit crab that inhabits empty polychaete tubes in the North Pacific. Here we describe some aspects of its life history (relative growth, population structure, reproductive biology, and incidence of parasitism) and discuss the relationships among them. Unlike most hermits, the two sexes of this species have similar size distributions. In both sexes, larger body size is accompanied by a higher reproductive output (larger clutch size in females and more intrasex competitive potential in males). The energy the females expend in egg production might be equaled in this species by the energy the males expend in supporting parasites. In fact, the extent of infestation by two rhizocephalans [Peltogaster boschmae and Thilacoplethus (=Thompsonia) reinhardi] is more pronounced in males, especially those in the larger size classes. However, rhizocephalans have little effect on their hosts; growth and secondary sexual characters are not influenced. The only morphological modification is the more frequent loss of the second pleopod. Infected hermits also showed a mock parental behavior, fanning the externae with the pleopods as ovigerous females fan their eggs. Larvae are released in sequential bursts, and hatching occurs exclusively at night, possibly to minimize predation by diurnal fishes. Hatching is also synchronized with neap tides, which might keep the larvae from being flushed out into open waters. In a species whose habitat (sabellarian bioherms) is rare and quite unpredictable, it is beneficial to retain larvae near the parental population.

Cholelithiasis and acromegaly: therapeutic strategies.

OBJECTIVE: The aims of this study were (i) to evaluate gall-bladder form and contents, (ii) to assess the prevalence of gallstones in acromegalic patients before octreotide treatment and the incidence of gallstone formation in patients with acromegaly during long-term (6-90 months, mean 44 months) octreotide treatment, and (iii) to test the efficacy of ursodeoxycholic acid in preventing and treating octreotide-induced cholelithiasis. DESIGN: Forty-nine patients (23 men and 26 women, aged 19-81 years) were studied by repeated gall-bladder ultrasonography performed at baseline and then every 6 months during octreotide therapy. All ultrasound scans were evaluated by the same radiologist. Statistical analysis was performed using the Chi-squared and regression analysis tests. RESULTS: Asymptomatic stones were recorded in 13/49 patients (26.5%) prior to octreotide treatment (the prevalence of cholelithiasis in the Italian population is 9.5% in men and 18.9% in women). During octreotide therapy gallstones developed in 10/36 patients (27.7%). No significant correlations with sex, age, body mass index, duration of the disease, daily dose and duration of octreotide therapy, altered gall-bladder form, family history of gallbladder stones, basal plasma values of cholesterol and triglycerides were found between the patients (10/36) who developed stones during octreotide treatment and the ones who did not (26/36). Fourteen patients (10 with newly developed stones and four with cholelithiasis diagnosed prior to octreotide) were put on ursodeoxycholic acid at the daily dose of 10 mg/kg. Gallstones completely disappeared in 6/14 patients (42.8%; five patients with newly developed stones and one with stones prior to octreotide therapy) after a mean of 30.8 months of ursodeoxycholic acid treatment. In addition, seven patients were treated with ursodeoxycholic acid at the preventive dose of 450 mg, administered as a once-a-day oral preparation in the evening. However, stones developed in one of these seven patients who was thereafter cured (gallstones completely disappeared) by the therapeutic dose of ursodeoxycholic acid of 10 mg/kg/day after 23 months of treatment. CONCLUSIONS: This study indicates that (i) acromegaly by itself is correlated with a high prevalence of gallbladder stones, (ii) the long-term treatment with octreotide increases the incidence of cholelithiasis, and (iii) ursodeoxycholic acid is useful in the treatment of gallstones in acromegalic patients but its prophylactic effect in patients on octreotide treatment requires further assessment.

Efficacy of a new long-acting injectable form of bromocriptine in hyperprolactinaemic patients.

OBJECTIVE: The objective of this study was to assess the relationship of different doses of a long-acting bromocriptine preparation (Parlodel LAR) to the degree and duration of PRL suppression. We also measured circulating bromocriptine levels and altered tolerability of the drug. DESIGN: A double-blind randomized study of three different doses 25, 50 and 100 mg of Parlodel LAR. PATIENTS: Twenty-one female patients (seven patients/dose) with both tumoral and non-tumoral hyperprolactinaemia. MEASUREMENTS: After a single injection of Parlodel LAR 25, 50 or 100 mg, serum PRL and plasma bromocriptine levels were assessed during a follow-up of 60 days together with changes in clinical symptoms and signs of hyperprolactinaemia. RESULTS: Serum PRL levels normalized in 19 of 21 patients. The suppression of PRL secretion lasted 28 days in four of seven patients treated with either 25 or 50 mg Parlodel LAR and in five of seven patients who received Parlodel LAR 100 mg. In five of seven patients treated with the 100 mg dose, serum PRL levels were still within the normal range on day 60. Plasma bromocriptine levels remained therapeutically active for 28 days in all three groups. On day 60 they were within the therapeutic range only in the 100 mg group. Clinical data show a rapid disappearance of symptoms and signs of hyperprolactinaemia. Adverse events were mostly mild and transient. CONCLUSIONS: These data support the excellent efficacy and good tolerability of Parlodel LAR in patients with hyperprolactinaemia.

A new oral slow release form of bromocriptine, Parlodel SRO, in the chronic treatment of 26 hyperprolactinemic patients.

Parlodel SRO, a new slow release form of bromocriptine, was studied in 26 patients with tumoral and non-tumoral hyperprolactinemia. Prior to the treatment, serum prolactin (PRL) levels ranged from 45 ng/ml to 7000 ng/ml and they decreased to within the normal range in all but one patient after 7 days-1 year of treatment with this new formulation of bromocriptine. The clinical improvement paralleled the normalization of PRL secretion. Tolerability was rated good or very good in 24 patients, even in the three patients who had been intolerant of oral Parlodel. In conclusion, Parlodel SRO administered as a single daily dose resulted in very effective lowering of serum PRL in patients with hyperprolactinemic disorders.

Hypocalcemic effects of rectal and intramuscular administration of synthetic salmon calcitonin.

To assess the acute biological activity of a new rectal form of synthetic salmon calcitonin (SMC), 10 healthy subjects were randomly assigned, according to a crossover design, to single doses of either 50 IU SMC intramuscularly or 100 IU SMC rectally. Ionized and total calcium were measured as SMC bioactivity indicators in blood samples collected during a 6-hour period after the administration of the drug. In all the subjects, rectal administration of 100 IU of SMC induced falls in both plasma total calcium and whole blood ionized calcium: similar levels were observed after intramuscular injection of 50 IU of SMC. The pharmacodynamic bioavailabilities for total and ionized calcium of the 100 IU suppository and the 50 IU intramuscularly were 106% and 60%. The total and ionized calcium AUCs were the same after i.m. injection and suppository. We conclude that, in normal subjects, synthetic salmon calcitonin administered by the rectal route at the dose of 100 IU is effective and has the same biological effects as 50 IU of SMC given intramuscularly. Therefore, this new rectal form may be a useful alternative to parenteral injection.