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.

Locally advanced squamous cervical carcinoma (M0): management and emerging therapeutic options in the precision radiotherapy era.

Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography-magnetic resonance imaging) PET-MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.

Collective learning modeling based on the kinetic theory of active particles.

This paper proposes a systems approach to the theory of perception and learning in populations composed of many living entities. Starting from a phenomenological description of these processes, a mathematical structure is derived which is deemed to incorporate their complexity features. The modeling is based on a generalization of kinetic theory methods where interactions are described by theoretical tools of game theory. As an application, the proposed approach is used to model the learning processes that take place in a classroom.

Mekuido: intervención en línea para escolares chilenos de apoyo a la prevención del sobrepeso / Mekuido: on line intervention for chilean school children to support prevention of overweight

Se describe la intervención MeKuido disenada para el proyecto "Prevención del sobrepeso y de la obesidad en escolares chilenos: Apuesta a la capacidad emprendedora de los niños" (FONIS SA10I20016). Sujetos y Método: Estudio descriptivo de la intervención realizada a población seleccionada mediante muestreo aleatorio por conglomerado del 50% de los colegios municipalizados de la comuna de La Pintana, conformada por los niños/as que en marzo de 2011, cursaban 5° y 6° año básico, (n=468) y aceptaron participar. Mekuido elemento central de la intervención, es un software con cuatro secciones construidas según marco referencial Orem. Post intervención, se aplicó cuestionario de satisfacción. Resultados: La implementación en el contexto de las actividades escolares demostró ser factible, pero no exenta de dificultades. El cuestionario de satisfacción fue respondido por 355 niños/as (90,8%). En todas las preguntas cerradas más del 80% muestran satisfacción con la intervención y recomendarían su uso. Conclusiones. El marco de referencia de Orem permite diseñar intervenciones para cambio de conductas asociadas a alimentación. Su uso es factible en el contexto escolar, requiere de decisión y compromiso de los profesores. La estrategia puede ser incorporada al curriculum y contribuir al desarrollo de objetivos transversales. La satisfacción con la intervención fue alta.

The MeKuido intervention is described, designed for the project "Prevention of overweight and obesity in Chilean children: Bettinhg on the enterprising capacity of children" (FONIS SA10I20016). Subjects and Method: A descriptive intervention study on a randomly selected population by cluster at 50% of municipal schools in the district of La Pintana, with children enrolled in 5th and 6th grade of primary school who agreed to participate (n = 468). Mekuido, central element is a software with four sections built according to Orem's referential framework. Post intervention, a satisfaction questionnaire was applied. Results: The implementation in the context of school activities proved feasible but not without difficulties. The satisfaction questionnaire was answered by 355 children (90.8%). All closed questions showed over 80% of satisfaction with the intervention and would recommend their use. Conclusion: The Orem framework allows the design of interventions to change behaviors related to feeding. Its use is feasible in the school context, requires determination and commitment of teachers. The strategy can be incorporated into the curriculum and contribute to the development of transversal objectives.

Effect of autologous transplantation of bone marrow cells concentrated with the MarrowXpress system in patients with critical limb ischemia.

Critical limb ischemia (CLI), a vascular disease affecting lower limbs, with high morbidity and mortality, is becoming a challenge due to the aging of the population. Patients without direct revascularization options have the worst outcomes. To date, 25% to 40% of CLI patients are not candidates for surgical or endovascular approaches, facing a major amputation as the ultimate option. This study sought to assess the safety and efficacy of transplantation of autologous bone marrow concentrates in "no-option" patients to restore blood perfusion by collateral flow and limb salvage. We performed a nonrandomized, noncontrolled pilot study for no-option CLI patients using intra-arterial infusion of autologous bone marrow concentrate. Variation of blood perfusion parameters, evaluated by laser doppler flowmetry after 6 and 12 months, was set as primary endpoint. Thirteen enrolled patients showed improvements in objective measurements of perfusion. This uncontrolled study provided evidence that transplantation of autologous bone marrow concentrates was well tolerated by CLI patients without significant adverse effects, demonstrating improved perfusion, confirming the feasibility and safety of the procedure.

Asimetría de extremidades inferiores: evaluación por imágenes en la edad pediátrica / Lower limb asymmetry: imaging evaluation in children

Limb length discrepancy or anisomelia has long been objectified with imaging.The biomechanical implications for patients with a developing skeleton are more relevant than the cosmetic aspects, both in treatment and in follow-up. The aim of this publication is to review the most common causes of lower limb asymmetry in children, with emphasis on imaging findings, which are of great importance for clinical management. A retrospective review was performed on patients younger than 15 years, who required evaluation at our center for lower limb asymmetry, using simple X-ray, CT scan and /or MRI. The anatomical findings and morphometric analysis were recorded for each case. The causes of limb length discrepancy are many, including congenital and sequelae conditions. A knowledge and proper assessment of the imaging findings helps to improve and standardize the radiology report.

La asimetría de extremidades inferiores o anisomelia ha sido largamente objetivada con imágenes y posee implicancias biomecánicas para los pacientes con esqueleto en desarrollo que son más relevantes que los aspectos cosméticos, tanto en su tratamiento como en el seguimiento. El objetivo de esta publicación es revisar las causas más frecuentes de asimetría de extremidades inferiores en la edad pediátrica con énfasis en los hallazgos imaginológicos, que son de gran importancia para el manejo clínico. Se realizó una revisión retrospectiva de pacientes menores de 15 años que requirieron evaluación en nuestro centro por asimetría de extremidades inferiores mediante radiografía simple, tomografía computarizada y/o resonancia magnética, consignando los hallazgos anatómicos y el análisis morfométrico para cada caso. Las causas de anisomelia son múltiples, incluyendo trastornos congênitos y secuelares. Su conocimiento y la adecuada valoración de los hallazgos en imágenes permiten enriquecer y estandarizar el informe radiológico.

Successful bone marrow transplantation reveals the lack of endothelial progenitor cells mobilization in a patient with critical limb ischemia: a case report.

Restoring blood flow to ischemic tissue is a prerequisite for treatment of ischemic diseases. Cell-based therapy based on bone marrow transplantation is a promising option for patients with critical limb ischemia (CLI). The efficacy of cell therapies to augment neovascularization seems to involve endothelial progenitor cells (EPCs); however, the mechanisms underlying the efficacy have not been fully elucidated. Herein we have described the case of a young patient with severe CLI, who experienced a 24-month beneficial clinical response to autologous bone marrow transplantation. The exceptional amelioration enabled him to perform standardized maximal treadmill exercise test that demonstrated lack of exercise-induced EPC mobilization, despite adequate stromal-derived factor 1 and vascular endothelial growth factor responses. Therefore, tissue ischemia is not sufficient to promote the recruitment of EPCs that have been demonstrated to be involved in the recovery from ischemia. The local implantation of marrow-derived elements may provide cells and/or trophic factors, which have the capacity to augment angiogenesis, opening new approaches to the etiopathogenesis of the disease.

Long-term effects of repeated autologous transplantation of bone marrow cells in patients affected by peripheral arterial disease.

Long-term effects of autologous mononuclear bone marrow cell transplantation were studied in patients with severe peripheral arterial disease (PAD) and critical limb ischemia. Ten patients with end-stage disease were infused twice with autologous bone marrow cells and they completed the 12-month follow-up study. Substantial improvement of blood flow and increasing capillary densities were seen when compared with a concomitant control group comprising patients who did not enroll in the study. The ankle-brachial index (ABI) and pain-free walking distance improved significantly in treated patients. The improvement was sustained 12 months after treatment. These results confirm that the autologous bone marrow transplantation is an effective therapeutic strategy in critical limb ischemia.

Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception.

BACKGROUND: Progestin-only methods are among the contraceptive options available for breastfeeding women, however the doses of progestin used in emergency contraception (EC) have not been evaluated in nursing mothers. We therefore investigated the pharmacokinetics of 1.5 mg levonorgestrel (LNG) in lactating women. METHODS: Twelve healthy exclusively breastfeeding volunteers received 1.5 mg LNG. Women refrained from nursing for 72 h after dosing and fed their infants with milk frozen beforehand. Serial blood and milk samples were collected for 120 h and assayed for LNG and sex hormone binding globulin. RESULTS: LNG concentrations peaked in plasma and in milk 1-4 h and 2-4 h after dosing, respectively. Concentrations in milk (M) paralleled those in plasma (P) but were consistently lower (mean M:P ratio 0.28). Estimated infant exposure to LNG is 1.6 microg on the day of dosing (1 microg in the first 8 h), 0.3 microg on the second day and 0.2 microg on the third day. CONCLUSIONS: Nursing mothers may need EC. These results suggest that to limit infant exposure to the period of maximum LNG excretion in milk, mothers should discontinue nursing for at least 8 h, but not more than 24 h, after EC.

Cell-enlargement-related polypeptides are induced via beta(1)-adrenoceptors in mouse parotids.

Induction of cell and gland enlargement (growth-in-size) and induction of a group of secretory polypeptides (polypeptides C-G) seem to occur in close relationship in mouse parotid glands stimulated chronically by the nonselective beta-adrenergic agonist isoproterenol. To determine whether beta(1), beta(2), or both subtypes of beta-adrenergic receptors are involved in those responses, dose-dependency studies were carried out during a 7-day period of daily stimulations to assess the relative abilities of the selective beta-adrenergic agonists dobutamine (beta(1)) and salbutamol (beta(2)) to induce polypeptides C-G and growth-in-size. The relative abilities of the selective beta-adrenoceptor antagonists atenolol (beta(1)) and I.C.I. 118.551 (beta(2)) to interfere with the induction of both responses by chronic treatment with the various beta-adrenergic agonists were also studied. Parotid growth-in-size was assessed by evaluating wet weight, whole protein content, and light microscopy histology. The presence of polypeptides C-G was evaluated after SDS-polyacrylamide gel electrophoresis and Coomassie blue staining. Under these experimental conditions, dobutamine was found to be at least one order of magnitude more potent than salbutamol at inducing growth-in-size. Dobutamine was also found to be clearly stronger than salbutamol as an inducer of polypeptides C-G. On the other hand, atenolol was more effective than I.C.I. 118.551 at preventing the induction of polypeptides C-G and growth-in-size by isoproterenol, dobutamine, or salbutamol. Taken together, these results suggest that in mouse parotid glands, polypeptides C-G and growth-in-size are induced preferentially via adrenergic receptors of the beta(1)-subtype.

Transcriptional and posttranscriptional control in synthesis of growth marker polypeptides in mouse parotids.

The chronic daily administration of isoproterenol provokes in mouse parotid glands the induction and progressive accumulation of a family of secretory polypeptides named polypeptides C, D, E, F, and G (polypeptides C-G). These polypeptides, which seem to be part of the family of proline-rich proteins, have been considered as molecular markers of the growth-in-size response in the mouse parotid acinar cells. In the present study, two pharmacological approaches were used to determine whether the induction and the postsecretory reappearance of polypeptides C-G may be distinguished from each other. First, actinomycin D, a transcriptional inhibitor, was found to interfere with the induction by isoproterenol but not with the postsecretory reappearance. Second, pilocarpine, a secretagogue that was found to be a very weak inducer of polypeptides C-G, was able to provoke secretion and then reappearance of the whole group of isoproterenol-induced polypeptides. Accordingly, these data suggest that the induction of polypeptides C-G is dependent on transcriptional activity and that it is unrelated to secretion stimulation. By contrast, the postsecretory reappearance of polypeptides C-G may occur even when transcriptional activity is inhibited and it would be related to the secretory activity.

Consideraciones psicopatologicas en torno al uso de beta-bloqueadores en los sindromes angustiosos. / Psychopathological considerations on the use of beta-blockers in anyiety syndrome

Se revisan las indicaciones terapeuticas de los beta-bloqueadores en los sindromes angustiosos, concluyendo que solo son efectivos en los casos que se asocian a un claro sindrome vegetativo beta-adrenergico Se postula la existencia de dos tipos basicos de angustia (angustia de riesgo y angustia de responsabilidad), de diferente semiologia vegetativa y vinculados, respectivamente, al polo neurotico el efecto del propranolol sobre los componentes psiquicos y somaticos de la angustia y se postula que ambas experiencia estan igualmente vinculadas a la respuesta vegetativa y son susceptibles de correcion mediante bloqueo beta-adrenergico.Se discute el mecanismo central o periferico del efecto ansiolitico de los beta-bloqueadores y se senala que este puede ser explicado, en la mayoria de los casos, exclusivamente por el bloqueo de la retroalimentacion aferente sobre el sistema nervioso central