Publications by authors named "Federico Banchelli"

52 Publications

How many cancer patients need palliative care? A population-based study.

J Pain Symptom Manage 2022 Jan 4. Epub 2022 Jan 4.

Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy. Electronic address:

Background: The number of cancer patients potentially amenable to palliative care is conventionally estimated from cancer deaths, as reported in the death certificates. However, a more representative population should also include cancer patients who die from causes other than cancer, as they may develop other life-limiting chronic conditions leading to terminal prognosis.

Aim: This study aimed at refining the assessment of the number of cancer patients potentially in need of palliative care, by linked hospital and death data.

Design: Retrospective study.

Setting/participants: Residents in the Emilia Romagna Region in Italy, who died between 2009 and 2017.

Results: We identified a potential palliative care population of 157,547 cancer patients. The use of different administrative data sources enhanced the sensitivity of our selection. Starting from a standard estimate of 129,212 patients based on cancer as the primary cause of death, we showed that the additional use of hospital records identified a further 11.4% of possible palliative care patients (14,687). Also considering cancer as secondary cause of death, the estimate further increased by 10.6% (13,648 new cases). Notably, the proportion of cancer patients selected by the additional data sources were characterized by more advanced age and higher prevalence of comorbidity.

Conclusion: Healthcare services addressing the issue of estimating palliative care needs of cancer patients at a population level should consider that relying on the death certificate alone may lead to underestimating these needs of about 22%.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.12.030DOI Listing
January 2022

Early palliative/supportive care in acute myeloid leukaemia allows low aggression end-of-life interventions: observational outpatient study.

BMJ Support Palliat Care 2021 Nov 8. Epub 2021 Nov 8.

Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy.

Objectives: Early palliative supportive care has been associated with many advantages in patients with advanced cancer. However, this model is underutilised in patients with haematological malignancies. We investigated the presence and described the frequency of quality indicators for palliative care and end-of-life care in a cohort of patients with acute myeloid leukaemia receiving early palliative supportive care.

Methods: This is an observational, retrospective study based on 215 patients consecutively enrolled at a haematology early palliative supportive care clinic in Modena, Italy. Comprehensive hospital chart reviews were performed to abstract the presence of well-established quality indicators for palliative care and for aggressiveness of care near the end of life.

Results: 131 patients received a full early palliative supportive care intervention. All patients had at least one and 67 (51%) patients had four or more quality indicators for palliative care. Only 2.7% of them received chemotherapy in the last 14 days of life. None underwent intubation or cardiopulmonary resuscitation and was admitted to intensive care unit during the last month of life. Only 4% had either multiple hospitalisations or two or more emergency department access. Approximately half of them died at home or in a hospice. More than 40% did not receive transfusions within 7 days of death. The remaining 84 patients, considered late referrals to palliative care, demonstrated sensibly lower frequencies of the same indicators.

Conclusions: Patients with acute myeloid leukaemia receiving early palliative supportive care demonstrated high frequency of quality indicators for palliative care and low rates of treatment aggressiveness at the end of life.
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http://dx.doi.org/10.1136/bmjspcare-2021-002898DOI Listing
November 2021

TRAIL receptors are expressed in both malignant and stromal cells in pancreatic ductal adenocarcinoma.

Am J Cancer Res 2021 15;11(9):4500-4514. Epub 2021 Sep 15.

Division of Oncology, Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences of Children & Adults, University of Modena and Reggio Emilia Modena 41124, Italy.

This study assesses the expression of all TNF-related apoptosis-inducing ligand (TRAIL) receptors in pancreatic ductal adenocarcinoma (PDAC) tumor tissue. We aimed to include TRAIL receptor expression as an inclusion parameter in a future clinical study using a TRAIL-based therapy approach for PDAC patients. Considering the emerging influence of PDAC desmoplastic stroma on the efficacy of anti-PDAC therapies, this analysis was extended to tumor stromal cells. Additionally, we performed PDAC stroma characterization. Our retrospective cohort study (N=50) included patients with histologically confirmed PDAC who underwent surgery. The expression of TRAIL receptors (DR4, DR5, DcR1, DcR2, and OPG) in tumor and stromal cells was evaluated by immunohistochemistry (IHC). The amount of tumor stroma was assessed by anti-vimentin IHC and Mallory's trichrome staining. The prognostic impact was determined by the univariate Cox proportional hazards regression model. An extensive expression of functional receptors DR4 and DR5 and a variable expression of decoy receptors were detected in PDAC tumor and stromal cells. Functional receptors were detected also in metastatic tumor and stromal cells. A poor prognosis was associated with low or absent expression of decoy receptors in tumor cells of primary PDAC. After assessing that almost 80% of tumor mass was composed of stroma, we correlated a cellular-dense stroma in primary PDAC with reduced relapse-free survival. We demonstrated that TRAIL functional receptors are widely expressed in PDAC, representing a promising target for TRAIL-based therapies. Further, we demonstrated that a low expression of DcR1 and the absence of OPG in tumor cells, as well as a cellular-dense tumor stroma, could negatively impact the prognosis of PDAC patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493377PMC
September 2021

Anti-GD2 CAR MSCs against metastatic Ewing's sarcoma.

Transl Oncol 2022 Jan 12;15(1):101240. Epub 2021 Oct 12.

Division of Oncology, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy; Rigenerand Srl, Medolla, Modena, Italy. Electronic address:

Background: Ewing's sarcoma (ES) is an aggressive cancer affecting children and young adults. We pre-clinically demonstrated that mesenchymal stromal/stem cells (MSCs) can deliver tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) against primary ES after local injection. However, ES is often metastatic calling for approaches able to support MSC targeting to the ES multiple remote sites. Considering that the disialoganglioside GD2 is expressed by ES and to optimise MSC tumour affinity, bi-functional (BF) MSCs expressing both TRAIL and a truncated anti-GD2 chimeric antigen receptor (GD2 tCAR) were generated and challenged against ES.

Methods: The anti-GD2 BF MSCs delivering a soluble variant of TRAIL (sTRAIL) were tested in several in vitro ES models. Tumour targeting and killing by BF MSCs was further investigated by a novel immunodeficient ES metastatic model characterized by different metastatic sites, including lungs, liver and bone, mimicking the deadly clinical scenario.

Findings: In vitro data revealed both tumour affinity and killing of BF MSCs. In vivo, GD2 tCAR molecule ameliorated the tumour targeting and persistence of BF MSCs counteracting ES in lungs but not in liver.

Interpretation: We here generated data on the potential effects of BF MSCs within a complex ES metastatic in vivo model, exploring also the biodistribution of MSCs. Our BF MSC-based strategy promises to pave the way for potential improvements in the therapeutic delivery of TRAIL for the treatment of metastatic ES and other deadly GD2-positive malignancies.
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http://dx.doi.org/10.1016/j.tranon.2021.101240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517927PMC
January 2022

A first trimester prediction model for large for gestational age infants: a preliminary study.

BMC Pregnancy Childbirth 2021 Sep 24;21(1):654. Epub 2021 Sep 24.

Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.

Background: Large for gestational age infants (LGA) have increased risk of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester.

Methods: Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019.

Results: A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95% CI: 1.6-4.9, p = 0.001), pre-pregnancy BMI (OR = 1.08, 95% CI: 1.03-1.14, p = 0.002) and PAPP-A MoM (OR = 1.43, 95% CI: 1.08-1.90, p = 0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to - 1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%.

Conclusion: At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactorily predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women deserving targeted interventions.

Trial Registration: ClinicalTrials.gov NCT04838431 , 09/04/2021.
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http://dx.doi.org/10.1186/s12884-021-04127-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464112PMC
September 2021

In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study.

Lancet Reg Health Eur 2021 Apr 2;3:100055. Epub 2021 Mar 2.

Cardiology Unit, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.

Background: The COVID-19 pandemic has put several healthcare systems under severe pressure. The present analysis investigates how the first wave of the COVID-19 pandemic affected the myocardial infarction (MI) network of Emilia-Romagna (Italy).

Methods: Based on Emilia-Romagna mortality registry and administrative data from all the hospitals from January 2017 to June 2020, we analysed: i) temporal trend in MI hospital admissions; ii) characteristics, management, and 30-day mortality of MI patients; iii) out-of-hospital mortality for cardiac cause.

Findings: Admissions for MI declined on February 22, 2020 (IRR -19.5%, 95%CI from -8.4% to -29.3%,  = 0.001), and further on March 5, 2020 (IRR -21.6%, 95%CI from -9.0% to -32.5%,  = 0.001). The return to pre-COVID-19 MI-related admission levels was observed from May 13, 2020 (IRR 34.3%, 95%CI 20.0%-50.2%, <0.001). As compared to those before the pandemic, MI patients admitted during and after the first wave were younger and with fewer risk factors. The 30-day mortality remained in line with that expected based on previous years (ratio observed/expected was 0.96, 95%CI 0.84-1.08). MI patients positive for SARS-CoV-2 were few (1.5%) but showed poor prognosis (around 5-fold increase in 30-day mortality). In 2020, the number of out-of-hospital cardiac deaths was significantly higher (ratio observed/expected 1.17, 95%CI 1.08-1.27). The peak was reached in April.

Interpretation: In Emilia-Romagna, MI hospitalizations significantly decreased during the first wave of the COVID-19 pandemic. Management and outcomes of hospitalized MI patients remained unchanged, except for those with SARS-CoV-2 infection. A concomitant increase in the out-of-hospital cardiac mortality was observed.

Funding: None.
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http://dx.doi.org/10.1016/j.lanepe.2021.100055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454529PMC
April 2021

The importance of medical treatment before surgery in pleomorphic carcinoma of the lung: A case series study.

Int J Surg Case Rep 2021 Sep 4;86:106275. Epub 2021 Aug 4.

Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy. Electronic address:

Introduction And Importance: Pleomorphic carcinoma of the lung is a rare malignant epithelial tumor. Due to its rarity, its clinicopathological characteristics are not clear, and there is no defined therapeutic path for this type of tumor.

Case Presentation: We retrospectively analyzed the medical and pathological reports of 8 patients who underwent surgical resection for pleomorphic carcinoma between 2007 and 2010.

Clinical Discussion: Eight patients were analyzed (7 males and 1 female, mean age 60). All patients underwent CT scans, and the average diameter of the nodules was 56 mm. Four patients were also investigated with FDG-PET with hypermetabolic activity in all four cases. In four patients, the carcinomatous component was adenocarcinoma (all with sarcomatoid component of spindle cell and giant cell carcinoma), although in two patients, it was squamous cell carcinoma (one with spindle cell and one with giant cell). In the two remaining patients, one showed a non-small cell carcinoma with giant cell carcinoma, and the other was a non-small cell carcinoma and squamous cell carcinoma with spindle and giant cell carcinoma. All cases were treated with surgical resection. Only two patients underwent neoadjuvant chemotherapy. At the time of data analysis, only one patient treated with neoadjuvant chemotherapy was alive.

Conclusion: The prognosis for these patients with a diagnosis of pleomorphic carcinoma undergoing surgery is generally better than those not treated with surgical resection, however the survival remains poor. Although with low number of patients, our research would suggest to consider neoadjuvant chemotherapy an appropriate approach for improving the outcomes before surgery.
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http://dx.doi.org/10.1016/j.ijscr.2021.106275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365429PMC
September 2021

The impact of tocilizumab on respiratory support states transition and clinical outcomes in COVID-19 patients. A Markov model multi-state study.

PLoS One 2021 12;16(8):e0251378. Epub 2021 Aug 12.

Unit of Statistical and Methodological Support to Clinical Research, Azienda Ospedaliero-Universitaria, Modena, Italy.

Background: The benefit of tocilizumab on mortality and time to recovery in people with severe COVID pneumonia may depend on appropriate timing. The objective was to estimate the impact of tocilizumab administration on switching respiratory support states, mortality and time to recovery.

Methods: In an observational study, a continuous-time Markov multi-state model was used to describe the sequence of respiratory support states including: no respiratory support (NRS), oxygen therapy (OT), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), OT in recovery, NRS in recovery.

Results: Two hundred seventy-one consecutive adult patients were included in the analyses contributing to 695 transitions across states. The prevalence of patients in each respiratory support state was estimated with stack probability plots, comparing people treated with and without tocilizumab since the beginning of the OT state. A positive effect of tocilizumab on the probability of moving from the invasive and non-invasive mechanical NIV/IMV state to the OT in recovery state (HR = 2.6, 95% CI = 1.2-5.2) was observed. Furthermore, a reduced risk of death was observed in patients in NIV/IMV (HR = 0.3, 95% CI = 0.1-0.7) or in OT (HR = 0.1, 95% CI = 0.0-0.8) treated with tocilizumab.

Conclusion: To conclude, we were able to show the positive impact of tocilizumab used in different disease stages depicted by respiratory support states. The use of the multi-state Markov model allowed to harmonize the heterogeneous mortality and recovery endpoints and summarize results with stack probability plots. This approach could inform randomized clinical trials regarding tocilizumab, support disease management and hospital decision making.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251378PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360516PMC
August 2021

Perinatal outcomes in women affected by different types of headache disorders: A prospective cohort study.

Cephalalgia 2021 12 20;41(14):1492-1498. Epub 2021 Jul 20.

Gynecology & Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.

Objective: This study aims to investigate pregnancy and perinatal outcomes in women with tension-type headache, migraine without aura and migraine with aura by comparing them to women without any headache disorders.

Study Design: Prospective cohort study including singleton pregnancies attending the first trimester aneuploidy screening at the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019.

Results: A total of 515 consecutive women were included and headache disorders were reported in 43.5% of them (224/515). Tension-type headache was diagnosed in 24.3% of the cases, while 14% suffered from migraine without aura and 5.2% from migraine with aura. Birthweight was significantly lower in women affected by migraine with aura respective to other groups, and a significantly higher rate of small for gestational age infants was found in tension-type headache (10.4%) and in migraine with aura (24.9%) groups respective to the others (p < 0.001). Moreover, the admission to the neonatal intensive care unit was significantly higher in all the headache groups (p = 0.012). Multivariate analysis showed that women presenting tension-type headache (OR 4.19, p = 0.004), migraine with aura (OR 5.37, p = 0.02), a uterine artery pulsatility index >90th centile (OR 3.66, p = 0.01), low multiple of the median (MoM) of Pregnancy-associated plasma protein-A (PAPP-A) (OR 0.48, p = 0.05) and high MoM of Inhibin-A (OR 3.24, p = 0.03) at first trimester, are independently associated with the delivery of small for gestational age infants when compared to women without headache disorders.

Conclusion: Migraine with aura and tension type headache expose women to an increased risk of delivering small for gestational age infants, in association with some utero-placenta markers evaluated at first trimester. These women with headache disorders have an additional indication to undergo first trimester aneuploidy screening and would possibly benefit from specific interventions.
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http://dx.doi.org/10.1177/03331024211029236DOI Listing
December 2021

Breastfeeding promotion and support: a quality improvement study.

Ann Ist Super Sanita 2021 Apr-Jun;57(2):161-166

Centro Nazionale per la Prevenzione delle Malattie e la Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.

Background: Breastfeeding success is determined by early skin to skin contact, early initiation of breastfeeding, rooming-in, baby-led breastfeeding, creation of a favorable environment, specific training of health professionals, and continuity of care.

Objective: To investigate the women's satisfaction regarding the care and support received in the first days after childbirth.

Material And Methods: A questionnaire of 24 items was administered to mothers before discharge, from May to September 2019 at the University Hospital of Modena.

Results: The predictive variables of exclusive breastfeeding were the delivery mode, age at birth and parity. The multivariate analysis showed that a high satisfaction score was associated with vaginal birth (OR=2.63, p=0.005), rooming-in during the hospitalization (OR=8.64, p<0.001), the skin to skin contact (OR=6.61, p=0.001) and the first latch-on within 1 hour after birth (OR=3.00, p=0.02).

Conclusions: Mothers' satisfaction is one of the important factors of positive experience during hospital stay and of better health outcomes.
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http://dx.doi.org/10.4415/ANN_21_02_08DOI Listing
December 2021

New Perspectives in Different Gene Expression Profiles for Early and Locally Advanced Non-Small Cell Lung Cancer Stem Cells.

Front Oncol 2021 31;11:613198. Epub 2021 Mar 31.

Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Introduction: Lung cancer is one of the most common cancers in the world, causing over 1.7 million deaths in 2018. Thus far, no effective treatments against lung cancer for advanced stages have been found. For early stages, although surgery is considered the gold standard treatment, 30-55% of patients develop recurrence within the first 5 years of surgery. Our aim is to assess whether cancer stem cells (CSC) display overexpression of a pool of genes that were previously identified for adenocarcinoma recurrence in patients with early and locally advanced stages of non-small cell lung cancer (NSCLC).

Methods: This cross-sectional study was carried out by harvesting surgical tumor specimens obtained from patients harboring early (I-II) and locally advanced (IIIA) stages of NSCLC. For each patient, cell sorting was performed to identify and isolate the ALDH (CSC) and ALDH (cancer cells) populations. The mRNA expressions of 31 recurrence-related genes (target genes) in both ALDH and ALDH populations were then assessed and compared.

Results: Surgical specimens were obtained from 22 patients harboring NSCLC. Sixteen (51.6%) out of 31 recurrence-related genes were significantly overexpressed in ALDH cells in the early stages and 9 (29.0%) were overexpressed in the locally advanced stages of NSCLC. Overall, the relative mRNA expressions for these recurrence-related genes were higher in early-stage patients. The average fold change, considering all 31 recurrence-related genes together, was 4.5 (95% CI = 3.1-6.3) in early-stage patients and 1.6 (95% CI = 1.2-2.2) in locally advanced-stage patients.

Conclusions: Our study represents the first attempt toward identifying genes associated with recurrence that are overexpressed in cancer stem cells in patients with early and locally advanced stages of NSCLC. This finding may contribute to the identification of new target therapies tailored for NSCLC stages.
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http://dx.doi.org/10.3389/fonc.2021.613198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047623PMC
March 2021

Knowledge, Information Needs and Risk Perception about HIV and Sexually Transmitted Diseases after an Education Intervention on Italian High School and University Students.

Int J Environ Res Public Health 2021 02 20;18(4). Epub 2021 Feb 20.

Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, 73020 Lecce, Italy.

Sexually transmitted diseases (STDs) among adolescents and young people represent a significant public health problem that generates a pressing requirement of effective evidence-based education to promote primary and secondary prevention. The objective of the study is to evaluate how knowledge, information needs, and risk perception about HIV and STDs can change after targeted education interventions for students. A total of 436 subjects aged 15-24 attending high school (134 biomedical and 96 non-biomedical fields) and university courses (104 scientific and 102 non-scientific disciplines) were enrolled to respond to a questionnaire before and after the intervention. An improvement in knowledge was found in all groups, with statistically significant knowledge score differences between the four groups in 60% of the items. More than 94% of the students consider it useful to promote information on these issues. Receiving this information generated awareness and safety in more than 85% of high-school students and 93% of University students. Students widely perceived a great risk being infected with HIV/STDs, although pregnancy was seen as a more hazardous consequence of unprotected sex. This study shows that educational interventions are effective in improving knowledge, apart from findings about key knowledge topics, information needs, and risk perception, which provide significant insights to design future targeted education programs.
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http://dx.doi.org/10.3390/ijerph18042069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923805PMC
February 2021

Methylprednisolone as rescue therapy after tocilizumab failure in patients with severe COVID-19 pneumonia.

Clin Exp Rheumatol 2021 Sep-Oct;39(5):1141. Epub 2021 Mar 3.

Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.

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September 2021

Efficacy and safety of human papillomavirus vaccination in HIV-infected patients: a systematic review and meta-analysis.

Sci Rep 2021 03 2;11(1):4954. Epub 2021 Mar 2.

Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41100, Modena, Italy.

The prophylactic vaccines available to protect against infections by HPV are well tolerated and highly immunogenic. People with HIV have a higher risk of developing HPV infection and HPV-associated cancers due to a lower immune response, and due to viral interactions. We performed a systematic review of RCTs to assess HPV vaccines efficacy and safety on HIV-infected people compared to placebo or no intervention in terms of seroconversion, infections, neoplasms, adverse events, CD4+ T-cell count and HIV viral load. The vaccine-group showed a seroconversion rate close to 100% for each vaccine and a significantly higher level of antibodies against HPV vaccine types, as compared to the placebo group (MD = 4333.3, 95% CI 2701.4; 5965.1 GMT EL.U./ml for HPV type 16 and MD = 1408.8, 95% CI 414.8; 2394.7 GMT EL.U./ml for HPV type 18). There were also no differences in terms of severe adverse events (RR = 0.6, 95% CI 0.2; 1.6) and no severe adverse events (RR = 0.6, 95% CI 0.9; 1.2) between vaccine and placebo groups. Secondary outcomes, such as CD4 + T-cell count and HIV viral load, did not differ between groups (MD = 14.8, 95% CI - 35.1; 64.6 cells/µl and MD = 0.0, 95% CI - 0.3; 0.3 log10 RNA copies/ml, respectively). Information on the remaining outcomes was scarce and that did not allow us to combine the data. The results support the use of the HPV vaccine in HIV-infected patients and highlight the need of further RCTs assessing the effectiveness of the HPV vaccine on infections and neoplasms.
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http://dx.doi.org/10.1038/s41598-021-83727-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925667PMC
March 2021

Cancer stem cells and macrophages: molecular connections and future perspectives against cancer.

Oncotarget 2021 Feb 2;12(3):230-250. Epub 2021 Feb 2.

Sulaiman AlRajhi Medical School, AlQaseem, Kingdom of Saudi Arabia.

Cancer stem cells (CSCs) have been considered the key drivers of cancer initiation and progression due to their unlimited self-renewal capacity and their ability to induce tumor formation. Macrophages, particularly tumor-associated macrophages (TAMs), establish a tumor microenvironment to protect and induce CSCs development and dissemination. Many studies in the past decade have been performed to understand the molecular mediators of CSCs and TAMs, and several studies have elucidated the complex crosstalk that occurs between these two cell types. The aim of this review is to define the complex crosstalk between these two cell types and to highlight potential future anti-cancer strategies.
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http://dx.doi.org/10.18632/oncotarget.27870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869576PMC
February 2021

Cytomegalovirus reactivation after hematopoietic stem cell transplant with CMV-IG prophylaxis: A monocentric retrospective analysis.

J Med Virol 2021 11 19;93(11):6292-6300. Epub 2021 Feb 19.

Section of Hematology, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Human cytomegalovirus (CMV) represents the most common viral infection after hematopoietic stem cell transplant (HSCT), mainly occurring as reactivation from latency in seropositive patients, with a different prevalence based on the extent and timing of seroconversion in a specific population. Here, we retrospectively analyzed a cohort of patients who underwent HSCT at our Institution between 2013 and 2018, all of whom were prophylactically treated with CMV-IG (Megalotect Biotest®), to define the incidence and clinical outcomes of CMV reactivation and clinically significant infection. CMV infection occurred in 69% of our patient series, mainly resulting from reactivation, and CMV clinically significant infection (CS-CMVi) occurred in 48% of prophylactically treated patients. CMV infection and CS-CMVi impacted neither on relapse incidence nor on overall survival nor on relapse-free survival. Moreover, a very low incidence of CMV end-organ disease was documented. CMV-IG used alone as prophylactic therapy after HSCT does not effectively prevent CMV reactivation.
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http://dx.doi.org/10.1002/jmv.26861DOI Listing
November 2021

Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned?

J Knee Surg 2021 Jan 28. Epub 2021 Jan 28.

Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy.

The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the Forgotten Joint Score-12 (FJS-12). Clinical results were dichotomized based upon KOOS and FJS-12 scores into either excellent or fair outcome, considering excellent KOOS and FJS-12 to be greater than or equal to 90. Intraoperative, postimplantation robotic data relative to computed tomography-based components placement were collected and classified. Following exclusions and loss to follow-up, a total of 74 subjects (75 knees) who received robotic arm-assisted lateral UKAs were taken into account with an average follow-up of 36.3 months (range: 25.0-54.2 months) postoperative. Of these, 66 patients (67 knees) were included in the clinical outcome analysis. All postoperative clinical scores showed significant improvement compared with the preoperative evaluation. No association was reported between three-dimensional component positioning and soft tissue balancing throughout knee range of motion with overall KOOS, KOOS subscales, and FJS-12 scores. Lateral UKA three-dimensional placement does not seem to affect short-term clinical performance. However, precise boundaries for lateral UKA positioning and balancing should be taken into account. Robotic assistance allows surgeons to acquire real-time information regarding implant alignment and soft tissue balancing.
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http://dx.doi.org/10.1055/s-0040-1722346DOI Listing
January 2021

ALDH Expression in Angiosarcoma of the Lung: A Potential Marker of Aggressiveness?

Front Med (Lausanne) 2020 30;7:544158. Epub 2020 Oct 30.

Department of Medical and Surgical Sciences, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy.

Primary angiosarcoma of the lung is a very aggressive rare malignant disease resulting in a severe prognosis (1). This type of cancer represents about 2% of all soft tissue sarcomas and has a high rate of metastasis through the hematogenous route. For the rarity of this malignant vascular tumor it is still challenging to set a diagnosis (1). The diagnostic features that have thus far been considered include primarily clinical and radiological findings. In some cases, immunohistochemical characteristics based on the most common markers used in pathology have been described. The aim of this report is to present two cases of angiosarcoma of the lung in which the aldehyde dehydrogenase (ALDH) marker was analyzed by immunohistochemistry. We report two cases of angiosarcoma of the lung in patients underwent lung surgery at our Unit. In addition to the standard histopathological analysis for this disease, immunohistochemistry using an ALDH1A1 antibody was performed in both of the cases. For ALDH quantification, a semi-quantitative method based on the positivity of the tumor cells was used: 0 (<5%), 1 (5-25%), 2 (>25-50%), 3 (>50-75%), 4 (>75%). One patient with recurrent lung disease survived, achieving complete remission after chemo- and radiotherapy. The second patient died of recurrent disease within 5 years of diagnosis. ALDH1A1 was evaluated in both of these cases using an immunohistochemistry scoring system based on the positivity for this marker. The scores were consistent with the patients' clinical outcomes, as the lower (score 1) was observed in the patient with the better clinical outcome, while the higher (score 3) was seen in the patient with the worse outcome. Our data suggest that ALDH may be an important clinical marker in angiosarcoma of the lung. Although further studies need to be performed in a larger cohort of patients, we believe that, if the results will be confirmed, ALDH1A1 may be used to stratify patients in terms of prognosis and for targeted therapy.
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http://dx.doi.org/10.3389/fmed.2020.544158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662079PMC
October 2020

Second primary tumors in head and neck cancer patients: The importance of a "tailored" surveillance.

Oral Dis 2021 Sep 8;27(6):1412-1420. Epub 2020 Nov 8.

Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy.

Objective: Head and neck cancer survivors have increased risk of developing second primary tumors compared to overall population. Because second primary represents a major cause of morbidity and mortality in this population, early detection is fundamental.

Materials And Methods: In this 10-year single-institution study, we investigated the following: incidence, clinical-pathological risk factors, and survival of patients with second primary tumor. We included all patients with diagnosis of squamous cell carcinoma of the head and neck seen at the Modena University Hospital from 2008 to 2018.

Results: Among 1,177 patients included, 222 (18.9%) developed second primary tumor; its survival probability at 5 years was 40.6%. Alcohol consumption (p = .0055) and index cancer in oropharynx (p = .0029), supraglottic larynx (p = .0000), glottic larynx (p = .0222) were associated with higher risk of second primary. The most common second primary sites were head and neck district and lung (70, 31.5%, and 67, 30.2%, respectively). Head and neck district were more common in oral cavity (18, 43%) and oropharynx index cancer (20, 31%); lung second primary in hypopharynx (4, 40%), supraglottic larynx (17, 43%), and glottic larynx index cancer (23, 35%).

Conclusion: Head and neck cancer survivors developing a second primary tumor have dismal prognosis. Tailored surveillance is recommended.
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http://dx.doi.org/10.1111/odi.13681DOI Listing
September 2021

Expression of ALDH and SOX-2 in Pulmonary Sclerosing Pnemocytoma (PSP) of the Lung: Is There a Meaning Behind?

Front Med (Lausanne) 2020 2;7:497. Epub 2020 Sep 2.

Department of Medical and Surgical Sciences, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy.

Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumor that derives from primitive respiratory epithelium of the pulmonary alveolus. The etiology and pathogenesis are still unclear. Histopathological diagnosis focuses on cells that are positive for TTF1, EMA, cytokeratin-7, and CAM 5.2. The aim of our study is to highlight the elevated expression of ALDH and the presence of SOX-2 in pulmonary sclerosing pneumocytoma. We report five cases of pulmonary sclerosing pneumocytoma undergone surgery at our Division of Thoracic Surgery, during a period between 1994 and 2011. ALDH and SOX-2 markers were also tested for positivity in all the patients. Patients showed elevated expression of ALDH during immunohistochemistry and mild expression of SOX-2, although in two cases in which SOX-2 was highly expressed. Among these two patients, one presented with lymph node recurrence while the other had no recurrence with a PET-positive nodule. In particular, the patient who had developed recurrence had an ALDH score of 4 and a SOX-2 score of 3, whereas the patient with the PET-positive nodule showed an ALDH score of 4 with a mild SOX-2 expression of score 1. This is the first attempt demonstrating the elevated expression of ALDH in this disease. SOX-2 expression was noted in both the patient who developed recurrence and the patient with a PET-positive nodule. We believe that further investigation may be highly useful to better characterize these two markers as well as understand their function.
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http://dx.doi.org/10.3389/fmed.2020.00497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492541PMC
September 2020

Investigating the association between physicians self-efficacy regarding communication skills and risk of "burnout".

Health Qual Life Outcomes 2020 Aug 6;18(1):271. Epub 2020 Aug 6.

Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Background: Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians' self-efficacy regarding communication to patients and risk of burnout.

Methods: We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models.

Results: Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout.

Conclusions: Our findings suggest that some physicians' BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.
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http://dx.doi.org/10.1186/s12955-020-01504-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409639PMC
August 2020

Robotic arm-assisted unicompartmental knee arthroplasty: high survivorship and good patient-related outcomes at a minimum five years of follow-up.

Knee Surg Sports Traumatol Arthrosc 2021 Oct 31;29(10):3316-3322. Epub 2020 Jul 31.

Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy.

Purpose: Robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA) has been shown to improve component placement, reduce intraoperative variability, increase patient satisfaction and improve short-term survivorship results. The aim of this retrospective study was to determine the incidence of revision and the clinical performance at a minimum of 5-year follow-up for a cohort of patients who received a medial RA-UKA.

Methods: Between April 2011 and July 2013, a total of 254 patients underwent medial RA-UKA at a single centre. Clinical performance was investigated using the Forgotten Joint Score-12 (FJS-12) and a 5-level Likert scale made of five items to assess joint perception and patient satisfaction. Kaplan-Meier implant survivorship was calculated and reasons for revision were collected. The effect of age, gender and body mass index (BMI) on the probability of reporting high FJS-12 and satisfaction were assessed.

Results: After considering exclusion criteria and loss to follow-up, a total of 216 patients (224 medial RA-UKAs) were assessed at a mean 5.9 years of follow-up. Five RA-UKAs underwent implant revision, resulting in an overall Kaplan-Meier survivorship of 97.8%. Unexplained knee pain (0.9%) was the most common reason for RA-UKA revision. Good-to-excellent FJS-12 scores and high satisfaction levels were reported at mid-term follow-up. Male patients had higher probability of having FJS-12 > 90 (p < 0.05) and high satisfaction levels (p < 0.05).

Conclusions: RA-UKAs demonstrated high survivorship and good-to-excellent patient-reported outcome measures and satisfaction levels at minimum 5-year follow-up. Results for male patients had improved clinical performance when compared to female subjects.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-020-06198-9DOI Listing
October 2021

Evaluation of midwifery students' satisfaction with regards to clinical internship.

Acta Biomed 2020 06 20;91(6-S):118-124. Epub 2020 Jun 20.

.

Background And Aim Of The Work: The clinical internship is fundamental for the training of the future socio-health professional. Through the practical activity, the student develops professional skills, critical thinking and decision-making ability, internalizing the complexity of the professional role. While in the nursing field there are several tools for assessing the clinical experience of students, in the obstetric field there is a lack of validated tools. Therefore, the purpose of this work was to investigate the perception of the students of the Degree Course in Midwifery regarding the internship experience.

Method: The study was conducted at the obstetric clinical internship where students carry out practical activities and involved all the students of the Degree Course in Midwifery at the University of Modena and Reggio Emilia. The data were collected through an anonymous online questionnaire (Google Model), which was inspired by the nursing CLES + T, simplified and adapted to the obstetric field.

Results: In total, 54 students took part in the research (81.8% of all students enrolled in the degree program examined). They were mainly of Italian nationality (98.1%), women (94.4%), aged between 18-22 years (85.2%). In general, the third-year students were more satisfied with the internship experience than the second- and first-year students, most likely for having achieved a degree of autonomy of care, awareness and greater professional motivation.  Conclusions. The results indicate the need to periodically investigate the quality and satisfaction of the clinical internships to ensure increasingly effective obstetric training.
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http://dx.doi.org/10.23750/abm.v91i6-S.9918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975836PMC
June 2020

Cancer Stem-Like Cells in a Case of an Inflammatory Myofibroblastic Tumor of the Lung.

Front Oncol 2020 15;10:673. Epub 2020 May 15.

Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Inflammatory myofibroblast tumor (IMT) is a rare tumor with obscure etiopathogenesis in which different inflammatory cells and myofibroblastic spindle cells are seen histologically. Although the majority of these neoplasms have a benign clinical course, the malignant form has also been reported. The gold standard is surgical treatment for complete removal. Our report describes a 50-year-old woman who underwent surgery for IMT of the lung. The aim is to determine whether cancer stem cells may be present in IMT of the lung. In April 2018, the patient underwent surgery for tumor mass asportation through lateral thoracotomy. The histology of the tumor was consistent with IMT of the lung. The ALDEFLUOR assay, after tissue digestion, was used to identify and sort human lung cancer cells expressing high and low aldehyde dehydrogenase (ALDH) activity. SOX2, NANOG, OCT-4, and c-MYC positivity were additionally determined by immunohistochemistry. The specimen contained 1.10% ALDH cells among all viable lung cancer cells, which indicates the population of cancer stem cells is not negligible. Immunohistochemically assessed cell positivity for ALDH1A1, SOX2, NANOG, OCT-4, and c-MYC, which are considered as lung cancer stem-like cells markers. For the first time, we demonstrated the presence of cancer stem cells in a case of IMT of the lung. This finding may provide a base for considering new pathological and molecular aspects of this tumor. This perspective suggests further studies to understand the possibility of developing recurrence depending on the presence of cancer stem cells.
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http://dx.doi.org/10.3389/fonc.2020.00673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243805PMC
May 2020

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation.

Eur J Intern Med 2020 11 30;81:32-37. Epub 2020 May 30.

Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena. Electronic address:

Background: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. However, the impact on outcome of AKI in TAVI-patients is not well established.

Methods: Inoperable patients with severe aortic stenosis (AS) undergoing TAVI in 2010-2018 were enrolled in this study. AKI and chronic kidney disease (CKD) were defined according to KDIGO guidelines. Patients were divided in two groups according to post-procedural AKI development. The primary endpoint was 30-day all-cause mortality across the two groups.

Results: A total of 373 patients (mean age 82.3 ± 6) were analyzed. Compared to non-AKI patients, those who developed AKI, were treated more frequently with trans-apical TAVI (66% vs 35%, p<0.01), with greater amount of contrast medium (200.6 vs 170.4 ml, p=0.02) and in presence of clinically significant peripheral artery disease (PAD, 33% vs 21%, p=0.04). Trans-apical access (OR 3.24, 95% CI 1.76-5.60, p<0.01) was associated with a 3-fold risk of AKI. After adjustment for age, Society of Thoracic Surgery risk score (STS), PAD, access type, EF and contrast medium amount, patients with AKI presented an increased risk of 30-day all-cause mortality (HR=1.25, 95%CI 1.09-1.69, p=0.008). Patients with CKD IV and V, who developed AKI, presented a 9-fold 30-day mortality risk (HR=9.71, 95% CI 2.40-39.2, p=0.001).

Conclusion: In our analysis, AKI was a strong predictor of 30-day all-cause mortality. Particularly, patients with severe CKD with AKI showed the highest 30-day mortality risk. Thus, this group of patients might benefit from closer monitoring and specific kidney protection therapies.
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http://dx.doi.org/10.1016/j.ejim.2020.05.027DOI Listing
November 2020

CD44+/EPCAM+ cells detect a subpopulation of ALDH cells in human non-small cell lung cancer: A chance for targeting cancer stem cells?

Oncotarget 2020 Apr 28;11(17):1545-1555. Epub 2020 Apr 28.

Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Objectives: Several studies demonstrated that aldehyde dehydrogenase (ALDH) and CD44 are the most considered cancer stem cells (CSC) markers. However, a comparison between ALDH high cells and CD44+ cells have been previously described with no significant correlation. Indeed, the aim of the present research is to identify a superficial marker able to match with ALDH high cells population in freshly isolated human lung cancer cells.

Materials And Methods: This cross-sectional study analyzed the expression of ALDH cells and the positivity for CD44 and epithelium cell adhesion molecule (EPCAM) antigens in surgical lung cancer tissues. The main approach was a cytofluorimetric analysis of ALDH expression and positivity for CD44/EPCAM on primary cell population obtained from 23 patients harboring NSCLC.

Results: There was a highly positive correlation between the expressions of ALDH and CD44+/EPCAM+ cells, with a Pearson's correlation coefficient equal to 0.69 (95% CI 0.39-0.86; = 0.0002), and Spearman's correlation coefficient equal to 0.52 ( = 0.0124). The average paired difference between the expression of ALDH and CD44+/EPCAM+ cells was very close to 0, being 0.1% (SD 2.5%); there was no difference between these subpopulations in terms of means (95% CI = -1.0; 1.2%, = 0.8464). These results highlight a strong similarity between ALDH and CD44+/EPCAM+ cells.

Conclusions: Our study is the first attempt which identifies a high correlation between the ALDH and the CD44+/EPCAM+ cells, thus suggesting the possibility to use this superficial marker for future target treatments against lung cancer stem cells.
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http://dx.doi.org/10.18632/oncotarget.27568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197447PMC
April 2020

Self-efficacy in breastfeeding support: a research on Italian midwifery students.

Acta Biomed 2020 03 13;91(2-S):27-34. Epub 2020 Mar 13.

School of Midwifery Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Italy.

Background And Aim Of The Study: Maternal breastmilk represents the best nourishment for the newborn baby during its first six months, as it offers several benefits for the health and well-being of babies and mothers. In order to promote, protect and support effectively mother and child during breastfeeding, it is essential for midwives to be properly educated and to acquire highly professionalizing skills. This study aimed to evaluate the level of self-efficacy of the students attending the Degree Course of Midwifery, regarding the support of mother and child in breastfeeding.

Method: A questionnaire of 37 items (Blackmanet al, 2015) validated in Italian by Mazzeo Melchionda (2019), was sent on-line to students of ten different Midwifery Degree Courses to assess their level of self-efficacy regarding the management of breastfeeding. Statistical analysis was carried out using statistic software R3.4.3 (The Foundation for Statistical Computing).

Results: 158 questionnaires were collected from ten Italian Midwifery Degree Courses. The areas in which students showed a high level of self-efficacy in managing breastfeeding include: the benefits of breastfeeding; the child's tendency to take the breast within an hour from childbirth and the relevance of skin to skin contact and rooming-in. Low levels of self-efficacy concerned the comfortably breastfeeding in public places and avoiding giving formula to the baby in its first six weeks of life.

Conclusions: Generally the students attending Midwifery Degree Courses show a high level of self-efficacy in assisting mothers during breastfeeding and they prove to have a good knowledge of the benefits of breastfeeding to improve the health of mothers and their children. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i2-S.9149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944660PMC
March 2020

Overall survival in patients with lung adenocarcinoma harboring "niche" mutations: an observational study.

Oncotarget 2020 Feb 4;11(5):550-559. Epub 2020 Feb 4.

Institute of Pathology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

In addition to the most common somatic lung cancer mutations (i. e., KRAS and EGFR mutations), other genes may harbor mutations that could be relevant for lung cancer. We defined BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET mutations as "niche" mutations and analyzed. The aim of this retrospective cohort study was to assess the differences in the overall survival (OS) of patients with lung adenocarcinoma harboring niche somatic mutations. Data were gathered for 252 patients. Mutations were observed in all genes studied, except c-MET, DDR2, MAP2K1, and RET. The multivariable analysis showed that 1) niche mutations had a higher mortality than EGFR mutations (HR = 2.3; 95% CI = 1.2-4.4; = 0.009); 2) KRAS mutations had a higher mortality than EGFR mutations (HR = 2.5; 95% CI = 1.4-4.5; = 0.003); 3) niche mutations presented a similar mortality to KRAS mutations (HR = 0.9; 95% CI = 0.6-1.5; = 0.797). Three cohorts of mutations were selected from patients with lung adenocarcinoma and their OS was compared. Mutations that were searched for, were 1) BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET; 2) K-RAS; and 3) EGFR. Differences in OS between these three cohorts were assessed by means of a multivariable Cox model that adjusted for age, sex, smoking habits, clinical stages, and treatments. Niche mutations exhibited an increased risk of death when compared with EGFR mutations and a similar risk of death when compared with KRAS mutations.
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http://dx.doi.org/10.18632/oncotarget.27472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007296PMC
February 2020

Subxiphoid thymectomy with a double sternum retractor: a pilot study.

Gland Surg 2019 Dec;8(6):657-662

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.

Background: Our study aims to describe the experience of a single team in terms of the potential and benefits of subxiphoid thymectomy using a double sternum hook retractor.

Methods: From November 2016 to July 2018, 34 patients have been undergone subxiphoid thymectomy at our Department. Twenty patients were diagnosed with Masaoka Stage I-III thymomas, 12 with thymic hyperplasia or cysts of the thymus, 2 with thymic tumors. All patients underwent a chest computed tomography (CT) with enhancement. 18-Fludeoxyglucose positron emission tomography (FDG-PET) was performed when recurrence was suspected. Neurological examinations were set. Patients underwent video-assisted thoracoscopic surgery (VATS) subxiphoid thymectomy with a double sternum retractor. A retrospective analysis of clinical, perioperative data, and follow-up was performed. Incidence rates for death or recurrence were calculated. Average pain score (NRS scale), average mental health, and physical health scores (SF-12) were analyzed.

Results: Thirty-four patients (mean age 54; 12 men and 22 women) with thymic neoformation (from 1.0 cm × 1.0 cm × 1.0 cm to 14.0 cm × 9.0 cm × 4.5 cm) were enrolled. All patients underwent subxiphoid thymectomy. No mortality or recurrence was observed. Median follow-up time was 17.9 months (range, 2.2-23.3 months). The morbidity rate was 9.7 events per 100 person-years. Average pain scores after surgery and after follow-up were 1.7±0.4 and 0.1±0.4, respectively; average mental health and physical health scores on the SF-12 scale were 45.6±2.4 and 33.6±2.4, respectively.

Conclusions: Subxiphoid thymectomy is a high satisfaction approach with positive aesthetic outcomes and low pain. Double sternum retractors are especially useful for creating space during thymectomy. However, the qualified experience is needed.
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http://dx.doi.org/10.21037/gs.2019.11.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989895PMC
December 2019
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