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"Mariani, Anna"
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Multimodal treatment with curative intent in a germline BRCA2 mutant metastatic ampullary adenocarcinoma: a case report
Background
Cancers of the Vater ampulla (ampullary cancers, ACs) account for less than 1% of all gastrointestinal tumors. ACs are usually diagnosed at advanced stage, with poor prognosis and limited therapeutic options.
BRCA2
mutations are identified in up to 14% of ACs and, differently from other tumor types, therapeutic implications remain to be defined. Here, we report a clinical case of a metastatic AC patient in which the identification of a
BRCA2
germline mutation drove a personalized multimodal approach with curative-intent.
Case presentation
A 42-year-old woman diagnosed with stage IV
BRCA2
germline mutant AC underwent platinum-based first line treatment achieving major tumor response but also life-threatening toxicity. Based on this, as well as on molecular findings and expected low impact of available systemic treatment options, the patient underwent radical complete surgical resection of both primary tumor and metastatic lesions. Following an isolated retroperitoneal nodal recurrence, given the expected enhanced sensitivity to radiotherapy in
BRCA2
mutant cancers, the patient underwent imaging-guided radiotherapy leading to long-lasting complete tumor remission. After more than 2 years, the disease remains radiologically and biochemically undetectable. The patient accessed a dedicated screening program for
BRCA2
germline mutation carriers and underwent prophylactic bilateral oophorectomy.
Conclusions
Even considering the intrinsic limitations of a single clinical report, we suggest that the finding of
BRCA
germline mutations in ACs should be taken into consideration, together with other clinical variables, given their potential association with remarkable response to cytotoxic chemotherapy that might be burdened with enhanced toxicity. Accordingly,
BRCA1/2
mutations might offer the opportunity of personalizing treatment beyond PARP inhibitors up to the choice of a multimodal approach with curative-intent.
Journal Article
Utility of Combining High-Sensitive Cardiac Troponin I and PESI Score for Risk Management in Patients with Pulmonary Embolism in the Emergency Department
Background and Objectives: Pulmonary embolism (PE) has a major burden of morbidity and mortality, consequently the need for a prompt risk stratification for these subjects is crucial. In order to evaluate the risk management and final disposition of patients with PE in the Emergency Department (ED), we conducted a study that was divided in two phases: Phase I retrospective study (RS), Phase II prospective study (PS). Materials and Methods: In Phase I, 291 patients were enrolled while in Phase II, 83 subjects were evaluated. In both study phases, the enrolled subjects were analyzed for final disposition in ED using PESI score, right ventricle (RV) imaging, and high-sensitive cardiac troponin I (hs-cTnI) data. The RS patients were divided into low risk and high risk according to the sPESI score, while PS patients were grouped in low, intermediate, and high risk classes according to PESI score. In both study phases, all the studied patients were further divided into negative (hs-cTnI−) or positive (hs-cTnI+) groups according to hs-cTnI levels within normal or above cutoff values, respectively. For all enrolled subjects, CT pulmonary angiography was analyzed to assess the RV/LV diameter and volume ratio as an indicator of RV involvement. Results: In both RS and PS phases, hs-cTnI+ group showed a higher PESI score. Nevertheless, a significant percentage of hs-cTnI+ patients resulted to be in the low-risk PESI class. Patients with a positive RV/LV ratio were more likely to have a hs-cTnI+ (p < 0.01), while among those with a negative ratio, 24 to 32% showed as hs-cTnI+. In the hs-cTnI+ group from both study phases, patients were more likely to be admitted in an ICU (RR 3.7, IC: 2.1–6.5). Conclusions: In conclusion, in patients with PE in the ED compared PESI score alone, the combination of hs-cTnI and PESI seems to be of greater utility in improving risk stratification and final disposition decision-making.
Journal Article
The Effect of Physical Activity on Executive Functions in the Elderly Population: A Systematic Review of Randomized Controlled Trials
Background/Objectives: In recent years, there has been increasing interest in the scientific, educational, and health sectors in investigating aspects upon which to design physical-activity interventions to prevent cognitive decline, a phenomenon that affects levels of autonomy and quality of life in older adulthood. Physical activity (PA) has been shown to be an effective strategy that can be used to preserve executive functions (EFs) by improving brain flexibility and efficiency. This systematic review aims to identify the most effective strategies used to maintain EF, prevent decline, and promote independence in the elderly. Methods: A systematic literature review was conducted according to PRISMA guidelines. The search was conducted in the following databases: Google Scholar, PubMed, Scopus, and Web of Science; the search used keywords such as “cognitive decline”; “cognitive flexibility”; “elderly”; “executive functions”; “inhibition”; “physical activity”; and “working memory”. Experimental studies published between 2019 and 2025 examining the effects of PA on EFs in adults over 60 were selected. After considering the inclusion and exclusion criteria, nine studies were included. The methodological quality of the included studies ranged from moderate to high according to the PEDro scale. Results: The analyzed studies show that short-term interventions positively affect one or two components of EFs, while medium- and long-term interventions produce benefits for all components (working memory, inhibition, and cognitive flexibility). Interventions combined with cognitive stimulation show a greater impact than PA alone. Conclusions: PA is an effective strategy for preserving EFs in the elderly, but the lack of standardized protocols makes it difficult to identify optimal interventions. Further research is needed to more precisely define the most effective intervention approaches.
Journal Article
Train teachers in digital citizenship to facilitate a sustainable education system
The technological development of the last twenty years, starting in Europe from the increased availability of Internet resources to the concept of the digital citizen, has involved our society at all levels, affecting politics, businesses, families and all forms of education and teaching at each and every level. The COVID pandemic that began in 2020 has led to further acceleration, so much so that both the Digital Agenda for information technology in public administration 2020-2022 (AGID) and the Action Plan for Digital Education 2021-2027 focus on a strong digital component in everyday life. A psychoeducational protocol for digital skills in teachers is hereby provided, tested on a sample over the course of 8 weeks. In order to be able to assess initial and final competences, a questionnaire on digital competences has been developed and validated, based on DigComp 2.1. Formare gli insegnanti alla cittadinanza digitale per facilitare un sistema educativo sostenibile. Lo sviluppo tecnologico degli ultimi vent’anni, a partire in Europa dalla maggiore disponibilità di risorse Internet fino al concetto di cittadino digitale, ha coinvolto la nostra società a tutti i livelli, interessando la politica, le imprese, le famiglie e tutte le forme di istruzione e didattica ad ogni livello. La pandemia di COVID iniziata nel 2020 ha portato a un’ulteriore accelerazione, tanto che sia l’Agenda Digitale per le tecnologie dell’informazione nella pubblica amministrazione 2020-2022 (AGID) sia il Piano d’Azione per l’Educazione Digitale 2021-2027 si concentrano su una forte componente digitale nella vita di tutti i giorni. Viene fornito un protocollo psicoeducativo per le competenze digitali degli insegnanti, testato su un campione nel corso di 8 settimane. Per valutare le competenze iniziali e finali è stato sviluppato e validato un questionario sulle competenze digitali, basato su DigComp 2.1.
Journal Article
La comision de la verdad en la trayectoria de la justicia transicional en Brasil
En 2011, veintisiete años luego del final de la dictadura militar en Brasil, una ley, aprobada con amplia mayoría en el Congreso, creó la Comisión Nacional de la Verdad. Sin carácter jurisdiccional, la Comisión tiene el mandato de aclarar, en dos años, las graves violaciones de los derechos humanos cometidas durante la dictadura, incluso si se produjeron en el extranjero. Al mismo tiempo sigue vigente una Ley de Amnistía anterior, de 1979, que, en su momento, resultó de un delicado acuerdo político entre el gobierno y la oposición. Dicha ley fue esencial para la transición pacífica del país a la democracia pero sus términos, hoy en contravía de los principios del derecho internacional de los derechos humanos, no permiten que los responsables por las violaciones sean juzgados y condenados. En su trayectoria de justicia transicional, Brasil solo aplicó el principio de la reparación y ahora camina hacia el principio de la verdad. Pero sigue legalmente impedido de aplicar la justicia. Cabe preguntarse cuál será la reacción de la sociedad brasileña ante las verdades aclaradas y el impacto que esa reacción pueda generar en la trayectoria de la justicia de transición brasileña: ¿indiferencia o cambios radicales? PALABRAS CLAVE Justicia transicional, Brasil, amnistía, Comisión de la Verdad, derecho internacional de los derechos humanos. Twenty-seven years after the end of the military rule (1964-1985), the Brazilian Congress passed legislation that established the Brazilian Truth Commission. With no judicial power, the Commission's mandate is to investigate details of the circumstances under which serious human rights crimes were committed during military rule in Brazil. However, contrary to the current developments of the International Human Rights Law, a Brazilian Amnesty Law, enacted in 1979 as a result of a delicate political compromise between government and opposition to end the military rule, forbids that \"political\" crimes committed at that time be investigated and taken to Court. Having implemented a complex reparation's program that benefited a large number of victims and establishing the Truth Commission to help coming to terms with the past, it is not clear, when the Commission concludes its work, what may follow, because of failure to meet the justice requirement. That will very much depend on Brazilian society's reaction to what will be revealed. Both indifference and outrage are possible outcomes. KEYWORDS Transitional Justice, Brazil, Amnesty, Truth Commission, International Human Rights Law.
Journal Article
Efficacy of extra-peritoneal pelvic packing in hemodynamically unstable pelvic fractures, a Propensity Score Analysis
Background
An option for emergency control of pelvic hemorrhage is Extra-peritoneal Pelvic Packing (EPP), which addresses the retroperitoneal source of exsanguination in pelvic fractures. The aim of this study was to demonstrate the efficacy of early EPP in reducing mortality due to hemorrhage from pelvic fractures, and to evaluate the impact of packing on transfusion requirements within the first 24 h and ICU length of stay (ICU-LOS).
All data pertaining trauma patients admitted from October 2002 and December 2103 with hemodynamic instability and pelvic fractures were selected from the Hospital Trauma Registry. Patients with severe brain injury and bleeding from extra-pelvic sources were excluded. Patient population was divided into two groups: EPP group, including patients admitted from 2009 to 2013, with EPP as part of the treatment algorithm, and NO-EPP group, from 2002 to 2008, without EPP as atherapeutic option. Descriptive statistical analysis was performed on allpatients. Twenty-five patients of each group with similar features were matched using Propensity Score Analysis (PSA).
Results
Six hundred eighty out of 4659 major trauma (14.6 %) presented a pelvic fracture. In 78 hemodynamically unstable patients (30 in EPP group,48 in NO-EPP group) the major source of bleeding was the pelvis. Among patients selected by PSA early mortality was significantly reduced in EPP group (20 vs 52 %,
p
= .03) compared to NO-EPP, notwithstanding similar hemodynamic impairment. No difference was observed in transfusion requirements and ICU-LOS.
Conclusions
The EPP is a safe and quick procedure, able to improve hemodynamic stabilization and to reduce acute mortality due to hemorrhage in patients with pelvic fracture, in combination with optimized transfusion protocol. EPP may be useful as a bridge for time-consuming procedures, such as angio-embolization.
Journal Article
Mental skill training to enhance sport motivation in adolescents
Adolescence is a period of strong changes for individuals; it can cause an important load of stressful stimuli with consequent anxious states with different intensity (Ferron et al., 1984). A large number of studies demonstrated that practicing sports and physical activity can lead to a large number of benefits for physical and mental health and can increase the vitality (Bouchard, Blair, & Haskell, 2007; Pelletier, Vallerand, & Sarrazin, 2007) and the improvement of some psychological and social factors in adolescents, such as self-esteem, mental well-being, academic performance and relationships with parents (Slutzky & Simpkins, 2009, Liu et al, 2014). Even if these benefits are known by the most part of people and the culture of an active lifestyle is broadening, there's a large number of people that stop participation or start to have a sedentary lifstyle (Sarrazin, Boiché, & Pelletier, 2007). According to Self Determination Theory (Ryan & Deci, 2007), the engagement in sport can be determined by factors as rewards, evaluations, pressure or by opinions from others (Ryan & Deci, 2007), definided as external or/andpeople can be moved by interest, curiosity or the desire for improvement. It can be useful to act at different levels in order to maintain sport participation. According to Hodge, Sleivert and Mackenzie (1996), Mental Skill Training can be a valid method to foster motivation, throughout goal setting, self-talk, relaxation and imagery. Our study had the aim to investigate the relationship between a mental skill training program and the level of sport motivation of a group of teenage swimmer athletes.
Journal Article
Consequences of Increases in Antibiotic Resistance Pattern on Outcome of Pancreatic Resection for Cancer
Background
The role of drug-resistance infections on surgical outcomes is controversial. The aim of the study was to determine whether increase antibiotic resistance was an independent risk factor for development of major non-infectious postoperative complications.
Methods
This work included a multicenter cohort study of patients who underwent pancreatic resections for cancer over a 3-year interval. The primary outcome was major non-infectious complication rate developing after the occurrence of multi-drug sensitive (MDS) infection, multi-drug-resistant infection (MDR), and extensive drug-resistant (XDR) infection. Multivariate logistic regression models were used to adjust for patient and operative effects.
Results
Eligible patients (517) were selected for the analysis. One hundred and thirteen (21.8%) patients had major non-infectious complications with a rate of 12.9% in the no infection group, 29.3% in the MSD, 41.5% in the MDR, and 58.8% in the XDR (
p
< 0.001). The median time of infection occurrence was postoperative days 4 (2–7 IQR) and 7 (3–12 IQR) non-infectious complications. At multivariate analysis, the risk of having major non-infectious complications was 2.67 (95% CI 1.24–5.77,
P
= 0.012) for MDR, 5.04 (95% CI 2.35–10.80,
P
< 0.001) for MDR, and 9.64 (95% CI 2.71–34.28,
P
< 0.001) for XDR.
Conclusion
Antimicrobial resistance is significantly associated with the risk of major non-infectious morbidity.
Journal Article
Effectiveness of Vitamin D Supplements among Patients Hospitalized for COVID-19: Results from a Monocentric Matched-Cohort Study
Objectives: Our study aimed to evaluate the usefulness of Vitamin D3 (VitD3) among patients hospitalized for COVID-19. The primary endpoint was to evaluate the difference in survival rates between patients receiving and not VitD3. The secondary endpoints were to evaluate clinical outcomes, such as needing non-invasive ventilation (NIV), ICU transfer, and laboratory findings (inflammatory parameters). Methods: We conducted a retrospective, monocentric matched-cohort study, including patients attending our ward for COVID-19. Patients were divided into two groups depending on VitD3 administration (Group A) or not (Group B) among patients with low VitD levels (defined as blood levels < 30 ng/mL), which depended on physicians’ judgment. Our internal protocol provides VitD3 100,000 UI/daily for two days. Findings: 58 patients were included in Group A, and 58 in Group B. Patients were matched for age, sex, comorbidities, COVID-19-related symptoms, PaO2/FiO2 ratio, blood exams, and medical treatments. Regarding the principal endpoint, there was a statistically significant difference between the two groups in survival rates [Group A vs. Group B = 3 vs. 11 (p = 0.042)]. When considering secondary endpoints, Group A patients were less likely to undergo NIV [Group A vs. Group B = 12 vs. 23 (p = 0.026)] and showed an improvement in almost all inflammatory parameters. Conclusions: The link between VitD3 deficiency and the clinical course of COVID-19 during hospitalization suggests that VitD3 level is a useful prognostic marker. Considering the safety of supplementation and the low cost, VitD3 replacement should be considered among SARS-CoV-2 infected patients needing hospitalization.
Journal Article