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"Spiro, M."
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Rome : an urban history from antiquity to the present
\"Spanning the entire history of the city of Rome from Iron Age village to modern metropolis, this is the first book to take the long view of the Eternal City as an urban organism. Three thousand years old and counting, Rome has thrived almost from the start on self-reference, supplementing the everyday concerns of urban management and planning by projecting its own past onto the city of the moment. This is a study of the urban processes by which Rome's people and leaders, both as custodians of its illustrious past and as agents of its expansive power, have shaped and conditioned its urban fabric by manipulating geography and organizing space; planning infrastructure; designing and presiding over mythmaking, ritual, and stagecraft; controlling resident and transient populations; and exploiting Rome's standing as a seat of global power and a religious capital\"-- Provided by publisher.
Book
Open data policy and data sharing in Astroparticle Physics: the case for high-energy multi-messenger astronomy
This paper is a position paper on open data policy and data sharing in Astroparticle Physics, focusing on the case of high-energy multi-messenger astronomy. It is presented on behalf of ApPIC, Astroparticle Physics International Committee [1], IUPAP (International Union for Pure and Applied Physics) working group 10.
Journal Article
In Vitro Antineoplastic and Antiviral Activity and In Vivo Toxicity of Geum urbanum L. Extracts
This study evaluated the in vitro antineoplastic and antiviral potential and in vivo toxicity of twelve extracts with different polarity obtained from the herbaceous perennial plant Geum urbanum L. (Rosaceae). In vitro cytotoxicity was determined by ISO 10993-5/2009 on bladder cancer, (T-24 and BC-3C), liver carcinoma (HEP-G2) and normal embryonic kidney (HEK-293) cell lines. The antineoplastic activity was elucidated through assays of cell clonogenicity, apoptosis induction, nuclear factor kappa B p65 (NFκB p65) activation and total glutathione levels. Neutral red uptake study was applied for antiviral activity. The most promising G. urbanum extract was analyzed by UHPLC–HRMS. The acute in vivo toxicity analysis was carried out following OEDC 423. The ethyl acetate extract of aerial parts (EtOAc-AP) exhibited the strongest antineoplastic activity on bladder cancer cell lines (IC50 = 21.33–25.28 µg/mL) by inducing apoptosis and inhibiting NFκB p65 and cell clonogenicity. EtOAc and n-butanol extracts showed moderate antiviral activity against human adenovirus type 5 and human simplex virus type I. Seventy four secondary metabolites (gallic and ellagic acid derivatives, phenolic acids, flavonoids, etc.) were identified in EtOAc-AP by UHPLC–HRMS. This extract induced no signs of acute toxicity in liver and kidney specimens of H-albino mice in doses up to 210 mg/kg. In conclusion, our study contributes substantially to the detailed pharmacological characterization of G. urbanum, thus helping the development of health-promoting phytopreparations.
Journal Article
Self-perception of fatigue in individuals diagnosed with head and neck cancer
Purpose
Head and neck cancer (HNCa) presents numerous challenges secondary to treatment. While there is substantial clinical awareness to the range of challenges demonstrated in this population, information on the impact of post-treatment fatigue is limited. This study investigated the degree of perceived fatigue in those treated for HNCa.
Methods
The study was a cross-sectional, self-report, survey design. Adult participants (n = 47) completed a series of three questionnaires; two validated fatigue measures – the
Fatigue Screening Inventory
(FSI) and the
Multidimensional Fatigue Inventory
(MFI-20) and a general health-related quality of life measure the
European Organisation of Research on the Treatment of Cancer – Quality of Life Questionnaire
(EORTC-QLQC30) and the head and neck site specific module (QLQ - H&N 35) were administered.
Results
Of the 47 participants, more than half (55%) were identified as having clinically significant self-reported levels of fatigue. Correlational analysis revealed an inverse relationship between fatigue and overall health-related quality of life (HRQOL) implying that as fatigue increases, one’s perceived HRQOL decreases.
Conclusions
These data suggest that efforts to proactively screen for and index fatigue and seek anticipatory interventions may benefit both short- and long-term HRQOL outcomes in those diagnosed with HNCa.
Level of Evidence:
IV.
Journal Article
International comparison of equity gradients in hospitalizations for ambulatory care sensitive conditions
Background
Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) are thought to be avoidable with effective preventive care and early disease management, usually delivered in community-based ambulatory care settings. These hospitalizations are both costly and sensitive to the socioeconomic situation of patients. Understanding whether different health systems mitigate the sensitivity of ACSCs to socioeconomic gradients may direct attention to equity-improving approaches to ambulatory health care. This study sought to identify differences in the gradient of Ambulatory Care Sensitive Conditions (ACSC) relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US).
Methods
The nine countries participating in the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) calculated age—and sex-specific ACSC hospitalization rates between January 1, 2019, and December 31, 2019, based on data from national data sources on hospitalization and sociodemographic information at small-area levels. We used a common definition of ACSC indicators developed through a literature review of indicators routinely used in healthcare performance monitoring. We employed linear regression models to assess inequalities in ACSC association with area-level socioeconomic deprivation and income using the Slope Index of Inequality and the Relative Index of Inequality.
Results
A persistent pattern higher ACSC hospitalization rates for individuals in most disadvantaged areas remained irrespective of the socioeconomic status measure used. There was, however, considerable variation in relative equity gradients in ACSC hospitalizations between countries. Using the nine condition ACSC definition, the greatest inequalities were observed in England (RII = 0.26), and the least inequalities in ACSC hospitalizations were observed in Spain (RII = 0.68) in the 18 + cohort.
Conclusions
A consistent equity gradient in ACSC hospitalizations was observed across high-income countries included in this study. Addressing these inequities with targeted policies can reduce the cost of care while improving access to high quality care.
Journal Article
Micellar Curcumin Substantially Increases the Antineoplastic Activity of the Alkylphosphocholine Erufosine against TWIST1 Positive Cutaneous T Cell Lymphoma Cell Lines
Cutaneous T-cell lymphoma (CTCL) is a rare form of cancer with local as well as systemic manifestations. Concomitant bacterial infections increase morbidity and mortality rates due to impaired skin barrier and immune deficiency. In the current study, we demonstrated that the in vitro anti-lymphoma potential of erufosine is diminished by TWIST1 expression and micellar curcumin substantially increases its antineoplastic activity. Pharmacokinetic analysis showed that the micellar curcumin (MCRM) used in our study was characterized by low zeta potential, slow release of curcumin, and fast cell membrane penetration. The combination ratio 1:4 [erufosine:MCRM] achieved strong synergism by inhibiting cell proliferation and clonogenicity. The combined antiproliferative effects were calculated using the symbolic mathematical software MAPLE 15. The synergistic combination strongly decreased the expression of TWIST1 and protein kinase B/Akt as proven by western blotting. Significant reductions in NF-κB activation, induction of apoptosis, and altered glutathione levels were demonstrated by corresponding assays. In addition, the synergistic combination enhanced the anti-staphylococcal activity and prevented biofilm formation, as shown by crystal violet staining. Taken together, the above results show that the development of nanotechnological treatment modalities for CTCL, based on rational drug combinations exhibiting parallel antineoplastic and antibacterial effects, may prove efficacious.
Journal Article
When a Headache Is More than the Flu: A Case Report
Introduction: When influenza (flu) season arrives, it is easy for emergency department clinicians to anchor on the diagnosis of flu, sending patients on their way with or without anti-influenza medication. It is important not to miss the outlier – the patient who seems to have typical symptoms of influenza but with certain subtleties that should make one consider expanding the differential diagnosis. Case Report: We describe an 11-year-old previously healthy male who presented with eight days of fever, myalgias, cough, congestion, and headache in the context of positive influenza exposure. The length and severity of his symptoms prompted laboratory and imaging investigation. He was positive for influenza type B with elevated inflammatory markers but otherwise normal laboratory workup and normal chest radiograph. He complained of a headache and was given fluids and antipyretics, and was admitted for overnight observation. He specifically did not have any forehead swelling. The next day during his inpatient stay he developed right frontal forehead edema and appeared ill. He was taken for a sinus computed tomography, which showed changes consistent with frontal bone osteomyelitis. Even after drainage by neurosurgery and otolaryngology, the patient subsequently developed repeat abscesses and ultimately a superior sagittal sinus thrombosis. Conclusion: Other sources of infection should be considered in patients who have flu-like symptoms that last longer than expected, present with focality, or appear ill.
Journal Article
Antineoplastic effect of a novel nanosized curcumin on cutaneous T cell lymphoma
Cutaneous T cell lymphomas (CTCLs) are a group of heterogeneous, life-threatening, extra-nodal and lymphoproliferative T cell neoplasms. Since chronic inflammation serves a key role in CTCL progression, curcumin, a natural pigment with proven anti-inflammatory and antineoplastic properties, as well as minimal toxicity, may be used as a therapeutic agent. In the present study, two formulations of curcumin (standard ethanolic and a Pluronic®P-123/F-127 micellar solution) were compared regarding their cytotoxic efficacy and speed of internalization in three CTCL cell lines, namely HuT-78, HH and MJ. In addition, the modulating effect of curcumin on selected proteins involved in the proliferation and progression of the disease was determined. The results indicated the superiority of the Pluronic®P-123/F-127 micellar curcumin over the standard ethanol solution in terms of cellular internalization efficiency as determined by spectrophotometric analysis. Notably, the presence of commonly used media components, such as phenol red, may interfere when interpreting the cytotoxicity of curcumin, due to their overlapping absorbance peaks. Therefore, it was concluded that phenol red-free media are superior over media with phenol red in order to correctly measure the cytotoxic efficacy and cell penetration of curcumin. Depending on the cell line, the IC50 values of micellar curcumin varied from 29.76 to 1.24 µΜ, with HH cells demonstrating the highest sensitivity. This cell line had the lowest expression levels of the Wilms' tumor-1 transcription factor. Performing western blot analyses of treated and untreated CTCL cells, selective signal transduction changes were recorded for the first time, thus making curcumin nano-formulation an attractive and prospective option with therapeutic relevance for CTCL as a rare orphan disease.
Journal Article
A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain
To identify a biomarker panel with sufficient sensitivity and negative predictive value to identify children with abdominal pain at low risk for acute appendicitis in order to avoid unnecessary imaging.
We prospectively enrolled 503 subjects aged two to 20 years with <72 hours of abdominal pain consistent with appendicitis. Blood samples from each patient were analyzed for CBC, differential, and 5 candidate proteins. Biomarker values were evaluated using principal component, recursive partitioning and logistic regression to select the combination that best discriminated between those subjects with and without disease.
The prevalence of acute appendicitis was 28.6%. A mathematical combination of three inflammation-related markers in a panel comprised of white blood cell count (WBC), C-reactive protein (CRP), and myeloid-related protein 8/14 complex (MRP 8/14) provided the best discrimination. This panel exhibited a sensitivity of 96.5% (95% CI, 92-99%), a negative predictive value of 96.9% (95% CI, 93-99%), a negative likelihood ratio of 0.08 (95% CI, 0.03- 0.19), and a specificity of 43.2% (95% CI, 38-48%) for acute appendicitis. Sixty of 185 CT scans (32.4%) were done for patients with negative biomarker panel results which, if deferred, would have reduced CT utilization at initial presentation by one third at the cost of missing five of 144 (3.5%) patients with appendicitis.
This panel may be useful in identifying pediatric patients with signs and symptoms suggestive of acute appendicitis who are at low risk and can be followed clinically, potentially sparing them exposure to the ionizing radiation of CT.
Journal Article