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BACKGROUND: The elastic scattering spectroscopy (ESS) device (DermaSensor Inc., Miami, FL) is a noninvasive, painless, adjunctive tool for skin cancer detection. OBJECTIVES: To investigate the performance of the ESS device in the detection of melanoma. METHODS: A prospective, investigator-blinded, multicenter study was conducted at 8 United States (US) and 2 Australian sites. All eligible skin lesions were clinically concerning for melanoma, examined with the ESS device, subsequently biopsied according to dermatologists standard of care, and evaluated with histopathology. A total of 311 participants with 440 lesions were enrolled, including 44 melanomas (63.6% in situ and 36.4% invasive) and 44 severely dysplastic nevi. RESULTS: The observed sensitivity of the ESS device for melanoma detection was 95.5% (95% CI, 84.5% to 98.8%, 42 of 44 melanomas), and the observed specificity was 32.5% (95% CI, 27.2% to 38.3%). The positive and negative predictive values were 16.0% and 98.1%, respectively. LIMITATIONS: The device was tested in a high-risk population with lesions selected for biopsy based on clinical and dermoscopic assessments of board-certified dermatologists. Most enrolled lesions were pigmented. CONCLUSION: The ESS devices high sensitivity and NPV for the detection of melanoma suggest the device may be a useful adjunctive, point-of-care tool for melanoma detection.

ABSTRACT Colorectal cancer (CRC) is a common disease, with incidence in Brazil of 45,630 new cases per 100,000 inhabitants between 2023-2025. Risk factors for CRC can be evaluated between environmental and hereditary and their mode of presentation are classified as sporadic, inherited and familial. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. The percentage of patients with a true hereditary genetic predisposition is less than 10%, and these are related to the presence or absence of colonic polyps as an important manifestation of the disease. Non-polyposis diseases are known as hereditary non-polypomatous colorectal cancer (HNPCC) or Lynch syndrome, and polyposis diseases are familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), and hamartomatous polyposis syndromes (e.g., Peutz-Jeghers, juvenile polyposis, phosphatase and tensin homologue - PTEN, Cowden syndrome). These diseases are linked to a high risk of developing cancer. With the development of treatments in metastatic disease and the use of targeted therapies and their biomarkers, it was possible to evaluate them within clinical studies both in the primary tumor and in the correspondence of metastases.

ABSTRACT Liver metastases from melanomas, sarcomas, and renal tumors are less frequent. Treatment and prognosis will depend on whether they are isolated or multiple, size and location, the presence or absence of extrahepatic neoplastic disease, age, stage of the initial disease, initial treatments instituted, time of evolution, and clinical condition of the patient. Recently, a high number of oncological therapies including monotherapy or in combination, neoadjuvants or adjuvants, and immuno-oncological treatments have been developed and tested, increasing disease-free time and survival.

Background: The elastic scattering spectroscopy (ESS) device (DermaSensor Inc., Miami, FL) is a noninvasive, painless, adjunctive tool for skin cancer detection. Objectives: To investigate the performance of the ESS device in the detection of melanoma. Methods: A prospective, investigator-blinded, multicenter study was conducted at 8 United States (US) and 2 Australian sites. All eligible skin lesions were clinically concerning for melanoma, examined with the ESS device, subsequently biopsied according to dermatologists’ standard of care, and evaluated with histopathology. A total of 311 participants with 440 lesions were enrolled, including 44 melanomas (63.6% in situ and 36.4% invasive) and 44 severely dysplastic nevi. Results: The observed sensitivity of the ESS device for melanoma detection was 95.5% (95% CI, 84.5% to 98.8%, 42 of 44 melanomas), and the observed specificity was 32.5% (95% CI, 27.2% to 38.3%). The positive and negative predictive values were 16.0% and 98.1%, respectively. Limitations: The device was tested in a high-risk population with lesions selected for biopsy based on clinical and dermoscopic assessments of board-certified dermatologists. Most enrolled lesions were pigmented. Conclusion: The ESS device’s high sensitivity and NPV for the detection of melanoma suggest the device may be a useful adjunctive, point-of-care tool for melanoma detection.

Fire disturbances are increasing under global climate change and ecological transformations of forests are occurring. Specifically, shifts from productive closed-canopy feather moss forests to low-productivity open-canopy lichen (Cladonia spp.) woodlands have been observed in boreal forests of eastern Canada. It has been hypothesized that high severity of fires would be the cause of this change, but this is difficult to validate a posteriori on mature forest stands. Because charcoal properties are affected by fire severity, we have put forward the hypothesis that the amount and physicochemical properties of charcoal (C, N, H, O, ash, surface area) would be different and indicative of a greater fire severity for open-canopy forests compared to closed canopy ones. Our hypothesis was partly validated in that the amount of charcoal found on the ground of closed-canopy forests was greater than that of open-canopy forests. However, the physicochemical properties were not different, albeit a greater variability of charcoal properties for open canopy stands. These results do not allow us to fully validate or reject our hypothesis on the role of fire severity in the shift between open and closed canopy stands. However, they suggest that the variability in fire conditions as well as the amounts of charcoal produced are different between the two ecosystem types. Furthermore, considering the role that biochar may play in improving soil conditions and promoting vegetation restoration, our results suggest that charcoal may play a role in maintaining these two stable alternative ecosystem states.

PURPOSEThis study aimed to develop a multivariable, weighted overall survival (OS) risk score (SRS) for nonmetastatic (M0) invasive breast cancer (M0-BC, SRSM0-BC).MATERIALS AND METHODSThis study included a training (1,890 patients) and a validation cohort (850 patients) from the Reggio Emilia Cancer Registry (RE-CR). Ten traditional prognostic variables were evaluated.RESULTSIn the training set, all the variables but the human epidermal growth factor receptor were significantly associated with OS at univariable analysis. A multivariable model identified an increased death risk for estrogen receptor (hazard ratio [HR], 2.0 [95% CI, 1.1 to 3.1]; P = .021), tumor stages T2-T3 (HR, 2.4 [95% CI, 1.3 to 4.7]; P = .009) and T4 (HR, 5.1 [95% CI, 2.0 to 13.0]; P < .001), and age >74 years (HR, 5.7 [95% CI, 4.0 to 8.2]; P < .001). By assigning scores according to HRs, four risk categories were generated (P for trend

Enhanced Recovery After Surgery (ERAS) protocols have changed perioperative care, aiming to optimize patient outcomes. This study assesses ERAS implementation effects on postoperative complications, length of hospital stay (LOS), and mortality in colorectal cancer (CRC) patients. A retrospective real-world analysis was conducted on CRC patients undergoing surgery within a Northern Italian Cancer Registry. Outcomes including complications, re-surgeries, 30-day readmission, mortality, and LOS were assessed in 2023, the year of ERAS protocol adoption, and compared with data from 2022. A total of 158 surgeries were performed, 77 cases in 2022 and 81 in 2023. In 2023, a lower incidence of postoperative complications was observed compared to that in 2022 (17.3% vs. 22.1%), despite treating a higher proportion of patients with unfavorable prognoses. However, rates of reoperations and readmissions within 30 days post-surgery increased in 2023. Mortality within 30 days remained consistent between the two groups. Patients diagnosed in 2023 experienced a statistically significant reduction in LOS compared to those in 2022 (mean: 5 vs. 8.1 days). ERAS protocols in CRC surgery yield reduced postoperative complications and shorter hospital stays, even in complex cases. Our study emphasizes ERAS’ role in enhancing surgical outcomes and recovery.

This study aimed to assess whether multidisciplinary team (MDT) management improves outcomes in patients with stage I–III colorectal cancer (CRC) compared to non-MDT care. This study included 460 CRC patients diagnosed from 2017 to 2018 in a northern Italian province, of whom 300 (65%) were managed by MDT. MDT patients were younger, more frequently had rectal cancers, were diagnosed at earlier stages, and were more likely to undergo surgery and chemotherapy. Disease-free survival (DFS) and overall survival (OS) were significantly better in the MDT group. The recurrence rate was 8.5%, with no significant differences between MDT and non-MDT patients, although MDT patients exhibited lower recurrence rates for early-stage tumors. A multivariable analysis showed that DFS and OS were adversely affected by older age, advanced stage, and lack of MDT management. Kaplan–Meier estimates demonstrated a 3-year DFS of 78% in the MDT group versus 65% in the non-MDT group, as well as an OS of 83% versus 69%, respectively. The MDT approach was associated with improved treatment adherence and better management of recurrences. While limited by a small sample size, this population-based study highlights the beneficial impact of MDT care on CRC outcomes. Further research with extended follow-up is warranted to confirm these findings.

Abstract Background First‐line nivolumab plus chemotherapy and nivolumab plus ipilimumab both demonstrated significant overall survival (OS) benefit versus chemotherapy in previously untreated patients with advanced esophageal squamous cell carcinoma (ESCC) in the CheckMate 648 trial, leading to approvals of both nivolumab‐containing regimens in many countries. We report longer‐term follow‐up data. Methods This open‐label, phase III trial (NCT03143153) enrolled adults with previously untreated, unresectable, advanced, recurrent, or metastatic ESCC. Patients were randomized 1:1:1 to nivolumab plus chemotherapy, nivolumab plus ipilimumab, or chemotherapy. Primary endpoints were OS and progression‐free survival (PFS) by blinded independent central review. Hierarchical testing was performed first in patients with tumor cell programmed death ligand 1 (PD‐L1) expression of ≥1% and then in the overall population. Results A total of 970 patients were randomly assigned. After 29 months of minimum follow‐up, nivolumab plus chemotherapy continued to demonstrate improvement in OS versus chemotherapy (hazard ratio [HR] = 0.59 [95% CI: 0.46–0.76]) in patients with tumor cell PD‐L1 expression of ≥1% and in the overall population (HR = 0.78 [95% CI: 0.65–0.93]) and with nivolumab plus ipilimumab versus chemotherapy (HR = 0.62 [95% CI: 0.48–0.80]) in patients with tumor cell PD‐L1 expression of ≥1% and in the overall population (HR = 0.77 [95% CI: 0.65–0.92]). In patients with tumor cell PD‐L1 expression of ≥1%, nivolumab plus chemotherapy demonstrated PFS benefit versus chemotherapy (HR = 0.67 [95% CI: 0.51–0.89]); PFS benefit was not observed with nivolumab plus ipilimumab versus chemotherapy (HR = 1.04 [95% CI: 0.79–1.36]). Among all treated patients (n = 936), Grade 3–4 treatment‐related adverse events were reported in 151 (49%, nivolumab plus chemotherapy), 105 (32%, nivolumab plus ipilimumab), and 110 (36%, chemotherapy) patients. Conclusions Nivolumab plus chemotherapy and nivolumab plus ipilimumab continued to demonstrate clinically meaningful OS benefit versus chemotherapy with no new safety signals identified with longer follow‐up, further supporting use as first‐line standard treatment options for patients with advanced ESCC.

The COVID-19 pandemic has caused delays in cancer diagnoses and reductions in treatments. The aim of this work is to evaluate the impact of the pandemic on prostate cancer by evaluating whether there has been a shift towards more aggressive (Gleason) and more advanced tumors (stage IV) and a decline in treatments. The study was conducted on 1123 cases of prostate cancer incident in the Province of Reggio Emilia, Northern Italy, in the period of 2018–2021. In 2020, there was a decline in new diagnoses of prostate cancer (−31%), followed by a slight recovery in 2021 (+5%). While Gleason 7 and 8–10 values remained constant, a significant decrease was recorded in stage I (38.7%, 41.6%, 35.5%, and 27.7%) and an increase in stage IV (13.1%, 13%, 15.4%, and 20%) cases in the years 2018, 2019, 2020, and 2021, respectively. However, there was no impact on surgical treatment (which remained constant at around 35%) and radiotherapy (around 39%). Our findings underline the profound impact of COVID-19 on prostate cancer management, highlighting the importance of healthcare resilience in the face of unprecedented disruptions.

Combining phytoextraction and biochar amendment was suggested as an alternative for selenium (Se) bioremediation in contaminated soils. The current study aimed to test the performance of activated biochar as an amendment for the phytoextraction of selenium-contaminated soil by Phleum sp. Results showed that Se immobilization in soil was enhanced by the addition of activated biochar owing to its improved physicochemical structure compared to pristine biochar. In parallel, activated biochar contributed to improving soil fertility by increasing pH and organic matter. The bioaccumulation factor (BAF) of Se in the absence of activated biochar and biochar amendment was 8.7, which suggests the suitability of the Phleum plant species as a Se secondary accumulator species to be further used in a Nordic context. Se plant uptake was positively correlated to Se level in soil, pH, redox potential, organic matter, cations (Ca, Mg, Na, K), metals (Al, Cr, Fe, Mn, Co, Pb) and anions (Cl, SO4). However, Se bioavailability for plant uptake was reduced due to Se immobilization in soil by activated biochar. Thus, activated biochar addition played an important role to support Se levels reduction in contaminated soil and consequently hinder phytoextraction performance by Phleum species. This combination of activated biochar and Phleum Se-accumulator plant was validated as an efficient solution for Se remediation in contaminated soil which could be applied at large scale under cold climates.

Cancer remains a significant public health challenge in Brazil, with an estimated 704 thousand new cases annually. Clinical oncology, a pivotal specialty in cancer diagnosis and treatment, has evolved since its formal establishment in 1946. Recent recognition by the Brazilian Federal Board of Medicine solidified its status, culminating in normative resolution nr. 2,162/2017. The present study aims to characterize Brazilian clinical oncologists and analyze their epidemiological and structural contexts using data from the Brazilian Society of Clinical Oncology's 2023 census and secondary sources, including the National Cancer Institute (Instituto Nacional de Câncer [INCA], in Portuguese) and Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatistica [IBGE], in Portuguese). A cross-sectional design employing qualitative-quantitative methods surveyed 761 clinical oncologists, revealing insights into demographics, workload, stress levels, and challenges. The results highlight regional disparities in cancer mortality rates despite the concentration of oncology services in the South and Southeast. Challenges include access to new treatments, late diagnoses, and systemic underfunding. Moreover, this study underscores gender and racial disparities within the specialty, indicating a predominantly white and heterosexual profile among practitioners. Addressing these issues is crucial for enhancing healthcare equity and improving patients' outcomes in oncology practice.

This Forum focuses on a variety of discourses that in one way or another "understand" and normalize the logic of Putin's war against Ukraine. These discourses have different epistemologies - some of them might simply reproduce Russian propagandistic cliches, while others are embedded in - and adjusted to - specific national contexts; some of them emanate from political milieus, while others have academic pedigrees. Of particular interest for the reader is a comparative frame of the Forum that gives floor to European and non-European perspectives on the topic that at some point resonate, engage, and communicate with each other. The authors discuss social and cultural conditions that produce professional and vernacular narratives sympathetic to or compatible with the Russian officialdom, and deploy them in different theoretical contexts - from neorealist to post-colonial.

Over the last decade, a number of non-mainstream European parties have cultivated friendly and mutually advantageous relations with the Russian political establishment. This phenomenon has been common to both the national conservative right and the radical left. This article critically discusses these parties' adaptation to the new political context triggered by Russia's full-scale invasion of Ukraine and assesses their strategies and tactics to adapt to the new reality. The cases analysed include primarily Western European Russia-friendly political forces and the level of analysis focuses both on the domestic and supranational EU-level dynamics.

Abstract Since its first introduction into medical practice, reflectance confocal microscopy (RCM) has been a valuable non-invasive diagnostic tool for the assessment of benign and malignant neoplasms of the skin. It has also been used as an adjunct for diagnosing equivocal cutaneous neoplasms that lack characteristic clinical or dermoscopic features. The use of RCM has led to a decreased number of biopsies of benign lesions. Multiple published studies show a strong correlation between RCM and histopathology thereby creating a bridge between clinical aspects, dermoscopy, and histopathology. Dermatopathologists may potentially play an important role in the interpretation of confocal images, by their ability to correlate histopathologic findings. RCM has also been shown to be an important adjunct to delineating tumoral margins during surgery, as well as for monitoring the non-surgical treatment of skin cancers. Advanced technology with smaller probes, such as the VivaScope 3000, has allowed access to lesions in previously inaccessible anatomic locations. This review explains the technical principles of RCM and describes the most common RCM features of normal skin with their corresponding histological correlation.

Ammoniacal nitrogen (N-NH3) is one of the pollutants that has adverse effects on the environment and is present in most effluents generated by mining operations. Therefore, mining companies must manage it to keep it below the regulated discharge criteria to avoid environmental contamination. In this context, the present study aims to valorize N-NH3 in the form of ammonium sulphate ((NH4)2SO4) for the manufacture of biochar pellets used as growth substrates for the production of forest seedlings. The biochar was first produced by fast pyrolysis, at 320 °C, and different recipes of pellets were then prepared to evaluate their hardness, binder type and content, humidity and durability. The optimal granule chosen was composed of biochar, corn starch and canola oil. Six combinations of different compositions were then prepared as substrates for black spruce growth: (1) Peat (P); (2) Peat and bulk biochar (PB); (3) Peat and bulk biochar impregnated with ammonium sulfate (PBAS); (4) Peat and biochar pellets impregnated with water (PBPeW); (5) Peat and biochar pellets impregnated with an ammonium sulfate solution (PBPeAS); (6) Peat, biochar pellets impregnated with ammonium sulfate and perlite (PBPeASPer). The effects of these substrates on the growth of black spruce seedlings, as well as fertilizer leaching, were measured. The results show that seedling biomass is equivalent to the control for the granular treatment, but higher biomass was obtained with bulk biochar (PB). This shows that a quarter of peat could be replaced by biochar to obtain similar or even better results of biomass yield and, consequently, solve part of the supply issue. As to plant nutrition, no tendency was observed for the experiments apart from the higher proportion of Ca in spruce needles. The prepared biochar-based pellet substrate appears to not only be advantageous for spruce production but also for other uses such as golf courses, forestry producers and horticultural nurseries using conventional fertilizers and peat as growing media. In addition, these approaches could help the Abitibi-Témiscamingue region in Québec, Canada to build a local circular economy.

Abstract This case describes a patient with development of radiation‐induced morphea after irradiation to the femurs for osteoblastic metastases of breast cancer. This rare and underdiagnosed complication of radiation therapy is an important contributor to morbidity in oncologic patients. Increased awareness of this condition will allow earlier dermatologic consultation and may improve cosmetic and functional outcomes.

Introduction: The objective of our study is to present the first Brazilian irreversible electroporation experience in the treatment of solid cancer. Material and Methods: A retrospective study with the first ten patients who underwent percutaneous or surgical IRE to treat solid cancer between March 2021 and May 2021. Preoperative data collection included patient demographics along with previous oncologic treatments. Operative and post-operative assessment involved number of probes, number of pulses, initial and final current and 30-days complications. Results: Primary tumor was locally advanced pancreatic cancer (70%), colorectal hepatic metastasis (20%), and cholangiocarcinoma (10%). All patients had previously undergone chemotherapy with stable disease in 80% and partial response in 20% before IRE. Eighty percent of the procedures was performed surgically and 20% percutaneously CT-guided. The mean procedure time of IRE was 38 minutes. Adverse events occurred in 4 patients (40%), all being grade I-II complications.

The aim of this study is to present the 5-year relative survival by stage of breast and colorectal cancer patients in a northern Italian province. For the period 2013-2015, cases were selected from the Reggio Emilia Cancer Registry. Breast cancer patients were divided into 3 age groups:

A adoção pode ser considerada um ato nobre no que diz respeito ao poder que tem em mudar o bem-estar do animal adotado. O abandono de cães e gatos tem aumentado, fazendo com que tenha muitos animais nas ruas em situações de vulnerabilidade e podendo transmitir zoonoses. As ONGs desempenham um papel extremamente importante, quando se leva em conta o abandono de animais, já que recolhem esses animais em situações de vulnerabilidade lhes proporcionando um novo lar, conscientizando a população e facilitando o processo de adoção. Esta revisão bibliográfica visa a conscientização sobre a importância da adoção animal.

Simple Summary: Colorectal cancer is a frequent neoplasm in the general population in both males and females. If oncological screening allows for the early diagnosis of the neoplasm, when present, the management of tumors that are not detected at an early stage becomes more complex. In recent years, in the most cutting-edge hospitals, the establishment of dedicated therapeutic paths that include a team of professionals from different specialties (oncologist, surgeon, radiotherapist, pathologist, radiologist, and, frequently, psychologist and data manager) has become increasingly common. This work shows how, in a province of Northern Italy, the presence of a multidisciplinary team dedicated to the management of patients with colorectal cancer is able to best deal with the patient's recurrences and take care of the person throughout the disease's complexity. In the era of personalized medicine, personalization involves not only drugs but also the management of the person and not just the tumor. This study aimed to assess whether multidisciplinary team (MDT) management improves outcomes in patients with stage I–III colorectal cancer (CRC) compared to non-MDT care. This study included 460 CRC patients diagnosed from 2017 to 2018 in a northern Italian province, of whom 300 (65%) were managed by MDT. MDT patients were younger, more frequently had rectal cancers, were diagnosed at earlier stages, and were more likely to undergo surgery and chemotherapy. Disease-free survival (DFS) and overall survival (OS) were significantly better in the MDT group. The recurrence rate was 8.5%, with no significant differences between MDT and non-MDT patients, although MDT patients exhibited lower recurrence rates for early-stage tumors. A multivariable analysis showed that DFS and OS were adversely affected by older age, advanced stage, and lack of MDT management. Kaplan–Meier estimates demonstrated a 3-year DFS of 78% in the MDT group versus 65% in the non-MDT group, as well as an OS of 83% versus 69%, respectively. The MDT approach was associated with improved treatment adherence and better management of recurrences. While limited by a small sample size, this population-based study highlights the beneficial impact of MDT care on CRC outcomes. Further research with extended follow-up is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Nitrogen is an essential nutrient for plant functioning, photosynthesis, and metabolic activities. In terrestrial settings, nitrogen is not always sufficiently available because its basic form (N2) must be fixed into other forms, such as nitrate and ammonium, to be usable by plants. Adding nitrogenous fertilizer to soils may provide a means of increasing forest productivity. Ammoniacal nitrogen (N-NH3), an effluent produced during gold extraction, requires mining companies to manage its long-distance and costly transportation offsite for disposal. Applying this nitrogenous effluent, in its treated form of ammonium sulfate (ammoniacal nitrogen from mine water was converted into ammonium sulfate locally), to regional forest stands could provide a cost-effective and more environmentally sound means of managing this waste product and enhance forest productivity. Here, we conducted greenhouse- and field-based experiments to evaluate ammonium sulfate fertilization on black spruce (Picea mariana) and jack pine (Pinus banksiana) seedling growth. We assigned five treatments, varying in terms of the fertilizer concentration and presence/absence of biochar, to seedlings in greenhouse trials. We also applied various concentrations of ammonium sulfate to an 8-year-old black spruce plantation in Abitibi-Témiscamingue, Québec. We found that black spruce and jack pine seedlings experienced greater growth than the controls in terms of the stem diameter (32–44%), seedling height (21–49%), and biomass (86–154%). In the field experiment, we observed 37% greater volumetric growth in plots receiving medium-level fertilization than the control. Although nitrogen fertilization lowered the soil pH, essential nutrients increased to favor greater seedling growth. Thus, ammonium sulfate, derived from local mining effluent, appears to offer a suitable alternative for enriching nitrogen-limited boreal soils and increasing tree growth. This application could benefit both regional mining industries and forest management bodies. [ABSTRACT FROM AUTHOR]

BackgroundObstructive sleep apnea affects a consistent percentage of the population, and only a minority of patients have been diagnosed and treated because of a discrepancy between resources available for diagnosis and the epidemiology of a disorder possibly affecting nearly one billion people in the world.AimWe conducted a study to compare a standard home respiratory monitoring system (Nox T3) with a novel device (Airgo™) consisting of an elastic band and a small recorder, light, comfortable for the patient, and low-cost complete with automatic analysis of the data that produces a screening report indicating the type and severity of sleep respiratory disorder.Patients and ResultsWe examined 120 patients, reduced to 118 for technical problems. The mean (SD) age of the patients is 55.7 ± 13 years, their BMI is 27.8 ± 4.3 kg/m2, and their AHI is 22 ± 22 events/h. Patients belong to all the different severity rates of OSA, with a percentage of them classified as free of respiratory disorders. The Airgo™ showed excellent agreement with the results of the gold standard, reporting high levels of sensitivity, specificity, positive and negative predicted value, and accuracy.ConclusionAirgo™ is a reliable tool to screen patients with suspected sleep respiratory disorders, well tolerated by the patient based on totally automatic analysis and reporting system, leading to more efficient use of doctor’s and clinician’s time and resources and extending the opportunity to diagnose more possible candidates for treatment.

Alberto Braghiroli,1 Fulvio Braido,2 Alessio Piraino,3 Paola Rogliani,4 Pierachille Santus,5 Nicola Scichilone6 1Department of Pulmonary Rehabilitation, Sleep Laboratory, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, NO, Italy; 2Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, Azienda Policlinico IRCCS San Martino, Genoa, Italy; 3Respiratory Area, Medical Affairs Chiesi Italia, Parma, Italy; 4Respiratory Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy; 5Pierachille Santus, Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy; 6Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, ItalyCorrespondence: Fulvio BraidoDepartment of Internal Medicine, IRCCS San Martino Genoa University Hospital, Genoa, ItalyEmail Fulvio.braido@unige.itAbstract: The topic of 24-hour management of COPD is related to day-to-night symptoms management, specific follow-up and patients’ adherence to therapy. COPD symptoms strongly vary during day and night, being worse in the night and early morning. This variability is not always adequately considered in the trials. Night-time symptoms are predictive of higher mortality and more frequent exacerbations; therefore, they should be a target of therapy. During night-time, in COPD patients the supine position is responsible for a different thoracic physiology; moreover, during some sleep phases the vagal stimulation determines increased bronchial secretions, increased blood flow in the bronchial circulation (enhancing inflammation) and increased airway resistance (broncho-motor tone). Moreover, in COPD patients the circadian rhythm may be impaired. The role of pharmacotherapy in this regard is still poorly investigated. Symptoms can be grossly differentiated according to the different phenotypes of the disease: wheezing recalls asthma, while dyspnea is strongly related to emphysema (dynamic hyperinflation) or obstructive bronchiolitis (secretions). Those symptoms may be different targets of therapy. In this regard, GOLD recommendations for the first time introduced the concept of phenotype distinction suggesting the use of inhaled corticosteroids (ICS) particularly when an asthmatic pattern or eosiophilic inflammations are present, and hypothesized different approaches to target symptoms (ie, dyspnea) or exacerbations. Pharmacotherapy should be evaluated and possibly directed on the basis of circadian variations, for instance, supporting the use of twice-daily rapid-action bronchodilators and evening dose of ICS. Recommendations on day and night symptoms monitoring strategies and choice of the specific drug according to patient’s profile are still not systematically investigated or established. This review is the summary of an advisory board on the topic “ 24-hour control of COPD and role of pharmacotherapy”, held by five pulmonologists, experts in respiratory pathophysiology, pharmacology and sleep medicine.Keywords: COPD, symptoms, dyspnea, night, sleep, follow-up, adherence, circadian LAMA, LABA, ICS

Resumo: A consciência de que a prática médica deve estar fundamentada na postura ética dos profissionais leva à crescente importância de um ensino de ética continuado e aprofundado, que ressalte os valores morais e humanos e o comprometimento social dos estudantes. Buscando adequar-se a esse novo paradigma, estudantes de Medicina da Universidade Federal da Bahia aceitaram a sugestão da criação, em novembro de 2000, de um grupo denominado Academética - Associação de Acadêmicos para o Estudo da Ética Médica e Bioética. Os objetivos traçados pela equipe são: continuar o contato com o conteúdo da disciplina Ética Médica, aprofundando e atualizando as discussões acerca de Ética Médica e Bioética, e desenvolver trabalhos ligados a este assunto. As discussões de temas são realizadas através do estudo de artigos, vídeos e estímulo à partidpação dos estudantes em congressos, palestras e afins. Desta forma, a Academética se constitui em mais uma ferramenta para que os alunos durante a graduação na faculdade de Medicina possam desenvolver o senso crítico e conhecimento acerca de assuntos que englobem a Ética Médica e Bioétia.

ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

ABSTRACT Objective: To test the hypothesis that undenatured type II collagen (UC-II) relieves pain, quality of life, and joint function in women aged from 60 to 80 years with knee osteoarthritis. Methods: 53 patients in the UC-II treatment group (for 90 days) and 52 in the control group (without UC-II) were evaluated at 1, 30, and 90 days regarding health-related quality of life, pain, and function with questionnaires, anthropometric data, alignment, range of motion, and radiographic analysis. Results: Quality of life increased significantly in the Physical domain in the treatment vs control group. Also, there was a difference between the first and the last evaluation on the pain visual analog scale (−3.8 ± 1.8 versus −1.3 ± 2.0) and on the WOMAC score (−9.5 ± 11.9 versus −1.3 ± 11.1). No variation in the temporal evolution of the Mental domain was found. Conclusion: Pain, joint stiffness, and quality of life (Physical domain) improved with the inclusion of UC-II for 90 days to the therapeutic toolbox for knee osteoarthritis in individuals aged 60 to 80 years. Level of evidence II, Comparative Prospective Study.

Introduction: Reactivation of hepatitis B virus (HBVr) is a problem still neglected worldwide. Objective: To assess knowledge of physicians regarding HBVr during immunosuppression including use of immunobiologics (IS/IB). Methods: Between August and October 2020, a national survey regarding current practices in HBVr prevention was sent to members of the Brazilian Societies of Hepatology, Gastroenterology, Hematology, Rheumatology, Oncology and Transplantation using a web-based approach. Results: 510 physicians answered the survey, mainly gastroenterologists (35%) and rheumatologists (31%). The majority had less than 20 years of clinical practice (62%). 91% reported to routinely request serology for HBV before IS/IB. To 90% of the interviewed doctors, in their clinical practice, serology is missing in less than 25% of their patients already using IS/IB. The most common serology panel requested (75%) is HBsAg, Anti-HBc and Anti-HBs. 76% recommend strategies to prevent HBVr for either HBsAg and/or anti-HBc-positive patients, however, 16% only prescribe to HBsAg-positive. 85% have an specialist on HBVr available for referring patients, but 30% start prevention strategies without the need for specialized evaluation. In this case, the preferred treatment options are entecavir (18%), tenofovir (17%) and lamivudine (6%). 88% reported good adherence of their patients to HBVr prevention strategy. Only 27% referred to maintain prevention strategy for at least 6 months after IS/IB interruption. Finally, 73% of the participants never experienced HBVr on their practice and 42% participated in educational activities about HBVr in the last 2 years. Conclusions: Compared to previous literature, Brazilian physicians seems to have a better compliance to international guidelines toward HBVr prevention. With the exception of duration of HBVr prophylaxis, medical knowledge on this field can be regarded as above average.

Simple Summary: COVID-19 has had a dramatic impact on new cancer diagnoses and the treatment of cancer patients. This study examines how the COVID-19 pandemic affected prostate cancer diagnosis, staging, and treatment in Reggio Emilia, Northern Italy. Using data from the Cancer Registry from 2018 to 2021, we found a significant drop in new prostate cancer diagnoses during 2020, the height of the pandemic. The number of new cases decreased by 31% in 2020, with a slight recovery of 5% in 2021. We also observed a shift towards more advanced stages and aggressive forms of prostate cancer, with fewer early-stage diagnoses and more cases of metastatic cancer. Despite these changes, treatments such as surgery and radiation therapy have remained constant. The pandemic disrupted an increasing trend of prostate cancer diagnoses seen before 2019, highlighting the need for ongoing diagnostic services and healthcare delivery, even during global health emergencies. Our study highlights the significant impact of COVID-19 on prostate cancer management and the importance of healthcare system resilience. The COVID-19 pandemic has caused delays in cancer diagnoses and reductions in treatments. The aim of this work is to evaluate the impact of the pandemic on prostate cancer by evaluating whether there has been a shift towards more aggressive (Gleason) and more advanced tumors (stage IV) and a decline in treatments. The study was conducted on 1123 cases of prostate cancer incident in the Province of Reggio Emilia, Northern Italy, in the period of 2018–2021. In 2020, there was a decline in new diagnoses of prostate cancer (−31%), followed by a slight recovery in 2021 (+5%). While Gleason 7 and 8–10 values remained constant, a significant decrease was recorded in stage I (38.7%, 41.6%, 35.5%, and 27.7%) and an increase in stage IV (13.1%, 13%, 15.4%, and 20%) cases in the years 2018, 2019, 2020, and 2021, respectively. However, there was no impact on surgical treatment (which remained constant at around 35%) and radiotherapy (around 39%). Our findings underline the profound impact of COVID-19 on prostate cancer management, highlighting the importance of healthcare resilience in the face of unprecedented disruptions. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer remains a prevalent neoplasm affecting both genders. Despite advancements in screening techniques facilitating early detection, effective patient management remains paramount. This study investigates the impact of a multidisciplinary team (MDT) approach on patient outcomes. Results reveal a significant improvement in survival rates among MDT-followed patients compared to those lacking MDT oversight. Notably, no-MDT patients exhibited a twofold increase in mortality risk from both colon and rectal cancers. Furthermore, advanced age (>70 years) and advanced-stage disease (III and IV) emerged as pivotal risk factors. Consequently, prioritizing MDT intervention for these high-risk cohorts is imperative to optimize therapeutic strategies. Colorectal cancer emerged as the third most prevalent malignancy worldwide, affecting nearly 2 million individuals in the year 2020. This study elucidates the pivotal role of a multidisciplinary team (MDT) in influencing the prognosis, as measured by relative survival rates, depending upon the stage and age. Cases recorded in an Italian Cancer Registry between 2017 and 2018 were included. Relative survival was reported at 1 and 3 years after diagnosis comparing MDT vs. no-MDT approaches. During the study period, 605 CRCs were recorded while 361 (59.7%) were taken care of by an MDT. Compared to no-MDT, MDT patients were younger with earlier stages and received more surgery. One year after diagnosis, survival was 78.7% (90% in MDT vs. 62% in no-MDT); stratifying by stage, in the MDT group there was no survival advantage for stage I (97.2% vs. 89.9%) and II (96.8% vs. 89.4%), but an advantage was observed for stage III (86.4% vs. 56.9%) and stage IV (63.7% vs. 27.4%). Similar values were observed at 3 years where a marked advantage was observed for stages III (69.9% vs. 35.1%) and IV (29.2% vs. 5.1%). The univariable analysis confirmed an excess risk in the no-MDT group (HR 2.6; 95% CI 2.0–3.3), also confirmed in the multivariable regression analysis (HR 2.0; 95% CI 1.5–2.5). Despite the increase in the number of MDT patients in 2018 (from 50% to 69%), this does not correspond to an improvement in outcome. [ABSTRACT FROM AUTHOR]

Claudio Iovino,1 Giuseppe Giannaccare,2 Marco Pellegrini,2 Federico Bernabei,2 Mirco Braghiroli,1 Tomaso Caporossi,3 Enrico Peiretti1,4 1Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; 2Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy; 3Department of Ophthalmology, Ospedale Careggi, Firenze, Italy; 4Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, ItalyCorrespondence: Enrico PeirettiEye Clinic, University of Cagliari, Via Ospedale 48, Cagliari 09124, ItalyTel|Fax +390706092319Email enripei@hotmail.comPurpose: To evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM).Methods: Forty consecutive pseudophakic eyes with idiopathic stage 3–4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated.Results: In all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups (p > 0.05).Conclusion: Combined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.Keywords: epiretinal membrane, intravitreal dexamethasone, macular pucker, intraretinal cysts

Abstract Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the “dog ear” which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.

Objective: The germline breast cancer gene (BRCA) mutation confers a lifetime high risk for breast cancer (BC) and bilateral prophylactic mastectomy is the procedure which allows the highest risk reduction rate. Among other techniques, lipofilling (LF) can be used for breast reconstruction of these patients. However, there are some oncological safety concerns on the subject. The purpose of this study was to assess the oncological risk of LF in BRCA healthy patients.Materials and Methods: A single institution case series was built including BRCA I/II mutated patients with no previous history of BC, who underwent bilateral prophylactic mastectomy followed by breast reconstruction with exclusive LF or combined with implants or latissimus dorsi flap. Data were collected regarding patient demographics, clinical information, reconstruction techniques used, and fat grafting details.Results: From September 1999 till November 2017, we identified 18 BRCA carriers with no history of BC who had undergone bilateral prophylactic mastectomy, followed by breast reconstruction with LF. A total of 36 LF procedures were performed following an implant or latissimus dorsi flap, or as an exclusive fat grafting breast reconstruction. The average number of LF sessions was 1.4 with a mean volume of 108.8cc per breast. Median follow-up was 33.0 months after mastectomy and 24.5 months after the last LF intervention; no patients were diagnosed with BC during follow-up.Conclusion: Germline BRCA mutation is a high-risk plight for BC. However, despite the limited follow-up, no BC was detected.

Pietro Emanuele Napoli1,* Mirco Braghiroli,1,* Claudio Iovino,1 Giuseppe Demarinis,1 Maurizio Fossarello1,21Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; 2Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy*These authors contributed equally to this work Background: Effective and tolerable therapeutic strategies for patients with refractory persistent epithelial defects (PEDs) are limited and generally provide poor outcomes. This retrospective case review describes four refractory cases of PEDs associated with recurrent corneal erosions (RCEs) and dry eye disease (DED), which were successfully treated with cyclosporine eye drops.Methods: Patients were treated with cyclosporine A 0.05% eye drops twice a day for at least 12 months. At enrolling time, each patient was asked to suspend topical steroids or other eye drops used for ocular surface abnormalities with the exception of lubricants and eye washing. A complete evaluation of ocular surface symptoms was performed including the McMonnies Dry Eye Questionnaire, Ocular Surface Disease Index, slit-lamp biomicroscopy, fluorescein break-up time, the fluorescein staining of the cornea and conjunctiva (according to the Oxford grading system), the Schirmer I test, and the meibomian secretion after digital pressure application on the lids. This set of exams was carried out at baseline and repeated at all follow-up assessments.Results: All participants that did not benefit from previous therapies, including corticosteroids tapering schedule, showed an important improvement in the clinical picture after two months with topical cyclosporine medication. Moreover, after 12 months of continuous therapy, all patients showed a clinical improvement in DED signs and symptoms, related to the absence of new RCE episodes. The treatment was well tolerated, and no adverse effects were reported.Conclusion: Although a small number of cases were available of our analysis, the treatment with cyclosporine eye drops represents a promising approach in the management of refractory PEDs with associated ocular comorbidities, since it may reduce the RCE episodes and improve the tear film stability, in absence of systemic or local side effects.Keywords: dry eye disease, persistent epithelial defects, cyclosporine eye drops, recurrentcorneal erosion, corneal adhesion