Search

Purpose and methods: As a part of reviewing the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines in Perugia in 2009, an expert group identified directions for future antiemetic research. Results and conclusions: In future trials, the prediction of nausea and vomiting may combine algorithms based on observed prognostic factors relating to the patient and the anticancer therapy, the identification of the genes that code for receptors, and pharmacogenetic studies of the metabolism of drugs. Design issues for future trials include standardising the emetic stimulus across studies and finding the minimum tolerated effective dose and schedule of an antiemetic. Also control of delayed emesis is not independent of the control of acute emesis. The full range of side effects and the impact on global quality of life scores should be part of the routine assessment of an antiemetic. With current high rates of control of acute vomiting, future trials will need to consider new primary endpoints such as nausea, a complex symptom, where improvement is needed. Economic endpoints should be incorporated to ascertain the cost benefit of antiemetic prophylaxis, taking into account the impact of nausea on work capacity. New antiemetic drugs may be targeted at different receptors, such as opioid, cannabinoid and peptide YY receptors. New research is needed into determining the extent of corticosteroid use. The emetic potential of a range of newer cytotoxics particularly when used in combinations and different scheduling, such as prolonged oral dosing of cytotoxics and use of targeted therapies, are all areas in need of research. More antiemetic studies are needed in niche areas such as in patients receiving high dose chemotherapy, radiation therapy or combined modality therapy. Further evidence of the efficacy of newer antiemetic agents is required in children. [ABSTRACT FROM AUTHOR]

Italian football represents a paradox. It produces teams which, at the elite level, are the most successful in European club competitions, and second only to Brazil in national competitions. The quality of its players, in terms of sporting excellence, make it one of the most admired football cultures in the world. The romance and tradition of Italian football captures the imagination of a global sporting public. On the other hand, the industry is chronically unprofitable and unstable, and characterized by a long history of financial scandal. The 2007/2008 season saw it continue to endure an ongoing crisis of confidence in the wake of financial and sporting scandals, an upsurge of spectator violence in dilapidated stadia and crowds well below their peak in the 1990s. This article presents a comprehensive case study of the recent history of Italian football focusing on its administration, governance and regulation. The objective of the case study is to provide a detailed context, in one of the big five European football markets (the others being England, France, Germany and Spain), against which to analyse and inform fresh thinking on how more effective systems of corporate governance in European football might be developed. Much of what is written about the governance of football tends to focus on the English industry. A premise of this article is that it is necessary to move beyond an anglo-centric orientation and analyse the systems and experience in other European football markets and cultures. This is because football in individual countries forms part of a pyramid structure ultimately governed by the European football governing body, UEFA. What happens in individual country markets has the potential to affect what happens in other markets either by way of example, through influencing UEFA policy, or through precedent-setting rulings in the courts, such as the Bosman ruling of 1995 which allowed players free movement at the end of their contracts without a transfer fee having to be paid as had hitherto been the case. The case study is interdisciplinary in its focus - economic, social and political dimensions are all important in trying to understand what constitutes the Italian model of football, a European model of football or indeed the European model of football. Critically the article asks the following questions: (1) Is it possible for Italian football to prosper in an environment in which there appears to have been significant shortcomings in governance? (2) If not, what should be the key planks of an agenda for reform? (3) Is there potential for 'contagion' of negative Italian experience in the rest of the European football market? [ABSTRACT FROM AUTHOR]

Abstract: This report summarizes the proceedings of the symposium VII on the role of neuroactive steroids in stress/alcohol interactions. The production of GABAergic neuroactive steroids, including (3α,5α)-3-hydroxypregnan-20-one and (3α,5α)-3,21-dihydroxypregnan-20-one is a consequence of both acute stress and acute ethanol exposure. Acute, but not chronic ethanol administration elevates brain levels of these steroids and enhances GABAA receptor activity. Neuroactive steroids modulate acute anticonvulsant effects, sedation, spatial memory impairment, anxiolytic-like, antidepressant-like, and reinforcing properties of ethanol in rodents. Furthermore, these steroids participate in the homeostatic regulation of the hypothalamic–pituitary–adrenal axis. Therefore, it is not surprising that neuroactive steroids are involved in ethanol/stress interactions. Nevertheless, the interactions are complex and not well understood. This symposium addressed the role of neuroactive steroids in both stress and alcohol responses and their interactions. Professor Giovanni Biggio of the University of Cagliari, Italy presented the effects of juvenile isolation stress on neuroactive steroids, GABAA receptor expression, and ethanol sensitivity. Professor Howard Becker of the Medical University of South Carolina, USA presented evidence for neuroactive steroid involvement in ethanol dependence and drinking behavior. Professor Patrizia Porcu of the University of North Carolina, USA described a potential neuroactive steroid biomarker that may predict heavy drinking in monkeys and mice. These presentations provide a framework for new theories on the nature of ethanol/stress interactions that may be amenable to therapeutic interventions. [Copyright &y& Elsevier]

Abstract: Objectives: Analyze morbidity and survival after pelvic exenteration (PE) of gynecological malignancies. Methods: We reviewed 106 consecutive patients with gynecologic malignancies who underwent PE from June 1996 to April 2007 at the Division of Gynecology, European Institute of Oncology (IEO), Milan. Results: PE was performed for cancer of the cervix (62 patients), vagina (21 patients), vulva (9 patients), endometrium (9 patients), ovary (4 patients) and 1 uterine sarcoma. Mean age was 53.6 (30–78) years. 97% of the patients received radiotherapy before PE and 3 patients had PE as primary treatment. We performed 53 anterior, 48 total and 5 posterior PE. Median operation time, estimated blood loss and hospital stay were respectively 490 (200–780) minutes, 1240 (300–6500) ml and 21.6 (11–55) days. No residual tumor was left in 93% of the patients. Median follow-up was 22.3 (1.6–117) months. There were no post-operative deaths (<30 days from surgery) nor intra-operative mortality. Total morbidity rate was 66%; 48% of patients had early complications (<30 days after PE) whereas 52 patients (48.5%) had late complications; 70% of these occurred to the urinary tract and 25% were due to bowel occlusions or fistulas. Overall survival was 52%, 35%, 19% and 16% respectively for cervical, endometrial, vaginal and vulvar cancer. Conclusions: PE is a feasible technique with no post-operative mortality and high percentage of long-survivors, although the morbidity rate still remains significantly high. Careful patient selection, pre- and post-operative care and optimal surgical skills in a Gynecologic Oncologic Center are the cornerstones to further improve quality of life and survival for these patients. [Copyright &y& Elsevier]