Search

Ilaria Cutica,1,* Silvia Riva,2,* Ester Maria Orlandi,3 Alessandra Iurlo,4 Claudia Vener,1 Chiara Elena,3 Cristina Bucelli,4 Daniele Cattaneo,1,4 Elisa Tomezzoli,5 Gabriella Pravettoni1,5 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; 2Department of Psychology and Pedagogic Science, St Mary’s University, London, UK; 3Hematology Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy; 4Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; 5Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy*These authors contributed equally to this workCorrespondence: Ilaria Cutica, Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20123, Italy, Tel +39 02 50321562, Fax +39 02 50318938, Email ilaria.cutica@unimi.itPurpose: Patients with chronic myeloid leukemia (CML) who present a sustained deep molecular response (DMR) for a stable period of time might benefit from discontinuing tyrosine kinase inhibitors (TKIs). A significant number of patients seem able to reach this stage due to the availability of TKIs. However, many patients remain reluctant about TKI discontinuation and may refuse treatment interruption. The purpose of this study was to explore the clinical and psycho-cognitive factors that may influence the decision to discontinue TKI therapy, thereby gaining a better understanding of patients’ viewpoints on TKI discontinuation.Patients and Methods: One hundred and nineteen patients diagnosed with CML aged between 34 and 69 were enrolled (67 males and 52 females). Different clinical information and psycho-cognitive aspects such as attitude toward risk behaviours, risk preferences, need for cognitive closure, and tendency to resist to changes were assessed through the administration of a battery of questionnaires.Results: A higher tendency toward risk behaviours and the tendency to focus on possible gain in the short term rather than on losses might represent important predictors for the willingness to accept TKI discontinuation. Possible relapses following interruption of the therapy are the most common reason for concern. Furthermore, lower levels of resistance to change and having previously experienced the desire to interrupt the therapy might lead patients to accept a higher probability of relapse risk when facing such a decision.Conclusion: TKI discontinuation appears appealing and challenging at the same time for many CML patients, and different factors may influence this decision. Psychology plays a crucial role in assisting physician-patient communication and informed decision-making.Keywords: TKI discontinuation, chronic myeloid leukaemia, patients’ perspective, risk preferences, decision-making

S Riva,1 S Del Sordo,2,3 U Genovese,1,3 G Pravettoni1 1Department of Oncology and Hemato-oncology, University of Milan, Italy; 2FOLSATEC (Foundations & Ethics of the Life Sciences) PhD School, University of Milan, Milan, Italy; 3Healthcare Accountability Lab, University of Milan, Milan, Italy Aims: The overall goal of this article is to make a scientific comment about the psycho-social consequences of hemophilia patients affected by human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) and to point out the related medicolegal issues. Methods: This commentary takes into account some published evidences about the current scenario of hemophilia patients infected by HIV and/or HCV who received contaminated blood products in the late 1970s through 1985. Results: Several psychological and medicolegal consequences are related with HIV and HCV contamination of blood products. A multidisciplinary approach is needed to treat all the difficulties experienced by these patients and to ensure good clinical decisions in medical practice. Conclusion: The literature on the psychosocial functioning of hemophilia patients with human HIV and HCV infection offers a number of implications, including medicolegal issues, that can be discussed for guaranteeing a good level of care and safeguard of this group of patients. Keywords: hemophilia, viral contaminated blood products, monetary compensation, medico-legal issues, medical decision making

Paola Arnaboldi,1 Silvia Riva,2 Chiara Crico,2 Gabriella Pravettoni1 1Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, 2Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Abstract: Stress has been extensively studied as a psychosomatic factor associated with breast cancer. This study aims to review the prevalence of post-traumatic stress disorder (PTSD), its associated risk factors, the role of predicting factors for its early diagnosis/prevention, the implications for co-treatment, and the potential links by which stress could impact cancer risk, by closely examining the literature on breast cancer survivors. The authors systematically reviewed studies published from 2002 to 2016 pertaining to PTSD, breast cancer and PTSD, and breast cancer and stress. The prevalence of PTSD varies between 0% and 32.3% mainly as regards the disease phase, the stage of disease, and the instruments adopted to detect prevalence. Higher percentages were observed when the Clinician Administered PTSD Scale was administered. In regard to PTSD-associated risk factors, no consensus has been reached to date; younger age, geographic provenance with higher prevalence in the Middle East, and the presence of previous cancer diagnosis in the family or relational background emerged as the only variables that were unanimously found to be associated with higher PTSD prevalence. Type C personality can be considered a risk factor, together with low social support. In light of the impact of PTSD on cognitive, social, work-related, and physical functioning, co-treatment of cancer and PTSD is warranted and a multidisciplinary perspective including specific training for health care professionals in communication and relational issues with PTSD patients is mandatory. However, even though a significant correlation was found between stressful life events and breast cancer incidence, an unequivocal implication of distress in breast cancer is hard to demonstrate. For the future, overcoming the methodological heterogeneity represents one main focus. Efficacy studies could help when evaluating the effect of co-treating breast cancer and post-traumatic stress symptoms, even if all the criteria for a Diagnostic and Statistical Manual of Mental Disorders diagnosis are not fulfilled. Keywords: PTSD, post-traumatic stress disorder, breast cancer, disease management

Silvia Riva,1 Alessandro Antonietti,2 Paola Iannello,2 Gabriella Pravettoni1–3 1Department of Health Sciences, Faculty of Medicine, University of Milan, Milan, Italy; 2Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy; 3Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy Objective: The aim of this review is to summarize current research relating to psychological processes involved in judgment and decision-making (JDM) and identify which processes can be incorporated and used in the construct of health literacy (HL) in order to enrich its conceptualization and to provide more information about people’s preferences.Methods: The literature review was aimed at identifying comprehensive research in the field; therefore appropriate databases were searched for English language articles dated from 1998 to 2015. Results: Several psychological processes have been found to be constituents of JDM and potentially incorporated in the definition of HL: cognition, self-regulation, emotion, reasoning-thinking, and social perception. Conclusion: HL research can benefit from this JDM literature overview, first, by elaborating on the idea that judgment is multidimensional and constituted by several specific processes, and second, by using the results to implement the definition of “judgment skills”. Moreover, this review can favor the development of new instruments that can measure HL. Practical implications: Future researchers in HL should work together with researchers in psychological sciences not only to investigate the processes behind JDM in-depth but also to create effective opportunities to improve HL in all patients, to promote good decisions, and orient patients’ preferences in all health contexts. Keywords: health literacy, judgment, decision-making, psychological processes, skills, cognitive factors

Silvia Riva,1 Alessandro Nobili,2 Codjo D Djade,2 Maria Elisa Mancuso,3 Elena Santagostino,3 Gabriella Pravettoni1–4 1Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; 2Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy; 3Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, IRCCS Ca’ Granda, Policlinic Hospital, Milan, Italy; 4European Institute of Oncology, Milan, Italy Abstract: Elderly patients with hemophilia have to face new challenges linked to concomitant pathologies and concurrent use of different treatments. In order to promote optimal care in the elderly hemophilia population, this study is aimed to analyze treatment compliance in relation to the presence of comorbidities and the role of potential determinants that can affect compliance (positively or negatively), including health-related quality of life, cognitive decline, and sociodemographic parameters (eg, living situation, partnership, presence of caregivers). This will be an observational study of elderly patients with hemophilia (aged >60 years). Patients will be interviewed during their routine medical visits. The data interview will pertaining to several dimension of treatment management. This study will detect more vulnerable patients with special care needs and will highlight psychological factors that should be considered for future psychosocial interventions.Keywords: hemophilia, cognitive assessment, cognitive decline, compliance, treatment, aging

Magnetohydrodynamics (MHD) investigates the intricate relationship between electromagnetism and fluid dynamics, offering a complete insight into the behavior of conducting fluids under the influence of magnetic fields. This theory plays a pivotal role in the framework of magnetic confinement fusion, where it can be applied to describe both thermonuclear plasmas confined inside the vacuum vessel and operating fluids, such as liquid metals and molten salts, flowing within the blanket of future tokamaks. Currently, the state-of-the-art numerical modeling of MHD scenarios employs a multi-physics framework to examine the interplay between magnetic fields and thermal hydraulics; however, due to the complexity of the involved physics, detailed models are required, resulting in a significant computational burden. In this regard, reduced order modeling (ROM) techniques may represent a promising solution, as they enable approximating complex systems with lower-dimensional models. Indeed, ROM methodologies can significantly reduce the required computational time while maintaining accuracy in capturing the convoluted physics involved in fusion reactors, especially in the contexts of sensitivity analysis, uncertainty quantification, and control. Despite their potential, ROM methods are relatively under-explored within the MHD framework; this study applies ROM techniques to MHD scenarios, focusing on their capabilities and possible limitations. To this aim, the backward-facing step, which is well suited for exploring the effects of different magnetic fields on turbulent dynamics, is adopted as case study. In particular, this work evaluates the potentialities of the ROM approach in enhancing computational efficiency within the MHD domain. Each of the methods evaluated was effective in precisely reconstructing flow dynamics at any given time and across the full range of magnetic field values tested while significantly reducing computational costs compared to full-order simulations. Practically, this study demonstrates the feasibility to create simplified models that accurately represent the magnetohydrodynamic flows of fluids within the blanket. [ABSTRACT FROM AUTHOR]

Centella asiatica is a medicinal plant widely used as a traditional medicine due to several biological activities, such as antioxidants in Indonesia. This study aims to identify the active antioxidant compounds of C. asiatica leaves extract using a liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS)-based metabolomics approach. Extracts were prepared using different concentrations of ethanol p.a., i.e. 70% ethanol, 50% ethanol, 30% ethanol, and water. Antioxidant activity was tested using the 2,2-diphenyl-1-picrylhydrazyl method. The results showed the highest antioxidant activity was C. asiatica extracted by 70% ethanol with IC50 of 72.48 ± 2.42 µg/mL. The positive control was ascorbic acid, having an IC50 value of 3.38 ± 0.04 µg/mL. Ascorbic acid and 70% ethanol extract have strong antioxidant activity. Metabolite profiling using LC-MS/MS could identify 35 metabolites consisting of flavonoids, fatty acids, phenolics, terpenes, and several other groups of compounds. Orthogonal partial least squares-discriminant analysis classified the metabolites into active (ethanol 70% and ethanol 50%) and inactive (ethanol p.a., ethanol 30%, and water) antioxidants. Five metabolites have potential as antioxidants, namely 4,5-dicaffeoylquinic acid (11), kaempferol (13), and three unknown compounds.