Lepirudin as a safe alternative for effective anticoagulation in patients with known heparin-induced thrombocytopenia undergoing percutaneous coronary intervention: case reports.

Heparin-induced thrombocytopenia (HIT) is a well-documented complication of heparin anticoagulation therapy. Heparin's frequent use in the cardiovascular population poses a significant challenge for managing patients with HIT in need of percutaneous coronary intervention (PCI). We describe four patients with HIT who successfully underwent PCI without thrombotic or hemorrhagic complications while on lepirudin.     

Wild carnivores as source of zoonotic helminths in north-eastern Italy

Summary Two hundreds and sixty red foxes, eighteen badgers and eight stone martens from north-eastern Italy were examined for zoonotic parasites by SCT, with particular attention to Trichinella sp. and Echinococcus multilocularis. No adult worms of E. multilocularis were observed in the intestine of red foxes or mustelids. Out of 223 fox faecal samples analysed by a commercial CA-ELISA, 5.8 % was positive to Echinococcus coproantigens. Trichinella sp. was detected by digestion of muscle in 1.2 % of examined foxes (2/172), but not in mustelids (0/11). Toxocara canis, responsible for human toxocarosis, resulted to be common in fox population (48.5 %). This parasite was found both in young (53.3 % of cubs and 61.9 % of sub-adults) and in adult animals (42.7 %). Other zoonotic parasites as Uncinaria stenocephala (52.3 %) and Trichuris vulpis (0.4 %) were detected in fox populations.     

Inflammatory carcinoma of the breast. Clinical review and summary of the Vanderbilt experience with multi-modality therapy

Inflammatory breast cancer is a distinct clinicopathologic entity that accounts for 1 percent of all cases of breast cancer. The diagnosis should be strongly suspected on the basis of the distinctive clinical findings, which include edema of the breast, inflammation, wheals, and a typical reddish-purple color of the overlying skin. Pathologic examination usually shows infiltration of the dermal lymphatics with carcinoma. Evidence of distant metastatic spread is more frequent than with other types of breast cancer and is seen in approximately 30 percent of patients. The five-year disease-free survival rate is less than 5 percent when local therapy alone (mastectomy and/or local radiotherapy) is used. The addition of combination chemotherapy to high-dose local radiotherapy has improved the five-year survival rate to approximately 30 percent. The potential for long-term survival is limited to the subgroup of patients with only local-regional disease at the time of diagnosis. Patients with inflammatory breast cancer should be treated with combined-modality therapy using combination chemotherapy and high-dose radiotherapy to the breast, since this approach is potentially curative. The fatalism formerly associated with this diagnosis is no longer warranted, particularly in patients with local-regional disease. Failure to employ intensive combined-modality treatment will deny some patients a chance for long-term survival.     

Extracorporeal membrane oxygenation and lethal diseases: A new perspective

Lethal cancer and chronic untreatable viral disease with life threatening consequences are among the major burden for morbidity and mortality in the western world. A large number of resources are employed every year in identification of new drugs to treat this condition. A remarkable percentage of resources are wasted for safety concerns about possible acute cardiac or pulmonary toxicity of the new identified compounds, that are rejected without further development even when promising. ExtraCorporeal Membrane Oxygenation (ECMO) is an established technique to support and replace cardio-pulmonary function that underwent rapid technologic improvement in the last years, resulting in reduced complication rate. ECMO has been used with success to treat acute life-threatening cardiac and pulmonary toxicity. Our hypothesis is that the new ECMO technological improvement could make this technique available to other setting, such as lethal cancer and infectious diseases, where it can provide a safe base to overwhelm acute cardiac and pulmonary toxicity of chemotoxic drugs and techniques. New drugs and old promising compounds rejected for toxicity could thus be re-introduced and employed, opening a new scenario in the treatment of life-threatening diseases.     

Anxiety,depression, and quality of life in Parkinson’s disease: the implications of multidisciplinary treatment

Anxiety and depression in Parkinson’s disease (PD) reduce well-being of the patients. Emotional alterations influence motor skills and cognitive performance; moreover, they contribute significantly and independently to worsen rehabilitative treatment response. We investigated anxiety, depression, and quality of life in PD patients subjected to multidisciplinary rehabilitative training. The self-controlled study included 100 PD patients (49 males and 51 females with the mean age of 64.66 years) admitted to 60 days hospitalization rehabilitative program, between January 2017 and December 2018. Motor, cognitive, linguistic abilities, and functional independence were evaluated at admission (T0 baseline visit) and 60 days after (T1) the multidisciplinary rehabilitation including motor exercises, speech therapies, and cognitive intervention. The multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood, motor abilities, autonomy in the activities of daily life, perception of quality of life, cognitive performance and speech skills. Non-motor symptoms may worsen severe disability and reduce quality of life. They are often poorly recognized and inadequately treated. Nonetheless, multidisciplinary rehabilitative training represents an optimal strategy to improve disease management. The study was approved by Istituito di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino-Pulejo” Ethical Committee (approval No. 6/2016) in June 2016.     

Flow cytometry data mining by cytoChain identifies determinants of exhaustion and stemness in TCR-engineered T cells

The phenotype of infused cells is a major determinant of Adoptive T-cell therapy (ACT) efficacy. Yet, the difficulty in deciphering multiparametric cytometry data limited the fine characterization of cellular products. To allow the analysis of dynamic and complex flow cytometry samples, we developed cytoChain, a novel dataset mining tool and a new analytical workflow. CytoChain was challenged to compare state-of-the-art and innovative culture conditions to generate stem-like memory cells (T_SCM) suitable for ACT. Noticeably, the combination of IL-7/15 and superoxides scavenging sustained the emergence of a previously unidentified nonexhausted Fit-T_SCM signature, overlooked by manual gating and endowed with superior expansion potential. CytoChain proficiently traced back this population in independent datasets, and in T-cell receptor engineered lymphocytes. CytoChain flexibility and function were then further validated on a published dataset from circulating T cells in COVID-19 patients. Collectively, our results support the use of cytoChain to identify novel, functionally critical immunophenotypes for ACT and patients immunomonitoring.     

Background parenchymal enhancement and breast cancer: a review of the emerging evidences about its potential use as imaging biomarker

Objectives:To conduct a systematic review of evidences about the relationship between background parenchymal enhancement (BPE) of the contralateral healthy breast and breast cancer: its association with clinicopathological breast cancer characteristics, its potential as predictive and prognostic biomarker and the biological linkage between BPE and breast cancer.Methods:A computerized literature search using PubMed and Google Scholar was performed up to June 2020. Two authors independently conducted search, screening, quality assessment, and extraction of data from the eligible studies. Studies were assessed for quality and risk of bias using the revised Quality Assessment of Diagnostic Accuracy Studies tool.Results:Of the 476 articles identified, 22 articles met the inclusion criteria. No significant association was found between BPE and invasiveness, histological cancer type, T- and N-stage, multifocality, lymphatic and vascular invasion and histological tumour grade while the association between BPE and molecular subtypes is still unclear. As predictive biomarker, a greater decrease in BPE during and after neoadjuvant chemotherapy was associated with pathological complete response. Results about the role of BPE as prognostic factor were inconsistent. An association between high BPE and microvessel density, CD34 and VEGF (histological markers of vascularization and angiogenesis) was found.Conclusions:BPE of the contralateral breast is associated with breast cancer in several aspects, therefore it has been proposed as a tool to refine breast cancer decision-making process.Advances in knowledge:Additional researches with standardized BPE assessment are needed to translate this emerging biomarker into clinical practice in the era of personalized medicine.