SURGERY IN PATIENTS WITH TESTICULAR MALIGNANT GERM CELL TUMORS: COMPLIANCE TO SURGICAL GUIDELINES AND RESULTS IN THE ITALIAN COOPERATIVE STUDY

Purpose: Surgery represents a main and often the only treatment in patients with testicular Malignant Germ Cell Tumors (MGCT). We analyzed the compliance to surgical guidelines and the results in a series of patients with testicular MGCT -/+ retroperitoneal node involvement, without distant metastases. Method: 42 patients, observed in 15 Centers were enrolled in the Italian Cooperative Study on MGCT (January2004–December2010). 14/42 were younger than 2 y. of age, 28/42 between 13–18 y. Treatment was delivered according to COG-Staging-System: St.I patients (complete excision with inguinal orchifunicolectomy+decrease of markers, +hemiscrotectomy if scrotal involvement) did not receive further treatment; St.II patients (scrotal involvement after hemiscrotectomy and/or retroperitoneal node (RPN) enlargement:2 cm) had RPN Dissection if residuals were suspected after PEBx3or4. Results: St.I: 26 patients. 3/26 had a scrotal approach due to suspected testicular torsion: 1/3 underwent hemiscrotectomy, 2 did not receive further therapy after decrease of alphaFP, due to patient’s or physician’s decision respectively. 3/26 were successfully treated for RPN relapse, occurred at 3,6,9 months after adequate surgery (2 adolescents, 1 infant). St.II: in 4 patients CTwas delivered due to slight enlargement of RPN (+persistent alphaFP in 1). St.III: 12 patients received CT and RPND (bilateral in 1). Histology was negative in 11/12. All patients are alive without disease, 39 in 1stCR, 3 in 2ndCR (f.u 9–86 m.:med.48). 1 St.1 patient suffered from postoperative scrotal hematoma. Among patients younger than 2 y, 10/14 had a pure YST, 12/14 had St.I disease; among those between 13–18 y, 27/28 had a mixed histology, 14/28 were St.II or St.III. In 3 adolescents a testicular prosthesis was positioned during primary operation. Conclusion: Outcome was excellent. Regional relapses, observed only in St.I patients, were cured. Surgical guidelines were followed in 40/42 cases. Scrotal approach did not worsen the outcome of patients who did not receive further treatment

Poor youths and ‘pacification’:dilemmas between discourse and practice from the perspective of young people about policing in Rio de Janeiro’s favelas

This article explores the social representations of youngsters from favelas in Rio de Janeiro on police practices in the context of the implementation of ‘Pacifying Police Units’. Drawing from fieldwork, participant observation and interviews, the authors analyse the narratives and practices which influence relations between young people and the police in the Complexo do Alemão area of the city. The interviewees expressed a demand for further public security and social services. Young people noted some progress in police practices, although these changes appear to be unstable. The permanence of violent practices and prejudice by the police was verified in youngsters’ narratives. Any change in this scenario should be based on the replacement of the war logic of ‘pacification’ for another logic, that of participation.2030-01-0

Mature and Immature Teratoma: A Report From the Second Italian Pediatric Study

Background. Teratomas demonstrate a benign clinical behavior, however they may recur with malignant components or as teratoma, and in a small group of patients prognosis could be fatal. After the ®rst Italian study, we collected cases of teratoma, alongside the protocol for malignant germ cell tumors. Procedure. Patients with teratoma were collected from 2004 to 2014. Teratomas were classi®ed according to the WHO classi®cations, as mature and immature. Patients with pathological aFP and/or bHCG, and those with a malignant germ cell component were not included. Results. The study enrolled 219 patients (150 mature, 69 immature teratomas) with a median age at diagnosis of 42 months. The primary sites involved were: 118 gonadal and 101 extragonadal teratomas. Two females with ovarian teratoma had a positive family history. Complete and incomplete surgeries were performed in 85% and 9% of cases. Seventeen events occurred: six females had a second metachronous tumor (5 contralateral ovarian teratoma, 1 adrenal neuroblastoma) and 11 teratomas relapsed/progressed (3 mature, 8 immature teratomas). Two patients died, one of progressive immature teratoma and one of surgical complications. At a median follow up of 68 months, the event-free, relapse-free, and overall survival rates were 90.6%, 94.3%, 98.6%, respectively. Conclusions. Teratomas show a good prognosis, especially the mature ones: surgery and follow-up remain the standard approach. Incomplete surgery in immature teratoma is the group at greatest risk of relapse. Bilateral ovarian tumors are a possibility, and the rare family predisposition to ovarian mature teratoma warrants further analyses

Effectiveness of dolutegravir-based regimens as either first-line or switch antiretroviral therapy: data from the Icona cohort

Introduction: Concerns about dolutegravir (DTG) tolerability in the real-life setting have recently arisen. We aimed to estimate the risk of treatment discontinuation and virological failure of DTG-based regimens from a large cohort of HIV-infected individuals. Methods: We performed a multicentre, observational study including all antiretroviral therapy (ART)-naïve and virologically suppressed treatment-experienced (TE) patients from the Icona (Italian Cohort Naïve Antiretrovirals) cohort who started, for the first time, a DTG-based regimen from January 2015 to December 2017. We estimated the cumulative risk of DTG discontinuation regardless of the reason and for toxicity, and of virological failure using Kaplan–Meier curves. We used Cox regression model to investigate predictors of DTG discontinuation. Results: About 1679 individuals (932 ART-naïve, 747 TE) were included. The one- and two-year probabilities (95% CI) of DTG discontinuation were 6.7% (4.9 to 8.4) and 11.5% (8.7 to 14.3) for ART-naïve and 6.6% (4.6 to 8.6) and 7.6% (5.4 to 9.8) for TE subjects. In both ART-naïve and TE patients, discontinuations of DTG were mainly driven by toxicity with an estimated risk (95% CI) of 4.0% (2.6 to 5.4) and 2.5% (1.3 to 3.6) by one year and 5.6% (3.8 to 7.5) and 4.0% (2.4 to 5.6) by two years respectively. Neuropsychiatric events were the main reason for stopping DTG in both ART-naïve (2.1%) and TE (1.7%) patients. In ART-naïve, a concomitant AIDS diagnosis predicted the risk of discontinuing DTG for any reason (adjusted relative hazard (aRH) = 3.38, p = 0.001), whereas starting DTG in combination with abacavir (ABC) was associated with a higher risk of discontinuing because of toxicity (aRH = 3.30, p = 0.009). TE patients starting a DTG-based dual therapy compared to a triple therapy had a lower risk of discontinuation for any reason (adjusted hazard ratio (aHR) = 2.50, p = 0.037 for ABC-based triple-therapies, aHR = 3.56, p = 0.012 for tenofovir-based) and for toxicity (aHR = 5.26, p = 0.030 for ABC-based, aHR = 6.60, p = 0.024 for tenofovir-based). The one- and two-year probabilities (95% CI) of virological failure were 1.2% (0.3 to 2.0) and 4.6% (2.7 to 6.5) in the ART naïve group and 2.2% (1.0 to 3.3) and 2.9% (1.5 to 4.3) in the TE group. Conclusions: In this large cohort, DTG showed excellent efficacy and optimal tolerability both as first-line and switching ART. The low risk of treatment-limiting toxicities in ART-naïve as well as in treated individuals reassures on the use of DTG in everyday clinical practice

Valence, Arousal, and Gender Effect on Olfactory Cortical Network Connectivity: a study using Dynamic Causal Modeling for EEG

The cortical network including the piriform (PC), orbitofrontal (OFC), and entorhinal (EC) cortices allows the complex processing of behavioral, cognitive, and context-related odor information and represents an access gate to the subcortical limbic regions. Among the several factors that influence odor processing, their hedonic content and gender differences play a relevant role. Here, we investigated how these factors influence EEG effective connectivity among the mentioned brain regions during emotional olfactory stimuli. To this aim, we acquired EEG data from twenty-one healthy volunteers, during a passive odor task of odorants with different valence. We used Dynamic Causal Modeling (DCM) for EEG and Parametric Empirical Bayes (PEB) to investigate the modulatory effects of odors’ valence on the connectivity strengths of the PC-EC-OFC network. Moreover, we controlled for the influence of arousal and gender on such modulatory effects. Our results highlighted the relevant role of the forward and backward PC-EC connections in odor’s brain processing. On the one hand, the EC-to-PC connection was inhibited by both pleasant and unpleasant odors, but not by the neutral one. On the other hand, the PC-to-EC forward connection was found to be modulated (posterior probability (Pp)>0.95) by the arousal level associated with an unpleasant odor. Finally, the whole network dynamics showed several significant gender-related differences (Pp>0.95) suggesting a better ability in odor discrimination for the female gender

Teaching evidence-based practice to physiotherapy students in Italy: a cross sectional study

Background: Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy. Methods: This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript. Results: Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021–2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%). Conclusions: The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards

The processing of actions and-action words in Amyotrophic Lateral Sclerosis patients

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with prime conse- quences on the motor function and concomitant cognitive changes, most frequently in the domain of executive functions. Moreover, poorer performance with action-verbs versus object-nouns has been reported in ALS patients, raising the hypothesis that the motor dysfunction deteriorates the semantic representation of actions. Using action-verbs and manipulable-object nouns sharing semantic relationship with the same motor represen- tations, the verb-noun difference was assessed in a group of 21 ALS-patients with severely impaired motor behavior, and compared with a normal sample's performance. ALS-group performed better on nouns than verbs, both in production (action and object naming) and comprehension (word-picture matching). This observation implies that the interpretation of the verb-noun difference in ALS cannot be accounted by the relatedness of verbs to motor representations, but has to consider the role of other semantic and/or morpho- phonological dimensions that distinctively define the two grammatical classes. More- over, this difference in the ALS-group was not greater than the noun-verb difference in the normal sample. The mental representation of actions also involves an executive-control component to organize, in logical/temporal order, the individual motor events (or sub- goals) that form a purposeful action. We assessed this ability with action sequencing tasks, requiring participants to re-construct a purposeful action from the scrambled pre- sentation of its constitutive motor events, shown in the form of photographs or short sentences. In those tasks, ALS-group's performance was significantly poorer than controls'. Thus, the executive dysfunction manifested in the sequencing deficit ebut not the selec- tive verb deficite appears as a consistent feature of the cognitive profile associated with LS. We suggest that ALS can offer a valuable model to study the relationship between (frontal) motor centers and the executive-control machinery housed in the frontal brain, and the implications of executive dysfunctions in tasks such as action processing

Combining electrodermal activity analysis and dynamic causal modeling to investigate the visual-odor multimodal integration during face perception

Objective. This study presents a novel methodological approach for incorporating information related to the peripheral sympathetic response into the investigation of neural dynamics. Particularly, we explore how hedonic contextual olfactory stimuli influence the processing of neutral faces in terms of sympathetic response, event-related potentials and effective connectivity analysis. The objective is to investigate how the emotional valence of odors influences the cortical connectivity underlying face processing and the role of face-induced sympathetic arousal in this visual-olfactory multimodal integration. Approach. To this aim, we combine electrodermal activity (EDA) analysis and dynamic causal modeling to examine changes in cortico-cortical interactions. Results. The results reveal that stimuli arising sympathetic EDA responses are associated with a more negative N170 amplitude, which may be a marker of heightened arousal in response to faces. Hedonic odors, on the other hand, lead to a more negative N1 component and a reduced the vertex positive potential when they are unpleasant or pleasant. Concerning connectivity, unpleasant odors strengthen the forward connection from the inferior temporal gyrus (ITG) to the middle temporal gyrus, which is involved in processing changeable facial features. Conversely, the occurrence of sympathetic responses after a stimulus is correlated with an inhibition of this same connection and an enhancement of the backward connection from ITG to the fusiform face gyrus. Significance. These findings suggest that unpleasant odors may enhance the interpretation of emotional expressions and mental states, while faces capable of eliciting sympathetic arousal prioritize identity processing