Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

[EN] Head and neck cancer is treated mainly by surgery and radiotherapy. Normal tissue toxicity due to x-ray exposure is a limiting factor for treatment success. Many efforts have been employed to develop predictive tests applied to clinical practice. Determination of lymphocyte radio-sensitivity by radio-induced apoptosis arises as a possible method to predict tissue toxicity due to radiotherapy. The aim of the present study was to analyze radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients and to explore their role in predicting radiation induced toxicity. Seventy nine consecutive patients suffering from head and neck cancer, diagnosed and treated in our institution, were included in the study. Toxicity was evaluated using the Radiation Therapy Oncology Group scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Radiation-induced apoptosis increased in order to radiation dose and fitted to a semi logarithmic model defined by two constants: α and β. α, as the origin of the curve in the Y axis determining the percentage of spontaneous cell death, and β, as the slope of the curve determining the percentage of cell death induced at a determined radiation dose, were obtained. β value was statistically associated to normal tissue toxicity in terms of severe xerostomia, as higher levels of apoptosis were observed in patients with low toxicity (p = 0.035; Exp(B) 0.224, I.C.95% (0.060-0.904)). These data agree with our previous results and suggest that it is possible to estimate the radiosensitivity of peripheral blood lymphocytes from patients determining the radiation induced apoptosis with annexin V/propidium iodide staining. β values observed define an individual radiosensitivity profile that could predict late toxicity due to radiotherapy in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results.

Mezzi innovativi nella difesa delle cucurbitacee da Fusarium solani f.sp. cucurbitae

Lo studio “Lotta biologica a Fusarium solani f.sp. cucurbitae su zucchino” si colloca nell’ambito della difesa integrata delle colture orticole dalle fitopatie fungine, in particolare quelle causate da patogeni ad habitat terricolo nei confronti dei quali è sempre più frequente il ricorso a mezzi di lotta diversi dai prodotti chimici. Interessante e innovativa appare la prospettiva di utilizzare microrganismi adatti a svilupparsi nel suolo, competenti per la rizosfera delle piante e con spiccate caratteristiche d’antagonismo verso i patogeni tellurici e di stimolazione delle difese sistemiche della pianta. Il marciume del colletto delle cucurbitacee, causato da diversi patogeni tra cui Fusarium solani f.sp. cucurbitae, rappresenta la principale malattia fungina di tipo tellurica che colpisce lo zucchino ed il melone nella Pianura Padana e che può portare a consistenti perdite produttive. Indagini condotte dal 2004 da parte del Diproval nell’areale bolognese, hanno evidenziato un’elevata frequenza del patogeno su zucchino coltivato soprattutto in tunnel. Considerata la carenza di conoscenze locali di F. solani f.sp. cucurbitae e di mezzi chimici di lotta efficaci, la ricerca svolta ha inteso approfondire la diagnosi della malattia e le caratteristiche biologiche degli isolati locali, e valutare la possibilità di utilizzare metodi biologici di lotta contro questo patogeno, nonché di studiare alcune delle possibili modalità d’azione di microrganismi antagonisti. Sono state pertanto prelevate, da zone diverse del Bolognese, campioni di piante di zucchino che presentavano sintomi di marciume del colletto ed è stato isolato il patogeno, che in base alle caratteristiche morfologiche macro e microscopiche, alle prove di patogenicità su diversi ospiti e a saggi biomolecolari, è stato identificato come Fusarium solani f. sp. cucurbitae W.C. Snyder & H.N. Hansen razza 1. Dagli isolati di campo sono state realizzate un centinaio di colture monosporiche venti delle quali sono state utilizzate per la prosecuzione delle prove. I venti ceppi sono stati saggiati per la loro patogenicità inoculandoli in terriccio sterile e con trapianto di giovani piante di zucchino. E’ risultata un’elevata variabilità del livello di virulenza tra i ceppi, stimata da 39% a 83% riguardo la gravità della malattia e da 61 a 96% per la frequenza di malattia. Sono state condotte prove di accrescimento miceliare che hanno evidenziato differenze tra i ceppi e tra gli esperimenti condotti a tre diverse temperature (17, 23 e 28°C) alla luce ed al buio. La crescita maggiore complessivamente è stata ottenuta a 23°C. I venti ceppi hanno anche mostrato di produrre, in vitro, vari livelli di enzimi di patogenesi quali cellulasi, poligalatturonasi, pectin liasi e proteasi. E’ stata evidenziata unan correlazione significativa tra attività cellulasica e pectin liasica con frequenza e gravità della malattia dei venti ceppi del patogeno. Le prove relative al contenimento della malattia sono state condotte in cella climatica. Sono stati considerati prodotti commerciali (Remedier, Rootshield, Cedomon, Mycostop, Proradix, Clonotry) a base rispettivamente dei seguenti microrganismi: Trichoderma harzianum ICC012 + T. viride ICC080, T. harzianum T22, Pseudomonas chlororaphis MA342, Streptomyces griseoviridis K61, P. fluorescens proradix DSM13134 e T. harzianum + Clonostachys rosea). I prodotti sono stati somministrati sul seme, al terreno e su seme+terreno (esperimenti 1 e 2) e in vivaio, al trapianto e vivaio+trapianto (esperimenti 3 e 4), riproducendo situazioni di pratico impiego. L’inoculazione del patogeno (un ceppo ad elevata patogenicità, Fs7 ed uno a bassa patogenicità, Fs37) è stata effettuata nel terreno distribuendo uno sfarinato secco di semi di miglio e cereali colonizzati dal patogeno. La malattia è stata valutata come intensità e gravità. I prodotti sono stati impiegati in situazioni di particolare stress, avendo favorito particolarmente la crescita del patogeno. Complessivamente i risultati hanno evidenziato effetti di contenimento maggiore della malattia nel caso del ceppo Fs37, meno virulento. La malattia è stata ridotta quasi sempre da tutti i formulati e quello che l’ha ridotta maggiormente è stato Cedomon. Il contenimento della malattia somministrando i prodotti solo nel terreno di semina o di trapianto è stato in generale quello più basso. Il contenimento più elevato è stato ottenuto con la combinazione di due tipologie di trattamento, seme+terreno e vivaio+trapianto. Le differenze tra i prodotti sono risultate più evidenti nel caso del ceppo Fs7. Per quanto riguarda lo studio di alcune delle modalità d’azione dei microrganismi contenuti nei formulati più efficaci, è stato verificato che tutti sono stati in grado di inibire, se pur in vario modo, la crescita del patogeno in vitro. Gli antagonisti più efficaci sono stati S. griseoviridis K61 (Mycostop) e P. fluorescens proradix DSM13134). I ceppi di Trichoderma, ed in particolare T.harzianum T22 (Rootshield), sono risultati i più attivi colonizzatori del substrato. Riguardo il fenomeno dell’antibiosi, il batterio P. fluorescens proradix DSM13134 ha mostrato di produrre i metaboliti non volatili più efficaci nel ridurre lo sviluppo del patogeno. Nelle condizioni sperimentali adottate anche i due ceppi di T. viride ICC080 e T. harzianum ICC012 hanno dimostrato di produrre metaboliti efficaci. Tali risultati, anche se relativi a prove in vitro, possono contribuire alla comprensione dei meccanismi dei microrganismi sul contenimento dell’infezione relativamente al rapporto diretto sul patogeno. E’ stato inoltre verificato che tutti i microrganismi saggiati sono dotati di competenza rizosferica e solo i batteri di endofitismo. Si conclude che, nonostante l’elevata pressione infettiva del patogeno che ha certamente influito negativamente sull’efficacia dei microrganismi studiati, i microrganismi antagonisti possono avere un ruolo nel ridurre l’infezione di F. solani f.sp. cucurbitae razza 1.

Changes in plant metabolism induced by dioxygenase inhibitors and their effect on the epiphytic microbial community and fire blight (Erwinia amylovora) control

Fire blight, caused by the gram negative bacterium Erwinia amylovora, is one of the most destructive bacterial diseases of Pomaceous plants. Therefore, the development of reliable methods to control this disease is desperately needed. This research investigated the possibility to interfere, by altering plant metabolism, on the interactions occurring between Erwinia amylovora, the host plant and the epiphytic microbial community in order to obtain a more effective control of fire blight. Prohexadione-calcium and trinexapac-ethyl, two dioxygenase inhibitors, were chosen as a chemical tool to influence plant metabolism. These compounds inhibit the 2-oxoglutarate-dependent dioxygenases and, therefore, they greatly influence plant metabolism. Moreover, dioxygenase inhibitors were found to enhance plant resistance to a wide range of pathogens. In particular, dioxygenase inhibitors application seems a promising method to control fire blight. From cited literature, it is assumed that these compounds increase plant defence mainly by a transient alteration of flavonoids metabolism. We tried to demonstrate, that the reduction of susceptibility to disease could be partially due to an indirect influence on the microbial community established on plant surface. The possibility to influence the interactions occurring in the epiphytic microbial community is particularly interesting, in fact, the relationships among different bacterial populations on plant surface is a key factor for a more effective biological control of plant diseases. Furthermore, we evaluated the possibility to combine the application of dioxygenase inhibitors with biological control in order to develop an integrate strategy for control of fire blight. The first step for this study was the isolation of a pathogenic strain of E. amylovora. In addition, we isolated different epiphytic bacteria, which respond to general requirements for biological control agents. Successively, the effect of dioxygenase inhibitors treatment on microbial community was investigated on different plant organs (stigmas, nectaries and leaves). An increase in epiphytic microbial population was found. Further experiments were performed with aim to explain this effect. In particular, changes in sugar content of nectar were observed. These changes, decreasing the osmotic potential of nectar, might allow a more consistent growth of epiphytic bacteria on blossoms. On leaves were found similar differences as well. As far as the interactions between E. amylovora and host plant, they were deeply investigated by advanced microscopical analysis. The influence of dioxygenase inhibitors and SAR inducers application on the infection process and migration of pathogen inside different plant tissues was studied. These microscopical techniques, combined with the use of gpf-labelled E. amylovora, allowed the development of a bioassay method for resistance inducers efficacy screening. The final part of the work demonstrated that the reduction of disease susceptibility observed in plants treated with prohexadione-calcium is mainly due to the accumulation of a novel phytoalexins: luteoforol. This 3-deoxyflavonoid was proven to have a strong antimicrobial activity.

Diversity of the proximal femur in humans: morphological variations of the head-neck junction

The proximal femur is a high-diversity region of the human skeleton, especially at the anterior junction between head and neck, where various bony morphologies have been recognized since mid nineteenth century. Classical literature on this topic is chaotic and contradictory, making almost impossible the comparison of data from different researches. Starting from an extensive bibliographic review, the first standardized method to score these traits has been created. This method allows representing both the anatomical diversity of the region already described in literature and a part of variability not considered before, giving few and univocal definitions and allowing to collect comparable data. The method has been applied to three identified and five archaeological European skeletal collections, with the aim of investigating the distribution of these features by sex, age and side, in different places and time periods. It has also been applied to 3D digital reconstructions of femurs from CT scan files of coxo-femoral joints from fresh cadavers. In addition to the osseous traits described in the standardized method, the presence and frequency of some features known as herniation pits have been scored both on bones and on CT scans. The various osseous traits of the proximal femur are present at similar frequencies in skeletal samples from different countries and different historical periods, even if with clear local differentiation. Some of the features examined show significant trends related to their distribution by gender and age. Some hypotheses are proposed about the etiology of these morphologies and their possible implication with the acquisition of bipedalism in Humans. It is therefore highlighted the possible relation of some of these traits with the development of disorders of the hip joint. Moreover, it is not recommended the use of any of these features as a specific activity-related marker.

Clinical applicability of an US model to calculate the head blood outflow through collateral vessels.

Le vene giugulari interne sembrano essere la via principale attraverso cui il sangue defluisce dal cervello verso il cuore, quando siamo in posizione supina. Nel 2008 il professor Paolo Zamboni ha scoperto che una diminuzione dell'attività giugulare può portare allo sviluppo di una condizione emodinamica chiamata CCSVI. Questa può causare ipossia, ritardi nella perfusione cerebrale e riduzione del drenaggio dei cataboliti, oltre ad un'attivazione infiammatoria delle piccole vene e dei tessuti vicini. Questa condizione è stata da subito associata alla sclerosi multipla e su questo argomento si sono dibattuti molti gruppi di ricerca. Inoltre, altre patologie sembrano essere associate alla CCSVI, come il morbo di Parkinson, l'Alzheimer e la sindrome di Meniere. Proprio quest'ultima è uno degli argomenti che attualmente interessa di più il gruppo di lavoro in cui mi sono inserita. Questa patologia comporta problemi uditivi, come sordità e tinnito, vertigini e nausea. Il gruppo Vascolar Disease Center (VDC) dell'Università di Ferrara ha previsto per l'anno 2015 uno studio multicentrico, in cui si cercherà di verificare la correlazione tra CCSVI e sindrome di Meniere. La mia tesi fa parte di un studio preliminare a quello multicentrico. All'inizio del lavoro mi sono dedicata ad un'analisi critica di un modello emodinamico per la quantificazione dei flussi sanguigni: il modello BMC, pubblicato nel 2013 dal gruppo VDC, effettuando in parallelo una ricerca bibliografica sullo stato dell'arte in materia. In seguito ho cominciato a studiare off-line diversi studi patologici e fisiologici, in modo da prendere confidenza con gli strumenti e con le metodologie da utilizzare. Sono stata poi coinvolta dal gruppo VDC per partecipare attivamente al miglioramento del protocollo legato al modello BMC. Infine ho analizzato, con due metodologie differenti, 35 studi effettuati su pazienti otorinolaringoiatrici. Con i risultati ottenuti ho potuto effettuare diverse analisi statistiche al fine di verificare l'equivalenza delle due metodologie. L'obiettivo ultimo era quello di stabilire quale delle due fosse la tecnica migliore da utilizzare, successivamente, nello studio multicentrico.

Quantitative analysis of extracapsular extension of metastatic lymph nodes and its significance in radiotherapy planning in head and neck squamous cell carcinoma

We performed a histopathologic analysis to assess the extent of the extracapsular extension (ECE) beyond the capsule of metastatic lymph nodes (LN) in head and neck cancer to determine appropriate clinical target volume (CTV) expansions.

Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure?

During short-term postural changes, the factors determining the amplitude of intracranial pulse pressure (ICPPA) remain constant, except for cerebrovascular resistance (CVR). Therefore, it may be possible to draw conclusions from the ICPPA onto the cerebrovascular resistance (CVR) and thus the relative change in cerebral perfusion pressure (CPP).

Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma

Small lymph nodes (LN) show evidence of extracapsular extension (ECE) in a significant number of patients. This study was performed to determine the impact of ECE in LN 7 mm as compared with ECE in larger LN.

Osteochondritis dissecans of the femoral head

Seven patients with symptomatic osteochondritic lesions of the femoral head are presented. All were male with a mean age of 26 years (16 - 33 years). Two distinct morphologic appearances of the hip joint could be identified. Five patients presented with a coxa valga deformity, four of whom had signs of epiphyseal dysplasia. There were 2 patients whose hips appeared normal apart from the osteochondrontic lesions. In both cases an additional acetabular rim lesion due to a reproducible femoro-acetabular impingement was diagnosed at arthrotomy. This may have acted as the underlying cause of osteochondritis dissecans in these cases. All 7 patients underwent surgical treatment. An intertrochanteric osteotomy (I.O.) alone was performed in 2 patients. Follow-up of these patients at 6.5 and 8.5 years after surgery revealed that the osteochondritic lesions had not healed and one individual remained symptomatic. In the remaining 5 patients, treatment consisted of femoral head dislocation and screw fixation of the osteochondritic lesion. This was combined with an I.O. in two of these patients for coxa valga and osteoplasty of a broad femoral neck in 2 other patients. All lesions had healed at an average follow-up of 4.3 years (2 - 8.5 years). Three patients were asymptomatic and 2 patients had minor residual pain. No progressive osteoarthritic changes or signs of avascular necrosis of the femoral head were observed.

Surgical hip dislocation for osteochondral transplantation as a salvage procedure for a femoral head impaction fracture

Obturator anterior hip dislocation is very rare. Poor results are described in patients with additional large transchondral fractures and treatment of these injuries remains challenging. Appropriate treatment recommendations are missing in the literature. This case report introduces surgical hip dislocation for osteochondral autograft transplantation with graft harvest from the nonweightbearing area of the head-neck junction as a salvage procedure in a large femoral head defect. We report the treatment and outcome of a 48-year-old man who sustained an anterior dislocation of the left hip after a motorcycle accident. After initial closed reduction in the emergency room, imaging analysis revealed a large osteochondral defect of the femoral head within the weightbearing area (10 × 20 mm, depth: 5 mm). The hip was exposed with a surgical hip dislocation using a trochanteric osteotomy. An osteochondral autograft was harvested from a nonweightbearing area of the femoral head and transferred into the defect. The patient was prospectively examined clinically and radiologically. Two years postoperatively, the patient was free of pain and complaints. The function of the injured hip was comparable to that of the contralateral, healthy hip and showed satisfying radiologic results. Surgical hip dislocation with a trochanteric flip osteotomy is a simple, one-step technique that allows full inspection of the hip to treat osteochondral femoral defects by osteochondral transplantation. The presented technique, used as a salvage procedure in a large femoral head defect, yielded good clinical and satisfying radiologic outcomes at the midterm.

On-table reconstruction of comminuted fractures of the radial head

The most widely accepted treatment for comminuted fractures of the radial head is either the excision or open reduction and internal fixation. The purpose of the present study is to evaluate the value of an 'on-table' reconstruction technique in severely comminuted fractures of the radial head. In this study, two patients with a Mason type-III and four patients with a Mason type-IV radial-head fracture were treated with 'on-table' reconstruction and fixation using low-profile mini-plates. After a mean follow-up of 112 months (47-154 months), the mean elbow motion was 0-6-141 degrees extension flexion with 79 degrees of pronation and 70 degrees of supination. The mean Broberg and Morrey functional rating score was 97.0 points, the Mayo Elbow Performance Index was 99.2 points and the mean Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure score was 1.94 points. One patient had symptoms of degenerative changes, with a slight joint-space narrowing. There were no radiographic signs of devitalisation at final examination. Comminuted fractures of the radial head, which would otherwise require excision, can be successfully treated with an 'on-table' reconstruction technique.

Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: 10-Year Follow-up of a Randomized Phase III Trial (SAKK 10/94)

To compare the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy versus treatment with hyperfractionated radiotherapy alone in patients with locally advanced head and neck cancer.