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ABSTRACT: Central venous catheters (CVCs) are essential in the management of pediatric patients receiving antineoplastic therapy or bone marrow transplants, and have significantly improved their quality of life, but CVC-related infectious complications are a major source of morbidity. It has been estimated that 14-51 % of the CVCs implanted in children with malignancies may be complicated by bacteremia, and that the incidence of infections is 1.4-1.9 episodes per 1,000 CVC days. However, there are few recent data concerning the epidemiology of CVC-related infections, the prevalence of antimicrobial resistance in their etiology, or the main factors associated with an increased risk of infection by type of catheter, patient age, the type of cancer, or the presence of neutropenia. Moreover, although various new strategies have been proposed in an attempt to reduce the risk of CVC-related infections, such as catheters impregnated with antiseptics/antibiotics, lock antibiotic prophylaxis, the use of ointments at the exit site, and antithrombotic prophylaxis, their real efficacy in children has not yet been demonstrated. The management of CVC-related infections remains difficult, mainly because of the number of still open questions (including the choice of optimal antimicrobial therapy because of the increasing isolation of multiresistant bacterial strains, treatment duration, whether catheters should be removed or not, the feasibility of guidewire exchange, and the usefulness of antibiotic lock therapy) and the lack of studies of children with cancer. Only well-designed, prospective clinical trials involving pediatric cancer patients can clarify optimal prevention and treatment strategies for CVC-related infections in this population.
European Journal of Clinical Microbiology 06/2012; 31(11):2869-77. · 2.86 Impact Factor
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F Nuzzo,
C Gallo,
S Lastoria,
M Di Maio,
M C Piccirillo,
A Gravina,
G Landi,
E Rossi,
C Pacilio,
V Labonia, [......],
M De Laurentiis,
M D'Aiuto,
M Di Bonito,
G Botti, P Giordano,
G Daniele,
A Morabito,
N Normanno,
A de Matteis,
F Perrone
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ABSTRACT: To measure bone mineral density (BMD) reduction produced by letrozole as compared with tamoxifen and the benefit of the addition of zoledronic acid.
A phase 3 trial comparing tamoxifen, letrozole or letrozole+zoledronic acid in patients with hormone receptor-positive early breast cancer was conducted; triptorelin was given to premenopausal patients. Two comparisons were planned: letrozole versus tamoxifen and letrozole+zoledronic acid versus letrozole. Primary end point was the difference in 1-year change of T-score at lumbar spine (LTS) measured by dual energy X-ray absorptiometry scan.
Out of 483 patients enrolled, 459 were available for primary analyses. Median age was 50 (range 28-80). The estimated mean difference (95% confidence interval [CI]) in 1-year change of LTS was equal to -0.30 (95% CI -0.44 to -0.17) in the letrozole versus tamoxifen comparison (P<0.0001) and to +0.60 (95% CI +0.46 to +0.77) in the letrozole+zoledronic acid versus letrozole comparison (P<0.0001). Bone damage by letrozole decreased with increasing baseline body mass index in premenopausal, but not postmenopausal, patients (interaction test P=0.004 and 0.47, respectively).
In the HOBOE (HOrmonal BOne Effects) trial, the positive effect of zoledronic acid on BMD largely counteracts damage produced by letrozole as compared with tamoxifen. Letrozole effect is lower among overweight/obese premenopausal patients.
Annals of Oncology 03/2012; 23(8):2027-33. · 6.43 Impact Factor
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ABSTRACT: Morphological reconstruction and biogeochemical characterisation of the lagoon of Comacchio (Italy) were carried out in order to provide recommendations for the recovery, conservation and sustainable management of the Fattibello-Spavola coastal lagoon ecosystem. Samples were taken in two seasons: July 1997 and November 1998. The irregular morphology of the Fattibello lagoon affects depositional processes and seawater exchange (tidal currents). Several depressions retain part of the dense water of the saline wedge; these stagnant waters became sinks for fine terrigenous and organic matter. The basin is already extensively supplied with N and P compounds from land. The inflow is demonstrated by the large quantity of organic C, N and organic and inorganic P compounds in the superficial sediment. The ratios between the various forms of macronutrients indicate that the organic matter is primarily of autochthonous origin, with relatively low C/N ratios (8.40.6 and 8.10.6 in July and November, respectively). Shallow areas were almost always oxygenated by tidal currents and thus rich in organisms, with a predominance of molluscs and Ficopomatus enigmaticus. However, the trophic equilibrium of the ecosystem was affected by the accumulation of organic matter in the depressions, favoured by the increased hydrodynamics during the autumn. These accumulations generate high oxygen consumption and release considerable quantities of nutrients into the water column, with the risk of serious dystrophy throughout the basin during the summer. Local dredging and an improvement of the circulation have been suggested and carried out to contain these processes. Reclamation measures in the longer term were proposed.
Hydrobiologia 04/2002; 475-476(1):387-401. · 1.78 Impact Factor
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ABSTRACT: In order to evaluate the origin and the transformation of organic matter on the shallow shelf of the NW Adriatic Sea, organic carbon, total nitrogen and stable isotope ratios of organic carbon were analysed in riverine suspended matter and sediments as well as in marine suspended and sedimentary organic matter, in marine phytoplankton and zooplankton.The deposition of organic matter is influenced by fine sediment concentration. Surface sediments were characterised by highly variable biogeochemical conditions on the sea floor, whereas sub-surface sediments showed a more homogeneous hypoxic/anoxic environment.Low Corg/N ratio and high organic carbon and nitrogen concentrations in riverine suspended organic matter indicate an important contribution of freshwater phytoplankton within rivers, particularly during low flow regimes, which adds to the marine phyto- and zooplankton at shelf locations.In order to evaluate the importance of terrestrial, riverine and marine sources of OM in shelf sediments, a three end-member mixing model was applied to shelf surface sediments using 13C/12C values for organic matter and N/C ratios. The model showed an elevated contribution of terrestrial organic substances at intermediate depths (10–15 m), mostly corresponding to an area of coarser grain-size, whereas the riverine and marine organic fractions were mainly accumulating near the coast and offshore, respectively.
Estuarine, Coastal and Shelf Science.
