511 Background: Low quality diets and physical inactivity are two modifiable lifestyle factors that together with vitamin D deficiency have been associated with unfavorable breast cancer (BC) outcomes and cardiometabolic health. We therefore tested the effect of a lifestyle program on BC recurrence and cardiometabolic risk factors on a background of vitamin D sufficiency. Methods: Women aged 30-74 years were enrolled in a phase III trial (NCT02786875) within 12 months of their primary BC diagnosis (stages I-III) in 7 oncologic centres in Italy. Consenting participants were randomized to one of two lifestyle treatments lasting 33 months: 1) positive control (n = 249), standard advice on a Mediterranean diet (MedDiet) and avoidance of sedentary behavior; 2) intervention (n = 243), high intensity advice on low-glycemic index MedDiet and 30-minute additional daily brisk walking. Oral vitamin D3 was administered throughout. Data were collected quarterly on health status, anthropometry, 7-day food records, daily steps, serum 25(OH)D concentrations and metabolic syndrome parameters. The primary outcome was BC recurrence (intention to treat analysis) at 33 months, with cardiometabolic risk factors as secondary outcomes. Hazard ratios (HR) and 95% confidence intervals (CI) for BC recurrence were computed using Cox proportional hazards models adjusted for recruitment center. One-year changes in treatment variables and cardiometabolic risk factors were tested by paired Student’s t-test within each treatment arm and by analysis of covariance between treatment arms, adjusted for baseline values. Results: Approximately 58% of patients were aged ≥50 years, 94% were postmenopausal, 86% had stages I-IIB and 75% hormone-positive BC. A total of 37 recurrences were observed with no differences between arms (HR = 0.94, 95%CI: 0.49-1.79). Independently of randomization arm, women with hormone-positive BC who were more adherent to the intervention program (41%), showed 76% lower risk of BC recurrence (HR = 0.24, 95% CI: 0.06-0.95). Weight loss of 3 kg, representing a 4.2% drop of initial body weight, was significantly greater in the test arm compared to 1.7 kg or 2.4% in the control arm (p = 0.0034). This translated in reductions of body mass index from 27.5±5.7 to 26.3±5.4 kg/m 2 in the intervention arm and from 27.2±5.1 to 26.6±5.1 kg/m 2 in controls (p = 0.0032). The presence of metabolic syndrome dropped by 65% in the intervention arm and 34% in controls (p = 0.008). The probability of metabolic syndrome remission was 2.5-fold higher in the intervention arm. Conclusions: A safe and low-cost lifestyle program with low-glycemic index MedDiet, daily brisk walking and oral vitamin D supplementation resulted in weight loss, reduced metabolic syndrome prevalence and was significantly associated with lower recurrences in women with hormone-positive BC. Clinical trial information: NCT02786875 .

Vitamin D plays a key role in immune modulation, cell proliferation, and hormone regulation. Dysregulated testosterone may contribute to breast cancer progression. We investigated whether long-term vitamin D supplementation affects serum testosterone levels in breast cancer survivors. Complete data at baseline, 12, and 24 months were derived from 253 women with early-stage breast cancer participating in the DEDiCa trial and randomized to receive either a high-dose vitamin D to maintain serum 25(OH)D at 60 ng/mL (group A) or a standard dose to maintain serum levels at 30 ng/mL (group B). Serum 25(OH)D levels significantly increased in both groups (p < 0.001). No significant changes in testosterone concentrations were observed between treatment groups over the 24 month treatment period (A: 0.125 to 0.140 ng/mL; B: 0.162 to 0.193 ng/mL; p = 0.682). Baseline serum testosterone levels emerged as the most significant predictor of testosterone trajectories, possibly modulated by hormone-suppressive therapy. These results are reassuring that vitamin D supplementation did not adversely affect testosterone levels in this population of breast cancer survivors and may partially concur with a healthy lifestyle to equilibrate testosterone levels.

Background: Plant-based diets are recommended in guidelines for the prevention of cancer and cardiometabolic diseases, which remain major causes of death in breast cancer survivors (BCS). Since not all plant foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods: Baseline dietary and cardiometabolic data were derived from 492 (median age 51, IQR 46–59) female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results: The OR of being obese (BMI ≥ 30 Kg/m2) was 0.47 (95%CI: 0.29–0.77), 0.37 (95%CI: 0.22–0.61) and 1.38 (95%CI: 0.83–2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥88 cm) was 0.64 (95%CI: 0.42–1.00) with higher hPDI. The OR for hypercholesterolemia (≥200 mg/dL) was 1.80 (95%CI: 1.16–2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150 mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20–0.71) and 0.59 (95%CI: 0.35–0.97), respectively, with higher PDI. No other significant association was observed. Conclusions: Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS, and this may be more likely when a plant-based diet is consumed, especially if low in unhealthy plant foods.

IntroductionHealthy lifestyle behaviors and improved quality of life have been associated with better prognoses in breast cancer survivors. However, sustaining behavioral changes remains challenging; therefore, identifying effective components of lifestyle education programs is essential to enhance adherence, improve quality of life, and facilitate their integration into clinical practice. This study aimed to predict patient adherence to a lifestyle intervention of diet, physical activity, and vitamin D supplementation and to forecast the most frequent Health-Related Quality of Life over the subsequent three measurements.MethodsA total of 316 breast cancer survivors were included in the analysis. Adherence was modeled as a multi-label time series classification task, with compliance recorded on a three-point scale for each treatment component at quarterly intervals over one year. Health-Related Quality of Life was predicted by evaluating first-year adherence data to estimate the mean score over the subsequent three measurements.ResultsThe dataset was split into 70% for training and 30% for evaluation. Random forest classifiers were employed for adherence prediction, achieving accuracy of up to 81%. An XGBoost regressor was used for Health-Related quality of life prediction, and it was compared to a baseline linear regression model. XGBoost demonstrated superior predictive performance, achieving an R-squared value of 0.62.DiscussionOur findings highlight the promise of machine learning techniques in supporting personalized medicine. Advanced predictive models may aid in identifying patients at risk of non-adherence, enabling early interventions, and improving long-term outcomes through tailored lifestyle strategies for breast cancer survivors.

One of the most difficult issues in the juice industry is to manufacture juices where processing processes minimise the impact on the native characteristics of the fruits. In this study, high-pressure technology was used on whole apple fruits in order to evaluate the effect on the juice production. Two varieties, cv. Limoncella and cv. Pink Lady, were considered. Preliminarily, the fruits were subjected to different pressures, and histological as well as pomological measurements were taken in order to identify the best treatment condition, which was established to be 600 MPa for 3 min. Juice samples were then characterised by measuring the colour, viscosity, total antioxidant capacity (TAC), and total phenolic content (TPC). The storage colour stability of the juices for both varieties showed not significant L* values between the untreated and pre-treated fruits. Juices obtained from pre-treated fruits had a viscosity significantly higher than that obtained from untreated ones. Interestingly, the TPC of high-pressure processing (HPP) pre-treated juice resulted in being significantly higher compared to the untreated ones. The HPP pre-treatment can be considered as a commercial application to modulate some quality standards for apple juice production.

We report on copper nanoparticles produced by laser ablation, in acetone and methanol, from a Cu target using a 1064 nm nanosecond pulsed laser. The morphology, size, structure and chemical composition of the nanoparticles are investigated as a function of the solvent employed. Different analyses confirm the metallic nature of the nanoparticles, without amorphous carbon or copper oxides shells. Then, the nanoparticles are embedded between two transparent electrodes, aluminium-doped zinc oxide (AZO) and zirconium-doped indium oxide (IZrO) as top and bottom layers, respectively. The Glass/IZrObott/Cu nanoparticles/AZO(top) structures are synthesized and optimized as plasmonic and conductive structure for photovoltaic applications. Optical properties show a strong dependence on the thermal annealing at 200 degrees C and type of copper nanoparticles embedded in transparent electrodes. The transparent electrode with the lowest E-gap limits the E-gap to the whole structure. The best structure shows a mean value of transmittance in the visible-NIR range of -79% with an E-gap of 3.43 eV and, moreover, it shows diffused transmittance between 2.5 and 6% in VIS-NIR range and a sheet resistance of 79 Omega/sq. The performances of the best structure are tested measuring the internal quantum efficiency of a tandem solar cell, getting values as high as 89%.

Composition and morphology of two types of bilayers of plasma‐enhanced chemical vapor deposition hydrogened silicon nitride (SiN x :H) and polyimide (PI), as effcient barrier against moisture in SiC‐based power devices, are investigated. Two types of silicon nitrides are obtained by changing the flow ratios of the SiH 4 and NH 3 precursors. Rutherford Backscatterered analyses show that the Si/N ratio varies from 0.6 to 0.8. Elastic recoil detection analyses show that the sample with higher nitrogen content has a higher total bound hydrogen content of 7.8 × 10 17 cm −2 with respect to the 7.1 × 10 17 cm −2 . Fourier‐transform infrared spectroscopy characterizations show Si–H group concentrations of 0.96 × 10 17 and 6.86 × 10 17 cm −2 and NH groups of 4.82 × 10 17 and 2.28 × 10 17 cm −2 , respectively. Silicon nitride films with higher concentration of N–H groups show higher reactivity and permeability to water, making them less effective as a barrier layer. Atomic force microscopy analyses of a PI layer deposited on the nitride layer, SiN x :H/PI show for both type of samples a similar roughness, indicating planarization that can increase the adhesion of SiN x :H/PI and resistance to moisture. The delamination mechanism of the bilayer under pressure pot test conditions is proposed.

Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis.

Hydrogen (HER) and Oxygen (OER) evolution reactions play a fundamental role in the field of green and environmental sustainability, because they are key reactions for water electrolysis. In this work copper (Cu) nanoparticles (NPs) are produced by pulsed laser ablation in liquid from a copper target in the framework of developing a low-cost, earth abundant and non-pollutant electrocatalyst. Various solvent and energy fluence are explored. Electrodes have been realized by drop-casting Cu NPs onto Nickel foam (NF) substrate, with a catalyst loading in the order of some μg/cm2. Electrochemical measurements have performed at room temperature in alkaline ambient and a three-electrode setup. The catalytic activity of the NPs is relevant already at 10mA/cm2 and the improvement with respect to the bare substrate become more evident at higher current densities. The ultra-low amount of the catalyst material makes these electrodes competitive in terms of mass activity compared to the state of the art.

Obesity and metabolic disorders have been associated with poor outcomes in non-Mediterranean breast cancer (BC) patients. The purpose of this study was to investigate the prognostic potential of anthropometric variables in patients with early BC living in Southern Mediterranean region of Italy. We enrolled 955 consecutive early BC patients treated in hospitals in Naples between 2009 and 2013 (median follow-up 11.8-year ending 15/09/2022). Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and metabolic syndrome (MetS) were collected. All-cause and BC-specific mortality were calculated. At the last day of contact 208 (22%) patients had died, 131 (14%) from BC. High WC (≥ 88 cm) or WHR (> 0.85) and the MetS were significantly associated with moderately increased risk of all-cause mortality (HR=1.39, 1.62, 1.61, respectively). A significant increased risk of BC-specific mortality was found in obese patients, in those with high WC, high WHR and those with MetS (HR=1.72, 1.71, 1.80, 1.81, respectively). Central obesity significantly increased total and BC-specific mortality particularly in pre-menopausal women and in luminal subtypes, while in post-menopause MetS was a stronger risk factor. Obesity and MetS may impair the effectiveness of BC therapies hence active lifestyle interventions are encouraged.

Background: “FODMAPs” (fermentable-oligo-, di-, monosaccharides, and polyols) are a group of fermentable carbohydrates and polyols largely diffused in food products. Despite their beneficial effects as prebiotics, people affected by irritable bowel syndrome manifest symptoms when eating these carbohydrates. A low-FODMAP diet seems to be the only possible therapy proposed for symptom management. Bakery products are a common source of FODMAPs, whose pattern and total amount can be affected by their processing. This work aims at studying some of the technological parameters that can influence the FODMAPs pattern in bakery products during the production process. Methods: high-performance anion exchange chromatography coupled to a pulsed amperometric detector (HPAEC-PAD) was used as a highly selective system for carbohydrates evaluation analyses on flours, doughs, and crackers. These analyses were performed using two different columns, the CarboPac PA200 and CarboPac PA1, which are selective for oligosaccharide and simple sugar separation, respectively. Results: emmer and hemp flours were selected to prepare doughs as they contained low oligosaccharide content. Two different mixes of ferments were used at different times of fermentation to evaluate the best conditions to achieve low-FODMAP crackers. Conclusion: the proposed approach allows carbohydrate evaluation during crackers processing and permits the selection of opportune conditions to obtain low-FODMAP products.

Recently, hydrogen evolution reaction (HER) in alkaline media has received a renewed interest both in the fundamental research as well as in practical applications. Pulsed Laser Ablation in Liquid (PLAL) has been demonstrated as a very useful technique for the unconventional preparation of nanomaterials with amazing electro-catalyst properties toward HER, compared to those of nanomaterials prepared by conventional methods. In this paper, we compared the electro-sorption properties of hydrogen in alkaline media by Pt, Pd, Pt80Pd20, and Cu(OH)2 nanoparticles (NPs) prepared by PLAL. The NPs were placed onto graphene paper (GP). Noble metal particles have an almost spherical shape, whereas Cu(OH)2 presents a flower-bud-like shape, formed by very thin nanowalls. XPS analyses of Cu(OH)2 are compatible with a high co-ordination of Cu(II) centers by OH and H2O. A thin layer of perfluorosulfone ionomer placed onto the surface of nanoparticles (NPs) enhances their distribution on the surface of graphene paper (GP), thereby improving their electro-catalytic properties. The proposed mechanisms for hydrogen evolution reaction (HER) on noble metals and Cu(OH)2 are in line with the adsorption energies of H, OH, and H2O on the surfaces of Pt, Pd, and oxidized copper. A significant spillover mechanism was observed for the noble metals when supported by graphene paper. Cu(OH)2 prepared by PLAL shows a competitive efficiency toward HER that is attributed to its high hydrophilicity which, in turn, is due to the high co-ordination of Cu(II) centers in very thin Cu(OH)2 layers by OH- and H2O. We propose the formation of an intermediate complex with water which can reduce the barrier energy of water adsorption and dissociation.

Introduzione. Nel rapporto “I Numeri del Cancro in Italia 2021” si rileva che la mortalità in Italia è in diminuzione per entrambi i sessi (-10% negli uomini, -8% nelle donne). Tuttavia tale tendenza non risulta uniforme e nelle regioni meridionali l’andamento dei tassi risulta stabile nel tempo. L’analisi dell’offerta oncologica nella Regione Campania ha messo in luce una serie di problemi strutturali e di ritardi che non consentono di garantire un efficiente ed efficace utilizzo delle risorse economiche a disposizione. Pertanto, nel settembre 2016, dalla Regione Campania è stata istituita la Rete oncologica campana (Roc) con il compito di intervenire nella prevenzione, diagnosi, cura e riabilitazione dei tumori ed erogare assistenza attraverso i Gruppi oncologici multidisciplinari (Gom). Nel febbraio 2020 nasce il progetto ValPeRoc con lo scopo di valutare periodicamente e progressivamente il modello organizzativo della Roc sia per le prestazioni cliniche erogate sia per gli aspetti economici. Metodi. In cinque Gom (colon, ovaio, polmone, prostata, vescica) attivi in alcuni ospedali della Roc sono stati misurati il tempo pre-Gom che intercorre tra la data della diagnosi e la data della prima riunione del Gom e il tempo Gom che intercorre tra la data della prima riunione del Gom e la data della decisione terapeutica. I tempi Gom di durata superiore a 28 giorni sono stati definiti elevati. Il rischio di elevato tempo Gom è stato analizzato con un algoritmo di machine learning di tipo Bart, considerando il set di regressori (features) disponibili per classificare i pazienti. Risultati. Nel test set (54 pazienti) è stata registrata una accuratezza di 0,68. La tecnica di classificazione riporta un buon adattamento nel Gom colon (93%) e una over-classificazione nel Gom polmone. Lo studio degli effetti marginali mostra un rischio più elevato per coloro che hanno effettuato un atto terapeutico precedente e nel Gom polmone. Conclusioni. Nell’ambito dei 5 Gom considerati la tecnica statistica proposta ha mostrato che, a seconda del Gom, circa il 70% degli individui risulta ben classificato per il rischio di ritardare i tempi di permanenza all’interno della Roc. Il progetto ValPeRoc valuta per la prima volta l’attività della Roc attraverso un’analisi replicabile dei tempi di percorso del paziente dalla diagnosi fino all’atto terapeutico. In particolare, i tempi analizzati misurano la qualità del sistema sanitario regionale.

This paper aims to address the topic of performance measurement in the healthcare industry by exploring the comprehension of the effects of dramatic and seamless digital evolution on the context itself. Our study aims to open new avenues of research hinged on three main topics: the digital transformation of the healthcare industry, the use of a digital platform in cancer networks, and the basis for structuring key performance indicators to monitor healthcare performance in the cancer networks effectively. The results shed light on the key role of digital platforms in KPIs constructions to assess healthcare performance. By exploring and merging the mentioned topics, we build a conceptual framework about the possible drivers for measuring healthcare performance, leading to the provision of instant care with a high degree of preventive capacity and decreasing costs. Our conceptual study could be useful for policymakers, practitioners, and academics interested in this area. From a theoretical point of view, the study offers valuable insights into two main fields: digital transformation in healthcare and performance measurement. It is a valuable tool for healthcare managers to redefine strategies based on patients. Additionally, it emphasizes the importance of institutions’ contributions to promoting digitization. It is not without limits. The results can be context-sensitive. Future research can extend the analysis to compare results in different countries making results generalizable.

In the field of sustainability, hydrogen (H2) is considered a clean fuel and a renewable energy source with no pollutant emissions. The production of H2 by water electrolysis is well-known among the scientific community. Still, alkaline electrolysis represents a challenging process and requires expensive materials have to be avoided in order to lower the impact of H2 production. This work deals with the production of copper (Cu) and nickel (Ni) nanoparticles (NPs) as catalysts for alkaline water splitting reactions. These NPs are synthesized using the pulsed laser ablation in liquid involving the ablation of Cu and Ni targets in methanol and ethanol. The morphological, structural, and compositional properties of the obtained NPs are studied. Then, a low amount of NPs-based catalyst (∼1μg/cm2) was loaded onto a nickel foam substrate and tested for both alkaline Hydrogen Evolution Reaction (HER) and Oxygen Evolution Reaction (OER). The best performance at 10 mA cm−2, in terms of overpotential (η), for OER was shown by Ni NPs, η = 327 mV, while for the HER, Cu NPs reached η = 211 mV at 10 mA cm−2 in aqueous 1M KOH. The ultra-low amount of the catalyst material makes these electrodes challenging in terms of mass activity [up to 14 A/mg at 10 mA cm−2] compared to the state of the art. In addition, the correlation between overpotential and the availability of electrons at the surface of the catalyst for H2 production was studied by using Mott–Schottky analysis.

INTRODUCTION According with "Numbers of cancer in Italy. 2021" mortality is decreasing for both the genders (-10% for men, -8% for women) in Italy. However, this trend is not uniform and seems stable in the Southern regions. Analyses of oncological care in Campania Region highlighted some structural critical issues and delays, which did not guarantee an efficient and effective use of the available economic resources. So, the Campania region established in September 2016 the Campania oncological network (Roc) addressed to prevention, diagnosis, treatment and rehabilitation of tumours through the establishment of multidisciplinary oncological groups (Gom). In February 2020, the ValPeRoc project was launched with the aim of periodically and progressively evaluating the Roc's performance both for the clinical services and for the economic aspects. METHODS In five Goms (colon, ovary, lung, prostate, bladder) active in some Roc hospitals, the pre-Gom time elapsing between the date of diagnosis and the date of the first Gom meeting and the Gom time elapsing between the date of the first Gom meeting and the date of the treatment decision were measured. Gom times longer than 28 days were defined as high. The risk of high Gom time was analyzed with a Bart-type machine learning algorithm, considering the set of regressors (features) available to classify patients. RESULTS The results on the test set (54 patients) report an accuracy of 0.68. The classification technique reported a good fit for colon Gom (93%) and an over-classification for lung Gom. The study of the marginal effects showed a higher risk for those who had a previous therapeutic act and for lung Gom. CONCLUSIONS Within the Goms took in consideration the proposed statistical technique showed that, depending on each Gom, correctly classified about 70% of individuals on risk of delaying permanence within the Roc. The ValPeRoc project evaluates Roc activity for the first time through a replicable analysis of patient pathway times from diagnosis to the act of treatment. Specifically, the times analyzed measure the quality of the regional health care system.