International Conference on Oncology Nursing, Cancer Care & Radiology and Imaging September 19-20 2016 Las Vegas, USA

Biography:

A Dommann is heading the Department of Materials Meet Life at Empa. He received his PhD in Solid State Physics in 1988 from ETHZ in Switzerland. His research concentrates on the surface analysis, bio surface interactions, structuring, coating and characterization of thin films. He is Member of different national and international committees and teaches biomaterials, crystallography and MEMS technology at different Swiss universities and has published more than 130 papers. He is Member of the Swiss Academy of Engineering Science (SATW) and is Adjunct Professor at the University of Berne.

Abstract:

The workshop concentrates on a novel technique that has demonstrated great potential for non-destructive testing (NDT) and non-destructive evaluation (NDE). This method uses the Talbot-Lau grating interferometer principle. It enables X-ray insights extended by two additional contrast mechanisms: X-ray phase contrast imaging (XPCI) and scatter dark field imaging (SDFI). Conventional radiographic systems, based on the absorption of x-rays in the sample, have limited contrast for light materials such as polymers and biological tissues. XPCI, on the other hand, is able to reveal subtle changes in the microstructure of the samples, such as micro-cracks in composite.

Biography:

Benedict B Benigno is a world-renowned Gynecologic Surgeon and Oncologist who has spent his career treating women with ovarian cancer. In 1999, he founded the Ovarian Cancer Institute and serves as its CEO. He received his MD degree from the Georgetown University School of Medicine, and completed his residency in Obstetrics and Gynecology at St. Vincent’s Hospital and Medical Center in New York City. He completed two fellowships in Gynecologic Oncology, one at the Emory University School of Medicine in Atlanta and the other at the M D Anderson Hospital and Tumor Institute in Houston. He is the Founder and President of University Gynecologic Oncology and the Director of Gynecologic Oncology at Northside Hospital in Atlanta, Georgia. He is a member of many societies including the Society of Gynecologic Oncologists, the Felix Rutledge Society, and the American Society of Clinical Oncologists. He is a Clinical Professor in the Department of Obstetrics and Gynecology at the Emory University School of Medicine, the Morehouse School of Medicine, and Mercer University. He serves on the board of the Parker H Petit Institute of Bioengineering and Bioscience at the Georgia Institute of Technology. He has published numerous articles and textbook chapters, and travels the world speaking on various aspects of gynecologic cancer. He is the author of the book, “The Ultimate Guide to Ovarian Cancer: Everything You Need to Know about Diagnosis, Treatment, and Research”. He was honored in 2002 with the Hero of Medicine Award for the Most Innovative Cancer Research in the State of Georgia. In 2014, he was appointed to the ovarian cancer steering committee based in the National Institute of Health.

Abstract:

Very little has changed in the management of patients with ovarian cancer in the last 30 years. Carboplatinum and Taxol are still given as first-line chemotherapy, and drugs such as Doxil, Gemzar and Topotecan, among others, are given for recurrent disease. Avastin, a VEGF inhibitor, is added to a chemotherapy regimen or is given alone. The PARP inhibitors represent a new class of drugs for patients with ovarian cancer. Unlike chemotherapy drugs, which work in various stages of division in the cell cycle, these drugs exert their effect within breaks in the DNA molecule. They are given orally and are far better tolerated than cytotoxic chemotherapy. They can be given only under very strict guidelines, but in those patients who were eligible to take them, we are seeing startling results. Even in patients who have failed three prior regimens of chemotherapy, there is an objective response rate of 34%. This lecture will address the role of these agents in the modern management of ovarian cancer. Physiology, dosage, results and complications will be discussed in detail so that the audience will have an in-depth understanding of this extraordinary new class of drugs.

Biography:

Hiroshi Osawa is a faculty of Department of Oncology and Hematology in Edogawa Hospital Tokyo, Japan. He graduated the Teikyo University School of Medicine in 1990. He got his degree in Oncology and Hematology, & Medicine Doctor's degree at the Tokyo Jikei University. He had learned clinical research and molecular biology at Cancer Institute Hospital (4 yrs) and researched resistance in TGF-β I correlates with aberrant expression of TGF-β receptor II in human B-cell lymphoma cell line at National Institute on Aging (3.5 yrs) as a research fellow, Baltimore, USA. Currently, he has been focusing clinical studies and research on gastrointestinal tract field.

Abstract:

Regardless of the fact that we often perform totally implantable venous-access ports (TIVAPs) for cancer chemotherapy, there have been several reports regarding complications. The objective of this study was to summarize the TIVAPs idiopathic complications of 400 devices in latest 6 years. The patients underwent TIVAPs in the internal jugular or sub-clavian vein via the Seldinger technique in our hospital. We used two different devices, which were the Bard X-Port™, used from 2009 to 2012, and the Power Port™ used from 2012 to 2015. These devices are composed of titanium and silicone rubber port (DomePort™, Bard Inc, Salt Lake City, UT, USA) connected to an 8Fr silastic Groshong™ catheter tube. 400 TIVAPs, total 89,568 days insertion, with a median follow up of 405 days. There were 30 idiopathic complications. The complications consisted of eleven complete occlusions (2.8%), eight pocket infections (2%), three of pneumothorax (0.8%), two pinch-offs and slip-offs due to pedunculated breast (0.5%), one catheter-related bacteremia, rubber port disconnection, rubber port rotation in pocket and wound dehiscence due to bevacizumab™(0.3%). Here, we focus to present the complete occlusion. Although, complete occlusion was most popular idiopathic complication of TIVAPs in this study, one patient has undergone complete occlusion with Trousseau syndrome. When we removed TIVAPs, we experimented 12 cm length red thrombus and elevated D-dimer which possibility triggered Trousseau syndrome in parallel. Finally, these complications were found by nurses, who are important in cancer nursing care.

Biography:

Katie J. Atkinson received her BSN from Villanova University and worked as a RN in pediatrics at NY-Presbyterian Hospital, Weill Cornell Medical Center for several years. She graduated from Columbia University, MSN Family NP Program in 2008, and worked as a NP in pediatric food allergy at the Jaffe Food Allergy Institute at the Mt. Sinai School of Medicine.  In 2014 she returned to Weill Cornell to work with Dr. James Bussel, director of the Platelet Disorders Center.  Katie enjoys working with Dr. Bussel seeing both pediatric and adult ITP patients, and participating in clinical research trials in ITP

Abstract:

Eltrombopag (Promacta) is an oral thrombopoietin (TPO)-receptor agonist that has been widely used in adults with chronic immune thrombocytopenia (cITP) with good success and minimal toxicity since its initial approval in 2008.1-4 Eltrombopag was recently approved in the US for use in children ≥ 1 year of age with cITP based on 2 large randomized, placebo-controlled trials including 171 children.5-6 The key points from these studies were:

1. The primary platelet response rate is high: 60%- 90% depending on the criteria used

2. The time to respond varied with the patient, the dose required to respond, and the time to steadily escalate to that dose, and may take weeks to occur. Platelet responses during the first 6 weeks of the studies are shown in Figure 1

3. As expected, increases in platelet counts were associated with reductions in bleeding and the need for rescue medications

4. Responders were often able to taper off concomitant ITP medications (such as prednisone)

Eltrombopag is generally well tolerated; across all the large studies in adults and children, approximately 3% of patients were unable to tolerate a therapeutic dose of eltrombopag. The main toxicity associated with eltrombopag is elevated aminotransferases, which is often mild and reversible. Risks associated with TPO-receptor agonists include bone marrow fibrosis, which is unlikely to be clinically significant, and thrombosis, which is observed much less frequently in children than it is in adults. Finally, there are important dietary directions to follow while administering eltrombopag; therefore, both physicians and nurses should work in partnership with the parent/caregiver to optimize management of pediatric patients and treatment with eltrombopag. In summary, eltrombopag is a highly effective medication that is taken orally every day and may help safely increase platelet counts in the majority of patients.

Biography:

Niccola Funel received his first graduation in Bio-Molecular Science (2000) from Pisa University, Italy, where he acquired both PhD graduation in “Experimental and Molecular Oncology” (2006) and Specialization in “Clinical Pathology” (2008). Since 2002 he has been working in Surgical Pathology division (Department of Surgery, University of Pisa) where he is involved in different projects focused on Pancreatic Ductal AdenoCarcinoma (PDAC). In 2010 he becomes PI of his project regarding “News therapeutic strategies against PDAC. He awarded six times from AISP at the annual meeting as “young investigator”. He received a grant as “Young Investigator 2013” from “Fondazione Veronesi”, Milan, Italy. He published 65 full papers and more that 150 abstracts presented in international congresses. His field of expertise includes PDAC, Oncology, Biomarkers, TMA, Laser Micro-dissection and Primary cell Cultures.

Abstract:

Introduction: Current therapy for PDAC is surgery followed by adjuvant chemotherapy for early-stage and palliative chemotherapy for advanced disease. Gemcitabine is the standard drug in both adjuvant and palliative treatment. The mixture of Alkaloids (NSC-631570) in combination with gemcitabine significantly increased the median survival of advanced PDAC patients with respect to gemcitabine alone (10.4 vs. 5.2 months; p<0.001). Furthermore, preclinical studies showed that this mixture had selective citotoxic effects in cancer cell lines derived from different tumor types, but not in normal cell lines.

Aim: To evaluate the citotoxic effects of NSC-631570 in 2 Primary Pancreatic Cancer Cell Lines (PPTCCs), fibroblasts derived from PDAC specimens (F-PDAC) and an immortalized epithelial ductal pancreatic cell line (HNPE).

Materials & methods: Cytotoxicity was assessed by the CellTiter 96 kit (Promega) based on the cellular metabolism of the tetrazolium compound XTT, which is reduced by living cells to yield a soluble formazan product in the presence of the electron coupling agent phenazine methosulfate, while the modulation of Ukrain uptake in the medium was studied using the fluorescence property of NSC-631570 with the AlphaDigiDoc software by UV light excitation (ULA-DC test).

Results: Citotoxic effects of Ukrain in PPTCCs were significantly higher than those observed in F-PDAC and HPNE cells (20% vs. 80% live cells, at 10 µM [drug]). Furthermore, the ULA-DC test revealed that PPTCCs cells consumed more drug than F-PDAC and HPNE cells (paired Student’s test, n=4, p<0.001).

Conclusion: These data demonstrated the selective effect of NSC-631570 in PPTCCs, which may be related to a different transport system or higher metabolism of the drug in PDAC. Indeed, the two different up-takes of alkaloids discovered in cancer and no pancreatic cancer cells seem to suggest a higher expression of multi drug resistant systems (MDR) in F-PDAC and HPNE cells and warrant further investigations in order to support the possible role of Ukraine in PDAC treatment.

Biography:

Seyedeh Esmat Hosseini is an MSc student of critical care nursing from Shahid Sadoughi University of Medical Sciences. She is a researcher in Royan Institute and reviewer of Client Care Journal. She has published more than 7 papers in reputed journals. She has been working as supervisor nursery in stem cell therapy and regenerative medicine in Royan Institute for several years and chosen as the model nurse in Royan Institute. She has made speeches in some international congresses in foreign country such as Malaysia and Istanbul.

Abstract:

Introduction: Bone Marrow Aspiration (BMA) is one of the methods for diagnosis and treatment of various diseases, that now day it is widely use in regenerative medicine. Although this procedure in adults is usually performed by using local anesthesia, it is associated with anxiety and pain. The purpose of this study is to research into the effect of Deep Breathing Technique (DBT) on patients who have undergone BMA for appeasement of pain and reduction of anxiety.

Method: This study was a parallel randomized clinical trial. 60 patients who underwent BMA were randomly divided into two groups. Intervention group received DBT training and control group did not go through any training program. To measure the scope of anxiety and severity of pain, Spielberger State Anxiety Inventory (SAI) and Visual Analogue Scale (VAS) were used respectively. The anxiety before and pain after BMA, were evaluated in two groups.

Result: Comparison of anxiety and pain variables in study groups revealed that the mean score of anxiety and VAS average in the intervention group have  been lower than  that of  the control group and this difference was significant (P = 0.018 and P < 0.001 respectively). Comparison of   vital signs before and after DBT showed reduced the vital signs after intervention. However, no significant change was observed in control group.

Conclusion: DBT is an effective technique to reduce anxiety and relieve pain in BMA candidate. Nurses need to be aware anxiety and pain procedures during BMA.

Biography:

Priscila Feliciano de Oliveira is pursuing her Doctorate in Health Sciences from Sergipe Federal University (UFS). She earned her Master of Speech Therapy and Audiology degree from Pontifical Catholic University of São Paulo (2007). In addition, she post-graduated in Hospitalar Speech Therapy and Audiology and in Hospital Administration. She is a specialist in audiology by Federal Council of Speech Therapy and Audiology and is Adjunct Professor of Audiology at UFS. She is Coordinator of Audiology monitor program and Coordinator of Audiological Diagnosis research in Oncology conducted at a Public Hospital of Medical Emergency in Sergipe.

Abstract:

The audiologist, as part of the oncology multidisciplinary team does the early diagnosis of hearing loss and makes an effort at preventing difficulty in oral communication. Besides, there is a concern about quality of life issues, which extends the care of the physical, psychological and social dimensions. In this manner, the research of QOL was carried out in a public hospital of the northeast of Brazil (Aracaju) with 137 patients assessed with EORTC QLQ-C30 questionnaire version 3.0. Most of them were in the end of the cancer treatment, their average age was 53.9 years of age and 41.6% had a diagnosis of breast cancer. The mean score of the global scale was 75.0 points, followed by functional (73, 3) and symptoms (28.8) scales, which indicates a good QOL. However, symptom score had a significant data in statistical analysis (p≤0,005) for women with family history of cancer, delay in the discovery of the disease and delay to carry out the first appointment. In order to welcome and inform patients and family members about the side effects, especially hearing loss and rehabilitation, extension actions were developed with guidance in the waiting room, distribution of educational brochures and conducting turbans workshop to bald patients.

Biography:

Dawn McDonald completed her MSc in Medical Imaging, from Kingston University in 2008, and became a Consultant Mammographer soon afterwards. Working with the same autonomy and professionalism as a Consultant Breast Radiologist, she is responsible for all aspects of breast diagnosis within her unit, including breast interventional and film reading, and works closely with the surgical team. Currently, she is working at the James Paget Hospital in Great Yarmouth UK, and Imperial College London.

Abstract:

Consultant radiographers are a growing breed of clinician in the UK, carrying out roles that were historically only undertaken by consultant radiologists. Completing a master’s degree in medical imaging, and becoming qualified in all aspects of breast diagnosis including clinical breast examination, breast ultrasound, intervention, and film reading, consultant radiographers are fast becoming an integral profession in hospitals in the UK, with their ability to lead and deliver a service with autonomy, professionalism and competency. Initially some barriers had to be broken as there was reluctance to recognise the role, but with the current shortage of consultant radiologists, the value of the consultant radiographer has now become fully recognised. The four key domains of the consultant radiographer role are: Expert clinical practice; professional leadership and consultancy; education, training and service development and; research and evaluation. These are the key areas that we adhere to in our clinical roles. This talk aims to show the view of the consultant mammographer, and illustrates the clinical role with some interesting case studies.

Biography:

Shajeem Shahudeen has completed his M.B.B.S at the age of 24years from Rajiv Gandhi University of Health Sciences and post-graduated (M.D) from D.Y Patil University School of Medicine. I am presently working as a consultant radiologist at Vivid Diagnostic Centre, Kochi and I am the managing director of this centre, which is a premier Health care Centre in Kerala,INDIA. Have five publication in reputed journals like ECR and 2 E-poster.

Abstract:

Role of computed tomography in congenital heart disease

Shajeem Shahudeen

Vivid Diagnostic Centre, India

Background: Congenital Heart Disease births 40,000 affect nearly 1% of year.

Infant deaths due to CHDs is approximately of 4.2% of all neonatal deaths.

Early detection and treatment plays an important role.

Echocardiography and catheter cardio angiography are the primary cardiac imaging modalities, but has its own limitations.

Introduction: Coronary computed tomographic angiography (CTA) is a non-invasive technique for evaluation of congenital heart disease and coronary artery anomalies.

It also enables the evaluation of cardiac chambers, myocardium and valves.

It can be used for accurate depiction of complex cardiovascular anatomic features both before and after surgery and of a variety of post treatment complications.

Procedure details : Using a CT 128 slice scanner:

The scan ranges from the tracheal bifurcation to the bottom of the heart.

Done in ECG gated protocol to achieve motion-free images of the coronary arteries and aorta.

Post processing technique to reconstruct images and volume rendering for evaluation of complex anatomy.

Conclusion: CT is a useful imaging modality for the morphologic evaluation and diagnosis of Congenital Heart Disease.

Reformatted images from multi section spiral CT can accurately and systematically delineate the normal and pathologic morphologic features of the cardiovascular structures.

Biography:

Himadri Sikhor Das, MBBS, MD is a Radiologist from Guwahati, India with 15 years post MD experience with special interest in Neuro-Radiology, Head & Neck, Ocular/Orbital Radiology & Neuro-Ophthalmology. He is presently working as Consultant Radiologist and Executive Director, Matrix (Unit of Apace Imaging & Diagnostic Centre Pvt Ltd.) and Honorary Visiting Consultant & Thesis guide. He is Diplomate of National Board (DNB) Radiology at Institute of Neurosciences-GNRC Hospitals. He completed his MBBS in September ‘93, MD Radiology in February 1999 and Post Degree Fellowship in Neuroradiology in March 2000 followed by Senior Residency in the Department of Neuro-Radiology, AIIMS, New Delhi. He has many national and international publications & presentations and is also involved in many on-going national & international collaborative projects like Population based Indian Cancer Registry (Govt. of India) & the Digital Web Repository with MEDting (Spain). He also is active life Member of many professional societies.

Abstract:

Orbital tumors encompass different variety of lesions according to cell of origin. Careful evaluation of a patient’s history and examination along with modern high-resolution imaging studies provide the best information regarding the possible origin of an orbital lesion. Given the variety of structures within the relatively confined orbit, a systematic approach is necessary to understand the classification and imaging characteristics of orbital tumors. Orbital tumors are also divided anatomically into intraconal and extraconal depending on their relationship with the muscle cone. The muscle cone is formed by the extraocular recti muscles and their intermuscular septae, which separate the intraconal from the extraconal space. The muscle cone has a conical shape with the globe serving as the base and the optic canal as its apex. The diagnostic approach to tumors’ of the orbit should focus on specific anatomical locations –the globe, intraconal space, extraconal space, preseptal space, bony orbit, paranasal sinuses, lacrimal gland, optic nerve and globe. Useful features on CT are density including calcification and contrast enhancement, and on MRI the signal characteristics of the mass and contrast enhancement. As a general rule, benign tumors cause displacement and moulding of adjacent structures, whereas malignant lesions display an aggressive pattern of growth, destroying and obliterating the contours of surrounding structures. In this presentation, a general overview of morphology, pathological characteristics and imaging features of primary orbital tumors is discussed. Metastatic lesions are also briefly reviewed.

Biography:

Dawn McDonald completed her MSc in Medical Imaging, from Kingston University in 2008, and became a Consultant Mammographer soon afterwards. Working with the same autonomy and professionalism as a Consultant Breast Radiologist, she is responsible for all aspects of breast diagnosis within her unit, including breast interventional and film reading, and works closely with the surgical team. Currently, she is working at the James Paget Hospital in Great Yarmouth UK, and Imperial College London.

Abstract:

The density of the breast has been shown to be a significant factor in the detection of breast cancer in the female breast. It can be more difficult to detect breast pathology in younger women who have a denser breast type- in comparison with an older woman with a more fatty breast. This is because as women age head towards the end of their reproductive life, there is an increase in the amount of adipose tissue and a considerable loss of lobular units. Factors such as age, pregnancy and even BMI (Body Mass Index) are thought to be some of the factors influencing breast density and subsequent diagnosis. The significance of this becomes apparent when considering that it is estimated one third of breast cancer can be explained by high breast density. The changes in breast composition can be demonstrated by the breast density in mammography, and this talk aims to show examples of problems that are associated with the dense breast.

Biography:

BogusÅ‚aw Maciejewski has completed his PhD and got scientific title of a Full Professor in Radiotherapy. He released research projects in the UCLA Los Angeles, Gray Lab London, MGH Harvard University, Boston, MDACC Houston and other cancer centers in Europe. He was the Director of Cancer Center–Institute Gliwice, Poland for 24 years, till 2015. He is author of over 200 papers published in reputed journals (IF=1650, citation index=3500). He was awarded G F Fletcher Gold Medal, Gold Medal of Life Achievements in Oncology given by all European Oncologic Societies as he is a honorary Member of American College of Radiology, Radiotherapy Expert of the IAEA in Vienna, and for 10 years, he was a Member of European Board of Radiotherapy, participating in the development European curriculum for radiotherapy. His major scientific interest is importance of treatment time and tumor repopulation and altered dose fractionation in clinical radiotherapy for human tumors.

Abstract:

Enormous, progress in technology and radiotherapy equipment -from simple orthovoltage machines and single dose irradiation through linear accelerators, IMRT, IGRT, particle beams to stereotactic robotic radiosurgery is described and discussed. Also step-by-step progression from 1 H (Holtzknecht) to biologically equivalent doses (NBED) expressed in izobioGy_2.0 in relation to dose fractionation modified from conventional to altered hyper-, accelerated and hypofractionation is exemplified by clinical results. Key role of overall treatment time and initial tumor volume seems to be - major factors determining treatment outcome in radiotherapy. Sequential combined therapy is confronted against teragnostic therapy showing therapeutic gain when combined therapeutic methods are individually designed. Importance of molecular margins and genetic and molecular profiling is discussed for selected solid malignant tumors. Significant gain in locoregional control due to combination of microvascular reconstructive surgery combined with postoperative IMRT is illustrated by clinical cases of H&N cancer. Impact of Diffusion Tensor Tractography MRI on efficacy of neurosurgery of glioblastomas is shown as example of stereotactic NeuroRadiosurgery System developed and working in the Gliwice Institute. Examples of clinical importance of molecular profiling of medullary thyroid cancer and breast, stomach and rectal cancers are presented. Significant technological and empirical improvement since Roentgen discovery about 120 years ago result in an increased efficacy of radiotherapy being on important part of individually designed combined treatment strategy.

Biography:

C.V.Patel is Full Professor of Surgery & Chief of Oncology in Seth.G.S.Medical College & K.E.M.Hospital, India. He was done his training in K.E.M.Hospital, Tata Memorial Centre, India, Westminster Hospital, Royal Marsden Hospital & Christie Hospital in England and M.D. Anderson Hospital, Memorial Hospital in USA. Presently, he is work in care of advanced cancer and terminal patients in rural India.

Abstract:

Immunotherapy-an old wine in a new bottle

Auto urine therapy: practised in India for over 5000 years. Based on concept that unused antibodies are excreted in urine after malignancy is established in body. By ingestion of urine, these are returned to the host (e.g. urokinase in patient of myocardial infarct.)

Antioxidants, Vit A, Vit E, extract of Sorghum Vulgare plants

Immune-modulator drugs like Levamisole, Immunomod.

Pyrotherapy- injection of streptococcal toxins, typhoid vaccine and injection of milk

Voluntary apnoea- either by increasing breath holding time, Co2 inhalation or rebreathing in paper bag( as for hiccups)

Specific methods

Extract of semicarpus anacardium (Bibba, Bhilva). The sap of fruit has a very powerful antigenic effect when it comes in contact with living tissues. Used by Dr Wad- Prof of medicine J.J group of hospitals, Mumbai in advanced cases of Ca. Oesophagus in 1930s.

Use of selective action of HEAT on malignant cells in situ.( Hyperthermic, Exsanguinating, Anoxic, Tumour infusion/perfusion). The combination of factors adverse to delicate malignant cells, cause partial or total damage to tumour, the surviving tumour cells activate the antibodies of host. Similar effect can be achieved by devascularisation of tumour cells (ligation of feeding artery or embolisation) in selective cases. Debulking of tumour by thermo-coagulation gives relief from bleeding, obstruction and prolonged suppression of tumour spread.

In special situation like bleeding from bladder tumours, hyperbaria, irrigation with formalin solution (0.5%),and intratumour injection of BCG vaccine has been useful. Application of formalin to surface tumours (Mohs’ chemosurgery with zinc chloride) helps control bleeding and spread of tumours.

Necessity is mother of invention. There is no end to finding out solutions to problems created by malignancy, while laboratory research continues to look for permanent cures.

In 3% of cases the life becomes bearable and comfortable when all accepted modes of treatment have been exhausted. Same thing can be said in treating intractable pain of malignancy by simple intrathecal injection of hypertonic saline

Three cases on record-1) Sherry john-lymphoma (semicarpous anacardium)

2) Dr A.V.Bavdekar- Ca. Stomach (Auto urine & semicarpous anacardium)

3) Mr. Bhagwat –metastatic pancreatic tumour (levamisole)