The European Union has determined that from 2016 breast cancer patients should be treated in Specialist Breast Units that achieve the minimum standards for the mandatory quality indicators as defined ...by Eusoma. The existing standard for axillary lymph node staging in breast cancer is sentinel node biopsy (SNB), performed using Technetium‐sulphur colloid (99mTc) alone or with blue dye. The major limits of radioisotope consist in the problems linked to radioactivity, in the shortage of tracer and nuclear medicine units. Among existing alternative tracers, SentiMag®, which uses superparamagnetic iron oxide particles, can represent a valid option for SNB. We conducted a paired, prospective, multicentre study to evaluate the non‐inferiority of SentiMag® vs. 99mTc. The primary end point was the detection rate (DR) per patient. The study sample consists of 193 women affected by breast carcinoma with negative axillary assessment. The concordance rate per patients between 99mTc and SentiMag® was 97.9%. The DR per patient was 99.0% for 99mTc and 97.9% for SentiMag®. SentiMag® appears to be non‐inferior to the radiotracer and safe. While 99mTc remains the standard, SentiMag® DR appears adequate after a minimum learning curve. In health care settings where nuclear medicine units are not available, SentiMag/Sienna+® allows effective treatment of breast cancer patients.
Abstract Aim The present study was specifically designed to assess the major clinical and pathological variables of patients with colorectal peritoneal carcinomatosis in order to investigate whether ...currently used criteria appropriately select candidates for peritonectomy procedures (cytoreductive surgery) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Patients and methods Preoperative, operative and follow-up data on 146 consecutive patients presenting with peritoneal carcinomatosis of colorectal origin and treated by surgical cytoreduction combined with HIPEC in 5 Italian Hospital and University Centers were prospectively entered in a common database. Univariate and multivariate analyses were used to assess the prognostic value of clinical and pathologic factors. Results Over a minimum 24-month follow-up, the overall morbidity rate was 27.4% (mortality rate: 2.7%) and was directly related to the extent of surgery. Peritoneal cancer index (PCI), unfavorable peritoneal sites, synchronous or previously resected liver metastasis and the completeness of cytoreduction, all emerged as independent prognostic factors correlated with survival. Conclusions Until research provides more effective criteria for selecting patients based upon the biomolecular features of carcinomatosis, patients should be selected according to the existing independent prognostic variables.
Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients ...underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted.
The following parameters were recorded:
hospital, age, medical record number Bio-pathological: tumor (T) size, grading (G), multifocality, histological type, LVI, ER-PR status, HER-2, ki67, molecular classification (luminal A, luminal B, HER2 like, triple negative) Sentinel and nonsentinel lymph node related: number of removed SLNs, number of positive and negative SLNs, copy number of positive sentinel nodes, ratio: number of positive SLNs to number of removed SLNs, number of removed and number of positive nodes after ALND. A total of 2460 patients have been included in the database. All the patients have been provided by the authors of this paper.
Multivariate logistic regression analysis demonstrated that only the number of a CK19 mRNA copies (p < 0.0001), T size (p < 0.0001) and LVI (p < 0.0001) were associated with NSN metastases. The discrimination of the model, quantified with the area under the receiver operating characteristics curve, was 0.71 (95 %, C.I. 0.69-0.73), thus confirming a good level of reliability.
The nomogram may be employed by the surgeon as a decision making tool on whether to perform an intraoperative axillary lymph node dissection on breast cancer patients with SLN positive. The large population employed and the standardized method of measuring the value of CK19 mRNA copies are appropiate prerequisites for a reliable nomogram.
Seagrass meadows are complex ecosystems representing an important source of biodiversity for coastal marine systems, but are subjected to numerous threats from natural and human-based influences. Due ...to their susceptibility to changing environmental conditions, seagrasses are habitually used in monitoring programmes as biological indicators to assess the ecological status of coastal environments. In this paper we used a non-destructive photo mosaicing technology to quantify seagrass distribution and abundance, and explore benefits of micro-cartographic analysis. Furthermore, the use of photogrammetric tools enhanced the method, which proved to be efficient due to its use of low-cost instruments and its simplicity of implementation. This paper describes the steps required to use this method in meadows of Posidonia oceanica, including: i) camera calibration procedures, ii) programming of video survey, iii) criteria to perform sampling activities, iv) data processing and micro-georeferenced maps restitution, and v) possible study applications.
The role of microRNAs (miRNAs) in glioma biology is increasingly recognized. To investigate the regulatory mechanisms governing the malignant signature of gliomas with different grades of malignancy, ...we analyzed miRNA expression profiles in human grade I–IV tumor samples and primary glioma cell cultures. Multiplex real-time PCR was used to profile miRNA expression in a set of World Health Organization (WHO) grade I (pilocytic astrocytoma), II (diffuse fibrillary astrocytoma), and IV (glioblastoma multiforme) astrocytic tumors and primary glioma cell cultures. Primary glioma cell cultures were used to evaluate the effect of transfection of specific miRNAs and miRNA inhibitors. miRNA microarray showed that a set of miRNAs was consistently upregulated in all glioma samples. miR-363 was upregulated in all tumor specimens and cell lines, and its expression correlated with tumor grading. The transfection of glioma cells with the specific inhibitor of miR-363 increased the expression level of tumor suppressor growth-associated protein 43 (GAP-43). Transfection of miR-363 induced cell survival, while inhibition of miR-363 significantly reduced glioma cell viability. Furthermore, miRNA-363 inhibition induced the downregulation of AKT, cyclin-D1, matrix metalloproteinase (MMP)-2, MMP-9, and Bcl-2 and upregulation of caspase 3. Together, these data suggest that the upregulation of miR-363 may play a role in malignant glioma signature.
The Italian Society of Surgical Oncology (SICO) Breast Oncoteam developed a survey to explore the state of the art of neoadjuvant treatment for breast cancer in Italy, specifically focusing on cases ...treated during the two-year period 2014–2015.
A questionnaire was sent to Italian Breast Units with a minimum of 150 new breast cancer cases treated/year according to the Senonetwork directory and to the SICO Breast Oncoteam Breast Unit network.
A total of 23/107 Breast Units submitted the survey, reporting a total amount of 20156 cases of breast carcinoma (17241 invasive, 2915 in situ) treated in the biennium, corresponding approximately to 20% of newly diagnosed breast cancers in Italy.
In the United States, medical treatment before surgery for breast cancer is indicated in about 22.7% of newly diagnosed cases according to the National Cancer Database, while a German study reported approximately 20% of cases treated with neoadjuvant therapy. In our survey, a total of 1673/17241 cases (9.7%) were treated with neoadjuvant therapy, ranging from 2.9% to 23.6% according to different centres, showing heterogeneity in neoadjuvant treatment indications, even in multidisciplinary breast units. Better resources should be engaged to achieve a standardised quality indicator for neoadjuvant treatment, and this indicator could be included among the European Society of Breast Cancer Specialists (EUSOMA) quality indicators. In the near future, we plan to develop a second survey to better test improvements in the employment of neoadjuvant therapy after the expiry of the 2016 European Parliament deadline and after the 2017 St. Gallen Conference recommendations.
The correct time to perform an upper endoscopy is decisive in acutely GI bleeding patients. However, patients’ physical status may affect mortality. We speculated that the physical status and ...procedural time could be the principal factors accountable for death-risk. The primary aim was to verify the interaction between physical status and time to endoscopy on mortality; the secondary aim was to verify the interaction of the physical status and time to endoscopy on the length of stay (LOS).
Consecutive patients admitted to 50 Italian hospitals were included. Clinical and endoscopic data were recorded. A multiple logistic regression analysis was performed and the interaction of adjusted clinical physical status and time to endoscopy on mortality was calculated.
Complete data were available for 3.190 patients. The time frames did not interfere with outcomes but influenced LOS. Conversely, the ASA score correlated with mortality, LOS, need for transfusions and rebleeding risk.
Endoscopy time should be tailored to the patient's physical. In our experience, ASA 1–2–3 patients can be safely submitted to endoscopy to reduce the LOS; on the contrary, keen attention should be paid to ASA4 patients, following the ‘not too early-not too late’ rule (12–24 h from admission).
. Pirro M, Bocci EB, Di Filippo F, Schillaci G, Mannarino MR, Bagaglia F, Gerli R, Mannarino E (From the Unit of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and ...Experimental Medicine; Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy). Imbalance between endothelial injury and repair in patients with polymyalgia rheumatica: improvement with corticosteroid treatment. J Intern Med 2012; 272: 177–184.
Objectives. Polymyalgia rheumatica (PMR) is a rheumatic disease that is characterized by intense activation of systemic inflammation. Systemic inflammation has been associated with an imbalance between endothelial injury and repair, defined by an increased number of circulating endothelial microparticles (EMPs) and a reduced number of endothelial progenitor cells (EPCs). We investigated the association between inflammation and endothelial injury and repair in patients with PMR and evaluated the effects of corticosteroid therapy on EMP and EPC levels.
Design, setting and subjects. We conducted a case–control study in 34 patients with never‐treated active PMR and 34 healthy age‐ and sex‐matched controls. Patients with PMR participated in a 1‐month intervention open‐label study with corticosteroid therapy. Circulating EMPs (CD31+/CD42−) and EPCs (CD34+/KDR+) were quantified by fluorescence‐activated cell sorting analysis.
Results. Patients with PMR had an increased EMP/EPC ratio compared with controls median (IQR): 6.5 (3.0–11.5) vs. 1.1 (0.7–1.5), P < 0.001, because of both increased EMP and reduced EPC levels. Levels of C‐reactive protein (CRP) were associated with an increased EMP/EPC ratio (β = 0.48, P = 0.001), irrespective of traditional cardiovascular risk factors. Corticosteroid therapy led to a significant CRP reduction from 3.9 (1.5–6.7) to 0.6 (0.2–1.2) mg dL−1, P < 0.05, paralleled by a consistent 81% decline in the EMP/EPC ratio. CRP and EMP/EPC ratio reductions were significantly correlated (rho = 0.37, P = 0.04).
Conclusions. Polymyalgia rheumatica is associated with a significant imbalance between endothelial injury and repair, which is dependent on the degree of systemic inflammation. Attenuation of inflammation by short‐term corticosteroid therapy might have a role in limiting endothelial fragmentation and promote endothelial repair.
The extension of accessibility of CH to disabled people is a current topic of great importance. Today, there exist a lot of ongoing projects aimed at the extension of accessibility using the most ...recent and low cost technologies to improve accessibility to CH. One of the technologies, today available that can help to improve accessibility to CH, is certainly rapid prototyping. The main goal of the research here illustrated is the application of rapid prototyping for the extension of accessibility of Cultural Heritage (CH) to blind and visually impaired people. This document reports an experiment that compared the effectiveness of different 3D models for the introduction of blind and visually impaired people to the tactile use of models of monuments. In addition, this study focuses on defining standards and guidelines regarding features of 3D models, e.g. print resolution, in order to obtain greater legibility of models at different scales by the blind or visually impaired people. This paper shows a part of a wider Interreg EU research project, named I-ACCESS, aimed to study accessibility problems and solutions for CH. The experiments conducted with the sample of disabled people, allowed to obtain results on the most suitable printing parameters to be used.
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