Breast Cancer Subtypes Can Be Determinant in The Decision Making Process to Avoid Surgical Axillary Staging: A retrospective cohort study

Purpose: The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a lowrisk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). Methods: We retrospectively evaluated 612 consecutive women affected by early breast cancer. We considered age, tumour size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o non-sentinel lymph node (NSLN). Chi-square, Fisher’s Exact test and Student’s t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. Results: A significant positive effect of vascular invasion and lymphatic invasion, and a negative effect of TN were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumour presence, but focusing on the number of metastases, also age has a (negative) significant effect. Conclusion: This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary su

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents ≤ 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB

Quality of life, alexithymia, and defence mechanisms in patients affected by breast cancer across different stages of illness

Objectives: The aim of this study was to evaluate the effect of alexithymia and defence mechanisms on the quality of life of patients affected by breast cancer at different stages of the disease. Methods A convenience sample of 110 patients with breast cancer was involved in the study: 41 were receiving adjuvant chemotherapyafter surgery, 29 had disease-free survival in follow-up and 40 were receiving chemotherapy for metastatic disease. Quality of life, alexithymia and defence mechanisms were assessed using the following instruments: EORTC QLQ-C30-BR23, Toronto Alexithymia Scale (TAS-20) and Defense Mechanism Inventory (DMI). Results Compared to the other groups, patients receiving chemotherapy for metastatic disease reported poorer quality of life in several domains, more severe cancer-related and treatment-related symptoms and higher levels of alexithymia. When the effect of other potential predictors was taken into account, TAS-20 difficulty in identifying feelings was significantly related to all the EORTC functional subscale. Conclusion: This study underlined the relevance of difficulty in emotional processing and defence mechanisms in modulating psychological adjustment in women affected by breast cancer, suggesting that these might be potential targets of psychological intervention for this population

Localization of sentinel lymph node in breast cancer. A prospective study

Introduction: Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically nodenegative patients. Patients and methods: A cohort of 898 female patients with breast carcinoma was considered, from 2001 to 2008. Once SLN was localized, by means of radio-colloid or blue dye staining, and isolated, a biopsy was performed. Only those positive for metastases were submitted to axillary dissection. Results: Only in nine cases a SLN was not isolated. We had 819 cases of first level SLN (group A) and 69 cases of second level SLN (group B). Considering all of 889 cases, SLN was localized in the second level in 69 patients (7.8%); but if we consider metastatic SLN alone (340 cases), it was in the second level in 23 subjects (6.8%). In total, we had a positive second level SLN in 2.3% of cases (23/889). Conclusion: Second level SLN could be considered only an anomalous lymphatic axillary drainage and it does not linked to particular histological variants of the primitive tumour. In our study, skip metastases were recognized in only 2.6% of cases, therefore, whenever a SLN is not isolated for any reason, the first level sampling represent a viable operative choice

Anomalous vascularization in a Wnt medulloblastoma: A case report

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. To date only few cases of medulloblastoma with hemorrhages have been reported in the literature. Although some studies speculate on the pathogenesis of this anomalous increased vascularization in medulloblastoma, the specific mechanism is still far from clearly understood. A correlation between molecular medulloblastoma subgroups and hemorrhagic features has not been reported, although recent preliminary studies described that WNT-subtype tumors display increased vascularization and hemorrhaging. CASE PRESENTATION: Herein, we describe a child with a Wnt-medulloblastoma presenting as cerebellar-vermian hemorrhagic lesion. Brain magnetic resonance imaging (MRI) showed the presence of a midline posterior fossa mass with a cystic hemorrhagic component. The differential diagnosis based on imaging included cavernous hemangioma, arteriovenous malformation and traumatic lesion. At surgery, the tumor appeared richly vascularized as documented by the preoperative angiography. CONCLUSIONS: The case we present showed that Wnt medulloblastoma may be associated with anomalous vascularization. Further studies are needed to elucidate if there is a link between the hypervascularization and the Wnt/β-catenin signaling activation and if this abnormal vasculature might influence drug penetration contributing to good prognosis of this medulloblastoma subgroup

New protein clustering of breast cancer tissue proteomics using actin content as a cellularity indicator

In the present study, we report the comparative proteome profiles of proteins solubilized from 37 breast cancer surgical tissues, normalized for the actin content. Blood-derived proteins were excluded from the analysis. Among the tumor-derived protein spots, a large proportion (39%) was found present in all patients. These included several glycolytic enzymes, detox and heat shock proteins, members of annexin and S100 protein families, cathepsin D, and two "rare" proteins, DDAH2 involved in the angiogenesis control, and the oncogene PARK7. Other proteins, such as psoriasin, galectin1, cofilin, peroredoxins, SH3L1, and others, showed sporadic presence and high expression level, which suggests their possible role for patient stratification

Evaluation of microfiltration and heat treatment on the microbiological characteristics, phenolic composition and volatile compound profile of pomegranate (Punica granatum L.) juice

BACKGROUND: Since processing technology and storage may influence the sensory and nutritional value as well as the shelf life of pomegranate juice (PJ), mild technologies based on microfiltration may be a promising alternative to heat treatments for fruit juice preservation. In this study, physicochemical and microbiological properties of raw (RPJ), microfiltered (MPJ) and cloudy pasteurized (PPJ) PJ were compared over a period of 4weeks. RESULTS: Data demonstrated that microfiltration was comparable to pasteurization in guaranteeing microbiological stability of the juice, avoiding spoilage of the final product. After treatment, PPJ showed the highest amounts of gallic acid (GA) and ellagic acid derivatives (EAs). During storage, the amount of ellagitannins, EAs and GA similarly decreased in all types of juice. Trends towards variations of monomeric anthocyanins in MPJ and variations of polymeric and copigmented anthocyanins in both MPJ and PPJ were found over storage. CONCLUSION: The optimization of pretreatments and filtration parameters can lead to the industrial scale-up of microfiltration technology for the development of high-quality non-heat-treated PJ. © 2017 Society of Chemical Industry

Volatile Organic Compound and Fatty Acid Profile of Milk from Cows and Buffaloes Fed Mycorrhizal or Nonmycorrhizal Ensiled Forage

Seed inoculation of forage crops by arbuscular mycorrhizal fungi (AMF) generally results in higher profitability, but also modifies the chemical composition of silage in terms of increased biomass, protein, and dry matter. Raw milk aroma is affected by the type of feed. This work investigated the influence of ensiled forage obtained by seed inoculation with AMF on the volatile fractions and fatty acid composition of milk. Two experiments were carried out: in the first, buffaloes were fed maize silage, and in the second, cows were fed sorghum silage. The volatile fractions of milk were quantified by headspace solid-phase micro-extraction (HS-SPME), combined with gas chromatography–mass spectrometry (GC-MS), and fatty acids by gas chromatography (GC). The ensiled forage obtained with AMF increased saturated fatty acids (SFAs), and decreased monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) in both experiments. The volatile fraction in milk samples obtained from bovines fed mycorrhizal ensiled forage showed an increase of free fatty acids and ketones, responsible for cheesy and fruity odors. Aldehydes, responsible for green and grassy notes, increased only in the milk from buffaloes fed ensiled maize. Our results suggest that inoculation of maize and sorghum seed with AMF, combined with a low rate of fertilizers, leads to ensiled forage that could slightly affect the FA profile and odor quality of milk

"Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature

Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, discomfort, jaundice, weight loss. The majority of patients are identified incidentally at the time of cholecystectomy for cholelithiasis. It is not possible to differentiate preoperatively between gallbladder adenocarcinoma and gallbladder neuroendocrine carcinoma (NEC) with imaging techniques. The only curative therapeutic modality for LCNECs is a complete en bloc surgical resection, including regional lymph node clearances and hepatic lobectomy, but only in patients without multiple metastasis. LCNECs benefit from an aggressive surgical resection in combination with chemotherapy, if resectability is possible. If the tumour is non-resectable, the primary management is therefore medical and not surgical. All patients with LCNEC presented a poor prognosis with a median survival of 10 months after the initial diagnosis. Only in five patients (62.5%) a wide surgical excision was performed, while in the other cases the tumour was non-resectable or multiple liver metastases were present at diagnosis

FERALGINE™ a New Oral iron Compound

Management of iron deficiency (ID) and iron deficiency anemia (IDA) is primarily focused to remove, when possible, the underlying cause of ID; subsequently its treatment is primary focused on iron stores repletion. Ferrous sulphate (FS) remains the mainstay of treatment and it is recommended as the first-line treatment of ID and IDA in children as in adults by all guidelines of scientific societies. However the effectiveness of FS is largely compromised by increased adverse effects, poor compliance and discontinuation of treatment. A new oral iron source named FERALGINE™ (FBC-A) has been recently developed. This new molecule is a patented co-processed one-to-one ratio compound between Ferrous Bysglicinate Chelate (FBC) and Sodium Alginate (AA), obtained by using a spray drying technology. The data presented in this short review highlight the efficacy and safety of the treatment with FBC-A and support its use in adult patients with IDA. Furthermore the present review also provides preliminary evidence to suggest FBC-A as first-line treatment for ID/IDA in patients with celiac disease (CD) or inflammatory bowel diseases (IBD)