Neoadjuvant therapy for breast cancer

Objective: To evaluate the frequency of neoadjuvant therapy (NT) in women with stage I–III breast cancer in Italy and whether it is influenced by biological characteristics, screening history, and geographic area. Methods: Data from the High Resolution Study conducted in 7 Italian cancer registries were used; they are a representative sample of incident cancers in the study period (2009–2013). Included were 3546 women aged <85 years (groups <50, 50–69, 70–64, and 75+) with stage I–III breast cancer at diagnosis who underwent surgery. Women were classified as receiving NT if they received chemotherapy, target therapy, and/or hormone therapy before the first surgical treatment. Logistic models were built to test the association with biological and contextual variables. Results: Only 8.2% of women (290 cases) underwent NT; the treatment decreases with increasing age (14.5% in age <50 and 2.2% in age 75+), is more frequent in women with negative receptors (14.8%), HER2-positive (15.7%), and triple-negative (15.6%). The multivariable analysis showed the probability of receiving NT is higher in stage III (odds ratio [OR] 3.83; 95% confidence interval [CI] 2.83–5.18), luminal B (OR 1.87; 95% CI 1.27–2.76), triple-negatives (OR 1.88; 95% CI 1.15–3.08), and in symptomatic cancers (OR 1.98; 95% CI 1.13–3.48). Use of NT varied among geographic areas: Reggio Emilia had the highest rates (OR 2.29; 95% CI 1.37–3.82) while Palermo had the lowest (OR 0.41; 95% CI 0.24–0.68). Conclusions: The use of NT in Italy is limited and variable. There are no signs of greater use in hospitals with more advanced care

The global burden of chronic respiratory diseases

Key points Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. In the period of 1990–2020, COPD deaths are expected to increase from 2.2 to 4.7 million worldwide. Reducing chronic disease death rates by an additional 2% annually would avert 36 million deaths by 2015. The abatement of the main risk factors for respiratory diseases, in particular tobacco smoking, environmental tobacco smoke, indoor biomass fuels, outdoor air pollution and unhealthy diet, can achieve huge health benefits. Educational aims To define the burden of chronic respiratory diseases all over the world. To underline the importance of chronic diseases recognition by the international health community. To provide details about the burden of chronic obstructive pulmonary disease (COPD): the predicted third cause of death by 2020. Summary Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. Moreover, chronic diseases are not only a problem of the ageing population in developed countries. In fact, it has been estimated that 80% of mortality for chronic diseases occurred in low-income and middleincome countries in 2005. Thus, the World Health Organization (WHO) Dept of Chronic Diseases and Health Promotion has suggested a new Millennium Development Goal for the next few years: to reduce chronic disease death rates by an additional 2% annually, in order to avert 36 million deaths by 2015

Weight Gain after Smoking Cessation

Both overweight or obesity and cigarette smoking are relevant risk factors for public health. Cigarette smoking is associated with lower body weight while smoking cessation is associated with weight gain. Most smokers who quit experience a weight gain, particularly within one year, and it may persist up to 8 years after smoking cessation. However, only a minority of quitters gain excessive weight. Some individual characteristics have been found to be associated with excessive weight gain after smoking cessation while methodological problems may affect estimates of weight gain observed in different studies. Main mechanisms to explain weight gain after smoking cessation include increased energy intake, decreased resting metabolic rate, and decreased physical activity. The health benefits of smoking cessation far exceed any health risks that may result from smoking cessation-induced body weight gain. As weight gain may be a barrier against quitting smoking or a reason to restart smoking, behavioural and pharmacological methods have been evaluated to control weight gain after smoking cessation. Physicians should apply efficient strategies to promote smoking cessation on their weight-concerned smoking patient. This review briefly addresses some issues on the relationship between smoking cessation and weight gain, with regard to the size of the problem, mechanisms, health risks and control strategies

Influence of bulla volume on postbullectomy outcome

Objective: To quantify the contribution of the resected volume and the presence of associated, functionally significant emphysema to the postoperative improvement of pulmonary function after resection of giant lung bullae. Design: Patients undergoing elective surgery for giant bullae who had complete pulmonary function and radiographic studies performed were reviewed retrospectively. Setting: All 25 patients underwent surgery at the thoracic surgery unit of the University of Pisa, Pisa, Italy. Methods: Pulmonary function was assessed before and 12 months after surgery. On the chest radiograph, the location of bullae, and the signs of compression and emphysema were evaluated. The radiographic total lung capacity (TLCX-ray) and the volume of bullae were measured according to the ellipse method. Postoperatively, functional and radiographic changes were analyzed. The percentage change in forced expiratory volume in 1 s(ΔFEV1%) after surgery was the main outcome measure. The influence of factors related to emphysema and bulla volume on the functional improvement postbullectomy was assessed by stepwise multiple regression. Results: Before surgery, the TLCx-ray overestimated the TLC measured by nitrogen washout, with a mean difference between the two measurements of 1.095 L. A close relationship was found between the TLCx-ray and the plethysmographic TLC (n=6; r=0.95). After surgery, dyspnea lessened (P<0.05) and FEV1 increased (P<0.01). Statistically, the radiographic bulla volume was the single most important factor determining the ΔFEV1% (r=0.80, P<0.0001). Conclusions: These findings suggest that the preoperative size of bullae is the most important contributor to the improvement in ventilatory capacity after bullectomy, and that it is possible to predict the expected increase of postoperative FEV1 from preoperative bulla volume

Lower limb deep vein thrombosis in COVID-19 patients admitted to intermediate care respiratory units

COVID-19 has been associated with an increased risk of thrombotic events; however, the reported incidence of deep vein thrombosis varies depending, at least in part, on the severity of the disease. Aim of this prospective, multicenter, observational study was to investigate the incidence of lower limb deep vein thrombosis as assessed by compression ultrasound in consecutive patients admitted to three pulmonary medicine wards designated to care for patients with COVID-19 related pneumonia, with or without respiratory failure but not requiring admission to an intensive care unit. Consecutive patients admitted between March 27 and May 6, 2020 were enrolled. Patients were excluded if they were less than 18-year-old or if compression ultrasound could not be performed for any reason. Patients were assessed at admission (t0) and after 7 days (t1). Major and non-major clinically relevant bleedings were recorded. Sixty-eight patients were enrolled. Two were excluded due to anatomical abnormalities that prevented compression ultrasound; sixty patients were retested at (t1). All patients were started on antithrombotic prophylaxis, unless therapeutic anticoagulation was required. Deep vein thrombosis as assessed by compression ultrasound was observed in 2 patients (3%); one of them was later deemed to represent a previous episode. No new episodes were detected at t1. One major and 2 non-major clinically relevant bleedings were observed. In the setting of patients with COVID-related pneumonia not requiring admission to an intensive care unit, the incidence of deep vein thrombosis is low and our data support not screening asymptomatic patients

Cholinergic stimulation by pyridostigmine bromide before myocardial infarction prevent cardiac and autonomic dysfunction

Inflammatory processes and cardiovascular autonomic imbalance are very relevant characteristic of the enormous dynamic process that is a myocardial infarction (MI). In this sense, some studies are investigating pharmacological therapies using acetylcholinesterase inhibitors, such as pyridostigmine bromide (PYR), aiming to increase parasympathetic tone after MI. Here we hypothesized that the use of PYR before the MI might bring an additional positive effect to the autonomic function, and consequently, in the inflammatory response and cardiac function. The present study aimed to evaluate left ventricular function, baroreflex sensitivity, autonomic modulation, and inflammatory profile in PYR- treated rats previously to MI. Methods: Male Wistar rats (250-300 g) were treated for 60 days with PYR. After treatment, they were submitted to the MI. After the MI, the autonomic and ventricular function were evaluated, as well as the systemic, left ventricle, and adipose tissue inflammatory profile. Results: PYR, performed before MI, prevented HR increase, systolic function impairment, baroreflex sensitivity drop, as well as pulse interval variance, RMSSD, blood pressure and parasympathetic modulation reduction in treated rats compared to untreated rats. Also, this positive functional changes may have been a result of the reduced inflammatory parameters in the left ventricle (IFN-alpha, IL-6, and IL-1 beta), as well as increased IL-10 expression and IL-10/TNF-alpha ratio in treated animals before MI. Conclusion: Prior treatment with PYR prevents impairment of the autonomic nervous system after MI, which may be associated with the attenuated expression of inflammatory factors and heart dysfunction9CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação2013/14788-9; 2014/06669-

Eroina e asma bronchiale

Il broncospasmo da eroina, di recente individuazione, è di raro riscontro probabilmente perché poco conosciuto o non adeguatamente indagato. L’eroina, principalmente attraverso un meccanismo di istamino-liberazione, induce ostruzione bronchiale che appare più grave negli asmatici cronici e negli atopici manifestandosi pochi minuti dopo l’inalazione della sostanza. Il narcotico può determinare: a) broncospasmo con insufficienza respiratoria che può richiedere cure intensive con ricorso alla ventilazione meccanica; b) depressione del centro bulbare del respiro; c) sintomatologia sistemica; d) sindrome da astinenza, che si può presentare poco dopo la risoluzione dell’episodio acuto. Un rapporto empatico con il paziente può agevolare il percorso diagnostico; infatti, la sua reticenza a svelare l’abitudine voluttuaria ritarda l’individuazione dell’esposizione alla sostanza. Ciò può comportare un trattamento terapeutico ritardato, con conseguente aggravamento della condizione clinica a possibile evoluzione infausta.Bronchospasm caused by inhaled heroin has recently been identified. The condition has been rarely identified and/or not sufficiently investigated. Through the reaction mediated by histamine, heroin causes a bronchial obstruction that seems more severe in chronic asthmatic and atopic individuals, immediately after inhalating the substance. Heroin can reveal: a) bronchospasm with respiratory failure that may require intensive care up to mechanical ventilation; b) depression of the bulbar center of breath; c) systemic symptoms; d) withdrawal syndrome that may be evident after an acute clinical event. Even though an empathic relationship between the patient and the doctor can facilitate the diagnostic process, a lack of early identification of exposure to the substance, due to the patient’s hesitation to disclose his/her behavior, may cause a delay in the treatment and a worsening of clinical conditions with unfavourable development

Integrating the care of the complex COPD patient

The European Seminars in Respiratory Medicine has represented an outstanding series updating new science in respiratory disease from the 1990\u2019s up to the early beginning of this 21st century [1,2]. Its aim is to update issues and current science, focusing on the multidisciplinary approach to patients with respiratory disease. As such, it represents a unique opportunity for specialists in Respiratory Medicine involved in Basic and Clinical Research to discuss topical and debated problems in medical care, at a top level forum guided by an expert panel of authors. The structure of the seminar is based on the following pillars: \u2022 Attendance at the Seminars is strictly limited: selection of participants is based, in order of priority, on scientific curriculum, age (younger specialists are privileged), and early receipt of the application form. \u2022 Each topic is allotted considerable time for presentation and discussion. The first section is devoted to a series of presentations (with adequate time allocated for discussion) by an expert panel of researchers and clinicians. In the second section involves discussions of controversial issues, in a smaller audience format encouraging interaction between the panel and audience. \u2022 \u201cMeet the expert\u201d seminars discuss topical subjects in more depth, utilizing an interactive tutorial