Comparison between invasive breast cancer with extensive peritumoral vascular invasion and inflammatory breast carcinoma: a clinicopathologic study of 161 cases.

Objectives: Extensive peritumoral neoplastic lymphovascular invasion (ePVI) is a marker of aggressiveness in invasive breast carcinoma (BC). Methods: We explored the impact of ePVI on different BC subtypes. In a total of 2,116 BCs, 91 ePVI-BCs, 70 inflammatory breast carcinomas (IBCs), and 114 casual BCs as a control group (CG-BC) were recruited. Results: Patients affected by ePVI-BC were younger, had larger tumors, higher histologic grade, elevated Ki-67 score, Her2/neu overexpressed, and more lymph node metastases compared with CG-BC ( P < .001). Interestingly, only younger mean age at diagnosis differentiated patients with ePVI-BC from patients affected by IBC. ePVI-BC showed a clinical outcome intermediate between the prognoses of IBC and CG-BC. Conclusions: Results suggest that ePVI-BC and IBC may share some pathologic processes, providing a novel perspective on the heterogeneity of BC. Epidemiologic data and molecular studies on gene expression features are needed to rationally classify these tumors into their identified subtypes

Road traffic pollution and childhood leukemia: a nationwide case-control study in Italy

Background The association of childhood leukemia with traffic pollution was considered in a number of studies from 1989 onwards, with results not entirely consistent and little information regarding subtypes. Aim of the study We used the data of the Italian SETIL case-control on childhood leukemia to explore the risk by leukemia subtypes associated to exposure to vehicular traffic. Methods We included in the analyses 648 cases of childhood leukemia (565 Acute lymphoblastic–ALL and 80 Acute non lymphoblastic-AnLL) and 980 controls. Information on traffic exposure was collected from questionnaire interviews and from the geocoding of house addresses, for all periods of life of the children. Results We observed an increase in risk for AnLL, and at a lower extent for ALL, with indicators of exposure to traffic pollutants. In particular, the risk was associated to the report of closeness of the house to traffic lights and to the passage of trucks (OR: 1.76; 95% CI 1.03–3.01 for ALL and 6.35; 95% CI 2.59–15.6 for AnLL). The association was shown also in the analyses limited to AML and in the stratified analyses and in respect to the house in different period of life. Conclusions Results from the SETIL study provide some support to the association of traffic related exposure and risk for AnLL, but at a lesser extent for ALL. Our conclusion highlights the need for leukemia type specific analyses in future studies. Results support the need of controlling exposure from traffic pollution, even if knowledge is not complete

An elliptical accretion disk following the tidal disruption event AT 2020zso

Aims. The modelling of spectroscopic observations of tidal disruption events (TDEs) to date suggests that the newly formed accretion disks are mostly quasi-circular. In this work we study the transient event AT 2020zso, hosted by an active galactic nucleus (AGN; as inferred from narrow emission line diagnostics), with the aim of characterising the properties of its newly formed accretion flow.Methods. We classify AT 2020zso as a TDE based on the blackbody evolution inferred from UV/optical photometric observations and spectral line content and evolution. We identify transient, double-peaked Bowen (N III), He I, He II, and H alpha emission lines. We model medium-resolution optical spectroscopy of the He II (after careful de-blending of the N III contribution) and H alpha lines during the rise, peak, and early decline of the light curve using relativistic, elliptical accretion disk models.Results. We find that the spectral evolution before the peak can be explained by optical depth effects consistent with an outflowing, optically thick Eddington envelope. Around the peak, the envelope reaches its maximum extent (approximately 10(15) cm, or similar to 3000-6000 gravitational radii for an inferred black hole mass of 5-10 x 10(5) M-circle dot) and becomes optically thin. The H alpha and He II emission lines at and after the peak can be reproduced with a highly inclined (i  = 85 +/- 5 degrees), highly elliptical (e  = 0.97 +/- 0.01), and relatively compact (R-in = several 100 R-g and R-out = several 1000 R-g) accretion disk.Conclusions. Overall, the line profiles suggest a highly elliptical geometry for the new accretion flow, consistent with theoretical expectations of newly formed TDE disks. We quantitatively confirm, for the first time, the high inclination nature of a Bowen (and X-ray dim) TDE, consistent with the unification picture of TDEs, where the inclination largely determines the observational appearance. Rapid line profile variations rule out the binary supermassive black hole hypothesis as the origin of the eccentricity; these results thus provide a direct link between a TDE in an AGN and the eccentric accretion disk. We illustrate for the first time how optical spectroscopy can be used to constrain the black hole spin, through (the lack of) disk precession signatures (changes in inferred inclination). We constrain the disk alignment timescale to > 15 days in AT2020zso, which rules out high black hole spin values (a  < 0.8) for M-BH  similar to  10(6) M-circle dot and disk viscosity alpha  greater than or similar to  0.1.</p

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Proceedings of the 24th Paediatric Rheumatology European Society Congress: Part three

From Springer Nature via Jisc Publications Router.Publication status: PublishedHistory: collection 2017-09, epub 2017-09-0

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Renal tumours bio-bank and molecular translational research

Introduzione: Numerosi studi hanno accertato il ruolo dei markers molecolari e citogenetici, specialmente in pazienti con carcinoma renale a cellule chiare (ccRCC) , allo scopo di aumentare l\u2019accuratezza diagnostica raggiungibile con le classiche caratteristiche clinico patologiche del tumore. Obiettivo: Il principale scopo del presente studio era quello di valutare il potenziale ruolo della perdita del cromosoma 9p e del 14q come predittori di rischio di recidiva in una coorte di pazienti andati incontro a nefrectomia parziale (PN) o radicale (RN) per carcinoma renale a cellule chiare (ccRCC) non metastatico. Materiali: Abbiamo identificato la perdita del cromosoma 9p e 14q in 175 pazienti che erano stati sottoposti a nefrectomia parziale o radicale tra il 1990 e il 2000 per carcinoma renale a cellule chiare non metastatico. Nessun paziente aveva ricevuto trattamento adiuvante dopo la chirurgia. Metodi: Abbiamo eseguito un\u2019analisi citogenetica in interfase, (F.I.S.H:fluorescence in situ hybridization ) utilizzando una specifica sonda telomerica (115 kb) che mappa sui telomeri del cromosoma 9p e 14q (SpectrumGreen LSI, Abbott) e una sonda centromerica (alpha-satellite DNA) che mappa sul cromosoma 9p11-q11. Per ogni paziente abbiamo estratto dall\u2019archivio tutte le piu\u2019 rilevanti caratteristiche cliniche. Abbiamo identificato nella sopravvivenza libera da malattia (DFS: disease-free serviva) il nostro principale parametro di valutazione prognostico. Abbiamo generato differenti modelli di analisi statistica multivariata allo scopo di dimostrare il valore predittivo indipendente delle anomalie citogenetiche analizzate, quando aggiustate in base agli effetti dei principali parametri usati per stratificare i pazienti in categorie di rischio durante le prove di fase 3 di valutazione di efficacia di nuove terapie adiuvanti. Risultati e limiti: In 135 casi (77.1%) non abbiamo osservato alterazioni citogenetiche, in 14 casi (8%) e in 9 casi (5.1%) abbiamo osservato la perdita del cromosoma 9p o 14q rispettivamente. In 17 casi (9.7%) si \ue8 osservata la contemporanea presenza delle due alterazioni citogenetiche. La durata del follow-up medio era di 36 mesi (interquartile range: 21\u201378). La simultanea perdita del cromosoma 9p and 14q \ue8 risultato essere un fattore predittivo indipendente di DFS, una volta aggiustato in base agli effetti della dimensione tumorale (pT) e del grado di differenziazione (G) (hazard ratio [HR]: 4.579; 95% confidence interval [CI], 1.767 11.868), del Leibovich score (HR: 3.704; 95% CI, 1.565\u20138.768), o dell\u2019 UCLA Integrated Staging System (UISS; HR: 3.194; 95% CI, 1.351\u20137.553). Il piu\u2019 rilevante limite del nostro studio \ue8 il campione di analisi relativamente piccolo. Conclusioni: la perdita del cromosoma 9p e 14q \ue8 un parametro predittivo indipendente di sopravvivenza libera da malattia (DFS) in pazienti andati incontro a nefrectomia parziale (PN) o radicale (RN) per carcinoma renale a cellule chiare (ccRCC) non metastatico , una volta aggiustato in base ai parametri o del Leibovich score o del sistema UISS. Questo studio dimostra che la sopravvivenza libera da recidiva in pazienti candidabili a protocolli di terapia adiuvante potrebbe essere fortemente influenzata dalle caratteristiche citogenetiche del tumore.Background: Several studies have assessed the role of molecular and cytogenetic markers, especially in patients with clear cell renal cell carcinoma (ccRCC), with the intent of increasing the prognostic accuracy that is achievable with the classic clinical and pathologic features. Objective: The main purpose of the present study was to evaluate the potential role of loss of chromosomes 9p and 14q as predictors of the risk of recurrence in a cohort of patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) for nonmetastatic ccRCC. Design, setting, and participants: We evaluated the loss of chromosomes 9p and 14q in 175 patients who underwent PN or RN between 1990 and 2000 for nonmetastatic ccRCC. None of the patients received adjuvant treatment after surgery. Intervention: We performed an interphase cytogenetic fluorescence in situ hybridization analysis using a telomeric-specific probe (115 kb) mapping on the chromosome 9p and 14q telomeres (SpectrumGreen LSI, Abbott) and a centromeric (alpha-satellite DNA) probe mapping on chromosome 9p11-q11. Measurements: For each patient, we extracted from the database all of the most relevant clinical records. Disease-free survival (DFS) was the main outcome of the study. We generated different multivariable models with the intent of demonstrating the independent predictive role of cytogenetic abnormalities once adjusted for the effects of the most common tools used to stratify patients in ongoing phase 3 trials evaluating the efficacy of adjuvant therapies Results and limitations: No cytogenetic abnormalities were observed in 135 cases (77.1%), and loss of chromosome 9p or 14q was detected in 14 cases (8%) and 9 cases (5.1%), respectively. The contemporary presence of both cytogenetic alterations was reported in 17 cases (9.7%). The median follow-up duration was 36 months (interquartile range: 21\u201378). The simultaneous loss of both chromosomes 9p and 14q turned out to be an independent predictor of DFS, once adjusted for the effects of pT and nuclear grade (hazard ratio [HR]: 4.579; 95% confidence interval [CI], 1.767 11.868), Leibovich score (HR: 3.704; 95% CI, 1.565\u20138.768), or UCLA Integrated Staging System (UISS; HR: 3.194; 95% CI, 1.351\u20137.553). The most relevant limitation is the relatively small sample of evaluated patients. Conclusions: Loss of chromosomes 9p and 14q was an independent predictor of DFS in patients who underwent PN or RN for nonmetastatic ccRCC, once adjusted for the effects of either Leibovich score or UISS. This study demonstrates that the recurrence-free survival of patients suitable for adjuvant protocols could be strongly influenced by the cytogenetic characteristics of the tumor

Long-Term COVID: Case Report and Methodological Proposals for Return to Work

Almost two years after the beginning of the SARS-CoV-2 pandemic, the knowledge of which in the infectious and therapeutic spheres is constantly evolving, attention paid to the medicolegal aspects linked to this emergency phenomenon has mainly focused on the liability implications falling on healthcare personnel. With regard to the medicolegal assessment of the outcomes of COVID-19 illness, although it is a procedure that is commonly used, and although references in the assessment tables in force have been adhered to, a specific assessment protocol has not been standardized that takes into account, from an objective point of view, the degree of severity of the long-term residual outcomes and their impact on the social and working lives of subjects. This shortcoming appears to be attributable to the immediate need to categorize the results of COVID-19, but, in our opinion, it deserves an in-depth study and protocols to enable evaluation committees to draw up an assessment as precisely as possible and that is free of gaps, which could be the subject of legal disputes. The aim of the present work, in light of a worldwide problem, is to arrive at specific and univocal evaluation criteria for COVID-19 disease outcomes, applicable in different operational contexts of reemployment