Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: correlation with tumor biological subtypes and pathological response after therapy

The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4-3), and non-response (grades 1-2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes

Investigation of the effects of vitamin D and calcium on intestinal motility: In vitro tests and implications for clinical treatment

The presence of vitamin D receptors in small intestine muscle cells may lead one to think that vitamin D may act locally, influencing intracellular calcium concentration and contributing to the contraction-relaxation regulation of the intestinal smooth muscle cells. This study investigates the potential effects of vitamin D and calcium on intestinal motility using an in vitro test. Different calcium concentrations added to the tissue not pre-treated with 1,25-dihydroxycholecalciferol [1α,25(OH)2D3] produced no response at low doses (1.25×10–3 and 2.0×10–3 mol L–1) and only a very weak response at higher concentration (3.0×10–3 mol L–1). The addition of 1α,25(OH)2D3 (1.44×10–10 mol L–1) had no effect on isolated ileum motility. When calcium (3.0×10–3 mol L–1) was added after at least 3 hours, it evoked evident and persistent contractions for 60-90 minutes. The contractions were at about 40 % of the peak produced by acetylcholine.Thus, simultaneous intake of vitamin D and calcium might be a useful co-adjuvant in intestinal atony therapy aimed to stimulate normal gut motility in humans. These findings imply that supplemental vitamin D may be important in all cases where calcium has to be prescribed

Reliability of the telephone-administered International Physical Activity Questionnaire in an Italian pilot sample

Background: the International Physical Activity Questionnaire (IPAQ) is an instrument for crossnational monitoring of physical activity and inactivity. The aim of the study was the reliability evaluation of the Italian telephone-administered IPAQ version in Rome. Methods: the IPAQ short form (IPAQ-SF), consisting of 7 items, was administered. The responses, used to compute Metabolic Equivalent Task (MET in minutes per week), were processed to analyze the internal consistency. Standardized Cronbach’s alpha was used for reliability estimation. Results: a total of 133 adults (51 males and 82 females) participated in the study, with a mean age of 51 years (SD=19). The mean MET was 4 130, corresponding to good physical activity levels. The standardized Cronbach’s alpha on 6 items, concerning time spent on vigorous and moderate activity and walking, was 0.614. Conclusions: according to the findings from other countries, the Italian IPAQ-SF has acceptable measurement properties, as good as other established self-reports. The IPAQ-SF has a questionable reliability as previously reported, but the results of the present pilot study are promising and suggest that these instruments can be used to compare population estimates of physical activity

Dietary habits in Italy: the importance of the Mediterranean diet.

The Mediterranean diet is the heritage of millennia of exchange of people, cultures and foodstuffs throughout the Mediterranean basin. This diet is characterized by abundance of vegetables and fruits, bread, fish, olive oil, poultry, a relatively low consumption of red meat and a moderate consumption of wine during a meal and is well-defined by the food pyramid. Nowadays a standard Western diet has become far more common in Italy, against Mediterranean diet, which stands as a model of health sustainability: it is therefore necessary also to promote suitable resource management and to support quality in food. Practical and large scale projects should be activated, aimed to produce advice about meals both for families and for the different kinds of community, respectively

The HPV infection in males: an update.

The role of Human papillomavirus (HPV) in malignant and non-malignant genital diseases in females is well known and the corresponding epidemiological burden has been widely described, in males instead, less is known about the role of the virus in anal, penile and head and neck cancer, and the burden of malignant and non-malignant HPV-related diseases. There are many types of HPV that can infect the epithelium: some types can cause genital warts (low risk genotype), other types (high risk genotypes) can cause cancers of the penis, anus or oropharynx. Relative to females, males tend to be less knowledgeable about the infection: some may view its consequences as less likely and severe for themselves than for females, and thus could perceive vaccination as unnecessary. Including boys in the vaccination program generally exceeded conventional thresholds of good value for money, even under favorable conditions of vaccine protection and health benefits; however, uncertainty still exists in many areas that can either strengthen or attenuate the findings achieved

Aging populations: the health and quality of life of the elderly.

The progressive tendency for the age structure of the population to shift towards the elderly has been observed in all developed countries and this has important implications for health, society, economics and epidemiology. According to the most recent estimates for the world, the number of persons aged over 60 years will double from the present number, 756 to 1400 millions by 2030. In Italy, by the year 2050, 34.6% of the population will be aged more than 65 years. This will have important implications for health. There are medical conditions that occur almost exclusively among the elderly and these are sometimes referred to as syndromes or geriatric pathologies; other conditions that can occur at younger ages, may present with different symptoms, and cause complications in the elderly. More than just the single pathologies, the presence of two or more conditions simultaneously may have a critical impact on the health status of the elderly. As their ages increase, the elderly may be considered "frail"; factors, not only physical but also psychological cognitive and social, contribute to this syndrome and all must be considered together in the diagnosis and treatment of the elderly patient. These subjects are at greater risk of physical and cognitive decline, disability and death. As the elderly are an increasing fraction of the total patient load, their problems require that the structure and organization of health services be accordingly adjusted and also that the cultural and professional training of doctors and other medical personnel is appropriate. As a consequence, the objective of governments should be to promote the health and the quality of life of the elderly and this would include primary secondary and tertiary prevention applied in a variety of different settings. The choice of the preventive measures should be determined by the general health status of the elderly individuals, of whom 60-75% are classified as healthy, 20-30% are diagnosed as suffering chronic diseases, and 2-10% are regarded as "frail". For pathologies which do not require hospitalization, among the other existing services there is also Integrated Home Help (Assistenza Domiciliare Integrata, ADI) and Medically Assisted Residences (Residenze Sanitarie Assistenziale, RSA)