positive axillary sentinel lymph node is axillary dissection always necessary

Summary There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive in early breast cancer, particularly when axillary involvement is minimal (micrometastases or isolated tumor cells). In fact, clinical practice has run ahead of the evidence, since recent population-based data indicate that AD is 'underused' in breast cancer patients when the SN is positive. Several trials are addressing the problem (IBCSG 23-01, ASCOG Z0011, EORTC AMAROS). Only Z0011 has published interim results, finding, after a median follow-up of 6.3 years, no differences in locoregional recurrence or regional recurrence between patients, with a positive SN, who received AD vs. no further axillary treatment. Our own retrospective study evaluated patients with micrometastases or isolated tumor cells in the SN who received no further axillary treatment. We found high five-year survival and low cumulative incidence of axillary recurrence, supporting the findings of Z0011 and justifying the increasingly common practice of foregoing AD in women with minimal SN involvement. It is important to sound a note of caution however: If axillary dissection is not always necessary in women with a positive axilla, it seems important to be able to reliably identify the patients at high risk of developing overt axillary disease who should receive elective AD. Ancillary analyses of the IBCSG 23-01 and AMAROS trials, still in follow-up, may be able to do this

Dog craniometry: a cadaveric study

The morphology of canine head differs greatly among breeds, so that they have been categorized in 3 groups (brachycephalic, mesaticephalic and dolichocephalic) based on craniometric measurements. However, several dog breeds are still unclassified, and skull measurements, often analyzed in adult dogs, are rarely studied in dog puppies. The aim of this work is to clarify whether dog puppies can be classified as dolichocephalic, mesaticephalic and brachycephalic. The skulls of spontaneously dead dog puppies aged 0 to 57 days were studied by using the following anatomic and radiographic measurements and indices: Skull Length, Cranial Length, Facial Length, Cranial Width, Skull Width, Cranial Index (CI), Skull Index (SI); radiographic Condylobasal Length, S-index and Facial Index were added. A new index, the modified-Skull Index, was created. Pearson test, ANOVA and neural nets were used in the statistical analysis. 173 dogs from 36 breeds were included in the study. Anatomic and radiographic CI and SI were significantly correlated (p<0,05). Almost all the anatomic and radiographic measurement significantly differed between brachycephalic and mesaticephalic breeds (p<0,05), while dolichocephalic breeds showed intermediate features. The new modified skull index was significantly different among the three classes (p<0,05). The neural nets allowed to classify three previously unclassified breeds. With this work it was proved that many breeds can be classified as brachycephalic, mesaticephalic or dolichocephalic as early as up to 2 months after birth, and some previously unclassified breeds were also classified. A new useful craniometric index was introduced. Finally, cadavers proved to be a very good model for dog craniometric studies

Stifle anatomic, tomographic and biomechanical features of growing dogs affected by quadriceps contracture.

Quadriceps contracture is a debilitating and uncommon condition, mostly affecting young dogs. Itcan be congenital or acquired ) and is reported to induce muscular hypotrophy/fibrosis, progressive degenerative joint disease, bone hypoplasia and limb hyperextension. The aim of this study was to elucidate anatomic, tomographic and biomechanical features of stifles affected by quadriceps contracture.Seven 2-month-old dead Dobermann Pinschers with unilateral quadriceps contracture were included. Before gross anatomic evaluation, all stifles underwent Computed Tomography before and after intra-articular administration of iodinated contrast medium. Images were acquired in double positioning (stifle extension and flexion) to identify articular cartilage, Ossification Centres’ (OCs) and menisci abnormalities, which were compared between affected and unaffected limbs. In all affected limbs the stifle was back-turned, the distal femur was extra-rotated and the patella was luxated proximo-medially. Severe lack of physiological stifle movements (rolling, gliding, spinning) was observed, so that affected joints could not be flexed. The articular cartilage of the femur was flattened and irregular in thickness, the femoral trochlea was hypoplasic and sloping, the menisci were misshaped. The OC of the distal femur and proximal tibia were misshaped; the tibial plateau was oriented caudodorsally-cranioventrally and significantly smaller (P<0,05). Quadriceps contracture influenced stifle development. The action of quadriceps insertion on the tibia prevented normal development of the plateau, causing wedging and abnormal orientation. Constant compression also induced external rotation of the distal femur (unable to develop distally) and patellar luxation, ending up in genu recurvatum. Static compression was likely responsible for femoral trochlea hypoplasia, articular cartilage and meniscal deformation, due to the lack of physiological stifle movements.Quadriceps contracture induces severe alterations of stifle development in affected puppies. Histology, histochemistry and immunohistochemistry may better define the nature of such bone, cartilage and meniscal alterations

Plasma Retinol and Prognosis of Postmenopausal Breast Cancer Patients

Abstract Background: The role of retinol (vitamin A) in breast cancer prognosis has never been investigated in postmenopausal women. We prospectively assessed the long-term prognostic role of retinol plasma levels in a cohort of postmenopausal breast cancer patients. Patients and Methods: We investigated 208 women self-reported as postmenopausal operated on for T1-2N0M0 breast cancer who participated in a chemoprevention trial as controls and never received chemotherapy or hormone therapy. Plasma samples were collected 3 months (median) after surgery and assayed within 3 weeks for retinol. Minimum and median potential follow-up were 12 and 15 years, respectively. The main analyses were on all women and on a subgroup ages ≥55 years, assumed too old to be in perimenopause. The main end point was breast cancer death. Breast cancer survival was estimated by the Kaplan-Meier method. The hazard ratios of breast cancer death by retinol level were estimated by Cox models stratified for age, where relevant, and recruitment period, and adjusted for tumor size and histology. Results: At 12 years, patients with low retinol (<2.08 μmol/L, median of distribution) had lower breast cancer survival than those with high retinol (log-rank P = 0.052); the difference was significant for women ≥55 years (log-rank P = 0.006). The adjusted hazard ratios for low versus high retinol were 2.11 (95% confidence interval, 1.08-4.14) for all women and 3.58 (95% confidence interval, 1.50-8.57) for those ≥55 years. Conclusions: Low plasma retinol strongly predicts poorer prognosis in postmenopausal breast cancer patients. Retinol levels should be determined as part of the prognostic workup. (Cancer Epidemiol Biomarkers Prev 2009;18(1):42–8

Polysynovitis in a horse due to Borrelia burgdorferi sensu lato infection – Case study

Lyme borreliosis (LB) is a multi-systemic tick-borne disease affecting both humans and animals, including horses, and is caused by a group of interrelated spirochetes classified within the Borrelia burgdorferi sensu lato (s.l.) complex. Despite the high reported seroprevalence in the European equine population for B. burgdorferi s.l., to-date no documented clinical cases have been described. A 6-year-old Paint gelding was referred with a history of three weeks of fever, intermittent lameness and digital flexor tendon sheath effusion of the right hind limb. Based on a strict diagnostic protocol, which included serological tests for infectious diseases and molecular investigations, a final diagnosis was made of polysynovitis due to B. burgdorferi s.l. infection. An unreported aspect observed in this case was the absence of the pathogen DNA in two of the affected joints. To the authors' knowledge, the case described represents the first documented clinical case of equine LB in Italy. Moreover, the absence of pathogen DNA in two of the affected joints observed in this case revealed a possible similarity with the same condition described in humans, where an immunomediated pathogenesis for arthropathy due to B. burgdorferi s.l. infection is suspected. Since humans and horses share the same habitat, this report supports the role of the horse as potential sentinel for human biological risk

Comparative spectroscopic and thermo-optic study of Tm: LiLnF4 (Ln = Y, Gd, and Lu) crystals for highly-efficient microchip lasers at ~2 μm

We report on a detailed comparative study of the spectroscopic and thermo-optic properties of tetragonal Tm:LiLnF4 (Ln = Y, Gd, and Lu) crystals indicating their suitability for highly-efficient microchip lasers diode-pumped at ~791 nm and operating at ~1.91 μm. An a-cut 8 at.% Tm:LiYF4 micro-laser generated 3.1 W of linearly polarized output at 1904 nm with a slope efficiency of η = 72% and a laser threshold of only 0.24 W. The internal loss for this crystal is as low as 0.0011 cm-1. For 8 at.% Tm:LiGdF4 and 12 at.% Tm:LiLuF4 lasers, the output power reached ~2 W and η was 65% and 52%, respectively. The thermal lens in all Tm:LiLnF4 crystals is weak, positive and low-astigmatic. The potential for the Tm:LiLnF4 lasers to operate beyond ~2 μm due to a vibronic coupling has been proved. The Tm:LiYF4 vibronic laser generated 375 mW at 2026-2044 nm with η = 31%. The Tm:LiLnF4 crystals are very promising for passively Q-switched microchip lasers

Fifteen-year results of a randomized phase III trial of fenretinide to prevent second breast cancer

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Familial breast cancer: characteristics and outcome of BRCA 1–2 positive and negative cases

BACKGROUND: The clinical and pathological characteristics and the clinical course of patients with breast cancer and BRCA 1–2 mutation are poorly known. METHODS: From 1997, patients with breast cancer and a family history of breast or ovarian cancer were offered BRCA testing. The clinical and pathological features of patients with known BRCA status were retrospectively assessed and comparisons were made between cancers arising in BRCA positive and BRCA wild type (WT) patients respectively. Type of treatment, pattern of relapse, event (local relapse, contralateral breast cancer, metastases) free and overall survival were also compared in the two groups. Out of the 210 patients tested, 125 had been treated and followed-up at our Institution and were evaluated in this study. RESULTS: BRCA positive patients tended to be more often premenopausal (79% vs 65%) and to have positive lymphnodes (63% vs 49%), poorly differentiated tumours (76% vs 40% – p = 0.002 at univariate analysis, not significant at multivariate analysis) and negative estrogen receptors (43% vs 29%). Treatment was not different in the two groups. In the 86 BRCA-WT patients, the first event was a local relapse in 3 (3%), metachronous contralateral breast cancer in 7 (8%) and distant metastases in 16 (19%). In the 39 BRCA positive patients, the corresponding figures were 3 (8%), 8 (21%) and 3 (8%). There was no difference in event free survival, with a median of 180 months in both groups of patients. At 20 years, projected survival was 85% for BRCA positive patients and 55% for BRCA-WT, but this difference was not statistically significant. CONCLUSION: Although BRCA positive patients have more frequently negative prognostic factors, their prognosis appears to be equal to or better than in patients with BRCA-WT

Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment