Lesioni non palpabili della mammella: la Mammotome-biopsy nella gestione preoperatoria del cancro della mammella

Premessa: Il tumore del seno è nei paesi occidentali al primo posto per frequenza nelle donne e la sua incidenza è in costante crescita. Grazie soprattutto alla diffusione dello screening mammografico e ad una maggiore consapevolezza del problema, negli ultimi anni è aumentata la diagnosi delle cosiddette lesioni “non palpabili”; parimenti si è assistito ad un importante sviluppo delle metodiche diagnostiche di tipo mininvasivo. Alla tradizionale citologia con ago sottile si sono affiancate infatti varie procedure bioptiche percutanee; tali metodiche microistologiche hanno quasi del tutto sostituito la biopsia chirurgica escissionale e l’esame intra-operatorio al congelatore. Pazienti e metodo: Nella nostra Divisione di Chirurgia Generale, Vascolare e Mininvasiva, dal dicembre 1999 al settembre 2004 abbiamo eseguito, in collaborazione con il servizio di Radiologia, 214 biopsie su guida ecografia utilizzando la vacuum-assisted biopsy (Mammotome® ) con ago 11-Gauge. I risultati ottenuti per ciò che concerne l’accuratezza diagnostica, la quantità e qualità delle informazioni ottenute, il significato delle stesse nella eventuale gestione chirurgica, il discomfort globale per la paziente sono stati analizzati e discussi nel presente lavoro. Risultati: Delle 214 biopsie eseguite con tecnica Mammotome, nell’89,3% dei casi si è trattato di lesioni clinicamente non palpabili, con un diametro medio di 8 mm. L’età media delle pazienti era di 57,6 anni (range 31-88). La positività per patologia maligna è stata di 90 casi (42%). Nei casi di iperplasia duttale atipica e radial scar (6%) è stata effettuata l’exeresi chirurgica della lesione che ha confermato nel 100% dei casi la precedente diagnosi bioptica. Il 19% delle pazienti sottoposte a biopsia Mammotome era stato precedentemente sottoposto ad un prelievo citologico con ago sottile. Confrontando i risultati delle due metodiche, l’attendibilità diagnostica della seconda risulta essere significativamente superiore (p<0,05) come pure il numero di informazioni ottenute (istotipo, invasività, grading, recettori ormonali, etc.); il discomfort legato alla procedura, valutato in termini di dolore (VAS), è risultato inferiore a quello del prelievo con ago sottile (p<0,05). L’unica complicanza della biopsia Mammotome è rappresentata dall’ematoma nella sede del prelievo (8% dei casi). Il numero dei falsi negativi è stato di un caso, dovuto ad un non corretto centraggio del bersaglio. Conclusioni: Allo stato attuale in presenza di una lesione non palpabile della mammella la scelta della metodica diagnostica (agobiopsia o Mammotome) è legata al sospetto radiologico nella prospettiva di un eventuale intervento chirurgico. La biopsia con Mammotome nelle lesioni non palpabil

Modulation of Nerve Growth Factor receptors in human monocytes and their influence in pulmonary inflammatory diseases

Neurotrophins (NTs) are a family of growth/survival factors with well-established functions in the nervous system. In the last decade, novel biological actions, from oncogenicity to inflammation, have been attributed to these factors. In particular, Nerve Growth Factor (NGF) acts through two different classes of receptors: the high affinity transducing TrKA receptor, associated to proliferation/survival, and the low affinity p75 receptor that, depending on its cross talk with TrKA, induces either apoptosis or survival. Recently, NGF and its receptors have been detected in healthy pulmonary tissues and seem to be involved in pulmonary inflammatory diseases. Since the expression of these NGF receptors in circulating monocytes is controversial, our initial aim was to investigate the role of these receptors both in pulmonary tissues and in peripheral blood monocytes of patients with Chronic Obstructive Pulmonary Disease (COPD). We therefore analyzed 38 healthy control subjects divided in two groups based on their smoking status. Serendipitously, the data obtained in these two control groups may have a value of their own, with potential implications in preventive medicine. We show here that in healthy subjects, smoking induces an early increase in p75 expression in monocytes, while TrKA seems unaffected. Furthermore, our control subjects could be divided in three subsets according to the constitutive TrKA expression in monocytes: TrKA-negatives, -intermediates (up to 50%) or -high (&gt; 50%), independently on their smoking status. Since TrKA activation promotes inflammation, we hypothesize that subjects with high-TrKA monocytes could be more prone to pulmonary inflammatory diseases, such as COPD. In fact, all 28 COPD patients in our series belonged to the high-TrKA subset, while all long term heavy smokers with no evidence of pneumologic diseases belonged to TrKA-negative subset. In conclusion, our data support the hypothesis that, since TrKA expression promotes survival, elevated levels of TrKA-positive monocytes may render subjects more prone to long term inflammatory diseases (e.g., COPD). Moreover, in patients constitutively expressing high levels of TrKA in monocytes, the smoking-dependent increase in p75 may in turn further extend monocytes survival, contributing to a chronic inflammation. Furthermore, the early increase in p75 expression in monocytes following smoking may support the hypothesis that p75 determination might represent a novel marker for passive smoking. Acknowledgments. This study was totally supported by Fondazione Cassa di Risparmio di Tern

A Seasonal and Age-Related Study of Interstitial Cells in the Pineal Gland of Male Viscacha (Lagostomus maximus maximus)

The pineal gland of viscacha exhibits histophysiological variations throughout the year, with periods of maximal activity in winter and minimal activity in summer. The aim of this work is to analyze the interstitial cells (IC) in the pineal gland of male viscachas in relation to season and age. The S-100 protein, glio-fibrillary acidic protein (GFAP), and vimentin were detected in adult and immature animals by immunohistochemistry (IHC). Double-IHC was also performed. The S-100 protein was localized within both, IC nucleus and cytoplasm. GFAP was present only in the cytoplasm. Vimentin was expressed in some IC, besides endothelial cells, and perivascular spaces. In the adult males, the morphometric parameters analyzed for the S-100 protein and GFAP exhibited seasonal variations with higher values of immunopositive area percentage in winter and lower values in summer, whereas the immature ones showed the lowest values for all the adult animals studied. Colocalization of S-100 protein and GFAP was observed. The IC exhibited differential expression for the proteins studied, supporting the hypothesis of the neuroectodermal origin. The IC generate an intraglandular communication network, suggesting its participation in the glandular activity regulation processes. The results of double-IHC might indicate the presence of IC in different functional stages, probably related to the needs of the cellular microenvironment. The morphometric variations in the proteins analyzed between immature and adult viscachas probed to be more salient in the latter, suggesting a direct relationship between the expression of the S-100 protein and GFAP, and animal age.Fil: Busolini, Fabricio Iván. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Rosales, Gabriela Judith. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Filippa, Veronica Palmira. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Mohamed, Fabian Heber. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentin

How Inequality Affects Health: Reconciling Evidence from Cross-Sectional, Relational, and Longitudinal Analyses

The income inequality hypothesis is one of the most influential ideas in public health. It posits that in the affluent world income inequality per se has a direct, independent and detrimental effect on health. This hypothesis, established in the 1990s, led to the publication of hundreds of articles across multiple disciplines. This hypothesis is also rather controversial. Debates surround the actual effect of income inequality and the hypothesized mechanisms. The evidence is consistently inconsistent. I argue that several conceptual and methodological limitations afflict this literature and hinder our understanding of the relationship between income inequality and health. In particular, I highlight four limitations: 1) simplistic treatment of inequality and poverty; 2) reliance on cross-national ecological comparisons that do not adequately consider the contributions of unusual cases; 3) reliance on cross-sectional comparisons; 4) reliance on a limited use of indicators. These limitations prompted the present dissertation research, which comprises three empirical studies. In the first study, I reanalyze publicly available data on income inequality and health across 20 affluent countries and 50 U.S. states. Drawing on the analytical difference between gap and headcount measures of income distributions, I argue that income inequality and poverty are dependent but distinct, and I estimate the extent to which poverty rates modify the relationship between income inequality and health. Across countries, the interaction of income inequality and poverty has a significant and adverse effect on health. Across U.S. states, instead, the interaction is not significant because the effect of poverty completely nullifies the effect of income inequality. In the second study, I delve into the interaction observed when comparing affluent countries in the first study. I use a recently developed methodology that decomposes regression coefficient estimates into unique case-specific contributions. I focus on the most frequently used measure of population health, life expectancy. I estimate OLS regression models with four different model specifications, which I then decompose. Four cases make major contributions to the coefficient estimates in all of the models. Two of these cases, Denmark and Japan, are particularly important because they challenge theoretical expectations: Denmark shows remarkably low life expectancy despite low levels of income inequality and poverty; Japan has the highest life expectancy despite relatively high levels of poverty. Denmark’s low life expectancy is explained by the high mortality risk of women born between WWI and WWII, who exhibited a lifelong high propensity to smoke. Japan’s high life expectancy is due to a concerted series of government initiatives (e.g., establishment of universal health insurance coverage, salt reduction campaigns, cost-effective antihypertensive drugs, dietary guidelines) that promoted healthy lifestyles and dietary habits. In the third and final study, I examine the income inequality hypothesis longitudinally. I estimate the effect of three indicators of income inequality (Gini coefficient, top 0.1% income share, and Theil index) on four outcomes (death rates for suicide, drug poisoning, homicide and heart disease) across the 50 U.S. states in 2000-2015. I estimate fixed-effects models that account for unobserved heterogeneity and omitted variable bias. My findings show no effect of income inequality on health. Lastly, I estimate mediation models that assess the indirect effect of income inequality on health via welfare generosity (in particular, the SNAP program, formerly known as the Food Stamp Program.) Across all specifications, income inequality has a negative indirect effect on mortality. Income inequality increases welfare generosity, which improves population health. As a whole, this dissertation shows that in the affluent world, income inequality has no direct or independent effect on health. Supporting individuals and household with no or low income might be a better way to improve population health than just reducing income inequality

Suicide and Social Policy, US, 2000-2015

Data set on suicide, state SNAP participation, state EITC, and correlates. From multiple sources