Evaluation of the prognostic value of impaired renal function on clinical progression in a large cohort of HIV-infected people seen for care in Italy

Whilst renal dysfunction, especially mild impairment (60 die;ve (Icona) Foundation Study collected between January 2000 and February 2014 with at least two creatinine values available. eGFR (CKD-epi) and renal dysfunction defined using a priori cut-offs of 60 (severely impaired) and 90 ml/min/1.73m2 (mildly impaired). Characteristics of patients were described after stratification in these groups and compared using chi-square test (categorical variables) or Kruskal Wallis test comparing median values. Follow-up accrued from baseline up to the date of the CCVD or AIDS related events or death or last available visit. Kaplan Meier curves were used to estimate the cumulative probability of occurrence of the events over time. Adjusted analysis was performed using a proportional hazards Cox regression model. We included 7,385 patients, observed for a median follow-up of 43 months (interquartile range [IQR]: 21-93 months). Over this time, 130 cerebro-cardiovascular events (including 11 deaths due to CCVD) and 311 AIDS-related events (including 45 deaths) were observed. The rate of CCVD events among patients with eGFR >90, 60-89, <60 ml/min, was 2.91 (95% CI 2.30-3.67), 4.63 (95% CI 3.51-6.11) and 11.9 (95% CI 6.19-22.85) per 1,000 PYFU respectively, with an unadjusted hazard ratio (HR) of 4.14 (95%CI 2.07-8.29) for patients with eGFR <60 ml/min and 1.58 (95%CI 1.10-2.27) for eGFR 60-89 compared to those with eGFR ≥90. Of note, these estimates are adjusted for traditional cardiovascular risk factors (e.g. smoking, diabetes, hypertension, dyslipidemia). Incidence of AIDS-related events was 9.51 (95%CI 8.35-10.83), 6.04 (95%CI 4.74-7.71) and 25.0 (95% CI 15.96-39.22) per 1,000 PYFU, among patients with eGFR >90, 60-89, <60 ml/min, respectively, with an unadjusted HR of 2.49 (95%CI 1.56-3.97) for patients with eGFR <60 ml/min and 0.68 (95%CI 0.52-0.90) for eGFR 60-89. The risk of AIDS events was significantly lower in mild renal dysfunction group even after adjustment for HIV-related characteristics. Our data confirm that impaired renal function is an important risk marker for CCVD events in the HIV-population; importantly, even those with mild renal impairment (90<60)&gt

Valutazione di fattori prognostici nel trattamento integrato dei GIST

Gastrointestinal stromal tumors (GIST) are mesenchymal tumorssupposed to arise from the cells of Cajal for mutations of the tyrosine re-ceptor kinases c-kit or platelet-derived growth factor receptor A. Ima-tinib selectively inhibits the kinase activity. Surgical treatments includ-ing radical resection and local excision remain the main treatment forprimary gastrointestinal stromal tumors (GISTs). Patients with high-grade GISTs have a higher risk of tumor recurrence and a shorter lifeexpectancy the introduction of Imatinib had changed drammaticallythe natural history of that kind of tunors, expecially in non-resectabletumors. AIM: we try to find the relationship between the tumor chara-teristics (size,mitosis, risk group, clinical sign and symptoms) and theoutcome (disease free survival and overall survival). Methods: from2001 to 2007, 20 patients (11 m/9 f) median age 68.9 (range 50-83yrs) underwent surgery for GIST resection, occasional diagnosys wasperformed in 3 patients. 15 were primary GIST, 2 recurrence localizedin ileum. Was performed 9 wedge gastric resections, 1 gastric resection,11 ileal resection. Main tumor size was 7.1 cm +/- 5, tumor necrosiswas found in 2 cases. After a median follow-up of 55.3 months (39.4-71.2) We stratify the patiens in risk group and we observed a statisticrelatrionship between tumor size and mitosis ane DFS and OS. Con-clusion: even in a small group surgical excision of low- and intermedi-ate-grade GIST has an excellent prognosis. Surgery remains the main-stay of treatments, and high-grade tumours carry a significantly worseprognosis. High mitotic rates and size are important poor prognostica-tor

Oncoplastic and reconstructive surgery in SENONETWORK Italian breast centers: lights and shadows

: • Despite the significance of oncoplastic procedure, an italian database is lacking. • Senonetwork established a multidisciplinary survey to assess their safety and efficacy. • Reconstructive outcomes were positive across low and high-volume centers. • After mastectomy, implant-based techniques are common. DTI reconstruction is advantageuos. • This contributes to the global understanding of effective strategies against breast cancer