Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines

Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines Background Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors. Goals & Objectives Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. Documentation of the time the specimen was initially placed in formalin. Documentation of the cold ischemic time (the interval time between removal of the specimen from the blood supply until it is initially placed in formalin). The cold ischemic time will be 60 minutes or less. The total time the specimen remains in formalin will be a minimum of 6 hours and a maximum of 72 hours. The benchmark for these indicators was 90%. The Her-2/neu Positivity Rate of invasive breast cancer specimens will be within a range of 15 – 20%. Methods This quality improvement project consisted of three PDSA Cycles that each contained a planning phase, a retrospective chart audit, data analysis, and an intervention to improve the process. Patients who had undergone mastectomy or lumpectomy were selected for the chart audits. Results Documentation of the time the specimen was removed from the body improved from 87.5% to 95%. Documentation of the time the specimen was placed in formalin improved from 80% to 90%. The cold ischemic was calculated in thirty-eight of the forty-two charts, or 90%, an improvement from 82.5%. The cold ischemic times in forty-two of forty-two cases were within sixty minutes, or 100%. All specimens were in formalin longer than six hours. Twenty of forty-two cases were in formalin for seventy-two hours or less, or 48%. Seventeen of the twenty-two cases, (78%) in which the specimen spent over seventy-two hours in formalin were performed on either a Thursday or Friday. Out of the thirty-six patients who had a diagnosis of invasive breast cancer, six were positive for Her-2/neu. The Her-2/neu positivity rate of 19% was within the expected range of 15% - 20% (Wolf et al., 2013). Conclusions The interventions were successful in improving five of six indicators which met or exceeded their benchmarks

Detection of serum allergen-specific IgE in atopic dogs tested in northern Italy: Preliminary study

Canine atopic dermatitis (CAD) is a pruritic allergic skin disease associated with IgE-mediated hypersensitivity. IgE is detected using Serum Allergen-Specific IgE test (SAT) in order to identify allergens. The present study aims to identify the environmental allergens in atopic dogs living in Northern Italy using SAT. The screening SAT (sSAT), using a monoclonal antibody cocktail-based ELISA to identify indoor and outdoor allergens, was performed. In all positive samples, an anti-IgE monoclonal antibody ELISA test was performed to extend panel of allergens. Out of 117 selected dogs, 69 were included in the study; 71% were positive and 29% were negative to sSAT. Among the 49 positive sSAT, 53% were positive for both indoor and outdoor, 38.8% only for indoor, and 8.2% only for outdoor allergens. This is the first study on the frequency of allergens involved in CAD in Italy using SAT. IgE hypersensitivity in atopic dogs of Northern Italy is usually associated with indoor allergens, primarily house dust mites. Among the outdoor allergens, an important role was played by Rumex acetosa. Polysensitization also commonly occurs. Therefore, since the numerous factors affect the IgE positivity in CAD, specific panels for geographical areas should be considered and re-evaluated at time intervals

Effect of dietary supplementation with ultramicronized palmitoylethanolamide in maintaining remission in cats with nonflea hypersensitivity dermatitis: a double-blind, multicentre, randomized, placebo-controlled study

Background Feline nonflea hypersensitivity dermatitis (NFHD) is a frequent cause of over-grooming, scratching and skin lesions. Multimodal therapy often is necessary. Hypothesis/Objectives To investigate the efficacy of ultramicronized palmitoylethanolamide (PEA-um) in maintaining methylprednisolone-induced remission in NFHD cats. Animals Fifty-seven NFHD cats with nonseasonal pruritus were enrolled originally, of which 25 completed all study requirements to be eligible for analysis. Methods and materials Cats were randomly assigned to PEA-um (15 mg/kg per os, once daily; n = 29) or placebo (n = 28) while receiving a 28 day tapering methylprednisolone course. Cats responding favourably to methylprednisolone were then administered only PEA-um (n = 21) or placebo (n = 23) for another eight weeks, followed by a four week long treatment-free period. Cats were maintained in the study until relapse or study end, whichever came first. Primary outcome was time to relapse. Secondary outcomes were pruritus Visual Analog Scale (pVAS), SCORing Feline Allergic Dermatitis scale (SCORFAD) and owner Global Assessment Score (GAS). Results Mean relapse time was 40.5 days (+/- 7.8 SE) in PEA-um treated cats (n = 13) and 22.2 days (+/- 3.7 SE) for placebo (n = 12; P = 0.04). On Day 28, the severity of pruritus was lower in the PEA-um treated cats compared to placebo (P = 0.03). Mean worsening of pruritus at the final study day was lower in the PEA-um group compared to placebo (P = 0.04), whereas SCORFAD was not different between groups. Mean owner GAS at the final study day was better in the PEA-um than the placebo-treated group (P = 0.05). Conclusion and clinical importance Ultramicronized palmitoylethanolamide could represent an effective and safe option to delay relapse in NFHD cats