Surgery on breast cancer in pregnancy

Pregnancy-associated breast cancer (PABC) is defined as breast cancer develops either during or within 1 year after pregnancy, it is a rare disease arising in 1:3,000 to 1:10,000 pregnant women. Prognosis of this tumor is influenced by local or systemic treatment, which might be conditioned by gestational age and limited by the concern on potential adverse impact on fetus. The aim of this literature review is to analyze the main topics regarding surgical treatment of patients diagnosed with breast cancer in pregnancy: anesthesia and maternal-fetal monitoring, type of breast surgery, immediate breast reconstruction after radical surgery and management of the axilla. Some important topics remain controversial since the relative rarity of PABC precludes the feasibility of large studies leading to a lack of literature data. Multi-institutional collaboration is warranted to collect women with PABC, in order to best define surgical treatment in view of associated maternal and fetal risks

From marginal to axial tidal-strait facies in the Early Pleistocene Siderno Strait

This geological guide presents the description of locations associated with a two-day field trip arranged in relation to the 10th International Congress of Tidal Sedimentology (Tidalites), Matera, Italy. The field guide describes sedimentological features of the largest among a series of tectonically controlled tidal straits that dissected the Calabrian Arc in southern Italy during the Early Pleistocene. The WNW-ESE trending, 50x20 km-wide Siderno Strait connected the Tyrrhenian with the Ionian seas. Due to tidal phase opposition between the two basins, continuous water-mass exchanges occurred through the strait, leading to powerful, bi-directionally flowing tidal currents. Sediments filling the Siderno Strait derived from both fluvial supply from the margins and intra-basinal autochthonous carbonate-factory debris. The main objective of the two-day field trip is to guide the visitor through a cross-section of the ancient strait, starting from one of the margins, ending in the deeper axial zone. The focus during the day one is on strait-margin deltaic fluvial-dominated deposits, shed from the tectonically-controlled, northern border and reworked by tidal currents in their distal reaches (delta front). Erosively-based, 4-5 m-thick pebbly-sandstone strata intercalated with 2-3 m-thick tidally-generated cross strata stack into a ca. 170 m-thick succession, exposed in a series of outcrops progressively located down-current with respect to the inferred entry point to the north. The focus of the day two is a ca. 150-190 m-thick succession consisting of cross-stratified mixed (bioclastic-siliciclastic) deposits, forming a series of WNE-ESE-oriented, elongated ridges that accumulated in the south-eastern axial zone of the Siderno Strait. The selected stops offer panoramic views of exceptionally continuous sections and close-up observations, revealing different scales of depositional architectures and a variety of sedimentary structures and trace fossils that record the development of these tidal sand ridges during the strait lifespan. The interplay between the tectonic uplift of a central bedrock sill and a number of syn-sedimentary faults and high-frequency relative sea-level changes (induced by glacio-eustacy and active tectonics) can be deciphered from the architecture of the tidally-generated cross strata composing the main body of the ridges

Who comes first. rescheduling endoscopic activity after the acute phase of the Covid 19 pandemic

The current health emergency caused by the COVID19 pandemic has caused an abrupt reduction in all ordinary endoscopic activities [1]. Our endoscopy unit, usually overloaded with procedures, has reduced its activities to immediate urgencies only, as recommended by position statements of many scientific societies [2–4]. After the most critical phase of the emergency, the need to evaluate the relative urgency of the endoscopic procedures was addressed. In our endoscopic academic tertiary referral unit, about 300 endoscopic procedures from March 16 to May 2 were suspended. According to local (hospital) and regional health department indications, outpatient services have been reorganised, by remodulating time slots for procedures, controlling and filtering patients’ access to the unit and reviewing the indications for each single endoscopic procedure programmed but not performed. Procedures initially classified as urgent (by 48 hours, n. 77) and short (by 10 days, n. 68) were directly rescheduled and performed. Furthermore, we decided to interview all the patients of postponed endoscopic procedures by phone calls carried out by trainees, tutored by a senior component of the endoscopy unit. A systematic questionnaire was developed based on the following items: demographic and clinical patient characteristics, current conditions, gastrointestinal signs and symptoms, exam indications and priority classes assigned by the general practitioner or other physicians, time and results of previous endoscopic examinations, laboratory tests, ongoing treatments. Results of the phone interview and any additional clinical documentation e-mailed by the patient was evaluated and archived including date and time of the interview with the patient’s informed consent. Based on the results of the reassessment, patients were rescheduled stratifing the procedures in the following 4 priority cl

SILAC labeling coupled to shotgun proteomics analysis of membrane proteins of liver stem/hepatocyte allows to candidate the inhibition of TGF-beta pathway as causal to differentiation

Background: Despite extensive research on hepatic cells precursors and their differentiated states, much remains to be learned about the mechanism underlying the self-renewal and differentiation.Results: We apply the SILAC (stable isotope labeling by amino acids in cell culture) approach to quantitatively compare the membrane proteome of the resident liver stem cells (RLSCs) and their progeny spontaneously differentiated into epithelial/hepatocyte (RLSCdH). By means of nanoLC-MALDI-TOF/TOF approach, we identified and quantified 248 membrane proteins and 57 of them were found modulated during hepatocyte differentiation. Functional clustering of differentially expressed proteins by Ingenuity Pathway Analysis revealed that the most of membrane proteins found to be modulated are involved in cell-to-cell signaling/interaction pathways. Moreover, the upstream prediction analysis of proteins involved in cell-to-cell signaling and interaction unveiled that the activation of the mesenchymal to epithelial transition (MET), by the repression of TGFB1/Slug signaling, may be causal to hepatocyte differentiation.Conclusions: Taken together, this study increases the understanding of the underlying mechanisms modulating the complex biological processes of hepatic stem cell proliferation and differentiation. © 2014 Montaldo et al.; licensee BioMed Central Ltd

Allergic bronchopulmonary aspergillosis in children with cystic fibrosis: An update on the newest diagnostic tools and therapeutic approaches

Cystic fibrosis (CF), the most common autosomal-recessive genetic disease in the Caucasian population, is characterized by frequent respiratory infections and progressive lung disease. Fungal species are commonly found in patients with CF, and among them, Aspergillus fumigatus is the most frequently isolated. While bacteria, particularly Pseudomonas aeruginosa, have a well-established negative effect on CF lung disease, the impact of fungal infections remains unclear. In patients with CF, inhalation of Aspergillus conidia can cause allergic bronchopulmonary aspergillosis (ABPA), a Th2-mediated lung disease that can contribute to disease progression. Clinical features, diagnostic criteria and treatment of ABPA are still a matter of debate. Given the consequences of a late ABPA diagnosis or the risk of ABPA overdiagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized. Along with traditional criteria, radiological features are emerging as tools for further classification as well as novel immunological tests. Corticosteroids, itraconazole and voriconazole continue to be the bedrock of ABPA therapy, but other molecules, such as posaconazole, vitamin D, recombinant INF-γ and Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators, have been showing positive results. However, few studies have been conducted recruiting CF patients, and more research is needed to improve the prevention and the classification of clinical manifestations as well as to personalize treatment. Early recognition and early treatment of fungal infections may be fundamental to prevent progression of CF disease. The aim of this narrative review is to give an update on ABPA in children with CF

MiR-675-5p supports hypoxia induced epithelial to mesenchymal transition in colon cancer cells

The survival rates in colon cancer patients are inversely proportional to the number of lymph node metastases. The hypoxia-induced Epithelial to Mesenchymal Transition (EMT), driven by HIF1\uce\ub1, is known to be involved in cancer progression and metastasis. Recently, we have reported that miR-675-5p promotes glioma growth by stabilizing HIF1\uce\ub1 here, by use of the syngeneic cell lines we investigated the role of the miR-675-5p in colon cancer metastasis. Our results show that miR-675-5p, over expressed in metastatic colon cancer cells, participates to tumour progression by regulating HIF1\uce\ub1 induced EMT. MiR-675- 5p increases Snail transcription by a dual strategy: i) stabilizing the activity of the transcription factor HIF1\uce\ub1 and ii) and inhibiting Snail's repressor DDB2 (Damage specific DNA Binding protein 2). Moreover, transcriptional analyses on specimens from colon cancer patients confirmed, in vivo, the correlation between miR-675-5p over-expression and metastasis, thus identifying miR-675-5p as a new marker for colon cancer progression and therefore a putative target for therapeutic strategies

Hypercoagulability of COVID-19 patients in Intensive Care Unit: A Report of Thromboelastography Findings and other Parameters of Hemostasis

BACKGROUND: The severe inflammatory state secondary to Covid-19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D-dimer as well as low fibrinogen. AIMS: Whole blood from 24 patients admitted at the intensive care unit because of Covid-19 was collected and evaluated with thromboelastography by the TEG point-of-care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis. RESULTS: TEG parameters are consistent with a state of hypercoagulability as shown by decreased R and K values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D-dimer was dramatically increased. C-reactive protein was increased. Factor VIII and von Willebrand factor (n=11) were increased. Antithrombin (n=11) was marginally decreased and protein C (n=11) was increased. CONCLUSION: The results of this cohort of patients with Covid-19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage and optimal duration of prophylaxis

Prévenir les troubles musculosquelettiques chez les soignants : connaître les expositions et étude des outils d’aide à la manutention

ObjectifsDans le cadre de la Caisse nationale de retaite des agents des collectivités locales (CNRACL), la démarche d’évaluation et de prévention des risques vise à conduire à une démarche spécifique au milieu hospitalier et à construire des outils d’évaluation des risques dans le réseau des CHU français. Les études menées sur la prévention des troubles musculosquelettiques (TMS) associent principalement les compétences en ergonomie, épidémiologie et médecine du travail des CHU d’Angers et de Grenoble. Méthode Une première étude épidémiologique a permis d’identifier les facteurs de risque de TMS et de lombalgie en milieu hospitalier ; une seconde s’est intéressée à l’évaluation des outils d’aide à la manutention des patients en milieu de soins sous un angle ergonomique. Résultats Les salariés du secteur santé sont en moyenne exposés à 2,4 facteurs de risque des 19 répertoriés (3,5 pour le reste du réseau) et ne souffrent pas plus de TMS des membres supérieurs que les autres salariés de la région des Pays-de-la-Loire. En revanche, les expositions aux manutentions manuelles de charges lourdes liées aux soins aux patients sont plus fréquentes. Les aides techniques pour la manutention étudiées ne répondent pas aux critères de dépendance du patient ou aux conditions organisationnelles du service. Du point de vue psychologique, le rapport du patient au matériel ainsi que l’usage du corps du soignant dans la relation aux soins doivent être pris en compte. Conclusion L’approche biomécanique a fait l’objet de cette première investigation. Il s’agit d’une démarche de prévention pluridisciplinaire intégrée dans la politique d’établissement

The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation

INTRODUCTION: In France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis. METHOD: Tuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube - QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes. RESULTS: In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected. CONCLUSION: The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved