Localization of sentinel lymph node in breast cancer. A prospective study

Introduction: Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically nodenegative patients. Patients and methods: A cohort of 898 female patients with breast carcinoma was considered, from 2001 to 2008. Once SLN was localized, by means of radio-colloid or blue dye staining, and isolated, a biopsy was performed. Only those positive for metastases were submitted to axillary dissection. Results: Only in nine cases a SLN was not isolated. We had 819 cases of first level SLN (group A) and 69 cases of second level SLN (group B). Considering all of 889 cases, SLN was localized in the second level in 69 patients (7.8%); but if we consider metastatic SLN alone (340 cases), it was in the second level in 23 subjects (6.8%). In total, we had a positive second level SLN in 2.3% of cases (23/889). Conclusion: Second level SLN could be considered only an anomalous lymphatic axillary drainage and it does not linked to particular histological variants of the primitive tumour. In our study, skip metastases were recognized in only 2.6% of cases, therefore, whenever a SLN is not isolated for any reason, the first level sampling represent a viable operative choice

"Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature

Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, discomfort, jaundice, weight loss. The majority of patients are identified incidentally at the time of cholecystectomy for cholelithiasis. It is not possible to differentiate preoperatively between gallbladder adenocarcinoma and gallbladder neuroendocrine carcinoma (NEC) with imaging techniques. The only curative therapeutic modality for LCNECs is a complete en bloc surgical resection, including regional lymph node clearances and hepatic lobectomy, but only in patients without multiple metastasis. LCNECs benefit from an aggressive surgical resection in combination with chemotherapy, if resectability is possible. If the tumour is non-resectable, the primary management is therefore medical and not surgical. All patients with LCNEC presented a poor prognosis with a median survival of 10 months after the initial diagnosis. Only in five patients (62.5%) a wide surgical excision was performed, while in the other cases the tumour was non-resectable or multiple liver metastases were present at diagnosis

Contracts for Abstract Processes in Service Composition

Contracts are a well-established approach for describing and analyzing behavioral aspects of web service compositions. The theory of contracts comes equipped with a notion of compatibility between clients and servers that ensures that every possible interaction between compatible clients and servers will complete successfully. It is generally agreed that real applications often require the ability of exposing just partial descriptions of their behaviors, which are usually known as abstract processes. We propose a formal characterization of abstraction as an extension of the usual symbolic bisimulation and we recover the notion of abstraction in the context of contracts.Comment: In Proceedings FIT 2010, arXiv:1101.426

Monitoring the invasion of an exotic tree (Ailanthus altissima) (Mill.) Swingle with Landsat satellite time series imagery in urban forest.

In the Mediterranean area, one the most threat tree to various ecosystems is Ailanthus altissima (Mill.) Swingle. This is an aggressive invasive species common in natural and semi-natural habitat. Monitoring and mapping of invasive species is an important information for the conservation and management of ecosystems. The study of distribution and diffusion of invasive species are useful to assess their environmental impacts, formulate effective control strategies, and forecast potential spread. The main target of this work is to examine the feasibility of mapping the expansion of A. altissima using remote sensing techniques in a highly complex urban forest setting. Remote sensing has been a useful tool to map the invasive plant. We mapped the pattern of ailanthus expansion from 1990 to 2015 in a suburban area of Palermo, the Favorita park, using time series of Landsat image. This images are nowadays available at no cost. We used that images to analyze larger areas but the 30 m resolution does not permit mapping of individual trees; the combinations of dates and medium spatial resolution with the phenology information allowed the detection of the species. Indeed, the ailanthus is a deciduous tree that we compared with the other evergreen vegetation. Time series of Normalized difference vegetation index (NDVI) and supervised classification were used as a dataset in the classification process. These results provide a basis for more detailed investigations on invasive species and the possibility to increase the spatial resolution with the new platforms might lead to further improvements plant species identification and their distribution patterns recognition

La colecistectomia laparoscopica nel paziente uremico

Nel presente studio vengono valutati i vantaggi della colecistectomia videolaparoscopica (VLC) eseguita in due pazienti uremici affetti da calcolosi della colecisti. Dal gennaio al luglio 2004, di 27 pazienti affetti da calcolosi della colecisti 15 sono stati sottoposti a VLC, delle quali 4 sono convertite. Due dei pazienti sottoposti a VLC erano in trattamento dialitico: una donna di 42 anni, sintomatica, affetta anche da iperparatiroidismo primitivo e da iperaldosteronismo primitivo, e un uomo di 55 anni, asintomatico, in lista per il trapianto renale. Non sono state osservate complicanze maggiori e minori ed entrambi i pazienti sono stati dimessi in IV giornata postoperatoria. Anche nei pazienti uremici la VLC deve essere il gold standard per il trattamento della calcolosi della colecisti sintomatica o non

Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation

Cell Therapy in Type 1 Diabetes

The incidence of diabetes mellitus has grown exponentially in the last few years. Etiopathogenesis of diabetes implies a ?-cells damage in the islet of Langerhans, either through an autoimmune reaction present in type 1 diabetic patients or through altered function within these cells that affect their ability to secrete a properly functioning insulin hormone, in patients suffering from type 2 diabetes. Exogenous insulin supply is, at the moment, the therapy of choice of the disease but it does not allow tight control of glucose regulation, leading to long-term complications. Over the past few decades, pancreas or pancreas-kidney organ transplantation has been the most effective treatment for severe diabetic patients. Recently, an alternative promising therapeutic approach, consisting of successful pancreatic islet transplantation to reconstitute the insulin producing ? cells, has also emerged. Unfortunately the number of donor islets is too low compared to high number of patients needing a transplant, so the search for new renewable sources of high-quality ?-cells becomes highly topical. In this review, starting from the description of state of art of islet transplantation, we summarize the more recent promising approaches to the generation of new ?-cells giving a big enfacy to adult stem/progenitor cells

Dissecting the different biological effects of oncogenic Ras isoforms in cancer cell lines: could stimulation of oxidative stress be the one more weapon of H-Ras? Regulation of oxidative stress and Ras biological effects

Ras proteins are small GTPase functioning as molecular switches that, in response to particular extracellular signalling, as growth factors, activate a diverse array of intracellular effector cascades regulating cell proliferation, differentiation and apoptosis. Human tumours frequently express Ras proteins (Ha-, Ki-, N-Ras) activated by point mutations which contribute to malignant phenotype, including invasiveness and angiogenesis. Despite the common signalling pathways leading to similar cellular responses, studies clearly demonstrate unique roles of the Ras family members in normal and pathological conditions and the lack of functional redundancy seems to be explainable, at least in part, by the ability of Ras isoforms to localize in different microdomains to plasma membrane and intracellular organelles. This different intracellular compartmentalization could help Ras isoforms to contact different downstream effectors finally leading to different biological outcomes. Interestingly, it has also been shown that Ha- and Ki-Ras exert an opposite role in regulating intracellular redox status. In this regard we suggest that H-Ras specific induction of ROS (reactive oxygen species) production could be one of the main determinants of the invasive phenotype which characterize cancer cells harbouring H-Ras mutations. In our hypothesis then, while K-Ras (not able to promote oxidative stress) could mainly contribute to cancer progression and invasiveness through activation of MAPK and PI3K, H-Ras-mediated oxidative stress could play a unique role in modulation of intercellular contacts leading to a loss of cell adhesion and eventually also to a metastatic spread

Fixation free laparoscopic obliteration of inguinal hernia defects with the 3D dynamic responsive scaffold ProFlor

Laparoscopic TAPP/TEP approaches are well-established options for the cure of inguinal hernias. As in the open approach, mesh fixation and poor-quality biologic response represent controversial questions and are a source of concerns. Furthermore, hernia defect patency represents another problem which seems not well acknowledged among surgeons. These problems are considered the cause of frequent intra and postoperative complications. To overcome these concerns, recently a different concept of cure has emerged. Based on a newly developed dynamic responsive 3D scaffold named ProFlor, a permanent hernia defect obliteration has been finalized. Following its inherent centrifugal expansion due to its dynamic responsivity, this hernia device is positioned fixation free within the defect and induces a probiotic biological response allowing for the re-establishment of the degenerated inguinal barrier. A laparoscopic approach with the 3D scaffold has been tested on 71 patients to demonstrate its effectiveness in reducing intra and postoperative complications. The operated patients presented with bilateral and/or recurrent inguinal hernia. Overall, 122 hernia defects were obliterated with 119 dynamic responsive scaffolds. The procedures were carried out from January 2018 to January 2022 with a defined protocol and detailed procedural steps. The laparoscopic technique with the 3D hernia scaffold allowed for fixation free placement, permanent defect obliteration and dynamically induced regenerative effects. The technique proved effective in reducing intra and postoperative complications. In particular, early postoperative pain and discomfort significantly decreased. No chronic pain and no recurrences were reported during follow up. The results achieved with the described laparoscopic technique seem to embody an innovative concept for inguinal hernia repair. Fixation free, dynamic responsive, permanent defect obliteration, histologically proven regenerative effects are the distinctive features of this 3D scaffold. It seems to embody a more physiological and pathogenetically coherent concept of cure, thus improving treatment results of this widespread disease