Metabolic and anthropometric changes in early breast cancer patients receiving adjuvant therapy

Weight gain and metabolic changes have been related to survival of early breast cancer patients (EBC). ''However, factors influencing metabolism post-diagnosis are not fully understood. We measured anthropometric [body mass index (BMI), body weight, waist and hip circumferences, and waist-to-hip ratio] and metabolic (levels of insulin, glucose, H1Ac, total, HDL, and LDL cholesterol, triglycerides, and the homeostasis model assessment score [HOMA]) parameters in 433 pre- and post-menopausal women with EBC at diagnosis and 3, 6, 9, 12, and 24 months thereafter. At diagnosis, compared with post-menopausal women, pre-menopausal patients were more likely to be leaner and to have a lower BMI, smaller waist and hip circumferences, and waist-to-hip ratio. They had also lower glucose, HbA1c, and triglyceride levels and a lower HOMA score. Furthermore, they were more likely to have an estrogen- and/or progesterone-positive tumor and a higher proliferating breast cancer. During the first two post-diagnosis years, all women showed a significant increase of weight (+0.72 kg/year, P < 0.001), waist circumference (+1.53 cm/year, P < 0.001), and plasma levels of LDL cholesterol (+5.4 mg/dl per year, P = 0.045) and triglycerides (+10.73 mg/dl per year, P = 0.017). In patients receiving chemotherapy only, there was a significant increase in hip circumference (+3.16 cm/year, P < 0.001) and plasma cholesterol levels (+21.26 mg/dl per year, P < 0.001). We showed that weight, body fat distribution, and lipid profile changed in EBC patients receiving adjuvant therapy. These changes occurred during the first 2 years after diagnosis and were not specifically related to chemotherapy, menopausal status, or initial body weight

Diagnosis of Imported Dengue and Zika Virus Infections in Italy from November 2015 to November 2022: Laboratory Surveillance Data from a National Reference Laboratory

Dengue (DENV) and Zika (ZIKV) viruses are mosquito-borne human pathogens. In Italy, the presence of the competent vector Aedes albopictus increases the risk of autochthonous transmission, and a national plan for arboviruses prevention, surveillance, and response (PNA 2020–2025) is in place. The results of laboratory diagnosis of both viruses by the National Reference Laboratory for arboviruses (NRLA) from November 2015 to November 2022 are presented. Samples from 655 suspected cases were tested by both molecular and serological assays. Virus and antibody kinetics, cross-reactivity, and diagnostic performance of IgM ELISA systems were analysed. Of 524 cases tested for DENV, 146 were classified as confirmed, 7 as probable, while 371 were excluded. Of 619 cases tested for ZIKV, 44 were classified as confirmed, while 492 were excluded. All cases were imported. Overall, 75.3% (110/146) of DENV and 50% (22/44) of ZIKV cases were confirmed through direct virus detection methods. High percentages of cross reactivity were observed between the two viruses. The median lag time from symptoms onset to sample collection was 7 days for both DENV molecular (range 0–20) and NS1 ELISA (range 0–48) tests, with high percentages of positivity also after 7 days (39% and 67%, respectively). For ZIKV, the median lag time was 5 days (range 0–22), with 16% positivity after 7 days. Diagnostic performance was assessed with negative predictive values ranging from 92% to 95% for the anti-DENV systems, and of 97% for the ZIKV one. Lower positive predictive values were seen in the tested population (DENV: 55% to 91%, ZIKV: 50%). DENV and ZIKV diagnosis by molecular test is the gold standard, but sample collection time is a limitation. Serological tests, including Plaque Reduction Neutralization Test, are thus necessary. Co-circulation and cross-reactivity between the two viruses increase diagnostic difficulty. Continuous evaluation of diagnostic strategies is essential to improve laboratory testing

Epidemiology of gastroenteropancreatic neuroendocrine neoplasms: a review and protocol presentation for bridging tumor registry data with the Italian association for neuroendocrine tumors (Itanet) national database

: Neuroendocrine neoplasms (NENs) are rare tumors with diverse clinical behaviors. Large databases like the Surveillance, Epidemiology, and End Results (SEER) program and national NEN registries have provided significant epidemiological knowledge, but they have limitations given the recent advancements in NEN diagnostics and treatments. For instance, newer imaging techniques and therapies have revolutionized NEN management, rendering older data less representative. Additionally, crucial parameters, like the Ki67 index, are missing from many databases. Acknowledging these gaps, the Italian Association for Neuroendocrine Tumors (Itanet) initiated a national multicenter prospective database in 2019, aiming to gather data on newly-diagnosed gastroenteropancreatic neuroendocrine (GEP) NENs. This observational study, coordinated by Itanet, includes patients from 37 Italian centers. The database, which is rigorously maintained and updated, focuses on diverse parameters including age, diagnostic techniques, tumor stage, treatments, and survival metrics. As of October 2023, data from 1,600 patients have been recorded, with an anticipation of reaching 3600 by the end of 2025. This study aims at understanding the epidemiology, clinical attributes, and treatment strategies for GEP-NENs in Italy, and to introduce the Itanet database project. Once comprehensive follow-up data will be acquired, the goal will be to discern predictors of treatment outcomes and disease prognosis. The Itanet database will offer an unparalleled, updated perspective on GEP-NENs, addressing the limitations of older databases and aiding in optimizing patient care. STUDY REGISTRATION: This protocol was registered in clinicaltriasl.gov (NCT04282083)

Control of mother-to-child transmission of Chagas disease: the Tuscany Region model

Chagas disease is an endemic parasitosis in Latin America where the main route of transmission is vectorial. In Europe, due to migration phenomena, Chagas disease cases are increasing and the main way of transmission is mother-to-child, perpetuating the infection from one generation to the other. Congenital Chagas disease is in most cases asymptomatic at birth, but, if not diagnosed and treated early, it puts the child at risk of developing severe cardiac and gastrointestinal problems throughout life. According to the Regional Resolution throughout the territory of Tuscany, pregnant women born in continental Latin America (or born to a mother born in that area) should be offered free of charge serological test for Chagas disease during pregnancy or at delivery, with the main objective of controlling and stopping the transmission of the disease

Valutazione di un test in chemiluminescenza per la diagnosi sierologica di Leishmaniosi Viscerale

Nel bacino del Mediterraneo la Leishmaniosi viscerale (LV) è una zoonosi sostentuta da L. infantum. La diagnosi dipende da caratteristiche del parassita e dell'ospite. Gold standard per la conferma sierologica è l'immunofluorescenza (IFAT). Test di laboratorio completamente automatizzati e applicabili a campioni inviati sporadicamente, potrebbero superare le criticità dell'IFAT. Scopo dello studio è stato quello di valutare nella diagnosi di LV il test in chemiluminescenza “Leishmania VIRCLIA IgG + IgM monotest”(VIRCLIA)(Vircell,Santa Fe, Granada, Spain). Sono stati utilizzati 20 campioni di siero provenienti da pazienti con diagnosi di LV confermata. Ogni campione è stato saggiato con VIRCLIA ed il risultato è stato comparato con le altre indagini microbiologiche disponibili (IFAT, esame microscopico, PCR). I sieri provenienti da pazienti con diagnosi di LV, sono stati selezionati in modo da rappresentare le più frequenti presentazioni della malattia nella nostra area geografica (HIV, trapiantati, immunosoppressione iatrogena, età pediatrica). Come sieri di controllo sono stati utilizzati n.1 campione proveniente da paziente con leishmaniosi cutanea (LC) e n. 18 campioni provenienti da pazienti in accertamento o con diagnosi alternative. Nei 20 campioni da soggetti con LV confermata parassitologicamente, la sierologia IFAT era disponibile per 16 e positiva in 14; VIRCLIA è risultato positivo in 18, equivoco in un caso, negativo in un paziente. VIRCLIA è risultato negativo nel caso di LC. Nei 18 campioni utilizzati come controlli (tutti con sierologia IFAT negativa), VIRCLIA è risultato negativo in 16 ed equivoco in 2. Nella casistica analizzata, costituita da una popolazione clinicamente eterogenea di pazienti con LV, il test VIRCLIA ha mostrato un’ottima performance, confermando sierologicamente tutti i casi ad eccezione di due soggetti ematologici (con sierologia IFAT negativa o al cut-off). La nostra esperienza suggerisce che il test VIRCLIA possa rappresentare una valida alternativa all’IFAT, nel percorso diagnostico integrato di sospetta LV. I valori al cut off dovrebbero essere attentamente valutati in relazione ai dati clinici ed altre metodiche diagnostiche disponibili

Ketogenic diet: a tool for the management of neuroendocrine neoplasms?

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms, whose incidence has rapidly increased in the last years. Nutrition plays an important role in their management; indeed, malnutrition negatively impacts on rates of complications, hospitalization, hospital stay, costs and mortality. Furthermore, it has been reported that a poor nutritional status could influence the outcome of patients with pancreatic NENs. Moreover, obesity, predisposing to insulin resistance and compensatory hyperinsulinemia, could stimulate the growth of these neoplasms. Ketogenic diet (KD), a high-fat, low-carbohydrate diet with adequate amounts of protein, has been reported to be a promising approach for the management of several types of cancer, mostly gynecological and neurological ones. Indeed, it appears to sensitize most cancers to standard treatment by exploiting the reprogramed metabolism of cancer cells and thus resulting in a promising candidate as an adjuvant cancer therapy. Thus, the aim of this review is to provide an overview on the importance of nutrition in cancer management and in particular in NENs' setting. Furthermore, we reported the current evidence on the efficacy of KD in the management of cancer and based on molecular mechanisms; we also hypothesize the potential use of this nutritional pattern in the management of NENs

Interruptions, work environment and work load perceptions in laboratory medicine: patient safety is a "moving target"

[no abstract available

Sex differences in carcinoid syndrome: A gap to be closed

The incidence of neuroendocrine neoplasms and related carcinoid syndrome (CS) has markedly increased over the last decades and women seem to be more at risk than men for developing CS. Nevertheless, very few studies have investigated sex differences in clinical presentation and outcomes of CS. However, as per other tumours, sex might be relevant in influencing tumour localization, delay in diagnosis, clinical outcomes, prognosis and overall survival in CS. The present review was aimed at evaluating sex differences in CS, as they emerge from an extensive search of the recent literature. It emerged that CS occurs more frequently in female than in male patients with NENs and women seem to have a better prognosis and a slight advantage in overall survival and response to therapy. Moreover, the disease likely impacts differently the quality of life of men and women, with different psychological and social consequences. Nevertheless, sex differences, even if partially known, are deeply underestimated in clinical practice and data from clinical trials are lacking. There is urgent need to increase our understanding of the sex-related differences of CS, in order to define tailored strategies of management of the disease, improving both the quality of life and the prognosis of affected patients

Preliminary data of VEGF-A and VEGFR-2 polymorphisms as predictive factors of radiological response and clinical outcome in iodine-refractory differentiated thyroid cancer treated with sorafenib

Tyrosine-kinase inhibitors (TKIs) have revolutioned the management of iodine-refractory differentiated thyroid cancer (DTC), previously considered as an orphan disease. VEGF pathway is one of the main molecular target of TKIs. We present a preliminary single center study about the possible role of germline VEGF-A and VEGFR-2 SNPs in predicting objective response and clinical outcome in iodinerefractory DTC patients treated with sorafenib