Is Aspirin Effective in Helping to Prevent Breast Cancer in Women Ages 45 Years and Older?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not aspirin is effective in helping to prevent breast cancer in women ages 45 years and older. STUDY DESIGN: Review of three English language primary studies published in 2005, 2007, and 2008 DATA SOURCES: Two randomized, double blind, placebo controlled clinical trials and one prospective, population based cohort study comparing aspirin to placebo were found using PubMed and Cochrane databases. OUTCOMES MEASURED: Breast cancer development was measured in several ways. Tumor characteristics were measured at diagnosis, including size, metastasis to lymph nodes, histology of the mass, histology differentiation, and estrogen and progesterone status. Outcomes were also measured by pathology reports, cytology reports, on strong clinical and radiologic or laboratory marker evidence, and also self reported questionnaire. RESULTS: The two randomized controlled trials showed that the use of aspirin has no significant effect on the prevention of breast cancer. The cohort study showed an inverse relationship between the use of aspirin and the risk of cancer incidence and mortality. CONCLUSIONS: Although the two RCTs showed no effect of aspirin on the prevention of breast cancer, the cohort study showed some promise in the use of aspirin and breast cancer prevention. The dose of aspirin used in the RCTs was only 100mg, and the doses in the cohort study varied based on individual reporting. Increasing the dose of aspirin to 325mg in future studies may show some effect in the prevention of breast cancer

Uncommon 18F-FDG-PET/CT findings in patients affected by limbic encephalitis: Hyper-hypometabolic pattern with double antibody positivity and migrating foci of hypermetabolism

Autoimmune limbic encephalitis (LE) is a rare disorder; its diagnosis can be challenging.We report two uncommon cases of LE evaluated by brain 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) positron emission tomography/ computed tomography describing themetabolic imaging patterns, which were different from those observed in previous studies: the first one presented an unprecedented 18F-FDG brain mixed pattern, involving also themidbrain, despite negative magnetic resonance imaging exams; the second one showed migrating foci of hypermetabolism, one of which turned into hypometabolism at a later examination

Complete vaginal stenosis and hematocolpus in two bitches with a history of GnRH treatment to postpone puberty

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗTwo mixed-breed bitches (18 and 19 months), that had been treated, one year before, with deslorelin acetate implant to postpone puberty, were hospitalized and monitored during their first heat. The heat was presumed by the owners, that observed vulvar swelling in both cases but no vulvar bloody discharge. The following diagnostic procedures were employed: physical genital tract examination, vaginoscopy, vaginal cytology, endocrine assay, ultrasound and X-ray using vaginal infusion of iodum and pneumobladder as positive and negative contrasts. In bitch 1, vaginal cytology and progesterone levels confirmed the presence of an ovulatory “dry” oestrus, without cytological presence of red blood cells, progressing to dioestrus. Ultrasound showed preovulatory follicles and, in the following days, transition to corpora lutea. The caudal abdomen presented a large ovoid cystic structure filled with echoic fluid, next to the bladder. Radiographic scans demonstrated a normal bladder profile, while the contrast medium failed to enter into the cranial vagina. On the basis of these findings, the bitch 1 was submitted to laparotomy 10 days after the end of oestrus. A vaginal dilatation (10x5 cm), from which brown fluid was aspirated, was found and resected together with uterus and ovaries. Bitch 2 had the same diagnostic route and findings, but she was laparotomized 3 months after the heat. During this period no spontaneous regression of the lesion was observed. At laparotomy, the vaginal dilatation (8x4 cm) was only aspirated and the bitch regularly neutered. In both cases, cytology of the fluid taken from the vaginal sac revealed superficial epithelial cells and abundant degenerate red blood cells. Histology (bitch 1) confirmed the vaginal origin of the dilatation and revealed an additional Gärtner duct cyst. The abnormality (hematocolpus) probably originated by an inadequate drainage of proestrous bloody discharge because of a severe vaginal stenosis. A congenital origin of the lesion was unlikely; it was strongly suspected that the treatment of the prepubertal bitches interfered, by an irreversible way, with the normal development of the vagina

Rituximab induction and maintenance in ANCA-associated vasculitis: State of the art and future perspectives

Antineutrophil cytoplasmatic antibody (ANCA)-associated vasculitis (AAV) is a group of rare autoimmune diseases characterized by inflammation of the vascular wall. The pathogenesis of AAV is strongly associated with B cell-derived ANCAs; thus, Rituximab (RTX) has become a promising drug in the induction and maintenance treatment of AAV. The purpose of this review is to describe the efficacy and safety of RTX in the induction of remission and maintenance therapy of AAV. Herein, we summarize the randomized controlled trials that have contributed to the refinement of the use of RTX in AAV in the past decades. RTX has been proven to be effective both in new-onset disease and in relapsing disease. Although the optimal duration of AAV maintenance therapy remains unknown, the ANCAs and the B-cell repopulation may offer support for the administration of further RTX cycles (or not). The safety of RTX is comparable with cyclophosphamide, with the advantage of a low risk of malignancy and no concern for fertility. In conclusion, RTX now plays an important role in the induction and maintenance therapy of AAV. Optimizing RTX-based treatment strategies in AAV is one of the main goals of the current research in AAV

Role of PET and SPECT in the study of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis has been defined as a "heterogeneous group of neurodegenerative syndromes characterized by progressive muscle paralysis caused by the degeneration of motor neurons allocated in primary motor cortex, brainstem, and spinal cord." A comprehensive diagnostic workup for ALS usually includes several electrodiagnostic, clinical laboratory and genetic tests. Neuroimaging exams, such as computed tomography, magnetic resonance imaging and spinal cord myelogram, may also be required. Nuclear medicine, with PET and SPECT, may also play a role in the evaluation of patients with ALS, and provide additional information to the clinicians.This paper aims to offer to the reader a comprehensive review of the different radiotracers for the assessment of the metabolism of glucose (FDG), the measurement of cerebral blood flow (CBF), or the evaluation of neurotransmitters, astrocytes, and microglia by means of newer and not yet clinically diffuse radiopharmaceuticals

Leukocyte modifications during the first month after foaling in mares and their newborn foals

During early post-partum period both neonatal foals and peripartum mares are most susceptible to diseases. The aim of this study was to establish physiologic modifications of leukogram during the first month after foaling in mares and their newborn foals. To this end blood samples were collected from nine mares and nine foals (T0-T10), every three days from the 1st day until the 30th day after foaling. Samples were analysed for white blood cell (WBC) count and differential leucocyte counts. Two-way repeated measure analysis of variance (ANOVA) showed, in postpartum mares WBC showed significant higher values at T0 (9.02±0.76) in respect to other time points, and at T2 (8.08±0.53) and T3 (7.92±0.59) compared to T1 (6.98±0.43), whereas in foals lower WBC values at T0 (6.11±0.49) compared to other experimental periods except T1 (6.90±0.94), and at T1 compared to T8 (7.95±0.61) and T10 (7.90±0.36) were observed. The differential leucocyte counts showed significant modifications in the percentage of neutrophils (π<0.001) and lymphocytes (p<0.001) both in postpartum mares and in foals during the experimental period. Furthermore ANOVA showed significant differences between postpartum mares and foals (P<0.01) in all studied parameters, and between postpartum mares and control mares in WBC and neutrophils values. The obtained results provide suitable information about the influence of foaling on leukogram of periparturient mares and reveal WBC dynamics in newborn foals during the first month post-partum

Serum total proteins and related electrophoretic fractions in growing foals

Abstract. The aim of this study was to evaluate the changes of serum total proteins, albumin, α1-, α2-, β1-, β2 and γ-globulins in growing foals during the first month of life. Nine clinically healthy foals (five females and four males, mean body weight 39.00 ± 3.50 kg) were enrolled in the study. From each animal, blood samples were collected by jugular venipuncture every 3 days during the first month of life starting from the day of birth. Serum concentration of total proteins, albumin, α1, α2, β1, β2 and γ-globulins was assessed. One-way repeated measures analysis of variance (ANOVA), followed by Bonferroni post hoc comparison test, was used to determine statistically significant effect of the day of life on studied parameters. A statistically significant effect of the day of life on serum total proteins (P < 0.0001), albumin (P < 0.0001) and γ-globulins (P < 0.005) was observed during the first month of life. Our findings emphasize the importance of establishing different reference intervals for serum electrophoretic protein profiles in growing foals based on their physiological status. This study provides useful information that could help clinicians to better interpret clinical data and diagnose equine neonatal disease

An unusual case of testicular disorder in sex development of arabian mare (64,xx sry-negative)

A 3-year-old Arabian mare underwent medical examinations due to the presence of abnormalities of the reproductive apparatus and stallion behavior (nervous temperament, aggressiveness, masculine attitude). During the clinical visit, an anovulvar distance shorter than normal was observed; moreover, vulvar lips were dorsally fused except for the lower neckline, showing a blind ending from which a penis-like structure protruded. The ultrasound examination revealed the presence of a cervix and corpus of a uterus, hypoplastic uterine horns, and small gonads with an echogenicity similar to a testis. Blood testosterone levels ranged from 0.4 to 0.6 ng/mL. Cytogenetic analysis showed a normal female karyotype (2n = 64,XX), while PCR amplification of SRY and ZFY genes revealed the absence of a Y chromosome. At necroscopic examination, internal genitalia arising from the genital ridge in the form of masculine type structures were found, while those deriving from the Mullerian ducts were of feminine type. In addition, an infundibular portion of the salpinx at the cranial pole of the gonads was found. This is the first case in equine species of DSD 2n = 64,XX SRY-negative, with the simultaneous presence of male (hypoplastic testicles, epididymal portions, and a penis-like structure) and female (cervix, horn and body of a hypoplastic uterus) genital structures

18F-FDG PET-Derived Volume-Based Parameters to Predict Disease-Free Survival in Patients with Grade III Breast Cancer of Different Molecular Subtypes Candidates to Neoadjuvant Chemotherapy

We investigated whether baseline [F-18] Fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)-derived semiquantitative parameters could predict disease-free survival (DFS) in patients with grade III breast cancer (BC) of different molecular subtypes candidate to neoadjuvant chemotherapy (NAC). For each F-18-FDG-PET/CT scan, the following parameters were calculated in the primary tumor (SUVmax, SUVmean, MTV, TLG) and whole-body (WB_SUVmax, WB_MTV, and WB_TLG). Receiver operating characteristic (ROC) analysis was used to determine the capability to predict DFS and find the optimal threshold for each parameter. Ninety-five grade III breast cancer patients with different molecular types were retrieved from the databases of the University Hospital of Padua and the University Hospital of Ferrara (luminal A: 5; luminal B: 34; luminal B-HER2: 22; HER2-enriched: 7; triple-negative: 27). In luminal B patients, WB_MTV (AUC: 0.75; best cut-off: WB_MTV &gt; 195.33; SS: 55.56%, SP: 100%; p = 0.002) and WB_TLG (AUC: 0.73; best cut-off: WB_TLG &gt; 1066.21; SS: 55.56%, SP: 100%; p = 0.05) were the best predictors of DFS. In luminal B-HER2 patients, WB_SUVmax was the only predictor of DFS (AUC: 0.857; best cut-off: WB_SUVmax &gt; 13.12; SS: 100%; SP: 71.43%; p &lt; 0.001). No parameter significantly affected the prediction of DFS in patients with grade III triple-negative BC. Volume-based parameters, extracted from baseline F-18-FDG PET, seem promising in predicting recurrence in patients with grade III luminal B and luminal B- HER2 breast cancer undergoing NAC