Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review.

PURPOSE: Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting. METHODS: We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818). RESULTS: We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min-max: 17-5142); median follow-up: 51 months (range: 21-268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients. CONCLUSIONS: There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.

A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment.

OBJECTIVE: To validate a new clinical scale of carpal tunnel syndrome (CTS). The scale is based on clinical history and physical examination findings and includes two figures. The first is a score determined by clinical history and objective findings. The second evaluates the presence/absence of pain as a dichotomous categorical score. METHODS: One hundred and sixty-eight consecutive idiopathic CTS hands were studied in two centers (Rome, Siena). We compare the results of the historical-objective scale (Hi-Ob scale) with the results of other validated measurements of CTS severity: (1) the Italian version of the Boston Carpal Tunnel Questionnaire, (2) the neurophysiological classification adopted by the Italian CTS study group. Furthermore, for the Hi-Ob scale the intra-observer and inter-observer evaluations were assessed. RESULTS: The main Hi-Ob parameter was positively related to the conventional validated measurements. Conversely, the category 'PAIN' of the Hi-Ob scale appeared unrelated to the other clinical and electrophysiological parameters. Intra- and inter-observer evaluation showed the reproducibility of the Hi-Ob assessment. CONCLUSIONS: Our data show that the Hi-Ob scale is a reliable measurement which may be useful in CTS evaluation either for clinical or for scientific purposes.

A useful electrophysiological test for diagnosis of minimal conduction block.

OBJECTIVE: To evaluate the usefulness, sensitivity and specificity of a new neurophysiological test for partial conduction block. METHODS. In 17 patients (17 nerves) with clinical pictures strongly suggesting the presence of motor conduction block and 20 healthy subjects (40 nerves), motor nerve conduction studies were performed with the conventional surface technique and with a new technique developed by us: the single fiber EMG (SFEMG) conduction block test. Moreover, we also evaluated patients with other neurological diseases. The recent American Association of Electrodiagnostic Medicine (AAEM) consensus criteria for partial conduction block were used for the standard conduction block tests. RESULTS: According to AAEM consensus criteria, 5/17 cases presented 'definite' partial conduction block and 6 presented 'probable' partial conduction block. In contrast, 16/17 cases (94%) presented evidence of conduction block at the SFEMG conduction block test. The 5/6 cases that did not fulfill in the AAEM criteria and that presented abnormal findings at SFEMG nerve conduction test could be considered affected by minimal conduction block. The sensitivity of this new test was greater than conventional test. The specificity was 100% (no abnormal findings in healthy subjects or patients with diseases other than neuropathy). CONCLUSIONS: The SFEMG conduction block test is a sensitive, complementary, technique for diagnosis of minimal conduction block in patients with normal findings in standard nerve conduction studies.

Quantitative evaluation of insulin antibodies by radiochemical analysis.

A method is described for determining insulin antibodies, and some applications are reported, concerning 45 patients, 30 with diabetic pathology, 15 of them receiving insulin. The diagnostic tool proved useful.

Inhibition of tumor necrosis factor-alpha secretion by pentoxifylline in advanced cancer patients with abnormally high blood levels of tumor necrosis factor-alpha.

TNF, in addition to its antitumor activity, would play an important role in the pathogenesis of cancer-related severe complications, including ARDS and DIC. Therefore, the modulation of TNF secretion could be important in the supportive care of advanced cancer patients. At present, PTX is the only drug which has been proven to be able to inhibit in vitro the release of TNF. The present study was performed to evaluate the effect of PTX on TNF blood concentrations in disseminated cancer patients with abnormally high TNF values. The study included 14 cancer patients, with initial or conclamate signs of ARDS (n = 8) or DIC (n = 6). PTX was given intravenously at a dose of 300 mg/day for 7 days. Mean serum levels of TNF significantly decreased in response to PTX therapy, and they returned to normal range in 5/14 patients. These preliminary data would suggest that PTX may be considered as a biological response modifier, capable of inhibiting TNF secretion in humans, with a following potential use in the treatment of cancer-related severe complications.

A prospective imaging study of 131I-B72.3 monoclonal antibody in patients with epithelial ovarian cancer: preliminary report.

Twenty patients with known ovarian cancer have been investigated in this pilot study to verify the clinical usefulness of radioimaging using the B72.3 monoclonal antibody labelled with iodine-131. No adverse reactions occurred after intravenous injection of B72.3 MoAb. The radioimaging results were compared with those obtained with other diagnostic methods, including computed X-ray tomography and ultrasound. A sensitivity of 85% in the detection of primary ovarian cancers and collections of ascites, and of 84% in the detection of abdominal and extraperitoneal metastases has been demonstrated using this radioiodinated antibody in vivo. No false localization occurred. Immunohistochemical studies showed no cross-reactions between B72.3 MoAb and mesothelial cells, confirming the high specificity of binding between B72.3 MoAb and neoplastic cells in ascites. Negligible uptake of radiolabelled B72.3 MoAb has been demonstrated in the unaffected ovary. The major advantage of using this monoclonal antibody is related to the expression of a recognized antigen (called TAG 72) in mucinous, serous and in differentiated adenocarcinomas of the ovary.

Lectin histochemistry of the Drosophila embryo.

A selection of lectins was used to characterise changes in the distribution of glycoconjugates during the embryonic development of Drosophila melanogaster. The blastoderm of pre-gastrulation embryos bound low levels of the lectins LPA, UEA-I and PNA. The germ line progenitors (pole cells) bound ConA, PNA and LPA. The yolk granules, the trachea, and the gut bound GSA-I. All lectins had detectable labeling of the ectoderm. The somata of the nervous system bound ConA and LPA. Electron microscopic analysis of PNA labeling of the nervous system revealed exclusive binding to the axon tracts and ensheathing glia. Hyaluronate lyase digestion of oligosaccharides revealed gut and nervous system binding with WGA and UEA-I. This study revealed useful biochemical probes of gut, epidermal and nervous system development that identify the distribution of likely ligands for as yet uncharacterised endogenous lectins.

Influence of information related to child physical abuse on professional ratings of adjustment and prognosis.

The study investigates the influence of access to information of a history of physical maltreatment on the evaluative responding of social service and clinical psychology professionals. Written vignettes were used in a 2 x 2 x 2 factorial design to manipulate the: (a) presence/absence of abuse history; (b) presence/absence of behavior problems; and (c) gender of the child. Professionals rated children presented in 12 case vignettes along five treatment-related dimensions: (a) overall adjustment; (b) predicted 6 months temporal stability of behavior; (c) likelihood of treatment referral; (d) expected home intervention success; and (e) expected school intervention success. Four dimensions related to social functioning were also rated, including likelihood of the child being: (a) recommended to serve as assistant to teacher; (b) elected as a school activity team leader; (c) elected as a class officer; and (d) nominated as a candidate for successful completion of a summer camp program. The findings verified the influence of information related to a history of maltreatment of professional judgments, despite matched vignette content for all factors other than maltreatment status. The results suggests a possible failure to recognize that some children have been buffered from the negative effects of abuse and point to the risk of erroneous judgments that may be directed toward maltreated children.

[Our experience in pancreatic injuries]. / Nostra esperienza sui traumi pancreatici

Eight cases of pancreatic traumas are considered and the literature reviewed. Personal cases include: 1 contusion treated nedically; 2 cases of complete rupture (1 of which primary treated with double jejunal pancreatic anastomosis); 1 associated with splenic rupture, treated with distal pancreatectomy and splenectomy; 1 contusion of the head associated with hepatic lesions treated with suture of the lesions external derived and cholecystostomy; 4 contusions without lesion of the duct associated with other visceral lesions (stomach, duodenum, spleen, liver), treated surgically by suture of the lesion, and drainage of the omental bursa. As regards diagnosis, the only pathognomonic examination is amylasaemia. Paracentesis proved important in cases of haemoperitoneum. Long-term results were observed by scintigraphy and through starch and maltose load curves. Scintigraphy pointed to the presence of functional deficiency in areas which seemed to be only contused or actually normal. It is therefore concluded, especially in cases of complete rupture, that therapy should be kept as conservative as possible (Duodenal pancreatic anastomosis). The purpose of this is to prevent fistulas of the residual stump, fostered by the pressure in Oddi's sphincter, and to lease the pancreatic tissue as operative as possible. This is particularly important if patients are young.

[Hypertrophy of the gastrocnemius muscles: possible etiology of the popliteal artery entrapment syndrome?]. / Hypertrophie des muscles jumeau: étiologie possible d'un syndrome de l'artère poplitée piégée (SAPP)?

Excessive hypertrophy of the both heads of gastrocnemius has been reported as a possible etiology of a popliteal artery entrapment syndrome. However, this syndrome is rather unusual among all those young adults and athletes with hypertrophied gastrocnemius. An other factor must exist in addition of hypertrophy. We describe a patient presenting a more cranial migration of the both heads of gastrocnemius with a shorter and more proximal tendinous attachment above the femoral epicondyles. Thus, excessive hypertrophy of the both heads of gastrocnemius may be in fact the cause of a popliteal artery entrapment syndrome when there is a congenital abnormality of muscular migration.

[A case of Hallermann-Streiff syndrome with rapidly fatal course]. / Su di un caso di sindrome di Hallermann-Streiff ad evoluzione rapidamente fatale.

The Hallermann-Streiff syndrome is a rare affection characterized by beaked nose, dyscephaly, hypotrichosis, cataracts, micrognathia and proportionate short stature. The most severe complication in the syndrome is respiratory embarrassment. Narrow air passage with abnormal glottic closure, prenatal growth deficiency, immunodeficiency and sometimes associated cardiovascular anomalies, can predispose these patients to pulmonary infections. The Authors describe a new-born with Hallermann-Streiff syndrome, who, after a brief period of obstructive apnea successfully treated with CPAP, developed a severe pulmonary infection that caused his death at the age of 61 days.

[Decreased plasma fibronectin (pFN) level in preterm infants with infections]. / Riduzione dei livelli plasmatici di fibronectina (FNp) in neonati prematuri infetti.

Plasma fibronectic (pFN) is a high molecular weight multifunction glycoprotein, which augments neutrophil and macrofage phagocytosis and acts as a nonspecific opsonin for the reticuloendothelial system. In this study we have determined pFN concentrations in fifty eight preterm infants to discriminate infected from non infected ones. Concentrations of pFN decreased from baselin in babies with early or late onset infections. The changes in pFN concentrations were not found before sepsis, but on day 1. By day 5 pFN concentrations have increased and have been no longer different from controls. We have calculated sensitivity (73.68%), specificity (74.36%), positive (58.35%) and negative (85.29%) predictive values of pFN and of other markers of infections (C-reactive protein--CRP-, Immature/Mature neutrophil ratio--I/M n. ratio-). Adding these tests to pFN, provided equal specificity and positive predictive value, but increased sensitivity (94.73%) and negative predictive value (96.43%). Thus, low concentrations of pFN may be a valuable but not early marker for neonatal infections. The combination of pFN, CRP and I/M n. ratio increase the precision of diagnostic testing.

Orthofile®: a new approach for mechanical interproximal reduction : a scanning electron microscopic enamel evaluation.

PURPOSE: The aim of this in vitro study was to evaluate the stripping achieved on different teeth (incisors, canines, and premolars) by two grades of abrasive strips used for the first and tenth time. Our second aim was to test the efficacy of these strips by calculating the time necessary to perform interproximal reductions of 0.10, 0.20, and 0.30 mm. METHODS: Four models were constructed using extracted teeth affixed in wax. The upper and lower arches were set on plaster bases and fixed in wax, carefully creating contact points. All model mouths were treated with artificial saliva (Oral Balance®) in order to simulate the biological conditions in the oral cavity. We then tested specific air-rotor strips of different grades and degrees of wear (15-µm-grain and 25-µm-grain Orthofile® strips). Afterwards the teeth from all samples were cut lengthwise in half, and each mesial and distal portion was gold-plated and observed under SEM at incremental magnification (30, 60, and 100 µm). RESULTS: The 25-µm-grain strip was more effective than the 15-µm-grain strip, irrespective of the tooth involved. Second, the finishing phase with specific polishing strips after interproximal reduction was fundamental in reducing the number of abrasions and irregularities created by stripping, in particular after using the 25-µm-grain strip. To achieve the best result, the entire abraded area must be polished. CONCLUSION: This system permits a rapid and effective stripping procedure in direct proportion to the strip's grain and in inverse proportion to the wear from its use. Further research will enable us to compare this system with similar procedures.

MRI of the small-bowel: how to differentiate primary neoplasms and mimickers.

MRI of the gastrointestinal tract is gaining clinical acceptance and is increasingly used to evaluate patients with suspected small-bowel diseases. MRI may be performed with enterography or enteroclysis, both of which combine the advantages of cross-sectional imaging with those of conventional enteroclysis. In this paper, MRI features of primary small-bowel neoplasms, the most important signs for differential diagnosis and the diseases that can be considered as mimickers of small-bowel neoplasms, are discussed.

Radiolabelled granulocytes in inflammatory bone disease.

Inflammatory lesions in 7 patients have been investigated using labelled in vivo granulocytes. Targeting of white cells was done with a monoclonal antibody, mouse IgG1 reacting with NCA (non-specific crossreacting antigen) and CEA (carcinoembryonic antigen) (BW 250/183) labelled with 99mTc. All inflammatory lesions were visualized, with excellent quality scintigram, between 3-6 and 24 h after the injection. Because the antibody can be stored in a freeze-dried form and labelled at any time with 99mTc without cell separation being necessary, the method appears to be suitable even for use in acute diagnosis.