Personalized risk assessment of heart failure patients: more perspectives from transforming growth factor super-family members.

More personalized risk assessment of patients with heart failure (HF) is important to develop more tailored based care and for a better allocation of resources. The measurement of biomarkers is now part of the standards of care and is important for the sub-phenotyping of HF patients to demonstrate the activation of pathophysiological pathways engaged in the worsening of HF. The sub-phenotyping of patients can lead therefore to a more personalized selection of the treatment. Several members of the transforming growth factor ß (TGF-ß) super-family, such as myostatin, activin A, GDF-15 and GDF-11, are involved in cardiac remodeling and the evaluation of their circulating levels might provide new insights to the course of the disease and also to guide prognostication and therapeutic selection of HF patients.

Optimal flagging combinations for best performance of five blood cell analyzers.

INTRODUCTION: Corelab automation needs increasingly more efficient hematology analyzers and algorithms to adequately detect abnormal samples. The aim of this study is to assess the effect of combining flags or to adjust their trigger level to identify positive samples for further detection within a smear. METHODS: Five hundred and seventeen EDTA samples from patients followed for hematological malignancies were randomly analyzed on Sysmex XE2100 and XN2000, Abbott Cell-Dyn Sapphire, Beckman Coulter DXH800 and Siemens ADVIA 2120. A blood smear as well as a buffy coat was further performed for each of them. RESULTS: Our results shows that depending on the flags, the combinations of them and the thresholds we use, analyzers can provide extremely variable results in their performances for detecting abnormal cells. ADVIA and XN2000 show remarkable performance for blasts detection. DXH800 is the most sensitive for the detection of abnormal lymphocytes, while XN outperforms the market for immature granulocytes and nucleated red blood cell. CONCLUSION: Flagging performances have been shown to be inconsistent among the different manufacturers. This article should help laboratory professionals in their quest for the best flagging schemes and give them a baseline in the selection of the most appropriate analyzer.

[Clinico-radiologic problems in the study of the male breast in gynecomastia]. / Problematiche clinico-radiologiche nello studio della mammella maschile nella ginecomastia.

INTRODUCTION: Gynecomasty is usually classified as normal of abnormal, except for 25% of cases which are classified as idiopathic because their causes and pathogenesis remain unknown. Gynecomasty is diagnosed mainly on clinical grounds, while integrated imaging, sometimes combined with cytology, is used to distinguish benign from malignant forms. Bilateral gynecomasty is easy to diagnose, especially when patients report assuming particular drugs or present other risk factors, but unilateral or asymmetrical gynecomasty is a diagnostic problem. Primary male breast cancer usually presents as a unilateral hard mass, often infiltrating the dermis and with early lymph node metastases; it is associated with gynecomasty in 20% of cases. MATERIAL AND METHODS: We examined 76 men (age range, 15-75 years) referred for breast enlargement; the patients with radiologic findings of breast adiposis were not included in our series. All patients were submitted to standard projection mammography with a high resolution dedicated film and to real time US with high frequency probes (7.5-12 MHz). RESULTS: Breast enlargement was unilateral in 48% of cases and bilateral in 52%. The radiologic patterns, compared with histologic or clinical-therapeutic follow-up, permitted the correct diagnosis in 72 of 76 patients (94%). The extant four patients had chronic inflammation (3 cases) and a malignant tumor with questionable imaging features. Overall imaging findings were: 55 cases (72%) of actual gynecomasty--unilateral in 17 and bilateral in 38 cases--9 unilateral malignant tumors (12%), eleven cases of inflammation (14%) and 1 case (2%) of unilateral metastasis from plasmocytoma. Sixteen (29%) actual gynecomasty patients (21% of the whole series) had a nodular form (unilateral in 6 and bilateral in 10 cases), 23 (42% and 30% of the whole series) had a dendritic form (unilateral in 7 and bilateral in 16 cases) and 16 (29%, 21% of the whole series) had a glandular form. CONCLUSIONS: Diagnosing gynecomasty is relatively easy in the patients with bilateral forms with a positive history of associated exogenous or endogenous factors, while focal unilateral or asymmetrical forms are difficult to distinguish into benign and malignant. The radiologic pattern may be questionable especially in chronic inflammation and in some malignant forms and must therefore be integrated with cytologic or surgical findings.

Diagnostic imaging in cervical incompetence.

Cervical incompetence is defined as an abnormal dilatation of the cervical canal at the body-neck junction with no pain or blood loss and in the absence of uterine contractile activity. Cervical incompetence is the frequent cause of abortion in the second trimester and premature delivery, with adverse fetal prognosis. Usually, three causative factors are considered: traumatic, constitutional, dysfunctional. While in multiparous women the medical and remote obstetric history poses the diagnostic suspicion, in primigravidae, in the absence of previous risk factors (traumas, malformations, etc) early diagnosis may allow prompt treatment with a better prognosis. Hysterosalpingographic (tunnel-shaped cervix or appearing as an inverted sac, diameter of internal uterine orifice) but especially sonographic findings (cervical length, dilated endocervical canal, tunnel-shaped internal uterine orifice, herniation of the amniotic sac into the endocervical canal) represent the most significant radiologic signs. The radiologist should be able to recognize the typical imaging of this condition to select the patients who should undergo serial controls in time since the start of the second trimester of pregnancy, or to indicate a suitable treatment based on sonographic signs suggestive for incompetence identified before the clinical exam. This is the present correct approach while waiting for future clinical and technological developments of three-dimensional sonography and MRI which will be able to detect those changes in cervical connective structures responsible for incompetence and still not identified by any imaging procedure.