Prognostic Markers of Microinvasive Breast Carcinoma: A Systematic Review and Meta-Analysis.

(1) Background: The prognostic factors of microinvasive (≤1 mm) breast carcinoma are not completely clear. The aim of this study was to perform a systematic review and meta-analysis to clarify these factors. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Two databases were interrogated, PubMed and Embase, and papers in English were included to address this question. The selected studies were those that reported on female patients affected by microinvasive carcinoma, and on prognostic factors with a hazard ratio (HR) for disease-free survival (DFS) and overall survival (OS). (3) Results: In total, 618 records were identified. After removing duplicates (166), identification, and screening (336 by title and abstract alone, 116 by full text and eventual supplementary material), 5 papers were selected. Seven different meta-analyses were conducted in this study, all referring to DFS, analyzing the following prognostic factors: estrogen receptor, progesterone receptor, HER2 status, multifocality and grade of microinvasion, patient's age, and lymph node status. Only lymph node status was associated with prognosis and DFS (total number of cases: 1528; Z = 1.94; p = 0.05). The other factors examined did not significantly affect prognosis (p > 0.05). (4) Conclusions: Positive lymph node status significantly worsens prognosis in patients with microinvasive breast carcinoma.

CIC-rearranged sarcoma presenting with superior vena cava syndrome: case report.

CIC-rearranged sarcomas are rare mesenchymal neoplasms belonging to the family of undifferentiated small round cell sarcomas. This report details the case of a 45-year-old man presenting with symptoms of mediastinal compression, radiological diagnosis of a mediastinal mass and rapid evolution to full-blown superior vena cava syndrome. The emergency was successfully managed with a pharmacological approach. Formulation of a pathological diagnosis of CIC-rearranged sarcoma was initially supported by fluorescence in situ hybridisation findings and later validated by next-generation sequencing, which showed CIC-DUX4 gene fusion. A chemotherapy regimen was started with immediate benefits for the patient. The spectrum of pathological entities able to cause superior vena cava syndrome is wide, and recognition of rare causes is important to tailor the therapeutic approach to the specific disease. This is, to the best of our knowledge, the first report of CIC-rearranged sarcoma presenting with superior vena cava syndrome.

Cutaneous Involvement in Diseases with Plasma Cell Differentiation: Diagnostic Approach.

Neoplasms with plasma cell differentiation may occasionally involve the skin. Cutaneous lesions may represent the first sign of an underlying systemic plasma cell malignancy, such as multiple myeloma, or the skin itself may be the primary site of occurrence of a hematological tumor with plasma cell differentiation. Starting from examples encountered in our daily practice, we discussed the diagnostic approach pathologists and clinicians should use when faced with cutaneous lesions with plasma cell differentiation. Cases of primary cutaneous marginal zone lymphoma, localized primary amyloidosis/amyloidoma, and cutaneous manifestations (secondary either to multiple myeloma or to plasmablastic lymphoma) are discussed, focusing on the importance of the adequate patient's work-up and precise clinicopathological correlation to get to the correct diagnosis and appropriate treatment. The pertinent literature has been reviewed, and the clinical presentation, pathological findings, main differential diagnoses, treatment, and outcome of neoplasms with plasma cell differentiation involving the skin are discussed.

Late acute aortic dissection following cardiac transplantation in lupus-affected donor aorta.

We report the case of a young woman who underwent cardiac transplantation from systemic lupus erythematosus affected donor and who developed a type A aortic dissection limited only to the graft aortic wall 9 years after.

Laboratory automation reduces time to report of positive blood cultures and improves management of patients with bloodstream infection.

The impact on time to results (TTR) and clinical decisions was evaluated for mono-microbial positive blood cultures (BC) processed using the BD Kiestra Work Cell Automation (WCA) system. Positive BC were processed by the WCA system by full-automatic subculture on solid media and digital imaging after 8 h of incubation (8-h method) followed by identification (ID) and antimicrobial susceptibility testing (AST). To evaluate the accuracy of the 8-h method, ID and AST from 8-h and overnight incubated colonies were compared for the same organisms. To evaluate its clinical impact, results from 102 BC processed by the 8-h method (cases) were compared with those from 100 BC processed by overnight incubation method (controls) in a comparable period. Identification after 8-h and overnight incubation gave concordant results in 101/102 (99.0%) isolates. Among a total of 1379 microorganism-antimicrobial combinations, categorical agreement was 99.4% (1371/1379); no very major error, 7 major errors, and one minor error were observed. TTR in cases (32.8 h ± 8.3 h) was significantly (p < 0.001) shorter than in controls (55.4 h ± 13.3 h). A significant reduction was observed for duration of empirical therapy (cases 54.8 h ± 23.3 h vs controls 86.9 h ± 34.1 h, p < 0.001) and 30-day crude mortality rate (cases 16.7% vs controls 29.0%, p < 0.037). Automation and 8-h digital reading of plates from positive BC, followed by ID and AST, greatly reduce TTR and shorten the duration of antimicrobial empiric therapy, possibly improving outcome in patients with mono-microbial bloodstream infections.

Aerobic physical exercise and negative compensation of non-exercise physical activity in post-menopause: a pilot study.

BACKGROUND: Sedentarism is a risk factor for mortality that is independent of physical exercise. As indicated in the literature, there is negative compensation of non-exercise physical activity due to exercise training. The aim was to investigate potential predictor variables of physical activity compensation in post-menopausal women beginning aerobic physical exercise training. METHODS: One hundred and three post-menopausal women (mean age, 58.31±5.33 years) were eligible for the study. Metabolic markers were measured (plasma leptin, insulin, glucose), together with cardiovascular parameters and body composition. Daily physical activity was recorded objectively. Following baseline measurements, participants walked at moderate intensity on 4 days/week, for 13 weeks. RESULTS: Baseline mean intensity of daily physical activity and leptin-to-fat mass ratio (L/FMkg) were independently and negatively correlated with variations in non-exercise physical activity. High L/FMkg was associated with negative compensation of non-exercise physical activity due to aerobic physical exercise. The same was shown for participants starting their exercise training who showed high daily physical activity. CONCLUSIONS: Knowledge of both L/FMkg and baseline spontaneous physical activity of participants in exercise training are important to programme physical exercise interventions and to prevent negative non-exercise physical activity compensation due to exercise training.

Psychophysical health status of breast cancer survivors and effects of 12 weeks of aerobic training.

The aim of this study was to analyse the health status of breast cancer survivors and the effects of 12 weeks of aerobic training. Twenty-three breast cancer survivors (51.71 ± 3.17 years) and 23 healthy women (50.73 ± 2.97 years) were investigated for body composition, daily physical activity, quality of life, salivary cortisol, and DHEA-S. Breast cancer survivors were then aerobically trained for 12 weeks. Breast cancer survivors have a worse psychophysical health than healthy women. Aerobic training increased salivary DHEA-S, aerobic fitness, self-reported health, and nocturnal sleeping time and reduced salivary cortisol in breast cancer survivors. Salivary cortisol variation correlated with change of sleeping time and self-reported health. Salivary DHEA-S correlated with change of self-reported physical pain and general health as well. Breast cancer survivors can live in a situation of continuous distress, requiring a multidisciplinary approach. Twelve weeks of aerobic training improve the psychophysical health of breast cancer survivors.

Nordic Walking and the Isa Method for Breast Cancer Survivors: Effects on Upper Limb Circumferences and Total Body Extracellular Water - a Pilot Study.

BACKGROUND: The negative side effects of breast cancer treatments can include upper limb lymphoedema. The growing literature indicates that Nordic walking is an effective discipline against several disease symptoms. The aim of this study was to determine whether introduction to Nordic walking alone is effective against total body extracellular water and upper limb circumferences in breast cancer survivors compared to its combination with a series of specifically created exercises (i.e. the Isa method). METHODS: 16 breast cancer survivors (49.09 ± 2.24 years) were recruited and randomly assigned to 1 of 2 different training groups. RESULTS: 10 lessons on Nordic walking technique plus the Isa method significantly reduced both extracellular body water and the extracellular-to-total body water ratio (p = 0.01 for both), and also the circumference of the upper limb, (both relaxed arm and forearm circumferences) (p = 0.01 for all), whereas Nordic walking alone did not. CONCLUSIONS: Introduction to Nordic walking does not seem to affect lymphoedema in breast cancer survivors. This might be because novice Nordic Walkers do not adequately generate an effective muscular pump through coordination of the alternated bimanual open-close cycle. The Isa method appears to close this gap.

Walking training in postmenopause: effects on both spontaneous physical activity and training-induced body adaptations.

OBJECTIVE: Because physical exercise has been widely used for primary and secondary preventions of cardiometabolic diseases arising with menopause, the aim of our study was to determine whether participation in aerobic physical exercise is linked to the modification of spontaneous physical activity and whether this compensation affects aerobic training-related body adaptations. METHODS: Both before and after a 13-week walking training program, 34 postmenopausal women (mean ± SD age, 55.89 ± 3.57 y) were analyzed for lipids, adipokines, glucose, and insulin plasma levels, as well as for body measures, heart rate and blood pressure at rest, maximal aerobic capacity, total daily energy expenditure, mean intensity of daily physical activities, and time and energy spent on physical activities with an intensity of more than three metabolic equivalents. RESULTS: Aerobic training induced significant reductions in body mass, body mass index, heart rate, systolic blood pressure, basal cardiac double product, plasma glucose, leptin, and resistin. Aerobic fitness, the reserve of the cardiac double product, and the quantitative insulin sensitivity index were significantly improved. Cluster analysis of the variations in the total daily energy expenditure, the mean intensity of daily physical activities, and the time and energy spent on physical activities with an intensity of more than three metabolic equivalents identified two subgroups: one showed reduced spontaneous physical activity (GROUP-), whereas the other did not (GROUP+). The subgroups differed significantly only for plasma lipid variation. GROUP+ showed significantly reduced low-density lipoprotein cholesterol and total cholesterol, whereas GROUP- did not show significantly modified plasma lipids. CONCLUSIONS: In postmenopause, participation in a program of aerobic physical exercise can result in a reduction of spontaneous physical activity, which inhibits the positive effects of the aerobic exercise on plasma lipids and lipoproteins.

Left ventricle relative wall thickness and plasma leptin levels: baseline relationships and effects of 4 months of walking training in healthy overweight postmenopausal women.

OBJECTIVE: Whether leptin has positive or negative influences on cardiac structure and function in healthy sedentary overweight postmenopausal women is unknown. We investigated the role of leptin in cardiac health and whether aerobic fitness enhancement influences any relationships revealed between leptin and echocardiographic measurements. METHODS: Thirty-nine sedentary postmenopausal women were enrolled after an initial screening. The women underwent blood sampling for hormone levels, anthropometric and echocardiographic measurements, dietary habits investigation, and fitness testing, both before and after 4 months of walking training. RESULTS: After the intervention, the women who had an adherence to training of 75% or higher showed significantly reduced percentage fat mass (P = 0.006) and plasma leptin levels (P < 0.001), whereas their maximum oxygen consumption increased significantly (P < 0.001). The women showed a significant reduction in left ventricle relative wall thickness (P = 0.039) and significant increases in both left ventricular end-diastolic diameter (P = 0.040) and left ventricular mass index (P = 0.043). At baseline, a negative correlation was seen between plasma leptin levels and left ventricle relative wall thickness (r = -0.553; P = 0.009). Further negative correlations were seen for the changes in left ventricle relative wall thickness with leptin levels (r = -0.456; P = 0.038) and with tricipital skinfold (r = -0.436; P = 0.05). CONCLUSIONS: In healthy overweight sedentary postmenopausal women with low fitness level, high plasma leptin levels seem to have a protective role against left ventricle relative wall thickness hypertrophy and to participate in its remodeling after 4 months of aerobic training.