The mammographic appearance of breast carcinomas of invasive ductal type: relationship with clinicopathological parameters, biological features and prognosis

OBJECTIVES: To evaluate the clinical significance of the mammographic appearance of tumors in 411 patients with infiltrating ductal carcinoma of the breast. STUDY DESIGN: Tumors were classified into five radiographic subgroups: spiculated mass (A-type), diffuse changes with or without suspicious microcalcifications (B-type), microcalcifications with a mass (C-type), circumscribed (D-type), and not visible (E-type). Intratumoral levels of estrogen (ER) and progesterone (PR) receptors, c-erbB-2, EGFR, pS2, cathepsin D and tPA, ploidy and S-phase fraction, were analysed in a significant number of cases. RESULTS: A-type A radiographic pattern was detected in 234 patients (57%), B-type in 46 (11%), C-type in 46 (11%), D-type in 68 (17%), and E-type in 17 patients (4%). On the other hand, a total of 155 tumors (37.8%) showed microcalcifications. The percentage of tumors showing A-type pattern was more frequent in postmenopausal women, in well-differentiated tumors, and in those showing higher levels of ER, pS2 of tPA. However, B-type pattern was detected in a high percentage of premenopausal women and in those showing larger tumors, positive nodes, poor differentiation or high S-phase fraction. Cox multivariate analysis showed that B-type pattern and the absence of microcalcifications were factors significantly associated to high risk for relapse. CONCLUSIONS: Our results suggest that the mammographic appearance of tumor may to provide useful clinical information in addition to classical prognostic factor in infiltrating ductal carcinoma of the breast.     

Lack of prenatal care: an independent risk factor for perinatal mortality among macrosomic newborns

Objective To examine the association between lack of prenatal care (LOPC) and perinatal complications among parturients carrying macrosomic fetuses. Study design The study population consisted of consecutive women with singleton fetuses weighing 4 kg and above, delivered between the years 1988 and 2003. A comparison was performed between parturients lacking prenatal care (fewer than three visits at any prenatal care facility) and those with three and more prenatal care visits. A multiple logistic regression model was constructed in order to investigate the association between LOPC and perinatal mortality. Results During the study period, 7,332 women delivered macrosomic newborns in our institute. Of those, 8.0% (n = 590) lacked prenatal care. Patients lacking prenatal care were more likely to be Bedouins, of higher parity and older than the comparison group. Higher rates of perinatal mortality were noted among patients lacking prenatal care (OR = 5.4, 95%CI 2.8–10.5; P < 0.001). Using a multivariable analysis and controlling for macrosomia-related complications, it was found that the association between LOPC and perinatal mortality persisted (OR = 4.1, 95% CI 2.1–8.1; P < 0.001). Conclusion Lack of prenatal care is an independent risk factor for perinatal mortality among macrosomic newborns.     

The clinical significance of bleeding during the second trimester of pregnancy

OBJECTIVE: This study aimed at investigating the clinical importance and pregnancy outcome in women suffering from bleeding during the second half of their pregnancies. METHODS: A population-based study including all deliveries between the years 1988 and 2005 was conducted. Comparison was performed between patients with and without vaginal bleeding during the second half of pregnancy. Pregnancies, which terminated before 22 weeks, multiple gestations and women lacking prenatal care were excluded from the analysis. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. RESULTS: During the study period, 175,093 singleton deliveries occurred in our institute. Of these, 2,010 (1.1%) were complicated with bleeding upon admission during the second half of pregnancy. The cases were mostly attributed to placental abruption (63.5%; n = 1,276) and placenta previa (36.5%; n = 734). Independent risk factors associated with bleeding, using a backward, stepwise multivariate analysis were oligohydramnios, polyhydramnions, [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.2-2.0; P = 001 and 1.5; 1.2-1.8; P < 0.01, respectively], suspected intra uterine growth restriction (IUGR, 3.2; 2.6-4.0; P < .001), gestational age, previous abortions and maternal age. These patients subsequently were more likely to deliver by cesarean section (CS, 72.9 vs. 12.1%, OR = 19.5; 95% CI 17.6-19.9; 14.9 vs. 1.1%; P < 0.001). Perinatal mortality among patients admitted due to second half bleeding was significantly higher as compared to patients without bleeding (P < .001). CONCLUSION: Bleeding upon admission during the second half of pregnancy is an independent risk factor for perinatal mortality. Careful surveillance, including fetal monitoring, is suggested in these cases in order to reduce the adverse perinatal outcome.     

Correlates of Calcidiol Deficiency in Adults—Cross-Sectional,Observational, Population-Based Study

The prevalence, determinants, and clinical significance of vitamin D deficiency in the population are debated. The population-based study investigated the cross-sectional associations of several variables with serum 25-hydroxyvitamin D (calcidiol) measured using standardized calibrators. The study cohort consisted of 979 persons of the Moli-sani study, both sexes, ages ≥35 years. The correlates in the analyses were sex, age, education, local solar irradiance in the month preceding the visit, physical activity, anthropometry, diabetes, kidney function, albuminuria, blood pressure, serum cholesterol, smoking, alcohol intake, calorie intake, dietary vitamin D intake, and vitamin D supplement. The serum calcidiol was log transformed for linear regression because it was positively skewed (skewness = 1.16). The prevalence of calcidiol deficiency defined as serum calcidiol ≤12 ng/mL was 24.5%. In multi-variable regression, older age, lower solar irradiance, lower leisure physical activity, higher waist/hip ratio, higher systolic pressure, higher serum cholesterol, smoking, lower alcohol intake, and no vitamin D supplement were independent correlates of lower serum calcidiol (95% confidence interval of standardized regression coefficient ≠ 0) and of calcidiol deficiency (95% confidence interval of odds ratio > 1). The data indicate that low serum calcidiol in the population could reflect not only sun exposure, age, and vitamin D supplementation but also leisure physical activity, abdominal obesity, systolic hypertension, hypercholesterolemia, smoking, and alcohol intake.     

Effect of bariatric surgery on pregnancy outcome

Objective

To compare the perinatal outcomes of women who delivered before with women who delivered after bariatric surgery.

Methods

A retrospective study was undertaken to compare perinatal outcomes of women who delivered before with women who delivered after bariatric surgery in a tertiary medical center between 1988 and 2006. A multivariate logistic regression model was constructed to control for confounders.

Results

During the study period, 301 deliveries preceded bariatric surgery and 507 followed surgery. A significant reduction in rates of diabetes mellitus (17.3% vs 11.0; P = 0.009), hypertensive disorders (23.6% vs 11.2%; P < 0.001), and fetal macrosomia (7.6% vs 3.2%; P = 0.004) were noted after bariatric surgery. Bariatric surgery was found to be independently associated with a reduction in diabetes mellitus (OR 0.42, 95% CI 0.26-0.67; P < 0.001), hypertensive disorders (OR 0.38, 95% CI 0.25-0.59; P < 0.001), and fetal macrosomia (OR 0.45, 95% CI 0.21-0.94; P = 0.033).

Conclusion

A decrease in maternal complications, such as diabetes mellitus and hypertensive disorders, as well as a decrease in the rate of fetal macrosomia is achieved following bariatric surgery.     

Evidence of immune system melatonin production by two pineal melatonin deficient mice, C57BL/6 and Swiss strains

Abstract:  We evaluated two pineal melatonin deficient mice described in the literature, i.e., C57BL/6 and Swiss mice, as animal models for studying the immunomodulatory action of melatonin. Plasma melatonin levels in C57BL/6 and Swiss strains were detectable, but lower than levels in control C3H/HENHSD mice. Since these strains are suppose to be pineal melatonin deficient an extrapineal melatonin synthesis may contribute to plasma levels. Regarding cells and tissues from the immune system, all of them were found to synthesize melatonin although at low levels. N-acetyltransferase (AANAT) mRNA was also amplified in order to analyze the alternative splicing between exons 3–4 described for pineal C57BL/6 mice which generates an inclusion of a pseudoexon of 102 bp. For the pineal gland, both the wild type and the mutant isoforms were present in all mice strains although in different proportions. We observed a predominant wild type AANAT mature RNA in thymus, spleen and bone marrow cells. Peripheral blood mononuclear cells (PBMC) culture shown an evident AANAT amplification in all strains studied. Although the bands detected were less intense in melatonin deficient mice, the amplification almost reached the control cell intensity after stimulation with phytohemaglutinin (PHA). In summary, melatonin detection and AANAT mRNA expression in inbred and outbred mice clearly indicate that different cells and tissues from the immune system are able to synthesize melatonin. Thus, the pineal defect seems not to be generalized to all tissues, suggesting that other cells may compensate the low pineal melatonin production contributing to the measurable plasma melatonin level.     

Isothermal phase transformations of a dental porcelain.

OBJECTIVES: The purpose of this investigation was to determine if the change in the leucite weight fraction during an isothermal heat treatment could be estimated by observing the deformation of PFM strips in a high-heating-rate, computer-controlled bending beam viscometer (BBV). METHODS: Specimens of a commercial body porcelain were fired according to the manufacturer's instructions-50 disk specimens for quantitative X-ray diffraction (XRD) and 100 bimaterial strip specimens for BBV. The XRD specimens were annealed at temperatures between 650 and 1000 degrees C, and leucite weight fraction was measured using an alumina internal standard. The BBV specimens were annealed in the BBV using time-temperature schedules designed to elucidate the leucite crystallization behavior between 700 and 1000 degrees C. Timoshenko's equation for a bimaterial thermostat was used to estimate the change in the thermal expansion of the porcelain near room temperature. Changes in leucite weight fraction were determined from these thermal expansion changes. RESULTS: The means and SDs were compared to values obtained by quantitative XRD. Good agreement was obtained between values of leucite weight fraction derived from beam deformation and those determined by quantitative XRD (p> or =0.45). The anneal sequence showed that the increase in leucite weight fraction at 800 or 900 degrees C is reversible by an anneal at 1000 degrees C. SIGNIFICANCE: The BBV technique yields comparable results to quantitative XRD and provides the opportunity to efficiently monitor porcelain leucite changes nondestructively over multiple heat treatments. This technique could prove useful for testing firing schedules designed to stabilize the leucite content in dental porcelain.     

General disease costing principles

The term “disease costing” applies to those economic appraisal methodologies that ascertain the cost borne by a community because of a disease. This approach has been used to calculate the social and economic costs, in terms of loss of productivity, caused by a disease that only in the most serious cases results in the death of an individual. The production losses, also defined as indirect costs, are not the only social costs caused by diseases. In addition we point also to the negative variations that are reflected onto two fundamental quantities: consumption of resources and state of health. In addition to production losses and consumption of resources, the third group is unquestionably the most important in the healthcare sector, since it deals directly with variations in the state of health. This group is denoted by the term “human costs”. In the headache field, we are far behind other pathologies, where there is a greater knowledge of the economic aspects of both the pathology-related costs and the likely benefits resulting from different therapeutical approaches. Notwithstanding the disease costing problems that are also reflected in the cost-benefit techniques, it is important for the economic analysis to gain ground since there is a growing need to keep account of the available resources and the results attainable in the healthcare policies, from the central to the peripheral levels, where the valuation tools prove even more expedient.