Negative prognostic value of intra-ductal fat infiltrate in breast cancer

BackgroundRecent studies showed a correlation between Body Mass Index and both breast cancer occurrence and progression. Nevertheless, no study reported an accurate evaluation of intra-ductal fat infiltrate. Therefore, the main aim of this study was to evaluate the putative association between intra-ductal fat infiltrate (IDFi) and breast cancer subtypes by using digital pathology.MethodsWe retrospectively collected 220 breast biopsies. Paraffin serial sections were used for haematoxylin and eosin staining and immunohistochemical evaluation of the following markers: estrogen receptor (ER), progesterone receptor (PR), Ki67 and c-erb2. Three haematoxylin and eosin sections for each paraffin block were digitalized. Digital slides were used to evaluate the areas of IDFi. Five randomized areas were evaluated for each slide. By using GraphPad software IDFi areas was correlated with a) breast cancer histotype, b) presence of microcalcifications and c) biomarkers expression.ResultsBreast biopsies were classified as follow: 20 normal breast, 50 benign lesions, and 150 malignant lesions (85 ductal in situ carcinomas; 65 ductal infiltrating carcinomas). Statistical analysis showed a significant increase of IDFi in malignant lesions as compared to both normal breast and benign lesions. We noted higher IDFi in breast ductal carcinomas as compared to lobular lesions. Significant differences were observed between breast lesions with microcalcifications respect to lesions without calcifications. Noteworthy, we also found a positive association between IDFi and the expression of both ER and Ki67.ConclusionResults of our study highlighted the possible role of fat in breast cancer progression suggesting a negative prognostic value of IDFi.     

Clinical engineering in Italy: two local experiences

Although biomedical engineering education and research are carried out in most major italian universities, both clinical engineering training programmes and hospital departments are extremely few. An outline of the organisation of such departments is provided. Data from surveys carried out in Piemonte, a region with 80 hospitals without any clinical engineering services, focus on the main problems which result from extensive use of electronic equipment in health facilities, such as electrical safety, maintenance cost, personnel training, costs and benefits of personal and minicomputer applications. Data from the 5 year experience of the Medical Equipment Department of the Local Health Unit of Trieste outline the economic advantage of inhouse maintenance services as well as the department's role in hazard prevention, personnel training and equipment selection. The reasons for the reluctant attitude of the National and Regional Health Authorities to organise clinical engineering services within the major health care facilities are presented and discussed.     

Dirofilariasis due to Dirofilaria repens in Italy, an emergent zoonosis: report of 60 new cases

AIMS: Sixty new cases of human dirofilariasis due to Dirofilaria repens, occurring in Italy between 1990 and 1999, are presented. This is the most extensive case study of this zoonosis reported worldwide by a single study group. The aim is to utilize this large experience to characterize the different histopathological findings in the parasitic lesions in man. METHODS AND RESULTS: Diagnosis was performed on histological sections of the nematode enclosed in the nodules excised at biopsy or surgery. The nematode was located in the subcutaneous tissue (49 cases), the epididymis (two cases), the spermatic cord (two cases), the lung (two cases), the breast (two cases), the omentum (two cases) and under the conjunctival tissue (one case). The majority of cases (46) were from Piedmont; the remainder were from Emilia-Romagna, Sardinia, Sicily, Tuscany, Apulia and Lombardy. The histopathological features of the lesions are described and the clinical and epidemiological aspects of the zoonosis are discussed. The prevalence in Italy in general and in the area of Piedmont in particular, comprising the provinces of Alessandria, Asti, Novara and Vercelli, which is one of the most severely affected areas of the world, is emphasized. The evident increase in the number of cases in the last few years is a clear indication that it is an emergent zoonosis. CONCLUSIONS: We recommend that each and every case observed be recorded, to enable the true extent of human dirofilariasis in Italy to be assessed, and that a reference centre be set up in the area to collate the data. The importance of the histopathologist's role in the diagnosis is stressed.     

Inhibition of animal virus production by means of translation inhibitors unable to penetrate normal cells

The correlation between virus and host protein synthesis, membrane leakiness, and virus production has been studied in vesicular stomatitis virus-infected L cells, herpes simplex virus (type 1)- and Sendai virus-infected 37RC cells. In all three systems, membrane leakiness, as measured by an altered permeability to low-molecular-weight translation inhibitors (e.g., hygromycin B), is detectable at a time when the cells are very actively engaged in virus protein synthesis. The alteration of the membrane increases as the virus life cycle goes on so that an almost total and specific inhibition of viral translation by hygromycin B is achieved late in infection. Although the overall protein synthesis is not shut off in Sendai virus-infected cells, a gradual replacement of host protein synthesis by viral translation parallels an increasing plasma membrane permeability to hygromycin B, which is also correlated with the ever increasing fraction of infected cells. These results indicate that cells actively engaged in viral protein synthesis have lost, at least partially, the permeability barrier that plasma membrane maintains in uninfected cells. The presence of hygromycin B in the culture medium significantly reduces the production of mature virus in the three systems studied suggesting that this approach may prove useful in the search for antiviral agents.     

Cytogenetically distinct leukemic cell lines displaying in vitro specific proliferative and differentiation capacities may account for early disease relapse in the blast phase of CML

The cytogenetic features and the proliferative and differentiation capabilities of blast cell fractions purified on a density gradient were studied in one patient with chronic myeloid leukemia (CML) in blast crisis, both at the emergence and at relapse of the disease. The results show that relapse was due to the appearance of a new leukemic cell line that was characterized by peculiar chromosomal, growth, and differentiation features, which seemingly accounted for early refractoriness to therapy and disease progression.     

Emergency Department Resuscitative Thoracotomy: Indications,surgical procedure and outcome. A narrative review

BackgroundEmergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient’s outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries.MethodsLiterature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints.ResultsA total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT.ConclusionsEDRT should be reserved for acute resuscitation of selected dying trauma patient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure.