The patient’s pathway for breast cancer in the COVID‐19 era: An Italian single‐center experience

COVID‐19 has been declared a pandemic by the World Health Organization. As of April 1, 2020, Italy was the country with the second highest number of cases in the world. The spread of COVID‐19 has required a rapid reorganization of health service delivery in face of the pandemic. Breast cancer units have reprioritized their workload to guarantee the health of oncologic patients at the highest risk and regular screening activities. However, at the end of the pandemic emergency, many benign and reconstructive cases will return to our attention and their surgical treatment will be necessary as soon as possible.     

Short‐term splenic impact of single‐strand DNA functionalized multi‐walled carbon nanotubes intraperitoneally injected in rats

In recent years, a great deal of studies have focused on the possible toxicity of carbon nanotubes (CNT), as a result of their potential applications in the field of nanotechnologies. The investigation of spleen toxicity is part of the carbon nanotubes‐induced toxicity assessment. In this study, we investigated the possible toxic effects of CNT on the rat spleen, after intraperitoneally (i.p.) administration of a single dose [1.5 ml; 2 mg multi‐walled (MW) CNT per body weight (bw)] of multi‐walled carbon nanotubes (exterior diameter 15–25 nm, interior diameter 10–15 nm, surface 88 m² g^–1) functionalized 1:1 with single‐strand DNA (ss‐DNA‐MWCNT, 270 mg l^–1). CNT functionalization with DNA determines a stable dispersion in the body fluids. For the detection of carbon nanotubes in the spleen, Raman spectroscopy, histopathologic examination, confocal microscopy and transmission electron microscopy (TEM) were performed at different time points (1, 6, 24, 48 and 144 h) after MWCNT administration. The dynamics of oxidative stress parameters (malondialdehyde, protein carbonyls and reduced glutathione), along with nitrosative stress parameters (nitric oxide, inducible NO synthase), the pro‐inflammatory cytokines [interleukin‐(IL)‐1β] and the number of cells expressing caspase 3 and proliferating cell nuclear antigen (PCNA) were assessed. Our results indicate that, after i.p. administration, MWCNT translocate progressively in the spleen, with a peak of concentration after 48 h, and determine lymphoid hyperplasia and an increase in the number of cells which undergo apoptosis, in parallel with the enhancement of the mitosis in the white pulp and with transient alterations of oxidative stress and inflammation that need further investigations for a longer period of monitoring. Copyright © 2013 John Wiley & Sons, Ltd.     

A State-of-the-Art Review on Advanced Joining Processes for Metal-Composite and Metal-Polymer Hybrid Structures

Multi-materials of metal-polymer and metal-composite hybrid structures (MMHSs) are highly demanded in several fields including land, air and sea transportation, infrastructure construction, and healthcare. The adoption of MMHSs in transportation industries represents a pivotal opportunity to reduce the product’s weight without compromising structural performance. This enables a dramatic reduction in fuel consumption for vehicles driven by internal combustion engines as well as an increase in fuel efficiency for electric vehicles. The main challenge for manufacturing MMHSs lies in the lack of robust joining solutions. Conventional joining processes, e.g., mechanical fastening and adhesive bonding involve several issues. Several emerging technologies have been developed for MMHSs’ manufacturing. Different from recently published review articles where the focus is only on specific categories of joining processes, this review is aimed at providing a broader and systematic view of the emerging opportunities for hybrid thin-walled structure manufacturing. The present review paper discusses the main limitations of conventional joining processes and describes the joining mechanisms, the main differences, advantages, and limitations of new joining processes. Three reference clusters were identified: fast mechanical joining processes, thermomechanical interlocking processes, and thermomechanical joining processes. This new classification is aimed at providing a compass to better orient within the broad horizon of new joining processes for MMHSs with an outlook for future trends.     

带离心功能的极坐标式移动平台的设计与分析

文章介绍了一款自动化装置的结构设计基本方案,该装置可应用在基于图像的显微病理分析中,能够对体液样本进行离心处理,并在不移动样本的情况下直接降低转速,配合沿样本平台径向直线运动的物镜,对样本进行逐格扫描.为了避免离心运动过后转速降低使得样品恢复原始状态,本文还设计了一款特殊的样本容器.该设计中还提出了一种新型微调平机构解决方案,用以调节旋转平台基准面与聚光镜发出光线的垂直度.最后通过有限元仿真软件对该机构进行模态分析.     

Pharmacokinetic and pharmacodynamic study of a clinically effective anti-CD2 monoclonal antibody

The humanized IgG1κ monoclonal antibody siplizumab and its rat parent monoclonal IgG2b antibody BTI-322 are directed against the CD2 antigen. Siplizumab is species-specific, reacting with human and chimpanzee cells but not with cells from any other species, including other non-human primates. Because siplizumab treatment has recently shown great potential in clinical transplantation, we now present the results of our previous pharmacokinetic, pharmacodynamic and safety studies of both antibodies. Fourteen chimpanzees received 1-3 doses of 0.143 to 5.0 mg/kg iv The effects were followed with flow cytometry on peripheral lymphocytes and staining of lymph nodes. Side effects were recorded. Serum antibody concentrations were followed. Across the doses, a rapid, transient depletion of CD2, CD3, CD4 and CD8 lymphocytes and NK cells was observed for both antibodies. Immune reconstitution was more rapid for BTI-322 compared to siplizumab. Paracortical lymph node T cell depletion was moderate, estimated at 45% with doses of >0.6 mg/kg. Restoration of lymph node architecture was seen after two weeks to two months for all animals. All four subjects receiving BTI-322 experienced AEs on the first dosing day, while the eight subjects dosed with siplizumab experienced few mild, transient AEs. Infusion with siplizumab and BTI-322 resulted in rapid depletion of CD2⁺ cells in circulation and tissue. Siplizumab had a longer t_1/2 and fewer AEs compared to BTI-322.     

Is the Dissociative Adult Suggestible? A Test of the Trauma and Fantasy Models of Dissociation

Psychologists have long assumed a connection between traumatic experience and psychological dissociation. This hypothesis is referred to as the trauma model of dissociation. In the past decade, a series of papers have been published that question this traditional causal link, proposing an alternative fantasy model of dissociation. In the present research, the relationship among dissociation, suggestibility, and fantasy proneness was examined. Suggestibility was measured through the Gudjonsson Scale of Interrogative Suggestibility (GSS) as well as an autobiographically based version of this measure based on the events of September 11, 2001. Consistent with prior research and with the trauma model, dissociation correlated positively with trauma severity (r = .32, p < .01) and fantasy proneness (r = .60, p < .01). Inconsistent with the fantasy model, dissociation did not correlate with the neutral form of the GSS and correlated negatively (r = –.24, p < .05) with the trauma-focused form of this suggestibility measure. Although some participants did become quite emotional during the procedure, the risk/benefit ratio was perceived by almost all participants to be positive, with more reactive individuals evaluating the procedure more positively. The results consistently support the trauma model of dissociation and fail to support the fantasy model of dissociation.     

Dual Pallidal and Thalamic Deep Brain Stimulation for Complex Ipsilateral Dystonia

PurposeGlobus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previous studies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Research has also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patients who had undergone unilateral DBS targeting the GPi and Vo.Materials and MethodsFive patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwent DBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale.ResultsBFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. Disability Rating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 month after surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone.ConclusionUnilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target for dystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.     

结缔组织增生性色素痣四例临床病理分析

目的 探讨结缔组织增生性色素痣的病理学特点及鉴别诊断.方法 对4例皮肤结缔组织增生性色素痣的临床表现、组织学表现、免疫组化及荧光原位杂交(FISH)特点进行分析.结果 4例结缔组织增生性色素痣中,男2例,女2例,年龄19 ～ 30岁,平均26.5岁;皮损位于四肢3例,外阴1例.组织学特点:均为皮内痣,病变左右对称,痣细胞呈上皮样和(或)梭形,聚集成团或单个散在分布于增生的纤维组织之间,均未见淋巴细胞聚集、坏死或溃疡.免疫组化显示,3例痣细胞为S100和Melan A阳性,2例为P16阳性;Ki-67阳性指数均小于5％;2例间质细胞为凝血因子FⅫ和CD34阴性.荧光原位杂交(FISH)显示结缔组织增生性色素痣在6p25(RREB1)、6q23 (MYB)、6p11.1-q11.1(Cep6)及11q13(CCND1)4个基因位点均无拷贝数异常.结论 结缔组织增生性色素痣是一种组织学独特的良性黑素细胞痣,ki-67 、S100、Melan A、凝血因子FⅩⅢ等免疫组化染色和黑素瘤FISH检测有助于其与皮肤纤维组织细胞瘤和黑素瘤鉴别.     

骨肉瘤皮肤转移一例

患者女,68岁,发现口腔、手背及肺部多处肿物20余天,无明显自觉症状。体检：各系统检查无异常。皮肤科检查：上颚可见2个蚕豆大小暗红色结节,左手背可见一鸽蛋大小暗红色结节,表面光滑,质硬,活动度差。正电子发射计算机断层显像（PetCT）：全身多处转移癌（脑、淋巴结、肺、胃肠道、双肾、多处骨及肌肉间转移）。口腔内上颚结节病理结果：肿瘤细胞分化较差,局部区域可见骨样基质、软骨样结构及肿瘤骨,免疫组化角蛋白阴性,S100局灶性阳性,波形蛋白阳性,CD99阳性,P63阳性,Ki67阳性（60%）,考虑右侧上颌骨骨肉瘤。手背皮损组织病理检查：表皮未见明显异常,真皮全层弥漫性中等至较大的组织样细胞浸润,细胞有异形性,局部区域可见红染不规则的骨样基质及肿瘤骨;免疫组化Ki67阳性（60%）,CD3、CD10、CD20、Bcl?2、BCl?6均阴性。诊断：骨肉瘤皮肤转移。患者放弃治疗,发病6个月后死亡。     

Suffering without a medical diagnosis. A critical view on the biomedical attitudes towards persons suffering from burnout and the implications for medical care

The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence‐based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves. Medically treating depression has a documented effect. This practice may pose threats to the increasing number of individuals experiencing burnout. The clinical guidelines in evidence‐based medicine mirror what counts as knowledge in medical inquiry, which in turn shapes attitudes towards individual patients. The aim of this article is 2‐fold: firstly, to assess how the values that accompany the biomedical paradigm affect clinical care, and secondly, to replace the biomedical model with a genuine person‐centred approach. In the study described, an existential phenomenological method was applied. Eight individuals, who experienced burnout, were included. They had been on long‐term sick leave (>1 year) due to symptoms of fatigue and pain and fulfilled the criteria for Exhaustion Disorder (ICD‐10, F43.8A). Their symptoms were not medically explained, and almost all the participants were labelled as depressed. Four themes emerged that described how they experienced living with burnout: “unhomelike being in the world,” “the limit of diagnosis,” “naked in the eyes of the public,” and “a path to hopelessness.” I identify 2 main problems; firstly, the mismatch between the patient's experience of his or her illness and the doctor's interpretation of the condition can lead to ineffective treatment. Secondly, the interviewees struggled to be recognized as ill. Thus, the inherent values in the biomedical paradigm might have serious implications for the medical care of patients with burnout.