Impact of 2013 ASCO/CAP guidelines on HER2 determination of invasive breast cancer: A single institution experience using frontline dual-color FISH.

PURPOSE: The new ASCO/CAP guidelines published in 2013 (AC2013) significantly modified the scoring criteria for HER2-FISH, introducing the most controversial change to the HER2-equivocal category. We retrospectively evaluated the impact of AC2013 in a cohort of consecutive invasive breast cancers (IBCs) analyzed with frontline dual-color FISH. METHODS: 2788 consecutive IBCs were reclassified based on the AC2013 guidelines. Clinico-pathological features of equivocal IBCs were compared with HER2-negative and HER2-positive IBCs. FISH HER2-equivocal cases underwent reflex tests: HER2-IHC, RARA-FISH, and SMS-FISH. Overall and disease-free survivals were evaluated in AC2007 HER2-positive patients treated with trastuzumab and in patients that became eligible for target-therapy according to AC2013. RESULTS: Two-hundred HER2-negative cases (7.2%) were classified differently, following AC2013: 0.3% (8/2788) became HER2-positive and 6.9% (192/2788) HER2-equivocal. AC2013, compared with AC2007, significantly increased initial HER2-equivocal cases (6.9%vs1.6%, p < 0.001). AC2013 equivocal-IBCs affected older patients and showed pathological features between HER2-negative and HER2-positive IBCs. After reflex tests, 102 of the 190 equivocal cases (53.7%) were reclassified as HER2-positive, 51 (26.8%) as negative and 37 (19.5%) as equivocal. IHC tested negative in 44.7% of cases, whereas SMS-FISH showed the highest percentage of positive results (45.8%). Clinical outcomes showed no statistically significant differences. CONCLUSION: Overall, 80.5% of FISH-equivocal cases were solved with at least one reflex test and 3.6% of patients became AC2013 HER2-positive, therefore eligible for target-therapy, but showed clinical outcomes similar to HER2-positive patients treated with trastuzumab. Our data belittle the clinical impact of AC2013 HER2-equivocal reclassification; further prospective randomized clinical studies are necessary to support these findings.

Uso de tecnologías de asistencia y fragilidad en adultos mayores de 80 años y más / Assisting technologies and frailty in aged 80 years and older / Uso de tecnologias de assistência e fragilidade em idosos de 80 anos ou mais

Objetivo: Identificar y analizar la asociación entre el uso de tecnologías de asistencia y la fragilidad en los adultos mayores más viejos. Método: Estudio cuantitativo, descriptivo y de corte transversal realizado en Ribeirão Preto, Brasil, con 144 adultos mayores de 80 años y más, de ambos sexos que viven en la comunidad. Para la recolecta de datos fue utilizado el Instrumento del perfil demográfico, la Escala de Fragilidad de Edmonton y el Instrumento de Tecnología de Asistencia. Para el análisis de los datos se utilizó estadística descriptiva y para la asociación, la prueba exacta de Fisher con significación p < 0.05. Resultados: Se observó predominio del sexo femenino, de viudos y de los que viven solos. De los entrevistados, el 77.4% usaban algún tipo de tecnología de asistencia, destacándose el uso de lentes de medida, barras de apoyo y bastón. En la evaluación de la fragilidad, el 23.6% fueron categorizados con fragilidad leve, el 13.1% moderada y el 7.8% grave. A la asociación se verificó significación estadística entre los diferentes niveles de fragilidad con el uso de tecnología de asistencia como el uso de silla de ruedas, bastón, andador y barras de apoyo. Conclusión: El uso de tecnología de asistencia auxilia al adulto mayor frágil para mayor independencia funcional y autonomía en el desarrollo de sus actividades cotidianas.

Objective: To identify and analyze the association between the use of assisting technologies and the frailty in aged 80 years and older. Method: This is a quantitative, descriptive and transversal study conducted in Ribeirão Preto, Brazil, with a sample of 144 aged 80 years and older of both sexes and living in the community. Data were gathered through the Edmonton Frail Scale (EFS), and the Assisting Technology Instrument. Data were analyzed using descriptive statistics and Fisher's exact test at a significant level of p < 0.05. Results: A prevalence of females, widowed, and living alone was observed. From those interviewed, 77.4% used some assisting technology, mainly lenses and supporting banisters. Concerning frailty assessment, 23.6% were considered as mild, 13.1% as moderate, and 7.8% as severe. A statistically significant association with the use of assisting technologies such as wheel chairs, banisters, and walkers was verified at all frailty levels. Conclusion: The use of assisting technologies can help elder adults achieve a more functional independence and autonomy in their daily life activities.

Objetivo: Identificar e analisar a associação entre o uso de tecnologias de assistência e fragilidade em idosos mais velhos. Método: estudo quantitativo, descritivo de corte transversal realizado em Ribeirão Preto, Brasil com 144 idosos de 80 anos ou mais, de ambos os sexos que vivem na comunidade. Para a coleta de dados foi utilizado o Instrumento de Perfil Demográfico, Escala de Fragilidade de Edmonton e o Instrumento de Tecnologia de Assistência. Para a análise dos dados utilizou-se estatística descritiva e para a associação a Prova Exata de Fisher com significância p < 0.05. Resultados: Observou-se predomínio do sexo feminino, viúvos e os que vivem sós. Dos entrevistados, o 77.4% usavam algum tipo de tecnologia de assistência, destacando-se o uso de lentes com graduação, barras de apoio e bengala. Na avaliação da fragilidade, o 23.5% foram categorizados com fragilidade leve, o 13.1% moderada e o 7.8% grave. À associação verificou-se significância estatística entre os diferentes níveis de fragilidade com o uso de tecnologia de assistência, tal como o uso de cadeira de rodas, bengala, andador e barras de apoio. Conclusão: o uso de tecnologia de assistência auxilia ao idoso frágil para maior independência funcional e autonomia no desenvolvimento de suas atividades cotidianas.

Nasopalatine duct cyst as a complication of dental implant placement: a case report.

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Assessing the need for computed tomography for lower-third-molar extraction: a survey among 322 dentists.

PURPOSE: Orthopantomograms (OPT) are used to assess the anatomical relationship between the inferior alveolar nerves (IAN) and the roots of third molars and the related risk of postextraction iatrogenic neurological lesions. When the risk is high, computed tomography (CT) or conebeam CT may be warranted. We investigated how dentists judged the need for CT from OPT to ascertain whether they comply with criteria of justification, appropriateness and optimisation in prescribing examinations involving radiation. MATERIALS AND METHODS: A total of 2,713 letters were sent to Italian dentists (Veneto region), inviting them to access an Internet Web site showing 20 OPTs and answer a questionnaire on the need for CT or periapical X-ray. The gold standards were CT images corresponding to the OPTs. The respondents' answers were rated for appropriateness and their tendency to over- or underprescribe CT. RESULTS: The questionnaire was completed by 11.9% of the dentists contacted. The response rate was compatible with a Web survey. Their answers generally came close to the gold standard, achieving a mean appropriateness rating of 0.636 (range 0-1). An overlap between the mandibular canal and the third-molar root was the anatomical relationship most often noted. Recommendations for CT were proportional to the number of radiographic signs indicating a risk of inferior alveolar nerve injury. Periapical X-ray was considered useful by 54.9% of dentists not recommending CT. The main reason stated for not recommending CT was that it was unnecessary for the purposes of the extraction. CONCLUSIONS: Our survey revealed a cautious approach among the professionals interviewed, who tended to overprescribe CT.

[Necrotizing lymphadenitis (Kikuchi's disease) and systemic lupus erythematosus: a single entity?]. / Linfoadenite necrotizzante (malattia di Kikuchi) e lupus eritematoso sistemico: un'unica entità?

Kikuchi's necrotizing lymphadenitis is a histologically alarming but self-limiting lesion typically affecting the cervical lymph nodes of young women. The authors report 2 cases of systemic lupus erythematosus with the finding of Kikuchi's disease on lymph node biopsy. Considering the common infectious and/or immunologic etiologies described in both disorders, coexistence of both conditions suggests the possibility that they share a common etiology.

Quantitative evaluation of anti-HBs in sera.

The Authors carried out a methodological study about the way of expressing in mIU/ml the antibody to HBV surface antigen (anti-HBs) titer. The results showed that Hollinger's formula seems to provide a good accuracy when enzyme immunoassay is employed (AUSAB EIA, Abbott). Moreover, moderate variations in the commercial anti-HBs kits studied (AUSAB, AUSAB EIA, Abbott) have been verified. Considering that and the progress of the calibration curve of the WHO Reference International Standard, it is also advised to include always in the test a calibration curve of the standard serum when a higher precision is required.