Genetic and infective diversity of the liver fluke Fasciola hepatica (Trematoda: Digenea) from Cuba.

In this study we present the first approach to exploration of the genetic diversity of Cuban Fasciola hepatica populations using microsatellite markers, coupled with observed prevalence in slaughterhouses. Nine populations of flukes recovered from cows and buffalos were studied in the central-western region of Cuba. The observed infection rates of definitive hosts (bovines) were 70-100% in most cases. An important amount of polymorphism was found in the four loci explored. However, no apparent genetic differences were found between populations from different provinces or bovine species. The absence of deviations from Hardy-Weinberg equilibrium suggests a high rate of cross-fertilization between F. hepatica individuals. This result was confirmed when all multilocus genotypes were tested for clonal reproduction and only four individuals differed statistically (P sex< 0.05). High values of expected heterozygosity coupled with highly probable mixing among strains make the metapopulation genetically diversified but similar in terms of certain alleles (low F ST values). These results suggest a close relationship between parasite diversity and cattle management in Cuba. Our findings should be taken into consideration by veterinary authorities to help mitigate fasciolosis transmission.

Type and trends in outcomes research in breast cancer between 2000 and 2007.

BACKGROUND: Interest in outcomes research (OR) derives from the need to know the value and the effectiveness of health interventions, especially for oncology. We focused our research on OR in breast cancer, providing an overview of the trend of publications. PATIENTS AND METHODS: We carried out a Medline search to retrieve all articles in English published from 2000 through 2007. The abstracts were reviewed and classified according to the research topics and the primary design of the trial. RESULTS: We selected 405 articles: their number remained constant until 2003, rose during 2004-2005 and decreased during the last 2 years. The most common topic was surgery (n = 234), alone or in association with other interventions. The category more investigated was the process. Clinical outcomes, and among them disease-free survival, were more frequent than other outcomes. The median value of 2007 Impact Factor of the journals publishing the selected references was 2.466 (range 0.272-25.547) and the median value of Citation Index was 8 (range 0-143). CONCLUSIONS: Our research showed a decreasing interest in OR during the more recent years. We are hopeful that it will regenerate interest, particularly by the light of the funds allocated to the comparative effectiveness research in the United States.

Acquired and inherited risk factors for developing venous thromboembolism in cancer patients receiving adjuvant chemotherapy: a prospective trial.

BACKGROUND: Acquired and inherited risk factors for venous thromboembolism (VTE) and the incidence of symptomatic VTE were investigated in patients on adjuvant chemotherapy for breast or gastrointestinal cancer (GI). PATIENTS AND METHODS: In a prospective observational study (January 2003 and February 2006), 199 GI (82 women/117 men; age range, 26-84 years) and 182 breast (180 women/2 men; age range, 29-85 years) cancer patients were enrolled and followed-up for symptomatic VTE during adjuvant chemotherapy. The effect of acquired (i.e. age, chemotherapy, tumour histotype, history of thrombosis, body mass index and smoking) and inherited risk factors [i.e. antithrombin, protein C (PC), protein S, homocysteine, activated PC resistance, factor V Leiden (FVL) and prothrombin (PT) mutations) was prospectively evaluated. RESULTS: Overall, 30 VTE events (7.87%) were recorded: 28 (7.35%) during treatment and 2 (0.52%) during the subsequent follow-up. Among all the 381 cancer patients, FVL was detected in 14 cases (3.67%) and PT mutation in 10 cases (2.62%). Multivariate analysis showed a significant association between the development of VTE and both thrombocytosis [hazard ratio (HR) 1.65; 95% confidence interval (CI), 1.04-2.637, P <0.0341] and a prior episode of thrombosis (HR 7.6; 95% CI, 1.77-33.1, P <0.006). FVL and PT mutations were not associated with the risk for VTE. CONCLUSION: The present data indicate thrombocytosis and history of thrombosis as risk factors for development of a thrombotic event during adjuvant chemotherapy in patients with malignant diseases.

Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I-II AJCC skin melanoma: outcome analysis from a single-institution prospectively collected database.

BACKGROUND: To investigate if the tumour infiltrating lymphocytes (TILs) are able to predict the sentinel lymph node (SLN) positivity, the disease-free survival (DFS) and overall survival (OS) in clinical stages I-II AJCC primary cutaneous melanoma (PCM). METHODS: The study included consecutive patients with PCM, all diagnosed, treated and followed up prospectively. Logistic regression was used to investigate the association between DFS, OS, SLN positivity and Breslow thickness, Clark level, TIL, ulceration, lesion site, gender, regression and age. RESULTS: From November 1998 to October 2008, 1251 consecutive patients with PCM were evaluated. Median age was 51 (range 15-96) with 32.2% (N=393) of them older than 60; 44.8% of them were males. Of the whole series, a total of 404 patients with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease underwent SLN biopsy. Of these, 74 (18.8%) had a positive SLN. In a multivariate analysis, primary melanoma on the extremities versus that on the axial locations (truncal and head/neck) (OR 0.49, 95% CI 0.25-0.98, p 0.04) and TILs (TILs versus no TILs) (OR 0.47, 95%CI 0.25-0.90, p 0.02) were predictive for lower probability of SLN involvement, while thickness (>4mm versus 0-1mm) (OR 24, 19, 95% CI 4.91-119.13, p<.001) was predictive for higher risk of SLN positivity. A multivariate stepwise analysis confirmed these results. The histological status of the SLN was the most significant predictor of DFS and OS. Patients with a negative SLN had a 5-year DFS of 75.9%, compared with 35.2% in patients with a positive SLN (p<.0001) and a 5-year OS of 88.7% versus 42.9%, respectively (p<.0001). CONCLUSIONS: Our study demonstrates that the absence of TILs predicts SLN metastasis, in multivariate analysis the SLN positivity predicts DFS and OS.

Axillary recurrence in sentinel lymph node-negative breast cancer patients.

BACKGROUND: Sentinel lymph node biopsy (SLNB) was developed to axillary lymph node dissection (ALND) in the treatment of breast cancer. SLNB is predictive of axillary node status. Major concern is the occurrence of a false-negative SLN. Purpose of this study is to determine the rate of axillary recurrence in our series of unselected patients. PATIENTS AND METHODS: All patients with a negative SLNB from November 1999 to December 2006 have been treated and followed at our unit. Information on patients' characteristics, treatment and follow-up has been collected. RESULTS: Eight-hundred and four patients with negative SLNB did not receive ALND. After a median follow-up of 38.8 months, 21 patients had distant metastases, four had axillary relapse, nine had an in-breast recurrence and two had both. All patients with axillary recurrence received axillary dissection and systemic adjuvant therapy. They are all presently alive and free from disease. CONCLUSION: Data from this series, the largest from a general hospital, showed that isolated axillary node recurrence after negative SLNB is rare (<1%) and comparable with those reported from referral cancer institutions. We confirm that SLNB for the treatment of early breast cancer patients of a community-based hospital is safe and reliable.

[Diseases caused by repetitive trauma. Trends in accusations and recognitions in the field of INAIL]. / Le patologie da traumi ripetuti. Andamento delle denuncie e dei riconoscimenti in ambito INAIL.

In this report the authors describe the situation of the work-related illnesses, associated with repetitive manual work (CTD-Cumulative Trauma Disorders-), report to the INAIL after the introduction of the mixed system (sentence of Constitutional Court 179/88). They described the medical-legal criteriology that they follow, disorder report, occupational sectors, the most important regions and the connection between the cases arrived to the General Direction and the recognized cases in the last five years.

Linguistic intergroup bias: differential expectancies or in-group protection?

The linguistic intergroup bias describes the tendency to communicate positive in-group and negative out-group behaviors more abstractly than negative in-group and positive out-group behaviors. This article investigated whether this bias is driven by differential expectancies or by in-group protective motives. In Experiment 1, northern and southern Italian participants (N = 151) described positive and negative behaviors of northern or southern protagonists that were either congruent or incongruent with stereotypic expectancies. Regardless of valence, expectancy-congruent behaviors were described more abstractly than incongruent ones. Experiment 2 (N = 40) showed that language is used in an equally biased fashion for individuals as previously demonstrated for groups. Experiment 3 (N = 192) induced expectancies experimentally and found greater abstraction for expectancy-congruent behaviors regardless of valence. All experiments confirmed the differential expectancy approach.