An updated perspective on diagnostics and treatment of idiopathic granulomatous mastitis.

AIM: To present our experiences with the anti-inflammatory treatment of idiopathic granulomatous mastitis (IGM) and highlight the imaging and anamnestic specifics of its diagnosis. METHODS: Patients with acute inflammatory breast disease underwent ultrasound examination followed by a collection of anamnestic data, and histological analysis of the process was performed using core-cut bio psy, confirming IGM. Subsequently, anti-inflammatory treatment was administered, consisting of a combination of colchicine, vitamin E, and local compresses made from an infusion of Plantago lanceolata. We also recorded any additional treatments administered extra muros prior to histological analysis (such as antibio tics, surgical intervention, and time from onset of symptoms to confirmation of diagnosis). We analyzed the effect of the anti-inflammatory treatment administered, including the onset of improvement, adverse effects, recurrences, and duration of treatment required for symptom resolution. RESULTS: Between 2016 and 2022, we diagnosed and histologically confirmed IGM in 53 patients through bio psy. Of these, 45 (84.9%) underwent the anti-inflammatory treatment we proposed, while eight (15.1%) opted for a different form of therapy. Currently, 27 patients (60%) are without treatment and clinical manifestations. The average duration of treatment was 34 months, and improvement in the clinical condition was observed within 2-8 weeks (average of 3 months). Four patients (14.81%) reported dyspepsia as an adverse effect. Recurrence occurred in five patients (18.52%) after 1-36 months (average of 7 months). Patients (22, 81.48%) who completed the treatment are without difficulties for 3-70 months (average of 34 months). The remaining 18 patients (40%) are currently undergoing treatment, lasting 3-41 months (average of 19 months). CONCLUSION: Anti-inflammatory treatment with colchicine, along with supportive therapy (compresses made from an infusion of Plantago lanceolata and vitamin E), represents a promising trend in the therapy of IGM, with minimal adverse effects.

Detection of BRAFV600E Mutation in Melanoma Patients by Digital PCR of Circulating DNA.

AIMS: About 50% of melanomas have the BRAFV600E mutation. This mutation is an attractive therapeutic target. The aims of our study were to detect BRAFV600E mutations within circulating cell-free DNA in plasma ("liquid biopsy") by a droplet digital PCR (ddPCR) method, and to investigate how well the Breslow-Clark score can be predicted by ddPCR. MATERIALS AND METHODS: We analyzed 113 patients with malignant melanoma. ddPCR was performed using the QX200 system (BIO-RAD®, Hercules). All samples were tested in duplicate. Besides the results of the liquid biopsy, we have collected data on gender and age of the patients, as well as the mitotic activity of the tumor; the tumor subtype and localization, and the Breslow-Clark score. The limit of detection (LoD) was determined by the method of Tzonev. The LoD was found to be five events per well. RESULTS: The BRAFV600E mutation was detected in 37 of 113 samples. A moderate predictive accuracy of the Breslow-Clark score can be attained with the mitotic activity and the type of melanoma as the most important predictors. CONCLUSION: Our results show that ddPCR is a highly sensitive method and could be used for a routine laboratory detection of the BRAFV600E mutation as well as for follow-up monitoring to determine the treatment response in patients with malignant melanomas.

The Value of High-frequency 20 MHz Ultrasonography for Preoperative Measurement of Cutaneous Melanoma Thickness.

High-frequency ultrasonography has become an important diagnostic tool in dermatovenerology. It is used for assessment of the cutaneous layers in diverse benign and malignant skin lesions and diseases. Herein we present the practical value of preoperative measurement of cutaneous melanoma thickness, the explanation of the possible reasons for different sonographic and histologic Breslow thickness, and the practical importance of high-frequency 20 MHz ultrasonography in preoperative measurements of cutaneous melanoma thickness. Fifty patients (31 women aged 41.6±15.4 years, 19 males aged 54.5±11.4 year (mean ± Standard Deviation) were examined in the Skin Cancer Clinic from January 2014 to December 2015. Suspected cutaneous melanomas were investigated with skin ultrasound Dermascan C (Cortex Technology, Denmark) before surgical removal. The Breslow thickness of cutaneous melanomas was analyzed by precise pathological examination after extirpation. Statistical analysis revealed a significant positive correlation between ultrasonographic melanoma thickness and Breslow thickness (r=0.92, P<0.001). The mean thickness of invasive tumors evaluated by high frequency ultrasonography was 6.77 % higher compared with the mean Breslow thickness. The high-frequency ultrasonography provides a sensitive, noninvasive and reproducible method of skin evaluation, which enables objective visualization in vivo, providing valuable information, especially about cutaneous melanoma. The results of our study indicate that high frequency ultrasonography may be a useful adjunctive tool in the evaluation of cutaneous melanoma in daily practice.

Teachers' gaze over space and time in a real-world classroom.

Reading students' faces and their body language, checking their worksheets, and keeping eye contact is a key trait of teacher competence. The new technology of mobile eye-tracking provides researchers with possibilities to explore teaching from the viewpoint of teacher gaze, but also introduces many new method questions. This study had the primary aim to investigate teachers´ attention distribution over space: the number and durations of several types of their gazes, and how their gaze depends on the factors of students´ gender, achievement, and position in the classroom. Results show that teacher gaze was distributed unevenly across both space and time. Teachers looked at the most-watched students 3-8 times more often than at the least-watched ones. Students sitting in the first row and the middle section received significantly more gaze than those sitting outside this zone. All three teachers made more single gaze visits - looking at the students but making no eye contact - than mutual gazes or student material gazes. The three teachers' gaze distribution also varied substantially from lesson to lesson. Our results are important for understanding teacher behavior in real classrooms, but also point to the relevance of appropriate method design in future classroom studies with eye-tracking.

Droplet digital PCR for detection of BRAF V600E mutation in formalin-fixed, paraffin-embedded melanoma tissues: a comparison with Cobas® 4800, Sanger sequencing, and allele-specific PCR.

Cutaneous melanoma has the worst prognosis of all skin cancers. Although emerging targeted therapies, such as B-Raf kinase inhibitor vemurafenib, improve prognosis they require an accurate and sensitive means of detecting the pathogenic BRAF V600E mutation. We compared the sensitivity of four BRAF V600E detection methods in formalin-fixed, paraffin-embedded melanoma biopsies from 87 consecutive melanoma patients with Breslow stage I-V disease (staging based on the depth of tumor of invasion). The methods assessed were the widely used Cobas® 4800 system based on real-time PCR amplification, Sanger sequencing, allele-specific PCR (AS-PCR), and droplet digital PCR (ddPCR). The BRAF V600E mutation was found in 8 (9.2%), 23 (26.4%), 23 (26.4%) and 31 (35.6%) biopsies, respectively. The limit of detection (LoD) was determined by three different methods: Poisson confidence limits, calibration regression and Tzonev's method. Pair-wise agreement between the methods was as follows: Cobas vs. Sanger, P = 0.33; Cobas® 4800 vs. AS-PCR, P = 0.33; Cobas® 4800 vs. ddPCR, P = 0.65; Sanger vs. AS-PCR, P = 1; Sanger vs. ddPCR, P = 0.08; AS-PCR vs. ddPCR, P = 0.06. Multinomial logistic regression was used for predictive modeling of the Breslow-Clark score; ddPCR emerged as the best predictor, the other predictors were mitotic activity, type of malignant melanoma and patient's age. Our results demonstrate that ddPCR is the most sensitive method of detecting the BRAF V600E mutation.

Neurofibromatosis associated with hypertrophic cardiomyopathy.

We present a case of an 18-year-old boy with neurofibromatosis type 1 and hypertrophic cardiomyopathy with systolic anteward movement of the anterior leaflet of the mitral valve. Gradient in the left ventricular outflow was 85 mm Hg secondary to subvalvular aortic stenosis with left ventricular diastolic dysfunction. The possibility of a coincidence, or a causal relationship of these 2 conditions is mentioned.