Targets for Neoadjuvant Therapy - The Preferences of Patients with Early Breast Cancer.

Background: Therapists and administrative bodies consider a pathological complete remission as an independent and relevant endpoint in evaluations of the clinical utility of neoadjuvant therapy for early breast cancer. The present study aims to investigate which treatment outcomes of a neoadjuvant therapy are considered by the patients themselves to be relevant. Materials and Methods: With the help of analytic hierarchy process (AHP) methods patient preferences about the treatment targets of neoadjuvant therapy were assessed quantitatively. All participants had undergone a neoadjuvant therapy in the form of chemotherapy and, in HER2-positive cases, as a targeted antibody therapy against HER2 for the primary diagnosis of early breast cancer 12-36 months prior to the interview. The criteria for the hierarchy model were identified in an earlier qualitative survey. The patient interviews were conducted by 4 experienced female interviewers. Results: Forty-one patients participated in the quantitative survey, of these 15 (36.6 %) had suffered from HER2-positive disease. The achievement of pCR was the most important therapeutic target for the patients, even before disease-free survival, overall survival and the option for breast-preserving operation. Avoidance of side effects was considered to be the least important. In a comparison of the side effects the patients judged fatigue to be most important before nausea and loss of hair. Conclusion: For the patients the achievement of a pathological complete remission is considered to be an independent, relevant and highly desired target of neoadjuvant therapy.

Diversity of 16S rRNA genes from bacteria of sugarcane rhizosphere soil

Sugarcane is an important agricultural product of Brazil, with a total production of more than 500 million tons. Knowledge of the bacterial community associated with agricultural crops and the soil status is a decisive step towards understanding how microorganisms influence crop productivity. However, most studies aim to isolate endophytic or rhizosphere bacteria associated with the plant by culture-dependent approaches. Culture-independent approaches allow a more comprehensive view of entire bacterial communities in the environment. In the present study, we have used this approach to assess the bacterial community in the rhizosphere soil of sugarcane at different times and under different nitrogen fertilization conditions. At the high taxonomic level, few differences between samples were observed, with the phylum Proteobacteria (29.6 percent) predominating, followed by Acidobacteria (23.4 percent), Bacteroidetes (12.1 percent), Firmicutes (10.2 percent), and Actinobacteria (5.6 percent). The exception was the Verrucomicrobia phylum whose prevalence in N-fertilized soils was approximately 0.7 percent and increased to 5.2 percent in the non-fertilized soil, suggesting that this group may be an indicator of nitrogen availability in soils. However, at low taxonomic levels a higher diversity was found associated with plants receiving nitrogen fertilizer. Bacillus was the most predominant genus, accounting for 19.7 percent of all genera observed. Classically reported nitrogen-fixing and/or plant growth-promoting bacterial genera, such as Azospirillum, Rhizobium, Mesorhizobium, Bradyrhizobium, and Burkholderia were also found although at a lower prevalence.

Diversity of 16S rRNA genes from bacteria of sugarcane rhizosphere soil.

Sugarcane is an important agricultural product of Brazil, with a total production of more than 500 million tons. Knowledge of the bacterial community associated with agricultural crops and the soil status is a decisive step towards understanding how microorganisms influence crop productivity. However, most studies aim to isolate endophytic or rhizosphere bacteria associated with the plant by culture-dependent approaches. Culture-independent approaches allow a more comprehensive view of entire bacterial communities in the environment. In the present study, we have used this approach to assess the bacterial community in the rhizosphere soil of sugarcane at different times and under different nitrogen fertilization conditions. At the high taxonomic level, few differences between samples were observed, with the phylum Proteobacteria (29.6%) predominating, followed by Acidobacteria (23.4%), Bacteroidetes (12.1%), Firmicutes (10.2%), and Actinobacteria (5.6%). The exception was the Verrucomicrobia phylum whose prevalence in N-fertilized soils was approximately 0.7% and increased to 5.2% in the non-fertilized soil, suggesting that this group may be an indicator of nitrogen availability in soils. However, at low taxonomic levels a higher diversity was found associated with plants receiving nitrogen fertilizer. Bacillus was the most predominant genus, accounting for 19.7% of all genera observed. Classically reported nitrogen-fixing and/or plant growth-promoting bacterial genera, such as Azospirillum, Rhizobium, Mesorhizobium, Bradyrhizobium, and Burkholderia were also found although at a lower prevalence.

Hospital admission policy for tuberculosis in pulmonary centres in Italy: a national survey. AIPO Tuberculosis Study Group. Italian Association of Hospital Pulmonologists.

SETTING: A national survey including 203 pulmonary centres (PCs) (144 hospital PCs with beds dedicated to TB patients and 59 out-patient PCs) managing tuberculosis cases in Italy during 1995. OBJECTIVES: To evaluate: 1) hospitalisation practices (criteria for admission/discharge; duration of hospitalisation) as primary end-points; and 2) as secondary end-points the availability of beds, the preventive measures adopted to reduce the spread of infection, the sources of referral for hospitalisation and the procedures adopted to follow up TB patients after discharge. DESIGN: A 26-point questionnaire mailed to 203 PCs. RESULTS: Of 167 PCs that responded to the questionnaire (82.3%), 159 questionnaires were considered valid for the analysis (110 from hospitals PCs and 49 from out-patient PCs). The criteria adopted by PCs to admit TB patients were: all TB cases 47%, only smear-positive pulmonary TB 14%, TB cases with clinical problems 39%. Hospital PCs hospitalised significantly more cases of smear-negative, extra-pulmonary TB. On average 71.6% of all cases were hospitalised (88.2% by hospital and 28% by out-patient PCs). The median hospital stay was 34 days for sputum smear-positive, 20 for sputum smear-negative and 21.5 for extra-pulmonary TB cases. Sputum conversion was considered the mandatory criterion to allow discharge from 61% of hospital PCs. CONCLUSION: A switch from the present policy (majority of cases hospitalised for a long period) to an outpatient oriented policy needs the co-ordinated educational effort of scientific societies and health authorities.

Tuberculosis and Pelger-Huët anomaly. Case report.

We describe a patient with pulmonary tuberculosis and a rare disturbance of leukocyte segmentation, known as "Pelger-Huët anomaly", which can be observed in various diseases such as malignancies and/or infections. The importance of this association is equivocal: some authors have related to the association the particular severity of tuberculosis or the death they observed; in the case reported we noted no evidence of such a relation, notwithstanding the presence of the homozygous form of the Pelger-Huët anomaly. We suggest therefore that, when Pelger-Huët anomaly is found, an underlying disease should be searched for; the course of this illness, however, might not be affected.

[Not Available]. / Valutazione dell'efficacia e tollerabilita di cefixima nel trattamento delle riacutizzazioni infettive delle BPCO.

An open, multicenter non-comparative study was carried out in 8 centres in Italy to evaluate the efficacy, safety and tolerability of cefixime (Suprax - Lederle), a third generation oral cephalosporin administered once daily to patients affected by exacerbation of chronic bronchitis. All patients, 124 males and 21 females, aged between 50 and 85, were treated with Suprax at the dose of 400 mg/day for a mean period of 7.4 days. Clinical and laboratory examinations were performed at: T0 (beginning of treatment), T1 (3-4 days after the beginning of treatment), T2 (end of treatment). The following signs/symptoms were recorded in order to evaluate the therapeutic efficacy: sputum quality and quantity, cough, dyspnoea, fever, bronchospasm, chest clinical findings. All these signs and symptoms significantly improved (p between < 0.001 and < 0.05; mean improvement for sign, weighted for time of improvement). Bio-humoral parameters were also recorded in order to evaluate potential therapeutic influences. A significant decrease was observed (p < 0.01 Student t test for paired data) in the white blood cell count and the leukocyte formula. The datum regarding the white blood cell count and leukocyte formula is to be considered a primary effect of the treatment, proving its success. A microbiological search for the pathogen responsible for the infectious process was also performed: in 70/145 subjects the responsible pathogen was identified. The micro-organism was eradicate in 66/70 at T2 (94.3%), the difference T0 = T2 is significant. The X-Ray evidence suggesting a chronic bronchitis, was also evaluated in 81 patients. At T2, in 75/81 subjects the X-Ray evidence turned out to be negative, while in 6/81 it remained positive. This difference was statistically significant (p < 0.01 sign test). An overall clinical evaluation showed a therapeutic success in 133/145 treated patients (91.7%). No side effects were observed.

Abdominal aortic coarctation inducing aortic occlusion and renovascular hypertension.

Abdominal aortic coarctation is a rare, non-atherosclerotic disease. It is a functionally significant at an early age when associated with aortic branch stenosis and renovascular hypertension. The pathogenesis of aortic constrictive lesions remains unknown, but may be related to developmental error or aortic growth arrest and various hypotheses have been reported. When the renal arteries are involved by the coarctation, severe hypertension is common at an early age and in untreated patients, life-threatening complications commonly occur. Patients who reach the age of 40 years generally have the coarctation below the renal arteries but even when the renal arteries are not involved by the coarctation, renovascular disease may still occur due to secondary atherosclerosis. Aortic thrombosis secondary to abdominal aortic coarctation with renovascular disease and lower limb ischemia, occurring in a 63-year old woman, is reported.

[Massive hemoperitoneum caused by spontaneous rupture of the gallbladder during anticoagulant treatment]. / Emoperitoneo massivo da rottura spontanea della colecisti in corso di trattamento anticoagulante.

The Authors report main complications of anticoagulant treatment. Particularly, they describe a rare case of hemoperitoneum by spontaneous rupture of the gallbladder. They discuss etiopathogenesis and consequent clinico-therapeutic implications.

Retroperitoneoscopy for biopsy of pelvic and medium-low para-aortic lymph nodes and tissues.

A mediastinoscope is used for pelvic, low and medium retroperitoneoscopy. Twelve procedures have been performed in 11 selected patients. The method is proposed for diagnosis and staging of lymphomas, genitourinary tumors and other miscellaneous pathology of the retroperitoneum.

[Cytological and karyological modifications of HeLa cells induced by periodic changes of extracellular potassium levels]. / Osservazioni su alcune modificazioni citologiche e cariologiche in cellule HeLa indotte da successive variazioni dei livelli extracellulari di potassio.

The effects of periodic changes in the external potassium concentration on chromosome structure and morphology of HeLa cells are reported. The observed cellular modifications seem to be directly related to changes in the ratio of external to internal potassium levels.