Glioblastoma multiforme with oculomotor nerve involvement: case report and literature review

Gliomas involving the cranial nerves III-XIII are rare. Even rarer are glioblastomas multiforme (GBMs) with only 10 cases previously reported. Oculomotor nerve involvement was described in only 2 patients. The mechanisms proposed so far include an origin from the nerve itself or an extension within the nerve of a midbrain tumor. We report the case of a 69-year-old man who presented with an isolated left oculomotor nerve palsy. He was found to have a left temporal GBM extended to the frontal lobe. Diagnostics and intraoperative and pathological findings clearly demonstrated a massive infiltration of the cisternal portion of the left oculomotor nerve. We suppose this could be the first case of direct oculomotor nerve invasion by exophytic spread of a supratentorial GBM or by subarachnoid seeding from a temporal tumor. Less probably, it could be the first case of an oculomotor nerve GBM with a temporal lobe invasion.

P112 REPRODUCIBILITY AND AGREEMENT OF 2D VS M–MODE ECHOCARDIOGRAPHIC LINEAR MEASUREMENTS IN ESTIMATION OF LEFT VENTRICLE MASS IN NORMAL ADULT SUBJECTS

Background:

Left ventricle (LV) mass is one of the echocardiographic parameters, essentials to define the LV remodeling

Degenerative cervical myelopathy: Neuroradiological, neurophysiological and clinical correlations in 27 consecutive cases

•

New insight into prognostic factors for recovery of clinical function following posterior decompression for degenerative cervical myelopathy.

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An increase of IOM amplitude of at least 50% coupled with preoperative T2-only and diffuse T2 signal changes on MRI is a positive prognostic factors for clinical improvement 6 months after surgery.

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Clinical improvement at 6 months follow-up can be expected in patients with T1 hypo intensity if a diffuse border of the lesion on T2 images is present.

PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma

There is a need to identify new and more effective treatments for posttraumatic stress disorder (PTSD). Allopregnanolone and its stereoisomer pregnanolone (together termed ALLO) are metabolites of progesterone that positively and allosterically modulate GABA effects at GABA_A receptors, thereby reducing anxiety and depression. Previous research revealed that women with PTSD had low cerebrospinal fluid (CSF) ALLO levels and a low ratio of ALLO to the allopregnanolone precursor 5α-DHP, consistent with deficient activity of the ALLO synthetic enzyme 3α-hydroxysteroid dehydrogenase (3α-HSD). The current study examined ALLO and the ratio of ALLO to 5α-DHP in plasma at rest and in response to psychophysiological stressors in trauma-exposed, medication-free women with and without PTSD. Participants were examined twice in random order during the early follicular phase (eFP) and mid-luteal phase (mLP) of the menstrual cycle. Plasma neurosteroids were measured using gas chromatography-mass spectrometry. Results indicate that the ALLO to 5α-DHP ratio in plasma increases between the eFP and mLP. In addition, women with PTSD have a lower ratio of ALLO to 5α-DHP than trauma-exposed healthy women, as well as blunted increases in this ratio in response to a moderately stressful laboratory procedure, i.e., differential fear conditioning, across the menstrual cycle. Clinically feasible testing for 3α-HSD dysfunction is critical to translating this line of research into clinical care. Measurement of this ratio in plasma could facilitate patient stratification in clinical treatment trials, as well as precision medicine targeting of treatments that address ALLO synthesis deficits in women with PTSD.

Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force

To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.

Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force

To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.

Problematiche internistiche in corso di gravidanza

<img src="/public/site/images/pgranata/rass.jpg" alt="" /><br /><p class="titolo"><strong>L’internista in ostetricia</strong><br /><em>V. Donvito, A. Maina, L. Balbi, D. Manfellotto</em></p><p class="titolo"><strong>Tromboembolismo venoso in gravidanza</strong><br /><em>A. Fontanella, M. Gino</em> </p><p class="titolo"><strong>Cardiopatie e gravidanza</strong><br /><em>R. Gerloni, D. Panuccio</em> </p><p class="titolo"><strong>Ipertensione arteriosa in gravidanza e preeclampsia</strong><br /><em>F. Saladini, N. Lazzarin, D. Manfellotto</em></p><p class="titolo"><strong>Trombocitopenia in gravidanza</strong><br /><em>R. Mestroni, A. Civardi</em></p><p class="titolo"><strong>Malattie broncopolmonari in gravidanza<br /> Gravidanza ed apparato respiratorio in fisiologia e patologia</strong><br /><em>O. Para, A. Sacchetta</em></p><p class="titolo"><strong>Management del diabete mellito in gravidanza<br /> Parte 1: Gestante con diabete pregravidico</strong><br /><em>I. Ambrosino, T.M. Attardo, G. Augello</em></p><p class="titolo"><strong>Management del diabete mellito in gravidanza<br /> Parte 2: Il diabete mellito gestazionale</strong><br /><em>T.M. Attardo, I. Ambrosino, G. Augello</em></p><p class="titolo"><strong>Tireopatie in gravidanza</strong><br /><em>E. Barbagelata</em></p><p class="titolo"><strong>Malattie del fegato e gravidanza</strong><br /><em>P. Crispino, L. Fontanella, M. Visconti, P. Gnerre</em></p><p class="titolo"><em><strong>Hyperemesis gravidarum</strong></em><br /><em>M.S. Montini, P. Gnerre</em></p><p class="titolo"><strong>Batteriuria asintomatica e infezioni delle vie urinarie sintomatiche in gravidanza</strong><br /><em>P. Gnerre, M. Giusti</em></p><p class="titolo"><strong>Terapia antibiotica in gravidanza</strong><br /><em>P. Gnerre, M. Giusti</em></p><p class="titolo"><strong>Conclusioni:<br /> <em>Learning points</em> per chi richiede (e per chi esegue) la consulenza</strong><br /><em>G. Pinna, R. Re</em></p><p class="titolo"> </p>

Saper desistere per curare fino in fondo: come intraprendere il migliore percorso di assistenza nel Paziente con grave insufficienza d’organo in Medicina Interna?

<img src="/public/site/images/pgranata/rass.jpg" alt="" /><br /><p class="titolo"><strong>La futilità in medicina e le difficoltà a desistere</strong><br /><em>L. Lusiani, L. Magnani</em></p><p class="titolo"><strong>Le prospettive Slow Medicine sulla desistenza terapeutica</strong><br /><em>S. Spinsanti, S. Vernero</em></p><p class="titolo"><strong>La desistenza terapeutica: il punto di vista del magistrato</strong><br /><em>V. Castiglione, V. Pedone</em></p><p class="titolo"><strong>La <em>desistenza terapeutica</em> è giustificabile sul piano etico?</strong><br /><em>E. Furlan</em></p><p class="titolo"><strong>Il punto di vista di un credente</strong><br /><em>G. Pinna</em></p><p class="titolo"><strong>Il buon samaritano, la misericordia del medico e desistenza terapeutica: concetti fra loro compatibili?</strong><br /><em>A. Greco, M. Greco, L. Cascavilla, G. Fasanella</em></p><p class="titolo"><strong>Le grandi insufficienze d’organo <em>end stage</em>: il documento SIAARTI</strong><br /><em>G.R. Gristina, L. Riccioni</em></p><p class="titolo"><strong>I determinanti della mortalità a breve termine dei pazienti non oncologici ricoverati in medicina interna: un’esperienza sul campo</strong><br /><em>M. Tiraboschi, S. Ghidoni, A. Zucchi, A. Carobbio, A. Ghirardi, M. Casati, F. Dentali, A. Squizzato, D. Torzillo, F. De Stefano, V. Gessi, E. Tamborini Permunian, S. Moretti, A. Assolari, A. Brucato</em></p><p class="titolo"><strong>Le parole per dirlo: la comunicazione al paziente, ai familiari e al <em>caregiver</em></strong><br /><em>M. Felici, S. Lenti, L. Occhini, A. Pulerà</em></p><p class="titolo"><strong>Le alternative possibili che il medico internista può proporre alla dimissione, rispetto all’aumento di intensità di cura e l’assistenza ospedaliera ordinaria: <em>la rete di cure palliative</em></strong><br /><em>D. Valenti, F. Moggia</em></p><p class="titolo"><strong>Scompenso cardiaco avanzato: dalla terapia attiva alle cure palliative</strong><br /><em>G. Mathieu</em></p><p class="titolo"><strong>Ictus ischemico ed emorragia cerebrale: problematiche di fine vita</strong><br /><em>C. Trocino</em></p><p class="titolo"><strong>Demenza avanzata</strong><br /><em>M. Coveri</em></p><p class="titolo"><strong>La dispnea al termine della vita</strong><br /><em>M. Giorgi-Pierfranceschi, S. Orlando</em></p><p class="titolo"><strong>Dialisi</strong><br /><em>M. Meschi, S. Pioli, A. Magnano, F. Spagnoli, M. Saccò</em></p><p class="titolo"><strong>Ventilazione meccanica invasiva e non</strong><br /><em>M. La Regina, F. Orlandini</em></p><p class="titolo"><strong>Il diabete mellito</strong><br /><em>L. Morbidoni</em></p><p class="titolo"><strong>Comunicare la scelta di desistere in medicina: una esperienza sul campo</strong><br /><em>C. Bullo, G. Bordin, L. Lusiani</em></p><p class="titolo"><strong>Le prospettive future in Italia e all’interno del nostro SSN</strong><br /><em>A. Fontanella</em></p><img src="/public/site/images/pgranata/appendix.jpg" alt="" /><br /><p class="titolo"><strong>APPENDICE<br />Metodi di riconoscimento e di valutazione del paziente in fase terminale o a rischio di elevata mortalità in ospedale: le malattie più frequentemente riscontrabili in Medicina Interna</strong><br /><em>R. Nardi, G. Belmonte, P. Gnerre, G. Pinna, D. Borioni, M. Campanini, R. Gerloni, A. Fontanella</em></p>

Problematiche di fine vita: il ruolo della medicina interna ospedaliera

<img src="/public/site/images/pgranata/PREFAZIONE.jpg" alt="" /><br /><p class="titolo"><strong>Etica cristiana e malattia</strong><br /><em>E. Bianchi</em></p><img src="/public/site/images/pgranata/rass.jpg" alt="" /><br /><p class="titolo"><strong>Le problematiche di fine vita: quale consapevolezza da parte degli internisti?</strong><br /><em>M. Gambacorta, M. Campanini, R. Nardi</em></p><p class="titolo"><strong>Il concetto di terminalità: certezze e incertezze</strong><br /><em>L. Lusiani, C. Bullo</em></p><p class="titolo"><strong>Traiettorie di malattia: non sempre i pazienti e le famiglie sono informati</strong><br /><em>L. Magnani</em></p><p class="titolo"><strong>La dignità come fattore di cura: pratica clinica nel fine vita nella medicina <em>patient centered</em></strong><br /><em>M. Felici, A. Pulerà, S. Lenti</em></p><p class="titolo"><strong>L’assistenza nel fine vita: quali responsabilità? Un approccio medico-legale al tema</strong><br /><em>A. Aprile, M. Bolcato, D. Rodriguez</em></p><p class="titolo"><strong>Il paziente terminale: aspetti di tipo etico</strong><br /><em>R. Cavaliere</em></p><p class="titolo"><strong>Cure palliative, assistenza domiciliare e <em>caregiver burden</em>: il modello dell’efficienza terapeutica</strong><br /><em>L. Occhini, A. Pulerà, M. Felici</em></p><p class="titolo"><strong>Nutrizione ed idratazione nei malati terminali</strong><br /><em>R. Risicato</em></p><p class="titolo"><strong>La gestione del dolore nel paziente terminale</strong><br /><em>G. Civardi, M. Bosco, R. Bertè</em></p><p class="titolo"><strong>Sedazione di fine vita: aspetti decisionali clinici ed etici</strong><br /><em>M. Carassiti, A. De Benedictis, M. Del Prete, B. Vincenzi, V. Tambone</em></p><p class="titolo"><strong>La rimodulazione della terapia negli anziani in fase terminale</strong><br /><em>A. Cester, F. Busonera</em></p><p class="titolo"><strong>Ruolo dell’infermiere nel <em>comfort care</em> del paziente a fine vita in Medicina Interna</strong><br /><em>D. Simonazzi, M. Lince, S. Tanzi, G. Bordin</em></p><p class="titolo"><strong>Percorso di fine vita e diagnosi di terminalità: l’esperienza dell’Ausl di Modena e Reggio Emilia</strong><br /><em>G. Chesi, E. Scalabrini, P. Vacondio, G. Pinelli, G. Carrieri, G. Cioni</em></p><img src="/public/site/images/pgranata/Sezioni.jpg" alt="" /><br /><p class="titolo"><strong>APPENDICE I<br />Metodi di riconoscimento e di valutazione del paziente in fase terminale o a rischio di elevata mortalità in ospedale</strong><br /><em>R. Nardi, G. Belmonte, L. Lusiani, M. Gambacorta, G. Pinna, M. Campanini, A. Fontanella</em></p><p class="titolo"><strong>APPENDICE II<br />RECENSIONE - Riflessioni sul dolore </strong>di Umberto Eco<br /><em>R. Nardi</em></p>

L'ipotensione

Ipotensione: concetti generali e classificazioneA. LagiIpotensione acutaG. Costantino, M. BonziIpotensione cronica non neurogenaA. LagiIpotensione neurogena nella multiple system atrophy e nella pure autonomic failureR. Furlan, F. Dipaola, R. Lembo, F. BarbicIpotensione cronica neurogena: malattia di Parkinson e demenza a corpi di LevyF. BarbicIpertensione clinostaticaA. Lagi, S. CencettiNeuropatie autonomicheA. LagiIpotensione e sincopeS. Cencetti

The transition from intra to extra-uterine life in late preterm infant: a single-center study

BACKGROUND

Infants born at 34 to 36 weeks of gestation (late preterm) are at greater risk for adverse outcomes than those born at 37 weeks of gestation or later. Aim of this paper is to examine risk factors for late preterm births and to investigate the complications of the transition period in late preterm infants (LPIs).

METHODS

All consecutive late preterm deliveries, excluded stillbirths, were included. Maternal and neonatal data, need for delivery room resuscitative procedures, temperature at birth (T1) and two hours after the admission (T2) were analyzed in all LPIs stratified by Gestational Age (GA) and divided into three groups (34, 35 and 36 weeks).

RESULTS

Two hundred seventy-six LPIs were analyzed. Pregnancy complications were present in 72 mothers (26.1 %), more frequently at 34 weeks of gestation respect to 35 and 36 weeks (p = 0.008, p = 0.006 respectively). Forty seven LPIs (17.1 %) needed for any resuscitation and 37 (13.4 %) were ventilated at birth. LPIs at 34 weeks were significantly more likely to receive ventilation respect to those at 35 and 36. At T1 the mean temperature resulted lower at 34 weeks respect to 36 weeks (p = 0.03). At T2 respect to T1, the rate of normothermic neonates increased at 35 and 36 weeks (p = 0.003, p = 0.005, respectively). Hypoglicemia rate was similar among the groups; 66.7 % of hypoglicemic neonates were hypothermic at T1. The rate of respiratory diseases and NICU admission decreased with increasing GA. Higher number of neonates ventilated at birth developed respiratory disorders respect to those unventilated (40.5 % vs 8.4 %; p < 0.001).

CONCLUSIONS

Transition period in LPIs may become critical, as resuscitation strategies can be required and heat loss can occur. LPIs, especially at 34 gestational weeks, are higher-risk group needing adequate and targeted management at birth.

Ependymoma with diffuse signet-ring features: report of a case and review of the literature

Signet-ring cell ependymoma is a rare variant of ependymoma with only seven cases described in literature. Biological behavior and prognosis of this entity are not well-known until now. We present a case of a 49-year-old female with a history of headache and gait instability. Magnetic resonance imaging showed an upper cervical tumor with cystic component and mural nodule. The patient underwent surgery. Microscopically some cells displayed an eccentric nucleus compressed to the periphery by vacuolated cytoplasm. Perivascular pseudorosettes and ependymal rosettes were seen only focally. The cells were positive for glial fibrillary acidic protein and epithelial membrane antigen. The diagnosis was ependymoma with diffuse signet-ring features, grade II according to the World Health Organization. It may be difficult to diagnose this unusual variant of ependymoma especially on small biopsies or frozen sections. A complete examination of the specimen is recommended with immunohistochemical confirmation to rule out potential morphologic mimics, such as metastatic adenocarcinomas and gliomas in the differential diagnosis.

Intraoperative neurophysiological monitoring for the resection of brain tumors in pediatric patients

Intraoperative neurophysiology (ION) is the gold standard to map and monitor brain functions during supratentorial surgery in critical areas. This is of great value for the surgery of brain gliomas in adults, but the same ION techniques can be used in the pediatric population with respect to both epilepsy and brain tumor surgery. While the principles of most ION techniques are the same for adults and children, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation of afferent and efferent pathways within the brain and the spinal cord. Accordingly, some adjustments, particularly with regards to stimulation parameters, are needed in younger children. This paper will review current ION techniques to assist during the resection of brain tumors in children, focusing on the aspects peculiar to mapping and monitoring of sensori-motor functions in the pediatric population. On the other hand, awake surgery, of common use in adult patients when aiming to identify cortical and subcortical cognitive functions, is of very limited use in children and will not be discussed here.

Position paper FADOI sulla prevenzione cardiovascolare nei pazienti complessi a rischio

<img src="/public/site/images/pgranata/intro.jpg" alt="" /><br /><p class="titolo"><strong><em>Position paper </em>FADOI (Federazione delle Associazioni dei Dirigenti </strong><strong>Ospedalieri Internisti) sulla prevenzione cardiovascolare </strong><strong>nei pazienti complessi a rischi</strong><strong>o</strong>     309<br /><em>M. Campanini, G. Pinna, R. Nardi</em></p><img src="/public/site/images/pgranata/rass.jpg" alt="" /><br /><p class="titolo"><strong>La patogenesi dell’aterosclerosi</strong>     319<br /><em>C. Nardin, M. Rattazzi, P. Pauletto</em></p><p class="titolo"><strong>La prevenzione secondaria nella cardiopatia ischemic</strong><strong>a</strong>     328<br /><em>D. Panuccio, P. Verdecchia</em></p><p class="titolo"><strong>La prevenzione cardiovascolare nello scompenso cardiaco</strong>     339<br /><em>R. Cavaliere, F. Gallucci, G. Mathieu</em></p><p class="titolo"><strong>Prevenzione secondaria degli eventi cerebrovascolari </strong><strong>aterotrombotici</strong>     356<br /><em>M. Paciaroni, R. Frediani, M. Stornello, G. Agnelli</em></p><p class="titolo"><strong>Prevenzione cardiovascolare secondaria e nefropatia</strong>     364<br /><em>D. Manfellotto, G. Vescovo</em></p><p class="titolo"><strong>Arteriopatia obliterante periferica cronica degli arti inferiori</strong>     371<br /><em>F. Dentali, A. Mazzone</em></p><p class="titolo"><strong>La prevenzione cardiovascolare secondaria nel paziente </strong><strong>con diabete mellito</strong>     379<br /><em>G. Augello, L. Magnani</em></p>

Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

BACKGROUND

As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years.

METHODS

Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients.

RESULTS

Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446).

CONCLUSIONS

The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.

Difficulties in the diagnosis of thyroid paraganglioma: a clinical case

Thyroid Paragangliomas are exceptionally rare tumors and only 35 documented cases have been reported in the literature. We report an additional unusual male case of thyroid Paraganglioma associated to a chronic lymphocytic thyroiditis and a papillary microcarcinoma. A 45-year-old man presented with a solitary thyroid nodule. Physical examination revealed a smooth, well-circumscribed, firm, mobile, painless thyroid nodule in the right lobe measuring 3 cm. Ultrasound examination showed a 40 mm hypoechoic, non-homogeneous nodule with peri- and intra-nodular vascular flow. An ultrasound-guided fine needle aspiration biopsy was performed showing the presence of atypical cells (Thy 3). He underwent a total thyroidectomy associated to VI level lymphectomy. Histology showed a thyroid Paraganglioma associated to a chronic lymphocytic thyroiditis and a papillary microcarcinoma measuring 0.3 cm in the greatest dimension. Thyroid Paraganglioma is an elusive tumor. It is difficult to diagnose and should be included in the differential diagnosis of all neuroendocrine tumors of the thyroid, even those arising in men or behaving in a locally aggressive fashion.

The Structure of a Zn(II) Metaphosphate Glass. I. The Cation Coordination by a Combination of X-Ray and Neutron Diffraction, EXAFS and X-Ray Anomalous Scattering

In order to clarify the reason of some discrepancies existing in literature, the zinc coordination in a Zn metaphosphate glass has been investigated by the complementary use of X-Ray Diffraction, Neutron Diffraction, Extended X-ray Absorption Fine Structure Spectroscopy and X-Ray Anoma-lous Scattering. All the techniques indicate a tetrahedral coordination of O atoms around Zn :+ ions, the Zn-O distance being 1.94 ± 0.01 Å. The simultaneous modelling of all the experimental data by Reverse Monte Carlo technique demonstrated that this coordination is consistent with an extended model in which metal ions are interposed between phosphate chains. The importance of describing the preparation conditions of the glasses is stressed when structural results have to be compared.

X-ray Diffraction Study of Aqueous Solutions of ZnSO4

Five aqueous solutions of ZnSO4 of concentrations ranging from 0.6M to 3.1 M were examined by X-ray diffraction. In the correlation functions no concentration effect on structural phenomena is detectable. The same model was then successfuly used for all cases, attributing two hydration shells to Zn2+ and one hydration shell to SO42+ . The reliability of the structural parameters obtained is discussed.

On the Structure in Aqueous Superconcentrated Calcium Nitrate

Liquid hydrous calcium nitrate of composition Ca(NO3)2 · 3.5 H2O was investigated by X-ray diffraction. Experimental data were interpreted in terms of geometrical models suggested by the structure of the crystalline hydrates Ca (NO3)2 · 3H2O and Ca(NO3)2 · 4H2O, in which calcium ions are coordinated to nine oxygen atoms, partly coming from water molecules, partly from NO3 -ions.

X-Ray Diffraction and Structural Properties of Aqueous Solutions of Divalent Metal-Chlorides

X-ray diffraction data are reported for aqueous solutions of CaCl2 (6.30 M), CdCl2 (0.87 and 1.26 M) and NiCl2 (1.96 and 3.88 M). The highly concentrated CaCl2 solution shows a medium range order resembling that of the corresponding hydrate crystal. The CdCl2 solutions are characterized by the presence of complexes with chloride ions in the first coordination sphere of the cation. In NiCl2 solutions, a first sphere Ni-Cl coordination can be excluded and the existence of six Ni-H2O nearest neighbour contacts is clearly confirmed. In these solutions no evidence was found for the existence of highly ordered structures; hexa-aquo cations interact with external water molecules and, at the highest concentration, some outer sphere Ni-Cl correlation is possible as due to packing.

Post-transcriptional regulation of cyclins D1, D3 and G1 and proliferation of human cancer cells depend on IMP-3 nuclear localization

RNA-binding proteins of the IMP family (insulin-like growth factor 2 (IGF2) mRNA-binding proteins 1-3) are important post-transcriptional regulators of gene expression. Multiple studies have linked high expression of IMP proteins, and especially of IMP-3, to an unfavorable prognosis in numerous types of cancer. The specific importance of IMP-3 for cancer transformation remains poorly understood. We here show that all three IMPs can directly bind the mRNAs of cyclins D1, D3 and G1 (CCND1, D3 and G1) in vivo and in vitro, and yet only IMP-3 regulates the expression of these cyclins in a significant manner in six human cancer cell lines of different origins. In the absence of IMP-3, the levels of CCND1, D3 and G1 proteins fall dramatically, and the cells accumulate in the G1 phase of the cell cycle, leading to almost complete proliferation arrest. Our results show that, compared with IMP-1 and IMP-2, IMP-3 is enriched in the nucleus, where it binds the transcripts of CCND1, D3 and G1. The nuclear localization of IMP-3 depends on its protein partner HNRNPM and is indispensable for the post-transcriptional regulation of expression of the cyclins. Cytoplasmic retention of IMP-3 and HNRNPM in human cancer cells leads to significant drop in proliferation. In conclusion, a nuclear IMP-3-HNRNPM complex is important for the efficient synthesis of CCND1, D3 and G1 and for the proliferation of human cancer cells.

Abstract P5-03-01: Cancer stem cells predict engraftment and poor prognosis of primary breast tumors

Breast cancer is a major health problem and heterogeneity of the disease has been considered as a strong limitation to find the best therapies to cure cancer, overcome recurrences and metastases. The establishment of models that reflect tumor biology and metastatic progression is critical to develop successful new therapeutic strategies. In the breast, orthotopic xenografts currently appear as the best models to study tumor growth, metastasis and develop tools for prognosis prediction. Furthermore, mouse transplant assays have been used to assess cancer stem cell (CSC) activity and demonstrate that leukemia and many solid tumors are organized along a hierarchical model.

Despite the promise of the CSC model sustained by mouse transplantation assays, the clinical relevance of xenografts studies to identify determinants of stemness able to influence clinical outcome remains challenging. In breast cancer, transcriptional programs from functionally validated CSC populations remain to be deciphered.

Here, we report the establishment of a bank of primary breast tumor-derived xenografts (xenobank). We showed that the xenografts retain the main features of primary tumors, that engraftment is correlated with the presence of CSC in tumors, and that engraftment in the mouse is able to predict prognosis in patients. This suggests that CSCs may govern breast cancer prognosis. We established the gene expression profiles of functionally validated ALDEFLUOR-positive CSC populations (breast CSC-GES) and demonstrated their clinical relevance. Among 2609 patients with breast cancers, we validated that he expression of the breast CSC-GES is correlated with poor outcome and metastasis in uni-and multivariate analysis (5-year MFS was 70% CI95 [67–74] in the breast CSC-positive class and 80% (CI95 [77–83]) in the breast CSC-negative class (p = 5.5E−04 with log-rank test). Furthermore, we identified a core of 19 genes commonly expressed in breast CSC, murine embryonic, neural and hematopoietic stem cells programs and demonstrated for each gene its ability to modulate breast CSC population, being implicated in self-renewing or differentiation programs. We found that the core of genes in common between four stem cell gene expression studies (CE-BCSC-3SC) displayed an adverse prognostic impact for patients with breast cancer. The core contained genes implicated in oxidative phosphorylation, detoxification, lipid metabolism, and genomic stability, and these shared determinants of stemness influenced clinical outcome.

Thus, we show ed that CSCs from orthotopically engrafted primary breast tumors have clinical and biological relevance. This functionally validated CSC population is highly correlated with survival and express genes governing main stem cell functions, substantiating a major prediction of the CSC model and opening further promises for new CSC therapies using valid preclinical models.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-03-01.

Synthesis of biologically active bridged diazabicycloheptanes

The chemistry underlying how diazabicycloheptanes are assembled is described, subdivided according to chemical structure of two types, the 3,6 diazabicyclo[3.1.1]heptane and the 2,5-diazabicyclo[2.2.1]heptane ring system. Detailed information on myriad of activities of compounds derived from the two scaffolds are reported.

Phase Contrast MR as Non-Invasive Tool in the Diagnosis of Benign Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is characterized by an increased intracranial pressure in the absence of expansive lesions or cerebrospinal fluid (CSF) circulation obstructions. Its physiopathology is still not fully understood. The diagnosis is currently established on clinical grounds (Dandy criteria) along with an invasive measurement of CSF dynamic parameters through the infusion test. This study compares the invasive pressure measurements with the biomechanical CSF parameters derived from a phase-contrast MR protocol to evaluate the accuracy and reliability of the phase-contrast MR protocol.

Self-reported psychological distress associated with steroid therapy for HIV

Anabolic androgenic steroid (AAS) replacement therapy is standard care for patients with low testosterone, including HIV-related conditions. These medications have been associated with development of aggressiveness, anxiety disorders, and depression, but only in short-term clinical trials. We conducted an anonymous street survey at a gay and lesbian community event and a survey in a clinic-based setting to study the wider prevalence of psychiatric side-effects associated with androgenic steroids. In the street-based survey, almost half of those prescribed AAS reported psychological side-effects, most commonly aggression (29%) followed by depression (21%). In the clinic survey of mostly HIV+ male patients, changes in sex drive were the most commonly reported effect of treatment while impulsive aggression, anxiety and depression were reported at levels similar to those in the street fair survey. These findings suggest that AAS therapy may be more frequently associated with distress than has been reported in the clinical literature.

MGMT methylation status as a prognostic factor in anaplastic astrocytomas

2052

Background: MGMT methylation status has been found to be an important prognostic factor in glioblastoma patients (pts). However, further data on the epigenetic feature are needed before its role in rare diseases such as anaplastic astrocytomas (AA) can be established. Methods: A retrospective analysis was made on a database of 139 AA pts followed prospectively from January 1995 and August 2008. We evaluated only pts who met the following inclusion criteria: age >18 years; PS 0–2; histological diagnosis of AA; postoperative radiotherapy (RT) and chemotherapy (CT). MGMT status was determined with methylation specific PCR. The study aim was to evaluate the role of MGMT methylation status in AA. The log-rank test was employed to evaluate the significance of the prognostic variables. Results: 80 pts (m/f: 46/34, median age: 41 years, range: 18–71 years) were enrolled. MGMT was assessable in 71 of 80 pts (88.8%), being methylated in 30 (42.9%), and unmethylated in 41 (57.7%) pts. Median PFS was 48.6 months (95% CI: 33.7 - 63.5), being 96 months (95% CI: 29–163) and 38 months (95%CI: 18.9–57.2) in MGMT methylated and unmethylated pts, respectively (p = 0.09). At univariate analysis, complete resection (p = 0.02), age (p = 0.002), and KPS (p = 0.003) were significantly correlated with PFS. At multivariate analysis only age remains correlated with PFS (p = 0.01). Median survival (OS) was 93.7 months (95% CI: 63.5–123.8), being not reached and 77 months (95% CI: 20–134.2), in MGMT methylated and unmethylated pts, respectively (p = 0.03). MGMT methylation (p = 0.03), age (p = 0.0003), and KPS (p = 0.03) were significantly correlated with OS at univariate analysis. At multivariate analysis, age (p = 0.0002) and MGMT methylation (p = 0.01) were correlated with a better OS. Conclusions: MGMT methylation status is an independent prognostic factor together with age in AA. This datum should provide the background to improve the therapeutic index with temozolomide concurrent with and adjuvant to RT in AA.

No significant financial relationships to disclose.

Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

BACKGROUND

Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice.

PURPOSE

To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT.

MATERIAL AND METHODS

The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone.

RESULTS

Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive.

CONCLUSION

CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

Haemorrhagic stroke and vasculitic-like cerebral angiography in a patient with eosinophilic fasciitis. Case report

Cerebral vasculitis is an uncommon cause of haemorrhagic stroke. A case of intracerebral haemorrhage in a patient with eosinophilic fasciitis, a rare scleroderma-like connective tissue disease, with a possible inflammatory involvement of cerebral vessels is reported. Pathogenetic mechanism of such association and diagnostic controversies are reviewed.

Distribution and abundance of Bluetongue vectors in Sardinia: comparison of field data with prediction maps

Following the spread of Bluetongue virus (BTV) in many Mediterranean countries during the last 5 years, presence of the main BTV vector, Culicoides imicola Kieffer (Diptera: Ceratopogonidae), was recorded in the region, including the island of Sardinia where the first BT epidemic originally started in the year 2000. Several models were also designed based on climate variables and satellite imaging in order to predict the presence and abundance of BTV vectors across Europe. A 3 years entomological survey (2001-2003) was conducted in the southern part of Sardinia confirming the widespread presence of C. imicola. However, substantial differences in terms of relative abundance were observed between field data and prediction maps based on satellite-derived climate variables. Distribution of other potential BT vectors, belonging to Culicoides obsoletus Meigen and Culicoides pulicaris Linnaeus groups was also not congruent with model-based predictions. These results stress the need of taking into account additional environmental factors (such as soil type, land usage, etc.) and local microclimatic conditions, especially related to breeding site requirements of Culicoides species, in order to predict the presence and abundance of BT vectors and to design reliable prediction maps on a local scale.

[Elastofibroma dorsi: case report and review of the literature]

Elastofibroma dorsi (ED) is a rare, benign, often bilateral lesion of the thoracic wall, occurring most commonly in the infra-scapular region beneath the muscular tissue, generally found in elderly women. Whether ED should be considered as a true neoplasm or merely as a reaction of connective tissue to repetitive minor trauma is still debated. ED has characteristic features but a low incidence and is therefore not always easily distinguished from other benign and malignant soft-tissue tumors. Inappropriate treatment may thus be administrated in the absence of a definitive diagnosis. We report a case of a 51-year-old woman who presented with a right infra-scapular swelling associated with pain and a clicking sensation during selective arm movements. Upon clinical and ultrasound examination, the lesion had the appearance of a deep dorsal lipoma, but intraoperative findings were suggestive of a sarcoma originating from the periosteum of ribs. Nonetheless, marginal surgical excision was performed and the tumor was histologically diagnosed as ED. In conclusion, ED should be always considered in the differential diagnosis of tumors deeply located in the infra-scapular area, especially in elderly women. As it is a benign lesion, surgical treatment is recommended only in symptomatic cases or if a large swelling is present.

Milk and Cheese Fatty Acid Composition in Sheep Fed Mediterranean Forages with Reference to Conjugated Linoleic Acid cis-9,trans-11

Two experiments were undertaken to evaluate the effect on milk and cheese fatty acid composition of feeding different fresh forages to dairy sheep both in winter (experiment 1, growing stage of the forages, early lactating ewes) and in spring (experiment 2, reproduction stage of the forages, midlactating ewes). Four forage species were compared: annual ryegrass (RY, Lolium rigidum Gaudin), sulla (SU, Hedysarum coronarium L.), burr medic (BM, Medicago polymorpha L.), and a daisy forb (CH, Chrysanthemum coronarium L.). The forages were cut twice daily and offered ad libitum to 4 replicate groups of Sarda dairy sheep (groups RY, SU, BM, and CH). The CH forage was particularly rich in linoleic acid in both periods, whereas BM and SU forages were rich in linolenic acid in winter and spring, respectively. Milk fatty acid composition was affected by the forage in both experiments. Milk conjugated linoleic acid and vaccenic acid contents were higher in CH and BM groups (winter) and CH group (spring) than in the other groups. No differences were observed when comparing fatty acid profile between milk, 1-d-old cheeses, and 60-d-old cheeses within experimental groups, suggesting that the fatty acid recovery rates during cheese making and ripening were not affected by the feeding regimens. After stepwise discriminant analyses of the pooled data, the milks and cheeses sourced in the different feeding regimens differed among them. Based on these results, we conclude that it is possible to manipulate the fatty acid profile of sheep dairy produce to maximize the content of beneficial fatty acids by the use of appropriate fresh forage-based regimens.