Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center

PURPOSE

To identify the prevalence of chronic endometritis (CE), compare the efficacy of antibiotic regimens for CE, and examine pregnancy outcomes after treatment for CE among patients in an academic fertility clinic.

METHODS

In this retrospective cohort study, data from patients who underwent endometrial sampling (ES) for CE evaluation at a single academic institution from 2014 to 2020 were collected and analyzed. Rates of CE were compared by indication for ES including recurrent pregnancy loss (RPL), implantation failure (IF), and recent first-trimester pregnancy loss. Treatment and pregnancy outcomes were also evaluated.

RESULTS

Six hundred fifty-three individuals underwent ES to evaluate for CE. The overall prevalence of CE was 28.5%; when stratified by indication, the prevalence of CE was 66.2% for recent first-trimester loss, 27.9% for RPL, and 13.1% for IF (p < .001). Of those with CE, 91.9% received antibiotics, most commonly doxycycline (76.0%). CE clearance was not significantly different when doxycycline was compared to all other regimens (71.3% vs. 58.8%, p = .17), and 68.5% of patients cleared CE after one course of antibiotics. Following two antibiotic courses, CE was cleared in 88.3% of patients. Live birth rates (LBRs) were higher for those with cleared CE compared to patients with untreated CE (34.1% vs. 5.6%, p = .014) and similar for those with cleared CE versus those without CE (34.1% vs. 29.3%, p = .297).

CONCLUSION

CE is common among patients with infertility, particularly those with a recent first-trimester loss. Treatment and clearance of CE were associated with higher LBRs; however, persistent CE was common despite treatment with antibiotics.

Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures

PURPOSE

This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures.

METHODS

The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear.

RESULTS

The surgeon most exposed eye lens median H_p(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy.

CONCLUSIONS

In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.

Correlates of mental health in the Swiss Household Panel – a network analysis

Background

Firstly, we aim to describe any differences in the mean levels of correlates and indicators of mental health and wellbeing between young (25-39 years) and middle-aged adults (40-55 years). Secondly, we aim to compare the network models depicting interrelations between correlates and indicators of mental health and wellbeing among these age groups.

Methods

This paper draws on longitudinal data from 6 waves (2013-2018) of the Swiss Household Panel (SHP) study, with a total sample of 5,315 individuals, including 2,044 young (25-39 years) and 3,271 middle-aged (40-55 years) participants. We used network analysis to examine and present complex relationships between the correlates and the indicators of mental health and wellbeing.

Results

Middle-aged individuals had worse mental health and wellbeing on all indicators but energy and optimism, which did not differ across groups. The effect sizes (according to Cohen’s d) were small, reaching the maximum of 0.20 for sadness. Despite higher household income and financial satisfaction, perceived job insecurity and work strain were higher in midlife, with socioeconomic prestige being lower. Moreover, middle-aged individuals had lower social support, relationships satisfaction, and health satisfaction. The network was denser in midlife, with two direct interrelations being stronger in this age group: health satisfaction and energy/optimism as well as accommodation satisfaction and life satisfaction. There were also several other differences in indirect interrelations between correlates and indicators of mental health and wellbeing, including a potentially more important role of self-mastery in midlife in bridging socioeconomic indicators, wellbeing and mental health.

Conclusions

We suggest further exploring the workplace as an avenue to improving population mental health and wellbeing, with a particular focus on the role of self-mastery.

Key messages

• Middle-aged individuals appear to have worse mental health and lower wellbeing than young adults.

• Health satisfaction is not only lower in midlife, but it seems of greater importance for mental health and wellbeing.

Retained pregnancy tissue after miscarriage is associated with high rate of chronic endometritis

The objective of this study was to evaluate prevalence of chronic endometritis in a cohort of patients with retained pregnancy tissue (RPT) following miscarriage, with and without a history of recurrent pregnancy loss (RPL). In a cohort of our single academic fertility centre, we evaluated women with unexplained RPL (two or more losses) without evidence of RPT and women undergoing hysteroscopic resection of RPT following miscarriage. Endometrial samples underwent staining with H and E and CD138. A pathologist blinded to patient history recorded the number of plasma cells per 10 high power fields (HPF) and the presence or absence of endometrial stromal changes. Our main outcome measure was to measure the prevalence of chronic endometritis. Endometrial samples from 50 women with RPT following miscarriage and 50 women with unexplained RPL without evidence of RPT were reviewed. The prevalence of chronic endometritis was significantly higher in the RPT cohort (62% versus 30%). A multivariable regression demonstrated significantly higher odds of chronic endometritis in the RPT cohort, aOR 7.3 (95% CI 2.1, 25.5). We conclude that women with RPT following pregnancy loss have a high rate of chronic endometritis, suggesting that RPT is a risk factor for this disorder. Impact StatementWhat is already known on this subject? Known risk factors for chronic endometritis include a history of pelvic inflammatory disease, intrauterine polyps and fibroids. The aetiology for increased chronic endometritis among women with RPL is unknown.What do the results of this study add? The prevalence of chronic endometritis is significantly higher among women with retained pregnancy tissue (RPT) following miscarriage compared to women with RPL. These data presented suggest that RPT is associated with chronic endometritis among women with a history of miscarriage.What are the implications of these findings for clinical practice and/or further research? We suggest a pathologic evaluation for chronic endometritis be performed on all patients who undergo hysteroscopic resection of RPT following miscarriage. Our findings also suggest that a uterine cavity evaluation with hysteroscopy to evaluate for RPT may be reasonable in women with a history of miscarriage who are found to have chronic endometritis on endometrial biopsy. Further research is needed to determine if resection of retained tissue is sufficient to treat RPOC associated chronic endometritis, or if additional antibiotic treatment is necessary.

AB0715 Anti-MDA5 Dermatomyositis after BNT162b2 vaccination

Background

Background: Anti-Melanoma Differentiation-Associated gene 5 (MDA-5) Dermatomyositis (MDA5, DM) is a rare systemic autoimmune disease, characteristically associated with Rapidly Progressive Interstitial Lung Disease (RP-ILD) and cutaneous manifestations. Anti-MDA5 dermatomyositis may develop in genetically predisposed subjects after environmental exposure such as vaccines, infections and neoplasms (1). Myalgia is one of the main symptoms related to SARS-COV2 infection and sometimes may occurs after COVID-19 vaccine administration (2). However, only few cases have reported the occurrence of severe inflammatory myopathies after COVID19 vaccine administration (3)

Objectives

To describe a case of Anti-MDA5 Dermatomyositis occurred after BNT162b2 vaccine administration

Methods

This is a case of a 44 year-old-patient affected by Anti-MDA5 Dermatomyositis occurred after BNT162b2 vaccination referred at the Center for Rheumatic Diseases in Venice, Italy

Results

A 44 year-old-woman presented to the Center for Rheumatic Diseases in Venice, suffering from a cutaneus rash on her face, upper limbs, décolleté, gluteus and lower limbs occurred two days after the first dose BNT162b2 vaccination (Figure 1). A few days after the second dose of the vaccine the rash got worse and myalgias, strength deficiency and fatigue occurred. Elevated inflammatory and myocytolysis parameters were detected (Table 1). After chest HRCT a mild ILD was diagnosed. Muscle edema was detected with whole-body short tau inversion recovery (STIR)-MRI (Figure 1).The Skyn biopsy showed features of dermatomyositis with perivascular inflammatory infiltrates. 1 mg/Kg/die of prednisone was administered and then cyclosporine 3mg/kg/die was associated with clinical benefit.

Table 1.

Clinical and laboratory characteristics of the patient

Age (years)44SexFemalePrevious Rheumatological diagnosis-Previous Vaccination reaction-Time to onset COVID 19 vaccination2 daysMMT-8*124/150 (150/150)Blood TestsHb* (12-16 g/dl)11,5 g/dlCRP* (< 5 mg/L)23,4 mg/LAST* (31 U/L)98 U/LALT* (1-34 U/L)63 U/LCPK * (10-145 U/L)1085 U/LAldolase (0-7,6)13,2 U/LSARS-CoV-2 RT PCRnegativeAutoantibodiesANA*1:1280 nucleolarMyositis antibodiesAnti-MDA5HLA- DRB103-04HLA-DQB02-03

MMT-8 MANUAL MUSCLE TESTING; Hb Hemoglobin; WBC withe blood cells count; CRP C-reactive proteine; AST Aspartate amino transferase; ALT Alanine amino transferase; CPK creatinine phosphokinase; ANA anti nuclear antibodies, ENA extractable nuclear antigens; HLA Human

Leukocyte Antigen

Conclusion

In rare cases COVID-19 vaccination could induce inflammatory myopathies (3). COVID-19 vaccine administration may have acted as a trigger for the myopathy driven by an autoimmune-mechanism. In such cases, it could be useful to investigate inflammatory myopathies, requiring blood tests (e.g. myocytolysis indices and anti myositis antibodies) and medical instrumental insights, in patients affected by skin manifestation and muscle pain occurred after vaccine administration. Although the association between vaccination and inflammatory myopathies is presumptive, the temporal proximity of the BNT162b2 vaccine to the onset of the signs and symptoms related to the inflammatory miopathies may suggest a possible relationship between these two events. To the best of our knowledge this is the first case of Anti-MDA5 Dermatomyositis occurred after BNT162b2 vaccination.

References

[1]Mehta P, Machado P.m, Gupta L. Understanding and managing anti-MDA 5 dermatomyositis, including potential COVID-19 mimicry. Rheumatol Int 2021 Jun;41(6):1021-1036

[2]Beatty A.L, Peyser N.D, Butcher X.E, Cocohoba J.M, Lin F, Olgin J.E, Pletcher M.J, Marcus G.M. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study Lancet Infect Dis 2021; 21: 939–49

[3]Maramattom B.V, Philips G, Thoas J, Santhamma Nair S.G. Inflammatory myositis after ChAdOx1 vaccination. The Lancet Rheumatology Volume 3, ISSU 11, e747-e749, November 01.2021

Disclosure of Interests

None declared

Bowel recovery after intra vs extracorporeal anastomosis for oncologic laparoscopic right hemicolectomy within an ERAS protocol: A retrospective study

Objective

Restoring bowel continuity after laparoscopic right hemicolectomy with an intra-corporeal (IC) rather than an extracorporeal (EC) ileocolic anastomosis, may offer advantages in post-operative recovery. The aim of this study was to compare bowel function recovery between these two techniques, in a context of complete mesocolic excision within an enhanced recovery after surgery (ERAS) protocol.

Methods

All consecutive patients who underwent oncologic laparoscopic right hemicolectomy from January 2012 until February 2021 in our institution were included in the study. Data were gathered from the prospectively maintained official ERAS (EIAS) database and completed through our institution's electronic health records. The primary endpoint was Prolonged Postoperative Ileus (PPOI), defined as the need to insert a nasogastric tube, or refractory nausea VAS &gt; 4, on or after the third postoperative day. Secondary endpoints were postoperative morbidity and length of hospital stay (LoS).

Results

122 patients met the inclusion criteria, 36 (30%) had IC, and 86 (70%) EC anastomosis. Baseline characteristics were similar. Operative time was longer in the IC group (197 min (176–223) vs. 160 min (140–189, p&lt;0.001). There was no difference in post-operative morbidity between groups. PPOI occurred in 2 (5.6%) patients in the IC group vs. 10 (11.6%) in the EC group (p=0.306). Patients in the IC group had an earlier first passage of gas (1.5 days (1–2) vs. 2 days (1–3), p=0.035) and stool (2 days (2–4) vs. 3 days (2–4), p=0.029). Upon multivariate analysis, pain VAS scores at 24 h, age and complications Clavien-Dindo &gt;III, but not the anastomotic technique were independent predictors of slower bowel function recovery. IC anastomosis was an independent predictor of lower pain VAS scores at 24 h (OR 0.341, 95%CI [0.151–0.767], p=0.009) and shorter LoS (OR 0.346, 95%CI [0.132–0.910], p=0.031).

Conclusion

Although IC anastomosis was not significantly associated to lower rates of PPOI, it conferred advantages in terms of less post-operative pain, a trend for faster bowel recovery and shorter LoS at the expense of longer operating times.

Joint Family and Work Trajectories and Multidimensional Wellbeing

Informed by the life course perspective, this paper investigates whether and how employment and family trajectories are jointly associated with subjective, relational and financial wellbeing later in life. We draw on data from the Swiss Household Panel which combines biographical retrospective information on work, partnership and childbearing trajectories with 19 annual waves containing a number of wellbeing indicators as well as detailed socio-demographic and social origin information. We use sequence analysis to identify the main family and work trajectories for men and women aged 20–50 years old. We use OLS regression models to assess the association between those trajectories and their interdependency with wellbeing. Results reveal a joint association between work and family trajectories and wellbeing at older age, even net of social origin and pre-trajectory resources. For women, but not for men, the association is also not fully explained by proximate (current family and work status) determinants of wellbeing. Women’s stable full-time employment combined with traditional family trajectories yields a subjective wellbeing premium, whereas childlessness and absence of a stable partnership over the life course is associated with lower levels of financial and subjective wellbeing after 50 especially in combination with a trajectory of weak labour market involvement. Relational wellbeing is not associated with employment trajectories, and only weakly linked to family trajectories among men.

Redefining chronic endometritis: the importance of endometrial stromal changes

OBJECTIVE

To develop diagnostic criteria for chronic endometritis and compare the prevalence of chronic endometritis between women with recurrent pregnancy loss (RPL) and controls.

DESIGN

Cohort study.

SETTING

Single academic fertility center.

PATIENTS

Women with unexplained RPL (two or more pregnancy losses) and prospectively recruited controls without a history of RPL or infertility.

INTERVENTIONS

Endometrial samples were stained with hematoxylin and eosin and CD138. A pathologist blinded to patient history recorded the number of plasma cells per 10 high-power fields (HPFs). In addition, the presence or absence of endometrial stromal changes was documented.

MAIN OUTCOME MEASURE

Prevalence of chronic endometritis.

RESULTS

Endometrial samples from 50 women with unexplained RPL and 26 controls were evaluated. When chronic endometritis was defined as the presence of one or more plasma cells per 10 HPFs, 31% of controls and 56% of women with RPL met the criterion. When both endometrial stromal changes and plasma cells were required for a diagnosis of chronic endometritis, no controls and 30% of women with RPL met the criteria.

CONCLUSIONS

Although rare plasma cells were found in biopsy samples from controls, the presence of both plasma cells and endometrial stromal changes was limited to the RPL cohort. We propose that chronic endometritis be defined as the presence of one or more plasma cells per 10 HPFs in the setting of endometrial stromal changes. With the use of these strict diagnostic criteria, women with RPL have a significantly higher rate of chronic endometritis, supporting an association between chronic endometritis and RPL.

Glycolytic pathway candidate markers in the prognosis of oral squamous cell carcinoma: a systematic review with meta-analysis

Molecular changes that affect mitochondrial glycolysis have been associated with the maintenance of tumor cells. Some metabolic factors have already been described as predictors of disease severity and outcomes. This systematic review was conducted to answer the question: Is the glycolytic pathway correlated with the prognosis of oral squamous cell carcinoma (OSCC)? A search strategy was developed to retrieve studies in English from PubMed, Scopus, and ISI Web of Science using keywords related to squamous cell carcinoma, survival, and glycolytic pathway, with no restriction of publication date. The search retrieved 1273 publications. After the titles and abstracts were analyzed, 27 studies met inclusion criteria. Studies were divided into groups according to two subtopics, glycolytic pathways and diagnosis, which describe the glycolytic profile of OSCC tumors. Several components of tumor energy metabolism found in this review are important predictors of survival of patients with OSCC.

Hyperoxia improves autonomic function in individuals with long-duration type 1 diabetes and macroalbuminuria

AIM

Acute oxygen inhalation and slow deep breathing improve measures of autonomic function transiently in individuals with short-duration type 1 diabetes. Our aims were to examine these interventions and changes in autonomic function in individuals with long-duration type 1 diabetes and to explore interactions with the presence of macroalbuminuria or existing cardiovascular autonomic neuropathy.

METHODS

Individuals with type 1 diabetes (n = 54) were exposed to acute oxygen inhalation, slow deep breathing and a combination of both (hereafter 'the combination'). Primary outcomes were change in baroreflex sensitivity and heart rate variability. Associations between changes in outcomes were evaluated using mixed effects models.

RESULTS

Mean age ± sd was 60 ± 10 years and diabetes duration was 38 ± 14 years. Changes are presented as per cent difference from baseline with 95% confidence intervals. Acute oxygen inhalation, slow deep breathing and the combination increased baroreflex sensitivity by 21 (10, 34)%, 32 (13, 53)% and 30 (10, 54)%, respectively. Acute oxygen inhalation trended towards increasing heart rate variability 8 (-1, 17)% (P = 0.056), and slow deep breathing and the combination increased heart rate variability by 33 (18, 49)% and 44 (27, 64)% respectively. Macroalbuminuria or cardiovascular autonomic neuropathy did not modify results.

CONCLUSION

Autonomic function is improved transiently in individuals with long-duration type 1 diabetes and normoalbuminuria or macroalbuminuria by acute oxygen inhalation and slow deep breathing. There is a risk of survival bias. Autonomic dysfunction might be a reversible condition, and hypoxia might represent a target of intervention.

Endometriosis

Pelvic endometriosis is a complex syndrome characterized by an estrogen-dependent chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. It is caused when shed endometrial tissue travels retrograde into the lower abdominal cavity. Endometriosis is the most common cause of chronic pelvic pain in women and is associated with infertility. The underlying pathologic mechanisms in the intracavitary endometrium and extrauterine endometriotic tissue involve defectively programmed endometrial mesenchymal progenitor/stem cells. Although endometriotic stromal cells, which compose the bulk of endometriotic lesions, do not carry somatic mutations, they demonstrate specific epigenetic abnormalities that alter expression of key transcription factors. For example, GATA-binding factor-6 overexpression transforms an endometrial stromal cell to an endometriotic phenotype, and steroidogenic factor-1 overexpression causes excessive production of estrogen, which drives inflammation via pathologically high levels of estrogen receptor-β. Progesterone receptor deficiency causes progesterone resistance. Populations of endometrial and endometriotic epithelial cells also harbor multiple cancer driver mutations, such as KRAS, which may be associated with the establishment of pelvic endometriosis or ovarian cancer. It is not known how interactions between epigenomically defective stromal cells and the mutated genes in epithelial cells contribute to the pathogenesis of endometriosis. Endometriosis-associated pelvic pain is managed by suppression of ovulatory menses and estrogen production, cyclooxygenase inhibitors, and surgical removal of pelvic lesions, and in vitro fertilization is frequently used to overcome infertility. Although novel targeted treatments are becoming available, as endometriosis pathophysiology is better understood, preventive approaches such as long-term ovulation suppression may play a critical role in the future.

MON-199 Anti-Müllerian Hormone Levels in Reproductive-Aged African-American Women: Insights from an Underrepresented Population

Anti-müllerian hormone (AMH) is the preferred biomarker for ovarian reserve testing based on its stability across the menstrual cycle. Despite its increased use, there have been very few studies that have followed AMH levels over time in young, healthy populations. The few existing studies are in women of European descent. The objective of this study was to determine factors that affect AMH levels with the ultimate goal of identifying and providing better counseling to women who are at the highest risk for a rapid decline in ovarian reserve. In this study, African-American women (AAW) aged 23-34 years (yr) at their first visit, were recruited from the Detroit, Michigan metropolitan area, as part of the Study of the Environment, Lifestyle and Fibroids. Anthropometric measurements, health information and blood samples were collected from participants at three time points over 3 years. Serum AMH levels were measured using the Ansh picoAMH assay. Summary statistics were derived for the variables of interest and linear mixed-effect models were used to estimate the effects of a range of exposures on AMH levels (Stata/SE 15.1). A total of 1,646 women with up to three visits were included in the analysis. The mean time between the first and third visit was 38±2.4 months. The median AMH values for the three visits were 4.1, 3.6, and 3.2 ng/mL, respectively. The mean age was 28.7 yr at the first visit, 30.4 yo at the second visit, and 32.1 yo at the third visit. There was a non-linear relationship between age and AMH, with highest levels at age 23 and a rapid decline after age 35. The majority of women were found to be obese at the three visits (60%, 63%, and 64%, respectively), with 45% of women being obese at all three visits. For approximately 1/3 (29%) of visits, there was hormonal contraception use by the participant. In models controlling for age and age², body mass index and hormonal contraception use were inversely associated with AMH. This large cohort study of 1,646 women with 4,455 measures provides important information on factors affecting AMH concentrations in reproductive aged AAW, a population that is largely underrepresented in the ovarian reserve literature. Further data collection in this cohort will allow us to examine patterns of AMH trajectories. Knowledge of AMH trajectories from diverse populations may lead to development of personalized reproductive-lifespan-estimates which would empower women to make informed and well-timed reproductive choices.

Lonomia obliqua bristle extract modulates Rac1 activation, membrane dynamics and cell adhesion properties

Lonomia obliqua is a caterpillar of potential therapeutic interest whose venom is able to induce severe blood leakage and modulate leukocyte migration. Since both phenotypes are associated with changes in cytoskeleton dynamics and cell adhesion properties, the aim of this study was to analyze the effects of Lonomia obliqua bristle extract (LOBE) in cell adhesion and migration signaling. Proteomic analysis revealed that epithelial cells (CHO-K1) exposed to LOBE (30 μg/mL, 30 min) exhibited changes in levels of actin regulatory proteins, including RhoGTPases. These changes correlated with an increase in the activity of the RhoGTPase family member Rac as measured by Förster resonance energy transfer (FRET). When plated in migration promoting conditions, CHO-K1 cells exposed to LOBE (10 μg/mL) showed an increase in membrane ruffling after short (30 min) period of incubation that was accompanied by changes in the distribution of the adhesion markers paxillin, vinculin and an increase of focal adhesion kinase autophosphorylation levels (Y397), suggesting changes in cell-extracellular matrix (ECM) adhesion properties and signaling. These data suggest that LOBE possesses bioactive molecules that are capable to modulated cell migration signaling, cytoskeletal dynamics and cell-ECM properties of several cell types.

Feasibility of a Cell Kinetic-Based Adjuvant Chemotherapy Trial in Axillary Node-Negative Breast Cancer

Aims and background

Accumulated information on biologic prognostic indicators and predictors of response to different types of treatment in patients with different tumor characteristics has made it possible to design clinical protocols on biologic bases. Among cell proliferation indices, the thymidine labelling index (TLI) has proved to be an independent and consistent prognostic indicator over time. Moreover, experimental and retrospective analyses of clinical studies have revealed a direct relation between TLI and response to chemotherapy. On the basis of the results, a prospective clinical protocol on axillary node-negative breast cancer was activated in Italy in 1989.

Methods

Patients with low TLI tumors were treated with local-regional therapy alone, whereas patients with high TLI tumors were randomized to receive local-regional therapy followed or not by adjuvant chemotherapy consisting of 6 cycles of CMF.

Results and Conclusions

The present paper reports on the feasibility of a prospective clinical protocol based on a subgroup of patients with specific pathologic (node negative) and biologic (rapidly proliferating) breast cancers. However, patient eligibility was only 11%.

Interobserver Reproducibility of Immunohistochemical Her-2/Neu Assessment in Human Breast Cancer: An Update from INQAT round III

The clinical interest in HER-2/neu is related to trastuzumab, a drug used to treat patients with invasive breast carcinoma overexpressing the HER-2/neu protein. It is very important to correctly identify those patients who may benefit from trastuzumab by accurate assessment of the HER-2/neu status. Of the various methods available, the Dako Herceptest for immunohistochemical assay is considered the most reliable to reach this goal. The aim of this study was to investigate within a group of Italian laboratories the reproducibility of the results of HER-2/neu assessment by means of the Dako scoring system on slides stained with the Herceptest kit. This study was also conceived as the continuation of one of our previous studies, which was similar in its aims but different in the classification criteria adopted. Our results show that, whereas the intra-observer reproducibility was generally satisfactory, the interobserver reproducibility was not. Moreover, our findings confirm that the two extreme classes (0 and 3+) are more easy to identify than the other two and that the Herceptest does not allow to discriminate optimally between scoring classes 2+ and 3+. These findings are relevant in clinical practice where the treatment choice is based on categories defined by this assay, suggesting the need of adopting educational programs and/or new reference materials to improve the assay performance.

Integrated cardiovascular/respiratory control in type 1 diabetes evidences functional imbalance: Possible role of hypoxia

BACKGROUND

Cardiovascular (baroreflex) and respiratory (chemoreflex) control mechanisms were studied separately in diabetes, but their reciprocal interaction (well known for diseases like heart failure) had never been comprehensively assessed. We hypothesized that prevalent autonomic neuropathy would depress both reflexes, whereas prevalent autonomic imbalance through sympathetic activation would depress the baroreflex but enhance the chemoreflexes.

METHODS

In 46 type-1 diabetic subjects (7.0±0.9year duration) and 103 age-matched controls we measured the baroreflex (average of 7 methods), and the chemoreflexes, (hypercapnic: ventilation/carbon dioxide slope during hyperoxic progressive hypercapnia; hypoxic: ventilation/oxygen saturation slope during normocapnic progressive hypoxia). Autonomic dysfunction was evaluated by cardiovascular reflex tests.

RESULTS

Resting oxygen saturation and baroreflex sensitivity were reduced in the diabetic group, whereas the hypercapnic chemoreflex was significantly increased in the entire diabetic group. Despite lower oxygen saturation the hypoxic chemoreflex showed a trend toward a depression in the diabetic group.

CONCLUSION

Cardio-respiratory control imbalance is a common finding in early type 1 diabetes. A reduced sensitivity to hypoxia seems a primary factor leading to reflex sympathetic activation (enhanced hypercapnic chemoreflex and baroreflex depression), hence suggesting a functional origin of cardio-respiratory control imbalance in initial diabetes.

Dynamic control over catalytic function using responsive bisthiourea catalysts

Responsive molecular motor-based bisthiourea organocatalysts were used in the enantioselective Henry reaction to achieve efficient dual stereocontrol in the presence of an external base.

Radiochirurgia con acceleratore lineare: 5 anni di esperienza clinica

Gli autori utilizzano una tecnica di radiochirurgia con acceleratore lineare dal 1982. La tecnica è basata su irradiazioni multiple ad archi intersecantisi focalizzate stereotassicamente su un bersaglio.

Dopo che una valutazione meccanica e dosimetrica ha dimostrato la validità della procedura, la tecnica è stata impiegata su un gruppo selezionato di pazienti. Dal novembre 1982 al marzo 1988 sono stati trattati 155 casi. Tra loro 72 erano affetti da malformazioni arterovenose cerebrali, 16 da gliomi a bassa malignità, 8 da neurinoma dell'acustico, 8 da meningiomi e 11 da tumori maligni radiosensibili: in questi gruppi di pazienti la tecnica si è dimostrata sicura ed efficace. I risultati vengono paragonati a quelli ottenuti con la Gamma Unit di Leksell e col Ciclotrone di Kjellberg.

The dental pulp stem cell niche based on aldehyde dehydrogenase 1 expression

AIM

To detect cells expressing the stem cell marker ALDH1 (aldehyde dehydrogenase1) in the pulp of human permanent teeth and to investigate the expression of ALDH1 in isolated dental pulp cells.

METHODOLOGY

Pulp tissue was collected and processed for immunohistochemistry to detect ALDH1-, STRO-1- and CD90-positive cells. In addition, cells were isolated and analysed by flow cytometry for ALDH1 activity and for the cell surface markers CD44, CD73, CD90, STRO-1 and CD45. Cells were also examined for multidifferentiation capacity. Within these cells, an ALDH1(+) cell subpopulation was selected and evaluated for multidifferentiation capacity.

RESULTS

The immunohistochemistry analyses showed that ALDH1-, CD90- and STRO-1-positive cells were located mainly in the perivascular areas and nerve fibres of dental pulps. Cells on the fifth passage had high expression for CD44, CD73 and CD90, whereas moderate labelling was observed for STRO-1 and ALDH1 in flow cytometry analysis. On the same passages, cells were able to differentiate into osteogenic, adipogenic and chondrogenic lineages. The ALDH1(+) cell subpopulation also demonstrated multilineage differentiation ability.

CONCLUSIONS

Dental pulp stem cells reside in the vicinity of blood vessels and nerve fibres, indicating the possible existence of more than one stem cell niche in dental pulps. Furthermore, ALDH1 was expressed by isolated dental pulp cells, which had mesenchymal stem cell characteristics. Thus, it can be suggested that ALDH1 may be used as a DPSC marker.

Deep breathing acutely improves arterial dysfunction in obese children: evidence of functional impairment?

BACKGROUND AND AIMS

Similarly to diabetes type 2, patients with obesity show insulin resistance and autonomic and vascular abnormalities associated with increased morbidity and mortality. We tested whether arterial dysfunction in obese children may have a functional nature, reversible with appropriate interventions (e.g., by reduction of sympathetic activity), or else results from anatomic arterial modifications (likely irreversible). For this purpose, we tested whether deep breathing (an intervention known to transiently reduce sympathetic activity) could acutely improve arterial function, hence showing a functional abnormality.

METHODS AND RESULTS

A total of 130 obese children and 67 age-matched healthy normal-weight control children were recruited. Arterial function was measured by augmentation index (AIx), by direct analysis of blood pressure contour, and by pulse wave velocity (PWV), during spontaneous and controlled breathing. The markers of metabolic syndrome were evaluated at baseline. AIx showed increased values in obese male participants as compared with the control group. Slow breathing acutely reduced Aix in obese children, to a greater extent than in normal-weight control children. Similarly, the blood pressure contour showed higher values in obese children that were significantly attenuated by slow breathing. Baseline PWV was not altered in obese participants. The markers of metabolic syndrome correlated with AIx and PWV.

CONCLUSIONS

Obese subjects showed impaired arterial function. The acute improvement in vascular abnormalities with reduction in sympathetic activity indicates that this alteration was largely functional, likely related to initial autonomic dysfunction and to metabolic abnormalities. As a consequence, this study provides a rationale for strategies aiming at preventing arterial function deterioration in the early ages.