Early and late onset cardiotoxicity following anthracycline-based chemotherapy in breast cancer patients: Incidence and predictors

INTRODUCTION

Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data on longitudinal studies about early and late onset cardiotoxicity in this group of patients is scarce. The objective of the present study was to assess predictors of early and late onset cardiotoxicity in patients with breast cancer treated with A.

METHODS

100 consecutive patients receiving anthracycline-based chemotherapy (CHT) to treat breast cancer were included in this prospective study. All patients underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac biomarkers including high sensitivity Troponin T (TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Heart-type fatty acid binding protein (H-FABP) were assessed.

RESULTS

Mean doxorubicin dose was 243 mg/m2. Mean follow-up was 51.8 ± 8.2 months. At one-year incidence of anthracycline related-cardiotoxicity (AR-CT) was 4% and at the end of follow-up was 18% (15 patients asymptomatic left ventricular systolic dysfunction, 1 patients heart failure and 2 patients a sudden cardiac death). Forty-nine patients developed diastolic dysfunction (DD) during first year. In the univariate analysis DD during first year was the only parameter associated with AR-CT (Table 1). In the logistic regression model DD was independently related with the development of AR-CT, with an odds ratio value of 7.5 (95% CI 1.59-35.3).

CONCLUSIONS

Incidence of late-onset cardiotoxicity is high but mostly subclinical. Diastolic dysfunction early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.

Incidence of new-onset benign anal disorders after bariatric surgery

New-onset benign anal disorders (NBADs) represent a potential complication following bariatric surgery, although their incidence in this population is not well studied. The preoperative characteristics, weight loss, bowel habits and NBADs data of 196 patients with bariatric surgery were collected by telephone interviews and medical records review and evaluated retrospectively. Ninety-nine patients had undergone gastric bypass (GBP) and 97 had a modified biliopancreatic diversion (MBPD). Fifty-nine patients were excluded. The mean follow-up of the remaining 137 patients was 87.8 months, and 51 of them (37.2%) developed NBADs. Haemorrhoids were the most common diagnosis and 27.5% of the patients that developed NBADs were treated surgically. Patients who developed NBADs had a longer follow-up time (92.5 vs. 85.1 months, P = 0.003), and those with an abnormal bowel habit (diarrhoea or constipation) had a higher percentage of NBADs (54.5 vs. 28.3%, P = 0.003). NBADs were more frequent after MBPD (52.9%) than after GBP (21.7%) (P < 0.001). Multivariate analysis found that only an abnormal bowel habit was associated with NBADs, with an odds ratio of 3.2 (95% CI: 1.5-6.9, P = 0.003). As NBADs are a common complication after bariatric surgery, further studies should be performed to find the reasons for these complications.

Diastolic Dysfunction Following Anthracycline-Based Chemotherapy in Breast Cancer Patients: Incidence and Predictors

INTRODUCTION

Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data from longitudinal studies of diastolic dysfunction (DD) in this group of patients are scarce. The objective of the present study was to assess the incidence, evolution, and predictors of DD in patients with breast cancer treated with anthracyclines.

METHODS

This analytical, observational cohort study comprised 100 consecutive patients receiving anthracycline-based chemotherapy (CHT) for breast cancer. All patients underwent clinical evaluation, echocardiogram, and measurement of cardiac biomarkers at baseline, end of anthracycline-based CHT, and at 3 months and 9 months after anthracycline-based CHT was completed. Fifteen patients receiving trastuzumab were followed with two additional visits at 6 and 12 months after the last dose of anthracycline-based CHT. A multivariate analysis was performed to find variables related to the development of DD. Fifteen of the 100 patients had baseline DD and were excluded from this analysis.

RESULTS

At the end of follow-up (median: 12 months, interquartile range: 11.1-12.8), 49 patients (57.6%) developed DD. DD was persistent in 36 (73%) but reversible in the remaining 13 patients (27%). Four patients developed cardiotoxicity (three patients had left ventricular systolic dysfunction and one suffered a sudden cardiac death). None of the patients with normal diastolic function developed systolic dysfunction during follow-up. In the logistic regression model, body mass index (BMI) and age were independently related to the development of DD, with the following odds ratio values: BMI: 1.19 (95% confidence interval [CI]: 1.04-1.36), and age: 1.12 (95% CI: 1.03-1.19). Neither cardiac biomarkers nor remaining clinical variables were predictors of DD.

CONCLUSION

Development of diastolic dysfunction after treatment with anthracycline or anthracycline- plus trastuzumab chemotherapy is common. BMI and age were independently associated with DD following anthracycline chemotherapy.

[The Cinematographic Narration of the Posthumanism]

The cinema constitutes today the aesthetic forefront of the posthumanism and a powerful instance of reflection on the posthuman future. In its more futurist dimension, the films present an evolutionary irreversible process linked to the technological development, which will determine the end of the human kind and its birth to a new posthuman reality. But it turns out paradoxical that the process of dehumanization of the human beings appears like inevitable and, nevertheless, appears as ideally Utopian the desire of humanization of the androids (to support the human values beyond the human kind). In consequence, the cinematographic reflection on posthumanism seems to be headed not towards the appearance of a new nature but towards the recovery of the genuine human values.

[Conscientous health objection in the prison environment]

To be fully in accordance with constitutional doctrines the notion of conscientious objection must be understood as a manifestation of the fundamental right to ideological freedom as contained in art. 16.1 CE (assuming of course that all objecting conduct is legitimate), but it must also be understood as a principle. That is to say, any conflict between the subject's fundamental right and legal duty that he rejects must be resolved by the judge who must make a careful judgement of values and property. This fundamental right still exists and may invoked and exercised by inmates and health personnel in the prison context in the face of predictions of the forcible imposition of medical treatment as stated in the LOGP and RP, with no more limit than public order itself.

Cytochrome P450 3A5 is highly expressed in normal prostate cells but absent in prostate cancer

Testosterone is essential for the growth and function of the luminal prostate cells, but it is also critical for the development of prostate cancer, which in the majority of the cases derives from luminal cells. Cytochrome P450 3A (CYP3A) enzymes hydroxylate testosterone and dehydroepiandrosterone to less active metabolites, which might be the basis for the association between CYP3A polymorphisms and prostate cancer. However, it is unknown whether the CYP3A enzymes are expressed at relevant levels in the prostate and which polymorphisms could affect this tissue-specific CYP3A activity. Thus, we measured CYP3A4, CYP3A5, CYP3A7, and CYP3A43 mRNA in 14 benign prostatic hyperplasias and ten matched non-tumoral/tumoral prostate samples. We found that CYP3A5 mRNA in non-tumoral prostate tissue was 10% of the average amount of liver samples, whereas the expression of the other CYP3A genes was much lower. Similarly to liver, CYP3A5*3 polymorphism decreased CYP3A5 mRNA content 13-fold. CYP3A5 protein was detected in non-tumoral prostate microsomes by western blot, and immunohistochemistry (IHC) localized CYP3A5 exclusively in the basolateral prostate cells. In contrast to the normal tissue, IHC and RT-PCR showed that tumoral tissue lacked CYP3A5 expression. In conclusion, prostate basolateral cells express high levels of CYP3A5 which dramatically decrease in tumoral tissue. This finding supports an endogenous function of CYP3A5 related to the metabolism of intra-prostatic androgens and cell growth, and that polymorphisms affecting CYP3A5 activity may result in altered prostate cancer risk and aggressiveness.

Human Papillomavirus Associated with Papillary Squamous Cell Carcinoma of the Oropharynx in a Renal Transplant Recipient

The papillary squamous cell carcinoma (PSCC) is a rare variant of the head and neck squamous cell carcinoma. Established etiological factors can include tobacco smoking and heavy alcohol abuse. Moreover, human papillomavirus infection can be involved in the pathogenesis of PSCC. This tumor is more frequent in patients with immunosuppression including those who have received a transplant. Most of the cases are produced by genotype HPV-6 and HPV-16, although there is a possibility of infection by other HPV subtypes. We present a case report of a PSCC and papilloma with oropharyngeal location in which high-risk HPV type 16 and low-risk HPV type 6, respectively, were identified by PCR in a renal transplant patient.

Forward-backward asymmetries of lepton pairs in events with a large-transverse-momentum jet at hadron colliders

We discuss forward-backward charge asymmetries for lepton-pair production in association with a large-transverse-momentum jet at hadron colliders. The lepton charge asymmetry relative to the jet direction A(j)(FB) gives a new determination of the effective weak mixing angle sin((2)theta(lept)(eff)(M(2)(Z)) with a statistical precision after cuts of approximately 10(-3) (8x10(-3)) at LHC (Tevatron). This is to be compared with the current uncertainty at LEP and SLD from the asymmetries alone, 2x10(-4). The identification of b jets also allows for the measurement of the bottom-quark-Z asymmetry A(b)(FB) at hadron colliders, the resulting statistical precision for sin((2)theta(lept)(eff)(M(2)(Z)) being approximately 9x10(-4) (2x10(-2) at Tevatron), also lower than the reported precision at e(+)e(-) colliders, 3x10(-4).

[Congenital atrioventricular block and Wolff-Parkinson-White Syndrome]

We report the case of a patient followed since childhood for congenital complete atrioventricular block. At 28 years of age, atrioventricular conduction through an accessory pathway with long conduction times was detected. Periods of atrioventricular conduction alternated with periods of atrioventricular block. Sinus tachycardia and 1:1 exclusive conduction through the accessory pathway developed with increased sympathic activity (exercise, isoproterenol infusion). We discuss the special features of this case.

Eta(') mass and chiral symmetry breaking at large N(c) and N(f)

We propose a method for implementing the large- N(c), large-N(f) limit of QCD at the effective Lagrangian level. Depending on the value of the ratio N(f)/N(c), different patterns of chiral symmetry breaking can arise, leading in particular to different behaviors of the eta(') mass in the combined large-N limit.

Enantioselective addition of a chiral thiazolidinethione-derived titanium enolate to acetals

[reaction: see text] High stereoselectivities (up to 98% de) have been achieved for the Lewis acid-mediated cross-coupling reaction of dimethyl acetals to a chiral 1,3-thiazolidine-2-thione-derived titanium enolate. The reaction affords enantiopure anti alpha-methyl-beta-alkoxy carbonyl compounds in a wide range of acetals.

Hydatid liver cyst perforation into the digestive tract

Complications of liver hydatid disease include those related to the compression of adjacent viscus, to the infection of the cyst's contents or to the perforation of the cyst. Perforations into hollow abdominal organs are rare, and can occur secondary to the infection of the cyst or to a primary pathology of the perforated organ. We report on 2 cases of perforation of a liver cyst into the duodenum, 1 due to the presence of a duodenal ulcer, and 1 secondary to a hydatid abscess. The surgical treatment of the lesions and their complications was, in both cases, successful.

Class I major histocompatibility complex antigens and tumor ploidy in breast and bronchogenic carcinomas

We determined the frequency of expression of the major histocompatibility complex antigens HLA-A,B,C in tumor cells from 207 primary tumor lesions of breast and bronchogenic carcinomas, to see if the expression of theses antigens was linked with several clinicopathological parameters associated with tumor aggressivity, such as abnormal cellular DNA content. We compared tumor tissues with nonneoplastic tissues and tissues from 15 benign breast lesions. HLA class I expressor and nonexpressor tumor cells were determined by using immunohistochemical stains (PAP and APAAP methods) and antibodies against these antigens. Reduction of HLA class I antigen was detected in 65 tumors (31.7%) and was significantly associated with poor tumor differentiation and abnormal cellular DNA content (p < 0.001). These characteristics might define a group of aggressive tumors in which the decrease of HLA class I antigens would enable tumor cells to avoid eliciting host immune responses. On the other hand, the altered regulatory mechanisms, of tumors with abnormal cellular DNA content, might modulate the expression of HLA class I molecules.