Oxytocin nasal spray in fibromyalgic patients

Fibromyalgia is a pain disorder associated with frequent comorbid mood, anxiety, and sleep disorders. Despite the frequent use of a complex, poly-drug pharmacotherapy, treatment for fibromyalgia is of limited efficacy. Oxytocin has been reported to reduce the severity of pain, anxiety, and depression, and improve the quality of sleep, suggesting that it may be useful to treat fibromyalgia. To evaluate this hypothesis, 14 women affected by fibromyalgia and comorbid disorders, assuming a complex pharmacotherapy, were enrolled in a double-blind, crossover, randomized trial to receive oxytocin and placebo nasal spray daily for 3 weeks for each treatment. Order of treatment (placebo-oxytocin or oxytocin-placebo) was randomly assigned. Patients were visited once a week. At each visit, the following instruments were administered: an adverse drug reaction record card, Visual Analog Scale of Pain Intensity, Spielberger State Anxiety Inventory, Zung Self-rating Depression Scale, and SF-12. Women self-registered painkiller assumption, pain severity, and quality of sleep in a diary. Unlikely, oxytocin nasal spray (80 IU a day) did not induce positive therapeutic effects but resulted to be safe, devoid of toxicity, and easy to handle.

Both thyroid autoimmunity and increased serum TSH are independent risk factors for malignancy in patients with thyroid nodules

AIM

To assess the relevance of thyroid autoimmunity and TSH as risk factors for malignancy in thyroid nodules (TN).

SUBJECTS AND METHODS

Retrospective analysis on 2053 patients with single/prevalent TN submitted to fine needle aspiration cytology (FNAC). Anti-thyroid autoantibodies (ATA) [anti-thyroperoxidase (TPOAb), anti-thyroglobulin (TgAb)] and TSH were measured. Cytology was classified as benign (class II), indeterminate (class III), and suspicious or malignant (class IV). Histology was available in 301 patients. Associations of malignancy with independent variables were determined by multivariate logistic regression analysis.

RESULTS

Higher prevalence of class IV (14.2% vs 6.8%: p<0.001) and class III (23.5% vs 17.1%: p<0.001) were found in ATA+ vs ATA- TN. Histology confirmed increased prevalence of cancer in ATA+ (p<0.05) TN and in those with diffuse lymphocytic thyroid infiltration (p<0.05). Interestingly, the prevalence of malignancies observed in operated class III nodules was strikingly lower in ATA+ (1/20, 5%), than in ATA- patients (34/67, 50.7%; p<0.001). Increased independent odds ratio (OR) for malignancy was conferred by any ATA [OR 2.21; 95% confidence interval (CI)=1.49-3.29, p<0.0001]; TPOAb (OR 2.15; CI=1.42-3.25, p<0.0001) and TgAb (OR 1.67; CI=1.05-2.67, p<0.05), by serum TSH>1.0 μUI/ml (OR 1.95; CI=1.01-3.76, p<0.05), and by young age (10-29 yr: OR 2.09; CI=1.02-4.26, p<0.05). A formula was calculated to assess the relative contribution of ATA, TSH, and age to the risk of TN malignancy.

CONCLUSIONS

Both thyroid autoimmunity and increased TSH represent independent risk factors for TN malignancy.

Is there a dose-response relationship of metformin treatment in patients with polycystic ovary syndrome? Results from a multicentric study

STUDY QUESTION

Do different dosages of metformin account for different clinical and biochemical outcomes in women with polycystic ovary syndrome (PCOS) and do basal anthropometric and metabolic characteristics of the patients provide any indications regarding the dose required to reach the target effect?

SUMMARY ANSWER

Different doses of metformin exerted the same effects on clinical, biochemical and metabolic parameters in patients affected by PCOS.

WHAT IS KNOWN AND WHAT THIS PAPER ADDS

Since the insulin-sensitizing agents came into use in the management of PCOS, metformin has shown a positive benefits-risks ratio. Nonetheless, therapeutic schedules are not well standardized. This is the first study which systematically analyses the effect of different doses of metformin on clinical, hormonal and metabolic features of PCOS. On the basis of our results, higher doses are no more effective than lower doses.

DESIGN

A multicentric cohort prospective study. A total of 250 PCOS women were enrolled, 49 lost to follow-up. Menstrual cyclicity, hormonal assays, oral glucose tolerance test, lipid profile and ultrasonographic pelvic examination were evaluated at the baseline and after 6 months of metformin treatment at different doses (1000, 1500 and 1700 mg).

PARTICIPANTS AND SETTING

A total of 201 PCOS patients completed the study without protocol violations in three university hospitals: seventy-three patients from Centre A (treated with metformin 500 mg twice a day), 60 patients from Centre B (treated with metformin 500 mg three times a day) and 68 patients from Centre C (treated with metformin 850 mg twice a day).

MAIN RESULTS AND THE ROLE OF CHANCE

Metformin exerted an overall positive effect on the clinical and endocrine-metabolic features of PCOS. The degree of these effects was independent of the administered dosage in every range of basal body mass index (BMI). When patients were stratified according to their insulinaemic status, scattered inter-doses differences were found in some of the outcome measures. Patients who exhibited an increase of >2 menstrual cycles/year were considered as responders to treatment. Responders had a higher basal BMI than non-responders and showed a greater reduction in plasma testosterone levels after metformin treatment, but other outcome measures did not differ significantly. Total insulin secretion in the 180 min following the glucose tolerance test before metformin treatment (basal AUC-I) was significantly correlated with the decrease in insulin secretion induced by metformin in both the whole group and in responders, but only correlated with the variation in the number of cycles in responders.

BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION

The different doses were administered in different centres, and between-centre variation is a potential confounding factor.

GENERALIZABILITY TO OTHER POPULATIONS

The paradigm of using the minimum effective dose of metformin could be pursued in other pathological conditions characterized by insulin resistance.

STUDY FUNDING/COMPETING INTEREST(S)

No funding or competing interests to declare.

P3-14-07: Relative Risk of Recurrence (RR) over Time in ER Positive and Negative T4 Breast Cancer Patients Achieving Less Than pCR (&lt;pCR) after Primary Chemotherapy: A Reversal Trend of Recurrence beyond 60 Months after Diagnosis

Background

It is widely assumed that patients (pts) who achieve a pCR have a good prognosis and better outcomes compared with pts with &lt;pCR, regardless of hormone receptor status. Emerging data suggest that achieving &lt;pCR identifies a heterogeneous group with different risks of recurrence and death, being ER negative the subgroup with the worst prognosis.

Aim of our study was to evaluate the relative risk of recurrence (RR) over time in ER-positive (ER+) and ER-negative (ER-) &lt;pCR patients.

Material and Methods: We analyzed 139 consecutive &lt;pCR T4 pts, of whom 85 were ER+ (cut-off 10%) and 54 were ER-. Median age was 53 y ( range 29–73). Median follow up was 137 months (range 8–233). All pts received primary anthra-based chemotherapy with or without taxanes followed by endocrine therapy for 5 years, if hormone receptor positive. We examined the RR of recurrence at 0–24, 25–60, 61–120 and beyond 120 months (m) interval after diagnosis.

Results: For all 139 pts, the total number of pts with recurrence was 95 (68%), 54 (63%) in ER+ and 41 (76%) in ER-.tumors. For the entire group and both in ER+ and in ER-, the RR of recurrence was greatest for the interval between 0–24 months, then decreased rapidly in ER- and slowly in ER+ through the 25–120 m interval. For the 0–24 m and 25–60 m intervals the RR of recurrence was higher for ER-pts and after 60 m it crossed and beyond 60 m the RR of recurrence was higher in ER+ than in ER- pts. Notably, beyond 120 months we observed a little second peak of recurrence, higher in ER+ (7) than in ER- (3) pts. Nine of these 10 relapses occurred between 120 to 180 m interval, 7 in ER+ (13%) and 2 in ER- (5%) subgroup. In the first 24 m ER- pts were 86% more likely to relapse compared with ER+, vice versa between 61–120 and beyond 120 m intervals, ER- pts were 19% and 18% less likely to relapse, respectively, compared with ER+ pts.

Conclusions: The present study confirmed the previous reports which showed unfavorable prognosis of the &lt;pCR patients with negative ER status, due to their significantly higher relative risk of recurrence between 0 to 60 months interval. The ER+ recurrences occurred more frequently in late follow-up. A reversal of recurrence between ER positive and negative patients beyond 60 months after diagnosis was detected. The fact might indicate the importance of long term adjuvant hormone therapy for T4 ER positive breast cancer patients with &lt;pCR after primary chemotherapy.

Nestin expression associates with poor prognosis and triple negative phenotype in locally advanced (T4) breast cancer

Nestin, an intermediate filament protein, has traditionally been noted for its importance as a neural stem cell marker. However, in recent years, expression of nestin has shown to be associated with general proliferation of progenitor cell populations within neoplasms. There is no reported study addressing nestin expression in T4 breast cancer patients. Thus, the aim of the present study was to investigate, through immunohistochemistry, the expression and distribution of nestin in T4 breast cancer, in order to determine its association with clinical and pathological parameters as well as with patients' outcome. Nestin was detectable in tumoral cells and in endothelial cells of blood microvessels, and it is significantly expressed in triple-negative and in inflammatory breast cancer (IBC) subgroups of T4 breast tumours. The Kaplan-Meier analysis showed that the presence of nestin in tumoral cells significantly predicted poor prognosis at 5-years survival (P=0.02) and with borderline significance at 10-years of survival (P=0.05) in T4 breast cancer patients. On the basis of these observations, we speculate that nestin expression may characterize tumours with an aggressive clinical behavior, suggesting that the presence of nestin in tumoral cells and vessels may be considered an important factor that leads to a poor prognosis. Further studies are awaited to define the biological role of nestin in the etiology of these subgroups of breast cancers.

Quality of life and associated clinical distress in fibromyalgia

OBJECTIVES

Fibromyalgia (FM) is a syndrome characterized by chronic, diffuse musculoskeletal pain and by a low pain threshold at specific anatomical points (tender points). Numerous other conditions (Irritable bowel syndrome, tension-type headache, migraine headaches, etc.) may overlap with FM. Aim of this study was to evaluate the quality of life and associated clinical distress in patients with FM.

METHODS

53 females affected by primary fibromyalgia and 40 healthy females were examined were examined by an experienced rheumatologist and interviewed using the Fibromyalgia Impact Questionnaire (FIQ). Clinical monitoring included Visual Analogue Scale for pain and pain pressure threshold measurements.

RESULTS

Mean FIQ scores were 66.39+/-14.94 in FM patients and 13.15+/-5.37 in control subjects and the difference was statistically significant. Among associated clinical distress higher frequencies have been found for paraesthesia (87%), sleep disturbance (72%), tension type headache (70%), oto-vestibule syndrome (72%) and irritable colon (60%). An R.O.C. bend was developed in the presence of paraesthesias and oto-vestibule syndromes at the same time. This allowed us to identify a FIQ cut off value of 66.85 so FM patients were divided into 2 groups according to their FIQ scores: severe degree and mild or slight degree.

CONCLUSIONS

Based on our data, it would appear possible to use a FIQ value equal to or higher than 66.85 for the clinical picture of FM to be classified as severe.

The Italian national trends in smoking initiation and cessation according to gender and education

OBJECTIVES. This study aims to assess the trend in initiation and cessation of smoking across successive birth cohorts, according to gender and education, in order to provide useful suggestion for tobacco control policy. STUDY DESIGN. The study is based on data from the "Health conditions and resort to sanitary services" survey carried out in Italy from October 2004 to September 2005 by the National Institute of Statistics. Through a multisampling procedure a sample representative of the entire national territory was selected.

METHODS

In order to calculate trends in smoking initiation and cessation, data were stratified for birth cohorts, gender and education level, and analyzed through the life table method.

RESULTS

The cumulative probability of smoking initiation, across subsequent generations, shows a downward trend followed by a plateau. This result highlights that there is not a shred of evidence to support the hypothesis of an anticipation in smoking initiation. The cumulative probability of quitting, across subsequent generations, follows an upward trend, highlighting the growing tendency of smokers to become an "early quitter", who give up within 30 years of age.

CONCLUSION

Results suggest that the Italian antismoking approach, for the most part targeted at preventing the initiation of smoking emphasising the negative consequences, has an effect on the early smoking cessation. Health policies should reinforce the existing trend of "early quitting" through specific actions. In addition our results show that men with low education exhibit the higher probability of smoking initiation and the lower probability of early quitting, and therefore should be targeted with special attention.

Adding cisplatin to an anthracycline-based primary chemotherapy in triple-negative (TN) and non-triple negative (non-TN) T4 breast cancer patients (pts): Long-term outcomes

583

Background: Clinical data demonstrated that standard anthracycline-based chemotherapy may be less beneficial in TN. Conversely, there is extensive preclinical work showing that TN tumors are highly sensitive to platinum agents. Only a few studies compared cisplatin vs non-cisplatin containing regimens among TN or non-TN homogeneous populations. The aim of this study was to evaluate the efficacy in terms of long-term outcomes of adding cisplatin to an anthracycline-based neoadjuvant regimen (cisplatin, C) compared with a standard anthracycline-based (Non-C) regimen in T4 breast cancer according to TN or non-TN status. Methods: We retrospectively analyzed 125 consecutive T4 breast cancer pts available for ER/PR and HER2 status; 98 pts (80%) were non-TN, of whom 63 treated with Non-C and 35 treated with C regimen; 27 pts (20%) were TN, of whom 10 treated with Non-C and 17 treated with C regimen. All pts received CMF, RT and hormone-therapy if indicated as adjuvant setting. None of the HER2 positive pts received peri-operative trastuzumab. Results: At a median follow-up of 101 months (8–217), estimated 10-year DFS and OS in TN pts treated with C were 47% and 59% versus 10% and 30% in pts treated with Non-C. In non-TN pts DFS and OS were 57% and 70% in pts treated with C versus 37% and 49% in pts treated with Non-C. Conclusions: Our data suggest that both TN and non-TN pts derive a better outcomes from the add of cisplatin over a standard anthracycline-based regimen. Of note, the magnitude of the benefit of cisplatin appears greater in the TN group. In order to validate these findings large prospective randomized trials are warranted.

[Table: see text]

No significant financial relationships to disclose.

The effect of puberty on insulin resistance in obese children

OBJECTIVE

Insulin resistance (IR) increases during puberty in normal children. IR is the first adverse metabolic event of obesity, and the marker of the metabolic syndrome. We aimed to study the effect of puberty on IR in obese and normal-weight children.

DESIGN

Cross-sectional evaluation of fasting glucose, insulin concentrations, and homeostasis model assessment of IR (HOMA-IR) in obese and control children throughout puberty.

PATIENTS AND METHODS

We recruited 424 obese children (207 pre-pubertal and 217 pubertal divided in Tanner stages 2-3, 4, and 5) and estimated IR using the HOMA-IR index. Data were compared to those obtained in 123 healthy normal-weight children (40 pre-pubertal and 83 pubertal divided in Tanner stages 2-3, 4, and 5).

RESULTS

In the obese children mean HOMA-IR increased progressively across Tanner stages, and was significantly higher in all groups (pre-pubertal and Tanner stages 2-3, 4, and 5) of obese than in control children. HOMA-IR was significantly correlated with BMI.

CONCLUSIONS

HOMA-IR in obese children increases at puberty more than in normal-weight children and does not return to pre-pubertal values at the end of puberty.

Expression of survivin protein in pterygium and relationship with oxidative DNA damage

Ultraviolet radiation is known to cause oxidative DNA damage and is thought to be a major factor implicated in the pathogenesis of pterygium. Among all the photo-oxidative DNA products, the 8-hydroxydeoxyguanosine (8-OHdG) is regarded a sensitive and stable biomarker for evaluating the degree of DNA damage. The protein p53 is a major cell stress regulator that acts to integrate signals from a wide range of cellular stresses. UV radiation has a carcinogenic effect resulting in DNA damaged cells with loss of normal growth control. This assumption is supported by the association between UV-B exposure and activation of survivin, a member of the inhibitor of apoptosis protein family (IAP), highly up-regulated in almost all types of human malignancy. In this study we demonstrate, for the first time in pterygium, the immunohistochemical presence of survivin, and investigate the correlation between survivin, p53 and 8-OHdG. Our results demonstrate that oxidative stress could lead to a significant activation of survivin expression, suggesting that this might be an important event in the development of pterygium, inducing and supporting a hyperproliferative condition. Survivin expression in pterygium would counteract UV-B-induced apoptosis and would cooperate with loss of p53. The co-operation between survivin and functional loss of p53 might provide a general mechanism for aberrant inhibition of apoptosis that could be responsible for the development of pterygium and its possible progression to neoplasia.

Nuclear survivin is associated with disease recurrence and poor survival in patients with cutaneous malignant melanoma

AIMS

Survivin is expressed in neoplastic cells and appears to be associated with resistance to therapy and shorter survival in various types of tumours. The aim of the present study was to determine whether nuclear or cytoplasmic expression of survivin is related to disease recurrence and overall survival of patients with Stage I and II melanoma according to the American Joint Committee on Cancer (AJCC) staging system.

METHODS AND RESULTS

Immunohistochemistry was performed on formalin-fixed paraffin-embedded sections of primary cutaneous melanoma from 50 patients. Survival rates were estimated using the Kaplan-Meier method and compared using the log rank test. Association of clinical variables (gender, age, tumour location, thickness, Clark level and AJCC stage) with survivin expression was analysed by Fisher's exact test. Patients with nuclear immunoreactivity for survivin had an increased risk of disease recurrence during the first three postoperative years (P < 0.05) and of death (P < 0.05). Cytoplasmic immunoreactivity was not correlated with either survival or clinical variables.

CONCLUSIONS

Nuclear presence of survivin may be an independent biomarker for disease recurrence and overall survival in patients with Stage I and II melanoma.

Ultrasound in polycystic ovary syndrome the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study

BACKGROUND

The introduction of transvaginal approach in ultrasound (US) has enabled the accurate evaluation of the structure of the ovary and stroma. Stroma represents an acknowledged US marker for polycystic ovary syndrome (PCOS). The proportion revealed between the stroma and the ovary surface in the median section (S/A ratio) had been indicated as a reliable marker for hyperandrogenism. In order to verify the feasibility of this determination in routine use and to confirm the efficacy of S/A ratio in predicting hyperandrogenism in PCOS, a multicentric study was performed in association with five Italian research groups.

METHODS

A total of 418 subjects of fertile age presenting oligomenorrhoea or secondary amenorrhoea, enlarged ovaries measuring >10 cm(3) and/or >12 follicles measuring 2-9 mm in diameter took part in the study. Clinical, US and hormonal evaluations were performed in the early follicular phase or on random days in amenorrhoeic subjects. US assessment included ovarian volume, follicle number, ovarian and stroma area in median section. The hormonal study included a baseline plasma determination of LH, FSH, estradiol (E(2)), androstenedione (A), testosterone (T), dehydroepiandrosteronesulphate, 17-hydroxy-progesterone, sex hormone-binding globulin and prolactin. Correlations and receiver operator curves were used in statistical analysis of data.

RESULTS

S/A was found to be the best significant predictor of elevated A and T levels. In order to ascertain significant cut-off values in relation to A and T levels Youden indexes were calculated and indicated 0.32 as the best cut-off for the S/A ratio.

CONCLUSIONS

This work underlines the importance of stroma measure in improving US diagnosis of PCOS and suggest that this parameter may be used in routine clinical practice. In fact, multicentre study demonstrated the easy feasibility of such procedure without need of sophisticated machines or intensive training for operators.

Outcomes in double-negative (HER2/PR negative) LABC phenotype treated with cisplatin-based primary chemotherapy: Impact of intensified regimen

11024

Background: It is widely assumed that HER2-negative and hormone receptors negative tumors (Triple-Negative as TN) are associated with poor outcome and would benefit from intensified chemotherapy and/or from specific EGFR-targeted therapies.Nevertheless, the lack of PR expression in presence of ER-pos tumors, (Double-Negative as DN) could reflect an aberrant growth factor signaling, identifying a more aggressive phenotype than ER-pos/PR-pos tumors that could contribute to the tamoxifen resistance and that could benefit from tailored specific treatment such as TN pts. Aim of our retrospective study was to evaluate,the clinical outcome among a group of LABC pts, according to the treatment’s schedule (standard vs intensified) and TN or DN phenotype. Methods: Between June 1996 and November 2001, 72 consecutive LABC pts, (77 % T4abc; 23 % T4d) median age 51 (29–70), ER/PR-neg 37,5%; ERpos/PR-neg 33%, were treated with primary PEV regimen (cisplatin 50 mg/m2; epirubicin 100 mg/m2; vinorelbine 25 mg/m2):q 3wks x 4 cycles in the first 24 pts (Standard); q 2 wks x 6 cycles in the subsequent 48 pts (Intensified), followed by adjuvant RT,CMF and TAM ± LH-RH ; 50 pts of 72 were IHC assessable for both HER2 and HR: 39 pts (78%) were identified as HER2-neg; 25 (64%) of 39 were HER2-neg/PR-neg irrespective of ER status, (any ER), of whom 12 were ER-neg (TN )and 13 were ER-pos ( DN ). Results: At a median follow up of 88 months (58–123) DFS was 20% and 80%; 20% and 100%; 20% and 62,5% in standard group and in intensified group respectively; OS was 40% and 80%; 40% and 100%; 40% and 62,5% in standard group and in intensified group respectively. Conclusions: Our findings suggest that DN as well as TN pts benefit from intensified primary chemotherapy. Therefore, tailored treatments are warranted for DN as well as TN pts. In addition, our data indicate that association of HER2-neg with PR-neg independently of ER expression (any ER) could be correlated with a more aggressive phenotype.

[Table: see text]

No significant financial relationships to disclose.

Is there any difference between microscopic residual disease (pTm) and no invasive disease (pT0) in the breast when there is residual disease in the axilla after primary chemotherapy for breast cancer (BC)? Results of a multicenter study

11069

Background: Several studies have demonstrated the importance of achieving pCR both in the breast and axilla, in terms of DFS and OS. We previously demonstrated that no difference exists between microscopic residual (pTm) and no invasive residual (pT0) tumour in the breast in terms of DFS and OS in breast cancer (BC) patients (pts) following primary chemotherapy (CHT). Nevertheless, when pN0 is achieved, we observed a statistical significant advantage for pT0 in comparison to pTm pts (DFS 94.7% vs 80%, p=0.03; OS 100% vs 86%, p=0.08). Aim of the present study was to investigate the clinical significance of pTm in the breast when there is residual tumour in the axilla. Methods: We analysed 48 out of 287 pts with clinical T2–4 BC, who achieved pCR, according to Sataloff’s classification, following different kinds of neoadjuvant CHT. One pt was considered not valuable for clinical outcomes, because lost to follow up. Median age was 47 years (29–68), clinical TN stage was T4 in approximately half of the pts (22/48, 45.8%) and N+ in 11/48 (22.9%). Hormone receptor status was ER- in 20 pts (41.7%) and PR- in 26 (54.2%). All pts received anthracycline-based neoadjuvant CHT, even standard (Q21 days) or intensified (Q14). Median number of administered cycles was 3 (2–6). Median follow up was 89 months (9–189). Results: Thirteen pts (27.6%) had residual disease in the axilla at the end of primary CHT, of whom 6 achieved pT0 and 7 pTm in the breast. Surprisingly, pTm pts had a significant better DFS and OS in comparison to pT0 pts. Results are shown in Table 1 . Conclusions: Our data indicate that the achievement of pT0 in the breast is not of clinical significance when there is residual tumour in the axilla. These results, even if affected by the small number of pts, could be explained by the fact that less aggressive treatments have been delivered to pT0 pts due to the complete clearance of the tumour. [Table: see text]

No significant financial relationships to disclose.

Participative risk communication in an industrial village in Sardinia

OBJECTIVE

In Italy the law on industrial risk has emphasised the necessity of building a local information process to answer people's questions on safety and provide greater community participation in risk management. The aim of this research is to analyse the local population's ideas and expectations of a participatory approach in risk management in order to design a risk communication programme based on health promotion principles.

DESIGN, SETTING AND PARTICIPANTS

The study was carry out in Portoscuso (Italy), an industrial district. A questionnaire was administrated through home interviews to 147 citizens.

MAIN RESULTS

Six risk management styles were identified on the basis of citizens' trust in the different stakeholders. Additional parameters (importance of information, organisations they would trust to get information on industrial risks, preferred risk communication methodologies) were analysed according to the management styles.

CONCLUSIONS

On the basis of these elements, a multi-approach strategy could be proposed. Each management style can have different roles. A programme of public forums could involve citizens with an interactive approach, interactive courses could involve citizens with a semi-participative approach, and leaflets and booklets could inform citizens oriented towards unidirectional communication. The participative process should always be open to new contributions from citizens who are not directly involved, and should allow for flexibility in the form and nature of partnership, as well as the details of implementation.

Smoking trends in Italy from 1950 to 2000

STUDY OBJECTIVE

To assess how the prevalence of smokers in Italy from 1950 to 2000 has changed, in parallel with law development and the growing attention towards smoking prevention.

DESIGN, SETTING, AND PARTICIPANTS

Historical data on smoking trends have been obtained using data collected in 2000 by the National Institute of Statistics. A correction coefficient is proposed to overcome the bias of differential mortality reported in other papers. The sample is made up of 102 261 people aged 15-69 years.

MAIN RESULTS

A general downward trend is seen; there is a more pronounced decrease starting from 1975 to 1980. In both sexes the peak prevalence tends to decrease according to the birth cohort because of the earlier age in which they gave up. A partial exception to the decline of tobacco use in recent years may be made for the 15-19 year-old age group, which has remained stable since 1990.

CONCLUSIONS

Although a comprehensive community programme against tobacco was not developed, the different prevention actions implemented in Italy have contributed to a change in attitude and behaviour. The effect of tobacco control strategies implemented in Italy until now is more evident in relation to the breaking of the smoking habit, which happens at an increasingly younger age, although it is not clear how much it is able to prevent people from starting smoking.

Prognostic prediction of the immunohistochemical expression of p16 and p53 in cutaneous melanoma: a comparison of two populations from different geographical regions

p16INK4a and p53 are tumor-suppressor genes frequently altered in various malignancies, including cutaneous melanoma. The purpose of the study was to establish the prognostic value of immunohistochemical expression of p16INK4a a and p53 in sporadic cutaneous melanoma (CM) in two regions with a high-risk for melanoma in Italy and Ecuador. Immunohistochemical staining of p16 and p53 was performed in samples of primary CM from 82 patients with Stage I and II melanoma according to the American Joint Committee on Cancer (AJCC) staging system. Survival differences between categories of p16 or p53 expression were analyzed using the product-limit procedure (Kaplan-Meier method, log-rank test). Clinical variables (gender, age, tumor location, Clark's level, thickness) were correlated with survival and p16 or p53 expression. p16 nuclear immunoreactivity was observed in 85% of Italian patients compared to 48.7% of Ecuadorians; a small number of cases showed p53 immunoreactivity in both populations. Only nuclear p16 expression exhibited a significant correlation with survival (Italians p=0.001, Ecuadorians p=0.017) but did not appear to correlate with any clinicopathological parameter. No significant difference was observed in survival with regard to p53 expression or cytoplasmic p16. Our results demonstrate that nuclear expression of p16 can be considered a molecular prognostic factor in patients with sporadic CM and indicate its importance as a clinical marker.

Long-term effect in outcomes of intensified primary chemotherapy in poor prognosis LABC T4 patients: Results of a multicenter Italian study

10518

Background: Recent data showed that anthracycline-based chemotherapy with increased dose-intensity improves clinical outcomes as compared to conventional regimens in adjuvant setting, particularly in high risk patients with HR negative tumors. Nevertheless dose-intensity in neoadjuvant setting remain controversial. The aim of this study was to evaluate the outcome between two different primary regimens and, furthermore, among soubgroups identified by HR status. Methods: Between 1996 and 2001, 72 consecutive LABC patients, (77% T4abc; 23% T4d; 88% axillary nodes involvement) median age 51 (29–70), ER neg 39%; PgR neg 71%, were treated with PEV regimen (cisplatin 50 mg/m2; epirubicin 100 mg/m2; vinorelbine 25 mg/m2) as primary chemotherapy. The regimen was delivered with different number of cycles and treatment intervals (3 wks × 4 cycles in the first 24 pts as PEV21 × 4; 2 wks × 6 cycles in the subsequent 48 pts as PEV14 × 6); the entire treatment in both groups lasted 12 weeks. All 72 patients received adjuvant CMF, RT and Hormonal treatment when indicated. Results: after a median follow up of 76 months (46–111), higher DFS and OS were observed in the intensified PEV14 × 6 group as compared to the counterpart (69% vs 42% p = 0.02 and 78% vs 58% p = 0.05 respectively). Statistically better DFS and OS were observed in the group ER/ PgR negative which received intensified PEV 14 × 6, whereas no statistically difference was found among ER/ PgR postive patients, regardless of the type of regimen. Conclusions: Our results suggest that primary intensified chemotherapy is associated with a better clinical outcome in poor prognosis LABC T4 patients,and that HR negative tumors benefit greatly from intensified regimen. Further prospective randomized studies are needed to confirm our data.

[Table: see text]

No significant financial relationships to disclose.

High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies

OBJECTIVE

We assessed the association between thyroid autoimmunity and thyroid cancer in a retrospective series of unselected thyroid nodules submitted to fine-needle aspiration cytology (FNAC) to avoid the selection bias of surgical series.

SUBJECTS AND METHODS

Ultrasound (US)-guided FNACs were obtained from 590 unselected consecutive patients with single thyroid nodules and positive (ATA + , n = 197) or negative (ATA - , n = 393) serum anti-thyroid antibody (ATA). Cytological results were classified in three classes of increased risk of malignancy: low risk or benign (class II); indeterminate risk (class III); and suspect or malignant (class IV).

RESULTS

A higher prevalence of class III (28.9% vs 21.4%, P < 0.05) and class IV (18.8% vs 9.2%, P < 0.001) and lower prevalence of class II (52.3% vs 69.5%, P < 0.001) were found in ATA + vs ATA - nodules respectively. By multivariate logistic regression analysis ATA + conferred a significant risk (odds ratio (OR): 2.29 (95% confidence interval (CI): 1.39-3.76)) for class IV cytology independently from age and sex. In 106 patients where thyroidectomy was carried out, thyroid cancer was found in 54/61 (88.5%) patients with class IV nodules (with similar positive predictive value for cancer in ATA + (96.4%) and ATA- (81.8%) nodules), in 6/31 (19.3%) of class III nodules (all ATA - ) and in none of 14 class II nodules. Non-specific cytological atypias from hyperplastic nodules in lymphocytic thyroiditis probably accounted for the different prevalence of cancer in class III ATA + and ATA - nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (27/197 = 13.7%) of ATA + , when compared with ATA - nodules (33/393 = 8.4%, P = 0.044), but the significance of this finding is limited by the low number of class II nodules operated on.

CONCLUSIONS

The presence of ATA + confers an increased risk of suspicious or malignant cytology in unselected thyroid nodules. Since ATA + is not responsible for increased false-positive class IV FNAC, our study provides indirect evidence supporting a significant association between thyroid carcinoma and thyroid autoimmunity, although further studies with a different design are needed for a definitive histological proof.

[Risk target effect on risk perception in an industrial area]

This study describes the results of a survey, carried out by the Department of Public Health between October and December 2002, about the perception of the main risk factors for health and environment in Portoscuso (Ca), an industrial area in south west of Sardinia, declared "Environmental high-risk area " with DPCM 23.04.1993. The aim of survey was to investigate the different risk perception between local and global level analyzed by McNemar test. The results showed that risk perception was significantly higher at global level. We didn't observe any difference about local problematics as industrial pollution, work accidents, acid rain, industrial accident. Regarding risk factors, as food safety and life style, the "unrealistic optimism effect" described by Sjöberg with people risk perception higher at global level, is confirmed. Perception of industrial risk, considered only similar and not higher than in other areas, is influenced by citizens' consciousness of living in an area declared at high risk of environmental crisis. These results should be taken into account in future risk communication process in order to avoid interpretation bias.

[Adherence to the screening program for HBV infection in pregnant women and application of the immunoprophylaxis protocol in babies born to HBV carrier women]

The aim of the study was to evaluate the frequency of the screening for HBV infection in pregnant women and the application of immunoprophylaxis in newborns to HBV carrier women. The study, carried out in 2001 for 2 months, involved 1596 pregnant women consecutively recruited in public and private hospitals of the Sardinia. Information has been collected by a questionnaire: 90.5% of the women underwent HBV screening during pregnancy and 2.6% of them were found positive to HBsAg test. Among the newborns to HBsAg carrier mothers, 89.2% received the immunoprophylaxis protocol (specific immunoglobulin and the first dose of vaccine within 24 hours from birth). Two variables resulted statistically associated with the lack of adherence to HBV screening: the original family size of women (more than 4 members in the household) and the delivery in a private hospital. These findings point out a satisfactory adherence to HBV screening during pregnancy and the application of immunisation protocol in most of the newborns to HBsAg carrier mothers. However, the increase of information programs turned to the population is required to reach the total application of the prevention tools available in Italian public health.

Case control study on health-related quality of life in adult coeliac disease

AIMS

To evaluate whether health-related quality of life in adult coeliac disease is related to: 1) adhesion to gluten-free diet; 2) manifestation of clinical features; and 3) associated diseases.

PATIENTS AND METHODS

A total of 68 coeliac patients (54 female and 14 male) aged between 18 and 74 years, on gluten-free diet for at least two years were studied. The subjective health status was measured by means of the Short Form 36 Health Survey. A series of 136 subjects, matched according to sex, age and ethnic group, were evaluated as control group.

RESULTS

Patients obtained worse scores with respect to healthy controls at all domains of Short Form 36 Health Survey (p<0.05); compliers showed better results than non-compliers. The lowest scores were obtained in patients with more than six symptoms, mostly in non-compliers, the highest in compliers with less than six symptoms. Patients with two or more associated diseases presented significantly worse scores than patients with only one associated disease.

CONCLUSIONS

The importance of gluten-free diet in clinical management of coeliac disease is confirmed by results of the present study; moreover, the results seem to indicate that a complex interplay of factors should be taken into account in evaluating health-related quality of life in adult coeliac disease. Accordingly, our data show that health-related quality of life of coeliac patients is impaired not only by poor compliance but also by different negative factors such as severity of illness (in terms of number of symptoms) at diagnosis and comorbidity.

[Mortality trends in Sardinia: 1965-1984]

An accurate epidemiological analysis plays an essential role for the proper formulation of health strategies. Mortality studies are still the most valid and reliable; so their preferential use is justified. In Italy the public health system is characterized by decentralization and local autonomy. This wide autonomy stresses the need for simple tools of epidemiological analysis that can be used by a large number of local health officers. The purpose of this research work is to describe the temporal changes in mortality rates in Sardinia for the years 1965 to 1984. The time series consist of yearly age-adjusted mortality rates in Sardinia from different causes of death. Since 1968 cerebrovascular diseases, which were once considered as diseases of nervous system, have been classified as cardiovascular diseases therefore we studied the two categories together in the assumption that the diseases of nervous system play an almost negligible role. The standardization has been carried out by the indirect method because the Sardinian age-specific mortality rates are not available for several years. The standard rates are the Italian age-specific death rates (0-14, 15-44, 45-64, 65 years) in 1981. Our model is based on the assumption that the time series result from a long term trend and some accidental factors. The time series have been studied using regression analysis techniques. The equation y = a exp (bx) defines an exponential model. The estimated mortality rates are denoted by the variable y. The variable x describes the time. We can define the constant b as force of increase; b is a valid measure of trend.(ABSTRACT TRUNCATED AT 250 WORDS)