Work after cancer-sickness absence. Barriers and facilitators from survivors’ perspective

 

People who have suffered from cancer find it difficult to return to work after a sickness absence (SA). Previous evidence indicates that people who survive a cancer have a higher risk than general population of leaving the labor market prematurely or being unemployed due to sequelae of both treatment and disease. Our objective is to identify barriers and facilitators associated with the return and permanence in the workplace of salaried workers after a SA due to cancer in Catalonia. The research used a descriptive qualitative approach with socio-constructivist perspective. A theoretical sampling was carried out until saturation. Three discussion groups (7 people/group) were conducted with people who had suffered a SA due to cancer in Catalonia. The sessions were held virtually and were recorded, transcribed verbatim, and analyzed using thematic analysis and mixed coding with Atlas.ti. Most of the people had returned to work after SA or were looking for a job that was suitable for their health status. Among the barriers to reincorporation to their job detected: (1) coping with the same workload they had before the SA, (2) sequelae associated with cancer treatment that affected their ability to work (stress, low ability to concentrate, chronic fatigue, mobility limitations), (3) having jobs with a high physical load, (4) expectations of colleagues and bosses. Among the facilitating factors: (1) sessions with psycho-oncologists, (2) availability of holidays to adapt their return after SA, (3) teleworking, and (4) job adaptation. Regarding proposals to improve this process, the most outstanding were the implementation of policies that allow a gradual return to work adjusted to the people who want to adhere to it and generalize the possibility of doing psycho-oncological therapy. End of SA after cancer is a key moment for people who go through it, they suffer many difficulties during the process that could be prevented with measures such as a gradual return to work.

Key messages

• Workers who suffer a SA due to cancer face difficulties on their return to work.

• Initiatives of adaptation and gradual reincorporation to the workplace could improve return to work process after a SA due to cancer.

One year of surgical mask testing at the University of Bologna labs: Lessons learned from data analysis

The outbreak of SARS-CoV-2 pandemic highlighted the worldwide lack of surgical masks and personal protective equipment, which represent the main defense available against respiratory diseases as COVID-19. At the time, masks shortage was dramatic in Italy, the first European country seriously hit by the pandemic: aiming to address the emergency and to support the Italian industrial reconversion to the production of surgical masks, a multidisciplinary team of the University of Bologna organized a laboratory to test surgical masks according to European regulations. The group, driven by the expertise of chemical engineers, microbiologists, and occupational physicians, set-up the test lines to perform all the functional tests required. The laboratory started its activity on late March 2020, and as of the end of December of the same year 435 surgical mask prototypes were tested, with only 42 masks compliant to the European standard. From the analysis of the materials used, as well as of the production methods, it was found that a compliant surgical mask is most likely composed of three layers, a central meltblown filtration layer and two external spunbond comfort layers. An increase in the material thickness (grammage), or in the number of layers, does not improve the filtration efficiency, but leads to poor breathability, indicating that filtration depends not only on pure size exclusion, but other mechanisms are taking place (driven by electrostatic charge). The study critically reviewed the European standard procedures, identifying the weak aspects; among the others, the control of aerosol droplet size during the bacterial filtration test results to be crucial, since it can change the classification of a mask when its performance lies near to the limiting values of 95 or 98%.

Bacterial co-infection at hospital admission in patients with COVID-19

Objectives

We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19.

Methods

Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included.

Results

A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57–3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69–4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11–2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19.

Conclusions

Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%.

Parents’ perception of overweight-obese children Quality of Life in different settings

Background

Children's Health-Related Quality of Life (HRQoL) has been frequently investigated, in particular among individuals affected by chronic diseases. It is reported that agreement between child and parent ratings regarding the child's HRQoL is strongly influenced by the latter's health status. To our knowledge, there is no evidence of how this agreement is related to different healthcare settings. Thus, our study aims to examine the relationship between child's and parent-proxy reported HRQoL of similar overweight/obese children according to the recruitment setting.

Methods

A cross-sectional study was conducted among 68 overweight/obese children, aged 6-10, recruited in a primary school (Group1, G1) and in a hospital outpatient clinic (Group2, G2) of Imola (Italy) in 2019. HRQoL was assessed using Italian version 4.0 of the Pediatric Quality of Life (PedsQL) questionnaire. For each child, we obtained self-reported children's and parents' perceived children's HRQoL total score (5 questions investigating Physical Health domain and 10 questions investigating Psychosocial Health domain divided in Emotional, Social and School Functioning).

Results

In G1 there were n = 42 overweight/obese children and in G2 n = 26. The correlation between children's reported and parents' perceived HRQoL scores is lower in G1 (Physical Health: r=-0,17; Psychosocial Health: r = 0.38) compared to G2 (Physical Health: r = 0.80; Psychosocial Health: r = 0.66). Notably, in G1, parents tend to overestimate their children's HRQoL, specifically in the Physical Health domain.

Conclusions

Correlation between children's and parents' HRQoL scores is higher in the clinical setting compared to the school setting. Implementing this questionnaire on a large scale would allow us to identify settings which need awareness-raising initiatives to improve parents' knowledge about their children's health.

Key messages

Parents’ overestimate children’s HRQoL in the school setting, particularly in the Physical Health domain. Children’s HRQoL misinterpretation might determine less targeted actions to improve their wellbeing and highlights the need for raising parents’ awareness about obesity and its effects on children.

Müllerian Adenosarcoma of the Uterus: A Report of 5 Cases

The clinicopathologic features of 4 cases of Müllerian adenosarcoma of the uterine body and 1 of the cervix are reported. They showed the characteristic pattern of benign epithelial growth within sarcomatous stroma. In the cervical tumor, malignant heterologous stromal cells were also present. All the patients are alive and well, confirming the good prognosis of this neoplasm. The authors think that the presence of a malignant heterologous component probably does not imply a worse prognosis.

Transient Optic Neuropathy Secondary to Mopp Chemotherapy in Hodgkin's Disease: Report of a Case

The authors describe a case of optic neuropathy in a child undergoing MOPP chemotherapy for Hodgkin's disease stage IIISA. Visual acuity improved after substitution of the aforementioned regimen with ABVD chemotherapy, and reached 1 during maintenance therapy with vinblastine. Various neurologic deficits have been ascribed to vincristine, a well-known neurotoxin. This case of optic neuropathy is supposed to be a rare example of involvement of the 2nd cranial nerve due to vinca alkaloids. The absence of neurotoxicity of vinblastine in this case is emphasized.

Variability of PM10 in industrialized-urban areas. New coefficients to establish significant differences between sampling points

One of the main problems that arise in the assessment of air quality in an area is to estimate the number of representative sampling points of each microenvironment within it. We present a new model that reduces the variability and increases the quality of the comparison of the sampling points. The study is based on the comparison between a city in eastern Spain, Vila-real, a macro city in México, Monterrey and the Piemonte region regarding the assessment of PM10 in microenvironments. Vila-real is located in the province of Castellón. This province is a strategic area in the framework of European Union (EU) pollution control. On the other hand, Monterrey in México, located in the northern state of Nuevo León, has several problems with particulate material in the atmosphere produced by the extraction of building materials in the hill that surround the city. Finally, the Piemonte region, which is located in the north of Italy, has to be in consideration due to higher concentrations of PM10 in the Po river basin. In the case of Vila-real the PM10 samples were collected by a medium volume sampler according to European regulations. Particle concentration levels were determined gravimetrically (EN 12341:1999). In the case of Monterrey the PM10 concentrations were determined by Beta Ray Attenuation according to US-EPA regulations. In the Piemonte region, the average concentration of PM10 was also obtained by means of the Beta Ray Attenuation as well as using gravimetric instruments. The methodology carried out in this paper is a useful tool for developing future Air Quality Plans in other industrialised areas.

COLONIZATION OF AMERICA BY DROSOPHILA SUBOBSCURA: LETHAL GENES AND THE PROBLEM OF THE O5 INVERSION

In this work, the process of colonization of North and South America by the species Drosophila subobscura has been studied by analyzing the variability of lethal genes. The genetic structures of a Palearctic natural central population (Bordils, Spain) and a colonizer population from America (Gilroy, California) have been compared. The frequencies of lethal chromosomes and their allelism are 29.007% and 0.0069 in the first population and 14.414% and 0.0526 in the American population. A founder effect is detected after the computation of some population parameters (N_e , h, he and the lethal load). Furthermore, the allelism of lethal chromosomes has revealed a strong association between a lethal gene and the O₅ inversion both in Gilroy and in the population of Puerto Montt (Chile). The interpopulation allelism shows that the O₅ arrangement from the USA and Chile is the same, confirming that the colonizing processes of North and South America are correlated. The O₅ arrangement can also be useful as a genetic marker to trace the origin of the colonization. The frequency of the O₅ arrangement in the original population of the colonization could be used to estimate the number of colonizers. This population is still unknown, but taking the extreme values of the frequency of the O₅ inversion in natural Palearctic populations (1-15%), the number of colonizers could vary between 9 and 149 individuals.

Human milk, a concrete risk for infection?

Breastfeeding should be considered a public health issue and the reference normative standards for infant feeding at least to the 6th month of life, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Numerous studies demonstrate that breastfeeding results in improved infant and maternal health. Moreover the reduction of the risk of severe retinopathy of prematurity, sepsis and necrotizing enterocolitis is particularly evident in preterm infants. There are a limited number of medical conditions in which breastfeeding is contraindicated, including some maternal infectious diseases. During breastfeeding the baby can be infected by mother's pathogens with several routes of transmission that can be considered, such as respiratory secretions and droplets (e.g. Adenovirus, Influenza virus, Respiratory Syncytial Virus, Haemophilus, Mycoplasma) direct contact with lesions in the breast and nipple (e.g. HSV 1-2, VZV, Treponema) and breast milk. Frequently, in case of infection, different routes of transmission are contemporary implicated. The basic assumption is that breastfeeding is rarely contraindicated during maternal infections, a few exceptions are HTVL-I and HIV in industrialized country. The theoretic risk for transmission trough breast milk should be discussed and balanced with the benefits of breast milk, so the mother and parents can make an informed decision concerning infant feeding.

Anatomical brain connectivity can assess cognitive dysfunction in multiple sclerosis

BACKGROUND

Brain disconnection plays a major role in determining cognitive disabilities in multiple sclerosis (MS). We recently developed a novel diffusion-weighted magnetic resonance imaging (DW-MRI) tractography approach, namely anatomical connectivitity mapping (ACM), that quantifies structural brain connectivity.

OBJECTIVE

Use of ACM to assess structural connectivity modifications in MS brains and ascertain their relationship with the patients' Paced-Auditory-Serial-Addition-Test (PASAT) scores.

METHODS

Relapsing-remitting MS (RRMS) patients (n = 25) and controls (n = 25) underwent MRI at 3T, including conventional images, T1-weighted volumes and DW-MRI. Volumetric scans were coregistered to fractional anisotropy (FA) images, to obtain parenchymal FA maps for both white and grey matter. We initiated probabilistic tractography from all parenchymal voxels, obtaining ACM maps by counting the number of streamlines passing through each voxel, then normalizing by the total number of streamlines initiated. The ACM maps were transformed into standard space, for statistical use.

RESULTS

RRMS patients had reduced grey matter volume and FA, consistent with previous literature. Also, we showed reduced ACM in the thalamus and in the head of the caudate nucleus, bilaterally. In our RRMS patients, ACM was associated with PASAT scores in the corpus callosum, right hippocampus and cerebellum.

CONCLUSIONS

ACM opens a new perspective, clarifying the contribution of anatomical brain disconnection to clinical disabilities in MS.

White matter damage along the uncinate fasciculus contributes to cognitive decline in AD and DLB

This study investigates the patho-physiological implications of the uncinate fasciculus (UF) in the two most common forms of dementia, namely Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Forty-five consecutive patients diagnosed with either probable AD or DLB, and 16 individuals with amnesic mild cognitive impairment (a-MCI) were investigated using diffusion tensor MRI. Thirteen healthy subjects (HS) were also studied as controls. In each subject, the UF was bilaterally reconstructed by probabilistic tractography. From each UF, macroscopic volume and correspondent fractional anisotropy (FA) (an index of microscopic white matter integrity) were derived for the whole tract, and for the frontal and temporal portion of the UF. No significant between-group volumetric differences were found. In contrast, FA values from the UF were reduced bilaterally in patients with dementia (either AD or DLB) compared to HS. In addition, patients with AD showed reduced FA values compared to those with a-MCI. No significant FA difference was found between AD and DLB patients, nor between a-MCI and HS. Finally, in all patients, UF FA values were associated with neuropsychological scores at tests exploring memory and executive functions. This study indicates that the UF is remarkably damaged in patients at the stage of dementia, independently from the diagnostic form. Moreover, this UF damage seems to be driven by temporal involvement in AD, for which a prodromal stage (a-MCI) is defined.

Challenge in differential diagnosis of a liver mass histologically defined as a metastatic lesion from an occult primary intestinal tumour. The importance of clinical findings and the limitations of histology and molecular profiles. A case report

Differential diagnosis of liver lesion in the absence of proven primary tumor is still a challenge. We experienced a case of an asymptomatic 14 cm lesion of right hemiliver in a 67 year-old man submitted to right hepatectomy in December 2010. One year before the patient underwent to endoscopic removal of a tubular adenoma of the right colon. Preoperative diagnosis was supported by ultrasound, CT scan, PET and liver biopsy. The patient received 6 cycles of preoperative chemotherapy (FOLFOX) with down-staging of the lesion diameter. Immunohistochemistry on the surgical specimen showed positivity for cytokeratins 19 and 20, CEA, MUC-2, negativity for cytokeratin 7 and a-fetoprotein. Moreover, the neoplastic cells showed a focal positivity with lower intensity for MUC-1 and MUC-5AC. The immunohistochemical profile suggested the possibility of a metastatic tumour from the large bowel, without excluding a primitive mucinous cholangiocarcinoma with intestinal phenotype. At 6 months after intervention, the patient was submitted to chemotherapy (FOLFOX). At present he is in good condition, without radiological signs of recurrence. Oncologists must evaluate the possible benefits of further adjuvant treatments based on the differential diagnosis between a primitive or metastatic liver tumour. In conclusion, correct diagnosis of liver masses is mandatory and remains a challenge that can differentiate either follow-up or surgical and adjuvant treatment. Histology and immunohistochemistry must be related to clinical findings as they may not always be sufficient to reach a correct final diagnosis, and can even be confusing. At present, molecular biology cannot be considered a helpful for diagnosis in these cases.

Multicentric/multifocal breast cancer with a single histotype: is the biological characterization of all individual foci justified?

BACKGROUND

Invasive multiple breast cancers with a single histological feature (MBCSH) are routinely assessed for biological parameters to indicate adjuvant treatments only in the largest invasive carcinomas. However, the heterogeneity of individual foci in multiple carcinomas has not been widely studied. We analyzed whether such biological features are differently expressed in different MBCSH foci.

PATIENT AND METHODS

One hundred and thirteen invasive MBCSH were tested over a 5-year period. The expression of estrogen (ER) and progesterone (PgR) receptors, Ki-67 proliferative index, expression of HER2 and tumor grading were prospectively determined in each tumor focus, and mismatches among foci were recorded.

RESULTS

Mismatches in ER status were present in 5 (4.4%) cases and PgR in 18 (15.9%) cases. Mismatches in tumor grading were present in 21 cases (18.6%), proliferative index (Ki-67) in 17 (15%) cases and HER2 status in 11 (9.7%) cases.

CONCLUSIONS

In our experience, invasive MBCSH showed heterogeneity among foci. In our clinical practice, such assessment led to 14 (12.4%) patients receiving different adjuvant treatments compared with what would have been indicated if we had only taken into account the biologic status of the primary tumor.

P1-12-17: Fluorescent In Situ Hybridization Evaluation of HER2 Status in Tumors with Chromosome 17 Polysomy

Introduction: According to the American Society of Clinical Oncology-College of American Pathologists recommendations for HER2 testing, a positive fluorescent in situ hybridization (FISH) result is defined as &gt;6 HER2 gene copies/nucleus (for test systems with no internal control probe [single-color]) or as HER2 gene/chromosome 17 centromere (CEP17) ratio &gt; 2.2 (for systems with an internal control probe [dual-color]). Although an increase in CEP17 copy number (average ≥ 3.0 copies/nucleus) is commonly considered to represent polysomy of chromosome 17, it can also be a result of gains of 17q with centromere involvement, or amplification of the centromeric region. The classification of HER2−positive tumors according to the HER2/CEP17 ratio may therefore misclassify a fraction of truly amplified cases as polysomic. We prospectively evaluated tumors with chromosome 17 polysomy but no HER2 amplification to assess HER2 status using the above two FISH classifications and immunohistochemistry (IHC).

Materials and methods: Tumors were tested for gene amplification by FISH with probes to HER2/neu and CEP17 using the PathVysion HER-2 DNA Probe Kit (Vysis). Classification was based on the HER2/CEP17 ratio (amplified when &gt; 2.2) and average HER2 gene copy number/nucleus (amplified when &gt; 6 copies). Both polysomic and equivocal cases (HER2/CEP17 ratio 1.8 - 2.2) were further studied by IHC using the HercepTest (Dako) with 0–3 scoring system (overexpression when 3+).

Results: From March 2010 to May 2011 we evaluated 31 primary breast cancers showing chromosome 17 polysomy. Median HER2/CEP17 ratio was 1.3 (range 0.5−1.9), median HER2 copy number was 5.4 (range 2.6−13.8), and median CEP17 copy number was 4.2 (range 3.2−8.0). Thirteen (42%) had an average HER2 gene copy number &gt; 6/nucleus (median 6.8, range 6.1−13.8) and would therefore be considered as amplified if classified according to the absolute HER2 gene copy number. Nine (75%) of these were 3+ at IHC and the remaining 4 were 2+, whereas among the 18 cases with an average HER2 gene copy number &lt; 6/nucleus, one was 2+, ten were 1+, and 7 scored 0. Twenty-nine cases showed negative HER2/CEP17 ratios (&lt; 1.8) and three cases equivocal HER2/CEP17 ratios (between 1.8 and 2.2). Using HER2/CEP17 ratio as first assessment and IHC only in equivocal cases, only one of the 31 “polysomic” cases would have been classified as HER2−positive. However, 8 polysomic cases with HER2/CEP17 ratio &lt; 1.8 showed 3+ immunostaining (all with average HER2 gene copy number &gt; 6/nucleus), while 3 other cases had an average HER2 gene copy number &gt; 6/nucleus with 2+ immunostaining.

Conclusions: Our results show that both FISH evaluation criteria and IHC can modify the percentage of polysomic tumors classified as HER2−positive. However, the number of gene copies/nucleus appears more frequently associated with 3+ IHC than the HER2/CEP17 ratio. The predictive impact of the former method on response to anti-HER2 treatments warrants further investigation.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-17.

P2-01-15: RT-PCR Gene Profiling for the Prediction of Bone Metastases in Primary Breast Cancer

Background: Patients with breast cancer frequently develop bone metastases, which are responsible for high morbidity and mortality. It is known that numerous molecules are involved in the bone metastasization process and that only cancer cells with a specific molecular profile are capable of reaching and colonizing bone tissue. The early detection of patients with a high probability of relapsing to bone could be used to select candidates for tailored therapy with bone-specific drugs such as bisphosphonates or RANK-L inhibitors. The aim of the present study was to identify a pattern of tissue markers from primary breast cancer capable of predicting bone metastatization.

Material and methods: The expression of different markers was retrospectively analyzed in frozen breast cancer tissue samples from 40 patients comprising 15 cases with no evidence of disease (NEDP), 15 with bone metastases (BMP), and 10 with visceral metastases (VMP). Twelve transcripts were analyzed by Quantitative Real time PCR: trefoil factor 1(TFF1), DKK1, bone sialoprotein (IBSP), heparanase (HPSE), osteopontin (SPP1), Agr2, SPARC, CTGF, COMP, follistatin (FST), osteoprotegerin and RANK. The predictive accuracy of each marker was calculated using receiver operating characteristic (ROC) curves.

Results: Analysis of marker expression in the 3 different subgroups showed twofold higher median values of COMP and HPSE in BMP with respect to either NEDP or VMP (no significant difference). Furthermore, TFF1 median value was about sevenfold higher in BMP than in the other 2 subgroups (p=0.05). The area under the curve (AUC) was 0.73 for TFF1 and 0.62 for COMP and HPSE. Considering markers as dichotomous variables, TFF1 expression in BMP reached 67% compared to 21% and 20% in NEDP and VMP, respectively. In dichotomous variable analysis, the most important result was observed for TFF1; in particular, TFF1 positivity was observed in 67% of cases in the BMP subgroup compared to only 21% and 20% in NEDP and VMP, respectively. The combination analysis of TFF1 and other markers showed that positivity to at least one of the three markers, TFF1, DKK1, or IBSP, was observed in 80% of cases for the BMP group, and in only in 21% and 20% of cases in NEDP and VMP subgroups (p=0.041). Another interesting marker was RANK: although sensitivity was fairly low (12%), specificity reached 100% in both control groups.

Conclusions: Our preliminary study identified a RT-PCR gene expression pattern in primary breast cancer that could predict patients destined to bone relapse. Such patients could consequently benefit from adjuvant treatment with bone-targeted therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-01-15.

Interference of Fano-Rashba conductance dips

We study the interference of two tunable Rashba regions in a quantum wire with one propagating mode. The transmission dips (Fano-Rashba dips) of the two regions either cross or anti-cross, depending on the distance between the two regions. For large separations we find Fabry-Perot oscillations due to the interference of forwards and backwards propagating modes. At small separations overlapping evanescent modes play a prominent role, leading to an enhanced transmission and destroying the conductance dip. Analytical expressions in scattering matrix theory are given and the relevance of the interference effect in a device is discussed.

Regional brain atrophy and functional disconnection across Alzheimer's disease evolution

OBJECTIVE

To assess the contribution of regional grey matter (GM) atrophy and functional disconnection in determining the level of cognitive decline in patients with Alzheimer's disease (AD) at different clinical stages.

METHODS

Ten patients with amnesic mild cognitive impairment (a-MCI), 11 patients with probable AD and 10 healthy controls were recruited. T1 volumes were obtained from each subject and postprocessed according to an optimised voxel based morphometry protocol. Resting state functional MRI data were also collected from the same individuals and analysed to produce connectivity maps after identification of the default mode network (DMN) by independent component analysis.

RESULTS

Compared with healthy controls, both AD and a-MCI patients showed a similar regional pattern of brain disconnection between the posterior cingulate cortex (PCC) and the medial prefrontal cortex and the rest of the brain. Conversely, the distribution of GM atrophy was significantly more restricted in a-MCI than in AD patients. Interestingly, the PCC showed reduced connectivity in a-MCI patients in the absence of GM atrophy, which was, in contrast, detectable at the stage of fully developed AD.

CONCLUSIONS

This study indicates that disconnection precedes GM atrophy in the PCC, which is a critical area of the DMN, and supports the hypothesis that GM atrophy in specific regions of AD brains likely reflects a long term effect of brain disconnection. In this context, our study indicates that GM atrophy in PCC accompanies the conversion from MCI to AD.

Abstract P1-13-04: Immunohistochemical Evaluation of RANK/RANKL/OPG Axis and CXCR4 in Primary Breast Cancer and Their Role in Bone Metastasization

Background: The RANK/RANKL/OPG axis plays an important role in the bone metastasization process. CXCL12 is overexpressed in bone and, like its receptor, CXCR4, is a determinant of organ tropism. The objective of the present study was to evaluate whether the expression of these markers in primary breast cancer can predict the onset of bone metastases. Methods: Marker expression was evaluated by immunohistochemical staining in paraffin-embedded sections of primary breast cancers from 40 individuals: 10 patients (median age 64 years, range 48-78) showed no evidence of disease (NED — control group) at a median of 9.8 (range 6.9-11.5) years, while 30 (median age 67 years, range 42-87) had relapsed. In the latter group, 10 (median age 66 years, range 42-87) had visceral metastases (VM — control group) and 20 (median age 69 years, range 42-87) had bone metastases (BM — case group), both confirmed radiologically. The 3 patient subgroups (NED, visceral lesions, bone lesions) were matched for age classes (≥60 years, &gt; 60 years). The study design was reviewed and approved by the local ethics committee.

Results: In the overall series, 17.5% of tumors were positive for RANK, 22.5% for OPG and 25% for CXCR4. None of the patients expressed RANKL. RANK and OPG resulted equally expressed in 20% of NED patients, while CXCR4 was expressed in only 10% of this group. OPG was expressed in 20% of VM patients, whereas RANK or CXCR4 were not detected. RANK and OPG positivity was present in 25% of BM patients, while CXCR4 was expressed in 45% of cases. CXCR4 was the only marker with a significantly higher frequency of expression in bone metastases than in visceral lesions (p=0.013). Taking into consideration all the patients without bone involvement (NED plus VM patients), it was observed that CXCR4 expression, alone and in combination with RANK, significantly discriminated between BM patients and the control group (p=0.008 and P&lt;0.001, respectively). ER-positivity and HER2-negative status were observed in 80% and 95% of BM patients, respectively, but neither discriminated between cases and controls. Conclusions: In our study, ER-positivity and HER2- negativity identified a high percentage of bone relapse patients, but also highlighted patients who did not have bone involvement. RANK and CXCR4 expression, on the other hand, would appear to be a more accurate predictor of bone relapse. Such evidence could help to identify patients with a high probability of developing bone metastases, which can be treated with bisphosphonates or other bone-targeted therapies, such as denosumab, in an attempt to prevent distant metastases. Our results are currently being validated in a larger series of breast cancer patients.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-13-04.

Abstract P6-05-02: Clinical-Pathological Features of All Nodules with the Same Histotype Affect Systemic Adjuvant Treatment Decision in Multifocal and Multicentric Breast Cancer

BACKGROUND

Decision criteria about systemic adjuvant treatment of patients affected by breast cancer include estrogen receptor (ER), progesterone receptor (PgR), HER2 status, histologic grading, and proliferative index. In case of multifocal or multicentric breast cancer, the College of American Pathologists (CAP) recommends to provide features for the largest invasive carcinoma. We evaluated the discordance of ER, PgR, HER2, grading, and proliferative index among all nodules with the same histotype of patients with multifocal or multicentric breast cancer and the impact on the choice of adjuvant treatment. METHODS

We retrospectively analyzed 113 consecutive patients operated for breast cancer between 2004 and 2009 in Forli (Italy). We performed histological examination of all nodules of each patient after surgery, at the same time. Immunohistochemical methods were used to detect ER/PgR status, and proliferative index (Ki67), whereas fluorescent in situ hybridization was used to determine HER2 status. ER/PgR &lt; 10% was considered negative. Ki67 was considered high if ≥20%. Grading was determined according to Nottingham's score system. HER2 amplification was defined according to CAP guidelines or as the presence of a focal HER2 amplified clone ≥30% of tumor cells. We considered as “discordance” a difference in at least one nodule for any of the biologic features considered. In order to determine whether discordance among nodules affects systemic treatment approaches, we asked ten independent oncologists whether and how they would modify their prescribed adjuvant treatment. RESULTS

Discordance in ER or PgR status among different nodules was detected in 5 (4.4%) and 16 patients (14.1%), respectively. The majority of the oncologists (7 out of 10) decided to modify their prescribed systemic treatment in 3 patients (2.6%), in favor of a combined treatment (endocrine plus chemotherapy), instead of endocrine-or chemotherapy alone as if their decision was based on the receptor status only of the largest nodule. Discordance in HER2 status was detected in 10 (8.8%) patients. In 4 patients (3.5%), all clinicians found indication to an anti-HER2 treatment. Discordance in proliferative index occurred in 17 (15.0%) patients and discordance in grading was detected in 18 (17.8% over 101) patients. Five of ten oncologists decided to modify their prescribed systemic treatment by adding chemotherapy to endocrine-therapy alone in 5 patients (4.4%) based on Ki67 value, whereas there was no change based on grade. DISCUSSION

This study shows a discordance for all analyzed histological features among different nodules with the same histotype in multifocal and multicentric tumors. In a total of 8 patients (about 7%) this discordance affected the therapeutic decisions of oncologists, resulting in changes of the prescribed adjuvant systemic treatment, with respect to the prescriptions based on the clinicopathologic features only of the largest nodule. Therefore, we conclude that the analysis of all nodules in case of multifocality/multicentricity should be taken into consideration, in order to identify the best adjuvant treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-05-02.

Sex-related variation in migration phenology in relation to sexual dimorphism: a test of competing hypotheses for the evolution of protandry

Timing of arrival/emergence to the breeding grounds is under contrasting natural and sexual selection pressures. Because of differences in sex roles and physiology, the balance between these pressures on either sex may differ, leading to earlier male (protandry) or female (protogyny) arrival. We test several competing hypotheses for the evolution of protandry using migration data for 22 bird species, including for the first time several monochromatic ones where sexual selection is supposedly less intense. Across species, protandry positively covaried with sexual size dimorphism but not with dichromatism. Within species, there was weak evidence that males migrate earlier because, being larger, they are less susceptible to adverse conditions. Our results do not support the 'rank advantage' and the 'differential susceptibility' hypotheses, nor the 'mate opportunity' hypothesis, which predicts covariation of protandry with dichromatism. Conversely, they are compatible with 'mate choice' arguments, whereby females use condition-dependent arrival date to assess mate quality.

Colonization of America by Drosophila subobscura: Experiment in natural populations that supports the adaptive role of chromosomal-inversion polymorphism

North America and South America have recently been colonized by the Palearctic species Drosophila subobscura. This double colonization offers a rare opportunity for evolutionary studies. Correlations between chromosomal arrangement frequencies and latitude were calculated for the colonizing populations. Signs of these correlations are highly coincident with those found in the Old World. These results provide experimental support for the adaptive value of the chromosomal-inversion polymorphism; historical and other nonadaptive explanations are thus excluded or relegated to a secondary role.

Focus on pandemic 2009 H1N1 influenza (swine flu)

At the moment of the onset of the pandemic there were few data about the transmission of the 2009 H1N1 virus infection from the mother to the newborn. Nevertheless neonates born to an ill mother from 2 days before through 7 days after illness onset in the mother were thought to be exposed and potentially infected. In October 2009 the Infectious Disease Group of the Italian Society of Neonatology provided a guide regarded the management of suspected or confirmed maternal infection with 2009 H1N1 influenza virus within labor and delivery, postpartum, and newborn care settings in hospitals. It was based on the available scientific information, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Italian Ministry of Labour, Health and Social Policy recommendations in order to protect the infant from exposure to respiratory secretion during or immediately after delivery. Moreover, we published 300,000 copies of a more popular pamphlet for parents. Rigorous attention to Standard Precautions and Droplet Precautions is required to reduce the opportunities for the transmission of the infection in the health-care setting.

[Myofascial pain syndrome in the pelvic floor: a common urological condition]

INTRODUCTION

Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed.

OBJECTIVES

To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment.

MATERIALS AND METHODS

We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like.

RESULTS

We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment.

CONCLUSION

It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Single domain amnestic MCI: a multiple cognitive domains fMRI investigation

Amnestic mild cognitive impairment (a-MCI) is associated with the highest annual incidence of conversion to Alzheimer's disease (AD) (10-15%). a-MCI patients may have only a memory deficit (single domain: sd-a-MCI) or additional dysfunctions affecting other cognitive domains (multiple domain: md-a-MCI). Using functional magnetic resonance imaging (fMRI), we investigated brain activation in 16 sd-a-MCI patients and 14 controls during four different tasks assessing language, memory, attention and empathy functions. We found greater activation in sd-a-MCI compared with controls in the left inferior temporal gyrus (language), the right superior temporal gyrus (memory) and the right dorsal precentral gyrus (attention). Moreover, patients' activation correlated significantly with neuropsychological scores obtained at tests exploring the corresponding function. These findings indicate that fMRI is sensitive to detect early changes occurring in AD pathology and that individuals with sd-a-MCI show increased activation in multiple task-related brain regions. We suggest that these functional changes relate to the development of early compensatory mechanisms that reduce cognitive deficits associated with the progressive accumulation of brain damage.