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This review focuses on the mechanisms determining bone fragility in patients with type 2 diabetes mellitus (T2DM). Despite bone mineral density (BMD) is usually normal or more often increased in these patients, fracture incidence is high, probably because of altered bone ”quality”. The latter seems to depend on several, only partly elucidated, mechanisms, such as the increased skeletal content of advanced glycation end-products causing collagen deterioration, the altered differentiation of bone osteogenic cells, the altered bone turnover and micro-architecture. Disease duration, its severity and metabolic control, the type of therapy, the presence or absence of complications, as like as the other known predictors for falls, are all relevant contributing factors affecting fracture risk in T2DM. In these patients the estimate of fracture risk in the everyday clinical practice may be challenging, due to the lower predictive capacity of both BMD and risk factors-based algorithms (e.g. FRAX). [ABSTRACT FROM AUTHOR]

Abstract: In the last decade the radial access use in the catheterization laboratory has sensibly grown up worldwide. From an initial sporadic use as alternative but challenging vascular approach, radial artery is today utilized by default for percutaneous procedures in many centers. The tangible interest in the transradial approach is also testified by increasing presence of specific sessions in the main interventional meetings and by continuous development of dedicated catheters and ancillary devices by manufacturers. In this review we describe the anatomical characteristics and the technical aspects related to transradial procedure underlying its pros/cons in opposition to femoral access. We also point up practical instructions trying to resolve the main concerns related to an extensive use of radial approach in catheterization laboratory, such as increased operator''s discomfort, higher radiation exposure, safety and feasibility for complex high-risk procedures. [Copyright &y& Elsevier]

Tumor phenotype may change during breast cancer (BC) progression and discordance between primary and metastases ranges between 16% and 21% for Hormone Receptor (HR) expression in some series. The impact of this change on patient (pts) management and outcome is not yet clear, even though preliminary data indicate that the molecular characterization of recurrent breast cancer may induce clinicians to modify the treatment choice in ∼14% of the cases and that a change in the receptor status is associated with poorer survival. This analysis evaluates the prognostic impact of receptor discordance between paired primaries and recurrences. We used data of 879 pts of the longitudinal cohort AMBRA study, identifying 3 different groups: Group A: HR+ BC remaining HR+ at relapse; Group BHR+ BC becoming TNBC; Group C:TNBC remaining TNBC. Change in HR status was evaluated on the biopsy done at the moment of relapse. Time to event was evaluated by Cox-Mantel Hazard Ratio and Logrank Test; Mean/median by Wilcoxon Rank-Sum Test. Pts who underwent biopsy at the time of relapse were 545/879 (62%), of those 462 (84.4%) were classified as Luminal tumors and 83 (15.2%) TNBC on primary. Change in tumor phenotype occurred in 31 (6.7%) of Luminal BC and 16 (19.3%) TNBC, probably due to a higher genomic instability (p = 0.021). Median DFS between Luminal BC was not different: HR+àHR+: 74.56 months (95%CI 66.8-82.1) vs HR+àTNBC: 89.73 months (95%CI:44.73-103.46). Table summarizes main data in time to event in the 3 identified groups. *PFS at 1strelapse; **PFS at 2nd relapse; ***Time to Treatment Change at 1strelapse; °OS at 1strelapse; §OS from 1stPD. Table 325P Table HR+/HR + (range) Group A HR+/TNBC (range) Group B p value Group A vs C TNBC/TNBC (range) Group C PFS1* (months) 13.65 (0,77-162,03) 9.45 (3,97-52,73) 0.36 8.13 (6.3-10.9) PFS2** (months) 6.83 (0,00-57,13) 6.12 (2,67-26,30) 0.84 4.20 (0,33-22,17) TTC1*** (months) 12.43 (0,13-163,10) 8.88 (0,00-48,40) 0.50 7.88 (0,23-27,80) TTC2**** (months) 7.45 (0,00-55,97) 6.73 (3,77-26,80) na na OS1° (months) 23.1 (20-26) 15 (8.7-26.3) 0.031 3.60 (0,60-25,38) OS (years) 8.52 (0,26-115,92) 7.86 (0,19-30,67) 0.43 3.58 (2.91-2.39) OS from PD1§ (months) 25.8 (0,00-207,53) 17.23 (2,67-104,30) 0.82 17.90 (2,37-53,57) Change in tumor phenotype has a significant impact on OS; BC pts who become TNBC at relapse should be treated in the same way as TNBC pts at diagnosis. Anyway, OS of Luminal BC who change phenotype seems to be better than TNBC. GIM - Gruppo Italiano Mammella. Celgene. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]