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The authors evaluated the relative risk of developing radiation-induced breast cancer (BC) in women treated with radiotherapy for Hodgkin's disease (HD) and analysed the imaging features of these breast neoplasms.We retrospectively studied 54 women who had all undergone radiotherapy between 1980 and 2010 (median age, 36.6 years). Women aged ≤30 years were screened with clinical breast examination, ultrasound (US) and, if necessary, mammography; women30 years had clinical breast examination, US and mammography. Three women underwent magnetic resonance (MR) imaging as well.Mammography detected seven invasive breast cancers in 6/54 women (11.1%). Median age at diagnosis was 26.1 years for HD and 42.4 for breast cancer. Breast cancer was diagnosed following a median latent period from radiotherapy of 15.1 years. Mean radiation dose was 37.6 Gy in women who developed breast cancer and 31.3 Gy in the other women.In our study, women who were exposed to radiation for HD had a 6.2-fold higher risk of developing breast cancer than the general population. In consideration of the young age and high breast density, women aged ≤30 years should be monitored by US and MR imaging; women aged30 years should be monitored by US, mammography and, when necessary, MR imaging.

Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size. We retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality. The median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77). DBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.

Nell’annullamento della condanna di Amanda Knox e Raffaele Sollecito un ruolo centrale è stato assunto da alcune questioni connesse alla interpretazione delle tracce di DNA. L’articolo si focalizza su alcuni passaggi della sentenza della Corte di Cassazione con specifico riferimento all’utilizzo e alla valutazione della prova genetica.

We set out to describe 17 patients with septo-optic dysplasia (SOD), focusing on the little-explored neurological, cognitive, and neuro-ophthalmological components. A further aim was to identify possible clinical correlations and phenotypic characteristics within the diagnostic spectrum.We collected clinical-instrumental data (from the history, general and neurological examination, developmental assessment, and neuro-ophthalmological, neuroradiological, neurophysiological, and endocrinological evaluations) on nine males and eight females (mean age 34.4mo, SD 31.6; range 4mo-9y 6mo) diagnosed with SOD who were referred to our Centre of Child Neuro-ophthalmology between 1999 and 2010.We observed a heterogeneous clinical spectrum characterized by nervous system, visual, and endocrine dysfunctions; optic nerve involvement was present in all 17 children, midline brain defects in 14, and cortical developmental malformations in seven. Developmental/cognitive delay and relational and communication difficulties were observed in eight and seven children, respectively, and reduced visual acuity and oculomotor dysfunction were observed in all. Pituitary hormone deficiencies were present in nine children.Nervous system involvement emerged as a key feature of SOD. As part of a holistic approach to the disease, particular attention should be paid to this aspect. The emergence of new clinical correlations and correlations between clinical features and three SOD subtypes opens the way for better clarification of this disease and, therefore, more targeted diagnosis, follow-up, and care of affected children.

Diastereomers made to order: In an unprecedented ligand-controlled process a racemic mixture of four stereoisomers can be converted with high selectivity into each one of the diastereomers of the product, at will (see scheme). The mechanism of this deracemization of epimers, that is, a de-epimerization, was also studied.

Objectives: Lymphocytic gastritis (LG) has been reported in patients with celiac disease (CD). The aim of the present study was to evaluate gastric mucosa involvement in celiac children and gastroenterological controls (GC). Methods: In a retrospective study on 226 patients with CD (82M; median age: 5.7years) at diagnosis and 154 GC (66M; median age: 7.4 years), the evaluation of gastric and duodenal mucosa was performed. CD was diagnosed according to the North America Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Gastric lesions were classified according to Updated Sydney System. Anti-gastric parietal cell antibodies (GPCA) were assayed by enzyme-linked immunosorbent assay. Results: A total of 21.2% and 7% of patients with CD showed chronic superficial gastritis (CSG) and LG, respectively. Helicobacter pylori (Hp) infection was found in 6 (2.7%) children with CD (66.7% had CSG, 16.7% LG, and 16.7% interstitial gastritis). CSG was present in 21.4% of controls. No control subject showed LG. Hp infection was found in 24 (15.6%) childrenwithGC(91.7%hadCSG).AmongpatientswithCSG,Hpinfection was more frequent in controls than in celiac children (P

Obiettivi: costruire e sperimentare un modello per lo studio della qualità percepita dai pazienti affetti da HIV/AIDS.Metodi: è stato condotto uno studio di tipo osservazionale descrittivo mediante un’indagine con l’utilizzo di un questionario di soddisfazione presso il Servizio di diagnosi e terapia dell’AIDS dell’UOA di Malattie Infettive dell’ASO “Maggiore della Carità” di Novara. I dati sono stati analizzati mediante l’analisi fattoriale e l’analisi dei cluster.Risultati: il campione è stato rappresentato da 62 soggetti (35 uomini e 27 donne, età media di 39,40 anni). Sono stati identificati tre fattori principali determinanti la soddisfazione dei pazienti: l’assistenza infermieristica (che ha spiegato il 24,03% della variabilità delle risposte), l’assistenza medica (21,18%) e l’organizzazione del servizio (22,22%). Nel dettaglio livelli di soddisfazione elevati sono stati registrati per la qualità dell’assistenza del personale, la competenza dei medici ed il funzionamento della terapia, mentre i più bassi sono stati misurati per il rispetto della privacy e la disponibilità di servizi accessori. L’analisi dei cluster ha permesso di aggregare gli utenti in 3 gruppi in base al livello di soddisfazione. I fattori che hanno maggiormente determinato il diverso livello di soddisfazione misurato nei tre gruppi sono stati: la prima accoglienza presso il servizio, il livello di informazione ricevuto e l’efficacia nel controllo del dolore e dei sintomi.Conclusioni: il modello di analisi adottato ha reso possibile l’identificazione dei determinanti della soddisfazione degli utenti afferenti al servizio, evidenziando gli elementi di criticità del percorso assistenziale. I risultati hanno dimostrato la necessità per gli studi di valutazione della qualità percepita di adottare i metodi e gli strumenti della ricerca quantitativa.

Obiettivi: quantificare i livelli di inappropriatezza delle richieste di consulenza dermatologica definendone l’impatto economico ed identificandone i determinanti. Metodi: è stata condotta un’indagine censuale riguardante gli accessi per patologia dermatologica presso il DEA dell’ASO di Novara. I criteri utilizzati per la definizione del livello di appropriatezza delle richieste di consulenza sono stati il codice di triage e il giudizio di un team di osservatori medici. La valutazione dei livelli di variabilità diagnostica è stata effettuata mediante il calcolo della concordanza tra diagnosi del pronto soccorso e del dermatologo, utilizzando come misure sensibilità, valore predittivo e K di Cohen. La valutazione economica è stata effettuata utilizzando la metodologia dell’Activity Based Costing. Risultati: sono state acquisite e valutate 1750 richieste di consulenza. Le richieste sono risultate inappropriate nell’87,64% dei casi. L’analisi economica ha permesso di quantificare in circa ¤9 ad accesso l’impegno sostenuto dall’azienda per ogni consulenza prestata; il costo complessivo delle prestazioni erogate è risultato pari a ¤12340,5. I livelli di concordanza sono risultati generalmente bassi, e il 40,88% delle diagnosi non concordanti era attribuibile ad errore diagnostico grave. L’inappropriatezza della prestazione è risultata condizionata dalla diagnosi e dal momento dell’accesso: eczema ed orticaria aumentano di 45 e 15 volte il rischio di inappropriatezza, mentre l’accesso in fascia oraria notturna dimezza tale rischio e l’ustione lo diminuisce di circa 5 volte.Conclusioni: I determinanti degli elevati livelli di inappropriatezza delle richieste di consulenza osservati sono stati individuati nell’insufficiente azione di filtro dei MMG, nelle richieste incongrue da parte dell’utenza e nell’incertezza professionale dei medici di PS; in particolare quest’ultima ipotesi trova riscontro nei risultati dell’analisi della concordanza diagnostica. L’impatto economico delle prestazioni inappropriate è stato relativamente contenuto. Gli interventi ipotizzabili necessitano di un approccio articolato, clinico ed organizzativo; in particolare potrebbe risultare utile l’introduzione della teledermatologia a livello territoriale.

Doubly stabilized sulfonium ylides undergo an intra- or intermolecular coupling reaction with alkynes in the presence of modified gold catalysts.

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Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Radial scar (RS), also known as complex sclerosing lesion, is a well recognized radiological and pathological entity. It is a benign breast lesion seen histologically as a radially symmetric finding characterized by a fibro-elastotic core which may...

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: The accuracy of breast cancer staging involves the estimation of the tumor size for the initial decision-making in the treatment. Indeed, the accurate assessment of breast cancer size is important as a determinant of primary therapeutic options and...

Your wish is my command: Deracemization is a powerful strategy wherein a racemate is converted into a 100 % yield of a single enantiopure product. A new concept in catalytic deracemization is presented, in which a racemate with n stereogenic elements can be selectively converted into each one of 2(m) (m = number of chiral centers of the product) different enantiopure products, by simple tuning of the reaction conditions.

This review is a detailed account of authors’ work in the field of biomimetic cyclization of geraniol-like dienes. The very high regio- and enantioselectivity achieved made these elegant reactions ...

Azlactones participate in stereoselective reactions with electron-deficient alkenes and N-sulfonyl aldimines to give products of 1,3-dipolar cycloaddition and Mannich addition reactions, respectively. Both of these reactions proceed with good to excellent diastereo- and enantioselectivity using a single class of gold catalysts, namely C2-symmetric bis(phosphinegold(I) carboxylate) complexes. The development of the azlactone Mannich reaction to provide fully protected anti-α,β-diamino acid derivatives is described. 1,3-Dipolar cycloaddition reactions of several acyclic 1,2-disubstituted alkenes and the chemistry of the resultant cycloadducts are examined to probe the stereochemical course of this reaction. Reaction kinetics and tandem mass spectrometry studies of both the cycloaddition and Mannich reactions are reported. These studies support a mechanism in which the gold complexes catalyze addition reactions through nucleophile activation rather than the more typical activation of the electrophilic reacti...

The high prevalence of celiac disease (CD) prompted us to evaluate a new, noninvasive disease screening strategy. The aim was to identify CD in 6- to 8-year-old children for a timely diagnosis, start gluten-free diet (GFD) in compliant subjects, achieve the growth target, and prevent CD complications.Five thousand subjects were invited to participate in the study. Four thousand forty-eight saliva samples were tested for anti-tissue transglutaminase (tTG) immunoglobulin (Ig)A using a fluid-phase radioimmunoprecipitation method. Positive children were tested for serum radioimmunoassay tTG IgA, enzyme-linked immunosorbent assay tTG IgA, and anti-endomysium IgA. Children confirmed as positive by serum assays underwent endoscopy with duodenal biopsies and, at the diagnosis of CD, were suggested to start GFD.Consent was obtained from 4242 parents (84.8%) for the screening to be performed, and adequate saliva samples were collected from 4048 children (95.4%). Thirty-two children were found to be salivary tTG IgA positive and 9 with borderline autoantibody levels. Thirty-one of the 32 and 3 of the 9 subjects were also serum positive. Twenty-eight children showed villous atrophy when undergoing intestinal biopsy, whereas 1 had Marsh 1 lesions; 3 children were suggested to start GFD without performing endoscopy. CD prevalence in the population investigated (including 19 CD known cases) was 1.16%. The ratio between screening-detected patients and those diagnosed before the screening was 3:2. The ratio between symptomatic and asymptomatic patients was 1:1.6.We demonstrated that it is possible to perform a powerful, simple, well-accepted, and sensitive CD screening using saliva. Until now, the compliance with GFD in children with CD has been optimal.

The authors sought to evaluate the diagnostic accuracy and cost-effectiveness of vacuum-assisted core biopsy (VACB) in comparison with diagnostic surgical excision for characterisation of nonpalpable breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) categories R3 and R4.From January 2004 to December 2008, we conducted 602 stereotactic, 11-gauge, VACB procedures on 243 nonpalpable breast lesions categorised as BI-RADS R3, 346 categorised as BI-RADS R4 and 13 categorised as BI-RADS R5. We calculated the diagnostic accuracy and cost savings of VACB by subtracting the cost of the stereotactic biopsy from that of the diagnostic surgical procedure.A total of 56% of the lesions were benign and required no further assessment. Lesions of uncertain malignant potential (B3) (23.6%) were debated at multidisciplinary meetings, and diagnostic surgical biopsy was recommended for 83.1% of them. All malignant lesions (B4 and B5) underwent surgical excision. VACB had a sensitivity of 94.9%, specificity of 98.3% and diagnostic accuracy of 97.7%. The cost savings per VACB procedure were 464.00 euro; by obviating 335 surgical biopsies, the overall cost savings was 155,440.00 euro over 5 years.VACB proved to have high diagnostic accuracy for characterising abnormalities at low to intermediate risk of malignancy and obviated surgical excision in about half of the cases, allowing for considerable cost savings.

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Dynamic breast magnetic resonance imaging (MRI) is the most sensitive modality for the detection, diagnosis and staging of breast cancer. Enhancement kineticsand lesion morphology areimportant for an accurate diagnosis [1-7]. Moreover, in recent...

A new atom-economical method for the synthesis of functionalized cyclobutenes is developed.

Background The capacity to reach an object presented through sound clue indicates, in the blind child, the acquisition of object permanence and gives information over his/her cognitive development. Aim To assess cognitive development in congenitally blind children with or without multiple disabilities. Study design Cohort study. Subjects Thirty-seven congenitally blind subjects (17 with associated multiple disabilities, 20 mainly blind) were enrolled. Outcome measures We used Bigelow's protocol to evaluate “reach on sound” capacity over time (at 6, 12, 18, 24, and 36 months), and a battery of clinical, neurophysiological and cognitive instruments to assess clinical features. Results Tasks n.1 to 5 were acquired by most of the mainly blind children by 12 months of age. Task 6 coincided with a drop in performance, and the acquisition of the subsequent tasks showed a less agehomogeneous pattern. In blind children with multiple disabilities, task acquisition rates were lower, with the curves dipping in relation to the more complex tasks. Conclusions The mainly blind subjects managed to overcome Fraiberg's “conceptual problem” — i.e., they acquired the ability to attribute an external object with identity and substance even when it manifested its presence through sound only — and thus developed the ability to reach an object presented through sound. Instead, most of the blind children with multiple disabilities presented poor performances on the “reach on sound” protocol and were unable, before 36 months of age, to develop the strategies needed to resolve Fraiberg's “conceptual problem”.

A new atom-economical method for the synthesis of functionalized cyclobutenes is developed.

This study was conducted to evaluate the diagnostic accuracy of axillary ultrasound (US) alone or in combination with fine-needle-aspiration cytology (FNAC) in patients with breast carcinoma, in comparison with the final histological examination (sentinel node biopsy and/or axillary dissection). Between January 2005 and June 2008, we evaluated 427 breast cancer patients with axillary US. The findings were classified according to the following criteria: hilum and cortex morphology, ratio between longitudinal and transverse diameter and ratio between hilar and longitudinal diameter of the lymph node. Patients with breast lesions ≤3 cm (n=147) underwent FNAC of the most suspicious lymph node. Overall concordance between axillary US and final histological examination was 85%, sensitivity was 72.3% and specificity was 93.4%. Concordance between FNAC and final histological examination was 93%, sensitivity was 88.1% and specificity was 100%. In 48.3% of patients, the combination of axillary US and FNAC guided treatment decisions towards immediate axillary dissection, thus sparing the patients sentinel node biopsy, with a significant reduction of costs and hospitalization time.

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: The improved survival rates among Hodgkin’s disease (HD) patients have brought with it added long-term morbidities [1]. Breast cancer (BC) is the most common second malignancy among female survivors, particularly in those treated at young ages...

Rhenium does the job! A readily available rhenium complex efficiently catalyzed the direct Meyer–Schuster-like rearrangement of different alkyl- and aryl-substituted propargylic secondary and tertiary alcohols to the corresponding α,β-unsaturated compounds, which were produced with virtually complete E stereoselectivity. The reaction proceeded under neutral conditions and no racemization of potentially enolizable stereocenters was observed.

This study was performed to evaluate the diagnostic accuracy of sonoelastography in differentiating and characterising nodular breast lesions.A total of 120 nodular lesions diagnosed on mammography and/or ultrasonography in 110 women (mean age 51.27 years) were evaluated with sonoelastography and classified according to elasticity score (S1-S5). Needle biopsy was performed in 104/120 cases, whereas 16/120 were sent for follow-up. Sensitivity and specificity of sonoelastography were determined by taking biopsy findings as the gold standard.Biopsy yielded the following results: 66 benign, three equivocal and 35 malignant lesions. Sensitivity and specificity of sonoelastography were, respectively, 88.5% and 92.7%. All nodules with an elasticity score of 5 were malignant, and those with a scoreor=3 were benign, with the exception of four cases of invasive carcinoma with atypical elasticity (two lobular and two ductal with liquefaction necrosis). Twenty-two lesions were scored 4: 17 were malignant, two equivocal (columnar cell hyperplasia and complex sclerosing lesion) and three benign (sclerotic fibroadenomas).The use of sonoelastography to complement mammography and ultrasonography could help in the differential diagnosis of nodular breast lesions, especially in Breast Imaging Reporting Data System (BI-RADS) 3 lesions with marked elasticity (Sor=3). In these cases, the high concordance between elastography and cytology or histology in diagnosing benign lesions could reduce the number of needle biopsies and guide women at low radiological risk towards follow-up.