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Human osteosarcoma (OS) is a rare human cancer, mostly occurring in children and adolescents. Simian virus 40 (SV40 = Macaca mulatta polyomavirus 1) sequences have been detected in different human cancers, including osteosarcoma. SV40 is an oncogenic virus in vivo, whereas it transforms different kinds of mammalian cells, as well as distinct human cell types. SV40 injected in rodents induces tumors of different histotypes, such as bone and brain tumors. Herein, the association between OS and SV40 large T antigen (Tag) was studied by employing indirect ELISAs using synthetic peptides that mimic different epitopes of the SV40 Tag, the viral oncoprotein. Indirect ELISAs were used to detect serum IgG antibodies against this oncogenic virus in samples from OS patients. Controls were sera from healthy subjects (HS) and oncological patients affect by breast cancer (BC), which is not associated with SV40. It turned out that sera of OS patients had a higher prevalence of SV40 Tag antibodies, 35%, compared to HS, 20% and BC, 19%, respectively. The different prevalence of SV40 Tag antibodies revealed in OS vs. HS and vs. BC is statistically significant with P < 0.05 and P < 0.01, respectively. Our immunological data indicate a significantly higher prevalence of antibodies against SV40 Tag epitopes in serum samples from OS patients compared to HS and BC, the controls. These results suggest an association between OS and SV40 Tag, indicating that this oncogenic virus may be a cofactor in OS development.

Simian virus 40 (SV40) large T antigen (LT) coding sequences were revealed in different human samples, whereas SV40 antibodies (Ab) were detected in human sera of cancer patients and healthy individuals, although with a lower prevalence. Previous studies carried out by the neutralization assay gave a SV40 seroprevalence, in the general population, up to 8%, although higher rates, 12%, were detected in kidney transplant children, in a group of HIV-positive patients, and in healthy females. In this study, serum samples from pregnant women, together with those from non-pregnant women, were analyzed to check the prevalence of IgG Ab reacting to SV40 LT antigens. Serum samples were collected from pregnant and non-pregnant women, with the same mean age. Women were in the range of 15–48 years old. Samples were assayed by an indirect ELISA employing specific SV40 LT mimotopes as antigens, whereas functional analysis was performed by neutralization of the viral infectivity in cell cultures. As a control, sera were analyzed for Ab against BK polyomavirus (BKPyV), which is a human polyomavirus homologous to SV40. Statistical analyses employed chi-square with Yates’ correction, and Student’s t tests. Indirect ELISAs indicated that pregnant women tested SV40 LT-positive with a prevalence of 17% (23/134), whereas non-pregnant women had a prevalence of 20% (36/180) (P > 0.05). Ab against BKPyV were detected with a prevalence of 80% in pregnant women and with a prevalence of 78% in non-pregnant women. These data indicate that SV40 infects at a low prevalence pregnant women. We may speculate that SV40, or a close human polyomavirus still undetected, could be transmitted from mother to fetus.

Objectives: To assess the prognostic role of isolated troponin I (TnI) elevation after elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease., Background: The prognostic role of minor troponin elevation after PCI is controversial., Methods: A total of 1532 consecutive patients who underwent elective PCI were included. Follow-up data were obtained for 1432 of 1532 (93.4%) patients. The events taken into account in the follow-up included total mortality, cardiac death, hospitalization for acute myocardial infarction and/or unstable angina., Results: The following variables were identified as predictive of major adverse cardiac events (MACE) by univariate analysis: age 75 years at least (P = 0.012), ejection fraction less than 50% (P = 0.001), prior myocardial infarction (P = 0.031) and TnI 1.0 ng/ml at least after PCI (P = 0.04). The Cox-regression model identified the TnI elevation after PCI, the older age and the ejection fraction as independent predictors of MACE during follow-up (TnI: P = 0.042; older age: P = 0.001; ejection fraction: P = 0.003). In a subgroup of patients with preserved ejection fraction, the incidence of MACE was significantly higher in those with TnI of at least 1.0 ng/ml at least than in the ones with TnI less than 1.0 ng/ml, with the highest incidence among the older cohort. The multivariate analysis confirmed the TnI elevation 1.0 ng/ml at least after PCI and the older age as predictors of MACE., Conclusion: This study documented that in clinically stable patients, minor TnI elevations after elective PCI are independent predictors of MACE during follow-up, as are older age and reduced ejection fraction. Additionally, TnI elevation was a predictor of MACE during follow-up in a subset of patients with preserved ejection fraction. The combination of TnI elevation and older age confers the highest risk of MACE.

Introduction: Carbon dioxide (CO2) has been validated as a contrast agent in a large series of studies. A particular advantages of CO2 over iodinated contrast medium (ICM) is the absence of nephrotoxicity and allergic reactions. One of the limitations of CO2 angiography is the difficulty of CO2 manual injection due to its compressibility. The manual gas injection does not permit optimal control of the gas output. Development of an automated CO2 injector has overcome these problems., Aim: This study compares the feasibility, safety, and diagnostic accuracy of automated CO2 digital subtraction angiography (DSA) in comparison with ICM-DSA in the evaluation of critical limb ischemic (CLI) patients., Methods: We performed DSA with both CO2 and ICM on 40 consecutive CLI patients and directly compared the two techniques. Sixteen females and 24 males participated in the study (mean age, 71.7 years). We assessed the diagnostic accuracy of CO2 in identifying arterial stenosis in the lower limb, with ICM-DSA used as the gold standard., Results: The overall diagnostic accuracy of CO2-DSA was 96.9% (sensitivity, 99.0%; specificity, 96.1%; positive predictive value, 91.1%; negative predictive value, 99.6%). Tolerable minor symptoms occurred in 3 patients. No allergic reactions or significant decline in renal function were observed in patients receiving the CO2 injection., Conclusion: Carbon dioxide DSA is a valuable and safe alternative to traditional ICM-DSA for evaluating CLI patients. This modality should be considered as the standard choice for CLI patients undergoing angiographic evaluation who are known to have renal insufficiency or contrast allergy.

Aim: Adaptive servo ventilation (ASV) is a method of ventilator support aimed to treat central sleep apnea (CSA). We investigated the effects of an acute use of ASV in chronic heart failure (CHF) patients with CSA and the potential influence on sympathetic nerve activity., Methods: Patients were studied with ambulatory cardio-respiratory 24 Holter (Somtè) recording of air flow, ECG and oxygen saturation. Comparison before and after ASV treatment was made for apnea index (AI), apnea-hypopnea index (AHI), pulse oxygen saturation, desaturation related to apnea, heart rate (HR) and heart rate variability (HRV)., Results: Seventeen patients were enrolled. At baseline, apnea index and apnea-hypopnea index were, respectively, 16.92 ± 7.8 and 41.37 ± 17.5. During ASV, they significantly decreased to 0.06 ± 0.0 (P < 0.001) and 2.84 ± 1.1 (P < 0.001). The mean and minimal oxygen saturation (%) increased from 94 ± 1 and 86.5 ± 4 to 95 ± 2 (P = 0.04) and 91 ± 2 (P = 0.008). Mean HR decreased from 68 ± 10 to 62 ± 7 beats/min (P < 0.003). In 11 out of 17 patients, HRV was calculated, documenting a significant improvement of the standard deviation of the average of NN - normal sinus to normal sinus (SDANN), standard deviation of NN intervals (SDNN) and SDNN index (respectively, 71.5 ± 31.1 vs. 80.4 ± 36.1, P = 0.008; 99.7 ± 31.3 vs. 112.7 ± 37.5, P = 0.003; 57.8 ± 20.7 vs. 69.3 ± 30.8, P = 0.03)., Conclusion: The acute use of ASV is effective on CSA by increasing oxygen saturation and reducing HR. Moreover, the significant improvement of HRV highlights ASV's benefit in moderating the sympathetic adrenergic tone.

Purpose: This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI)., Materials and Methods: Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up., Results: Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered., Conclusions: Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

Purpose: To prospectively determine the diagnostic performance of breast magnetic resonance (MR) imaging in predicting the malignancy of breast lesions classified as borderline at core needle biopsy (CNB)., Materials and Methods: This prospective study was approved by the local ethics committee, and all patients provided written informed consent. Between February 2007 and October 2009, 193 patients underwent ultrasonography (US)-guided CNB. Thirty-two lesions in 32 patients were classified as "borderline" ("lesions of uncertain malignant potential" according to the United Kingdom National Health Service Breast Screening program or those that are "probably benign" according to the Breast Imaging Reporting and Data System [BI-RADS] lexicon) at pathologic examination and were evaluated. All 32 patients underwent contrast agent-enhanced breast MR imaging 1-3 weeks after CNB; surgical biopsy was performed within 60 days of MR imaging. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated., Results: Findings from surgical biopsy confirmed the diagnosis of seven atypical ductal hyperplasia lesions, four atypical lobular hyperplasia (ALH) lesions, five papillary lesions, two fibroepithelial lesions, three radial scars, three lobular carcinomas in situ, three ductal carcinomas in situ (DCIS), four invasive ductal carcinomas, and one invasive lobular carcinoma. With regard to malignancy, breast MR imaging helped correctly classify 22 of the 32 lesions as negative and seven as positive. Two of the lesions confirmed to be ALH were incorrectly classified as suspicious (BI-RADS category IV; false-positive finding), whereas one small DCIS was incorrectly classified as nonsuspicious (BI-RADS category II; false-negative finding). The sensitivity, specificity, accuracy, and positive and negative predictive values for the correct demonstration of malignancy at MR imaging were 88% (seven of eight lesions), 92% (22 of 24 lesions), 91% (29 of 32 lesions), 78% (seven of nine lesions), and 96% (22 of 23 lesions), respectively., Conclusion: Breast MR imaging can improve the evaluation of lesions classified as borderline at CNB. In cases of nonsuspicious enhancement or no enhancement at breast MR imaging, follow-up rather than surgical biopsy might be performed., (© RSNA, 2010.)

To evaluate the usefulness of tumor-associated trypsin inhibitor (TATI) as a marker for the diagnosis of lung cancer we determined serum levels of this peptide in 255 patients with lung cancer and in 74 patients with chronic obstructive lung disease. A reference population consisting of 151 healthy volunteers was also studied. TATI concentrations were measured by radioimmunoassay. As a cut-off point we used the 99th percentile of the TATI concentrations in a reference population, which was 32 micrograms/l. TATI does not appear to be a good tumor marker in lung cancer. Its sensitivity is poor in comparison with CEA and TPA. The correlation between TATI levels and stage of the disease and histological type was weak.