A Cross Sectional Survey on Breast Self Examination Practice, Utilization of Breast Professional Examination, Mammography and Associated Factors in Romagna, Italy

In 1988, a cross-sectional survey was carried out in the Romagna region (Italy) to evaluate the association between knowledge of breast pathophysiology and preventive attitudes and screening tests practice for breast cancer. A self-administered questionnaire was distributed to a sample of asymptomatic women aged 20–64 years living in the city of Faenza (Northern Italy). Of the 657 responders, 58 % reported that they practiced breast self-examination; 55% had had a professional breast examination, and only 9 % had had a mammogram as a screening test. Logistic regression analysis (including variables such as age, education, employment) was performed to explore the relationship between screening tests practice and factors associated with their use. Breast self-examination practice (n = 590) was associated with preventive attitudes (aOR = 1.67, 95°/o CI = 1.09–2.53) and with a positive history of breast disease (aOR = 3.48, 95 % CI = 1.72–7.04). Professional breast examination (n = 480) was related to preventive attitudes (aOR = 2.37, 95 % CI = 1.51–3.71), knowledge of breast pathophysiology (aOR = 2.07, 95 % CI = 1.31–3.28), and use of oral contraceptives (aOR = 1.81, 95% CI = 1.12–2.91). Mammography use (n = 540) was associated with preventive attitudes (aOR = 3.08, 95 % CI = 1.40–6.76). The results show an inadequate utilization of screening tests in our population. Breast self-examination is strongly related to a positive history of breast disease, and this could reflect the lack of health educational programs aimed at the general population.

A novel biotechnology product for the degradation of biofilm-associated polysaccharides produced by Streptococcus mutans

In this study we evaluated the activity of ABR preparation, a first-in-class agent obtained through fermentation process by genetically unmodified Bacillus spp., in breaking down polysaccharide produced by Streptococcus mutans, primary coloniser of tooth surface and abundant in dental biofilms. Our results showed that ABR preparation is able in degrading sugars formed by S. mutans, both in broth culture and onto teeth surface. Its activity is not influenced by the presence of saliva, commercial mouthwashes or oral disinfectants. ABR preparation has the potential to remove preformed plaque and counteract its development, thus offering conservative control of gingival and periodontal disease.

Epirubicin (E) followed by cyclophosphamide, methotrexate, 5-fluorouracil (CMF) versus paclitaxel (T) followed by epirubicin and vinorelbine (EV) in patients (pts) with high-risk operable breast cancer

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Background: > 3 N+ pts have a poor outcome, even in the presence of otherwise favourable phenotypic features. CT, alone or combined with endocrine therapy (ET) in hormone receptor (HOR)+ pts, is the gold standard for these women. However questions still exist about the optimal CT regimen. Methods: 244 >3N+ pts were randomized to either four 3-weekly courses of E (100 mg/sqm,d 1)followed by four 4-weekly cycles of CMF (600, 40, 600 mg/sqm, dd 1,8)(E-CMF:N=122)or four 3-weekly courses of T (175 mg/sqm, d1) followed by four 3-weekly cycles of EV (E:75 mg/sqm, da 1; V: 25 mg/sqm dd 1,8;.) (T-EV:N=122). After CT, tamoxifen (plus a LH-RH analog in menstruating women ) was given for 5 years to all HOR+ pts.S was the primary end-point. Results: At 82 mos median f-up, S and RFS did not differ significantly between groups (7-yr S: E-CMF:76%,T- EV:74%;adjust. HR: 0.89;0.54–1.49;p=0.7; 7-yr RFS: E-CMF:67%,T-EV:63%;adjust. HR: 0.95;0.61–1.47;p=0.8;).Cox analysis confirmed no difference between treatments. However RFS forest plots showed some heterogenity in CT effect according to HOR and HER2 status: E- CMF was superior to E-TV in HOR + pts (HR=0.43; CI 0.20–0.93 p=0.03),irrespective of HER2 status, but it was inferior (HR=1.91;CI 0.48- 7.64;p=0.4) in triple negative pts. The two regimens showed different toxicity profiles;however toxicities were manageable and there were no difference in the %of pts receiving all the 8 planned CT cycles (E-CMF: 87.6%;T-EV:81.1% p=0.2) or who discontinued CT (E-CMF: 12.8%; T-EV: 18.9% p=0.2). Conclusions: T-EV was not superior to E-CMF which,combined with ET, still represents an adequate choice for this high risk pts subset, especially for HOR+ pts.

No significant financial relationships to disclose.

Upgraded diagnostic value of Gen-Probe PACE 2 assay for detection of Chlamydia trachomatis infection

In this study, we evaluate the performance of a nucleic acid amplification assay, COBAS AMPLICOR (Roche Molecular systems) (PCR), compared to non-amplified DNA probe assay PACE2 (Gen-Probe Inc.) for the detection of C. trachomatis in a total of 2,916 samples (2,114 females and 802 males) consecutively collected in two different clinical pathology laboratories, over a period of three years. In the females, the endocervical swabs showed a similar range of detection when using the two different methods: out of 1,581 females processed with PACE 2, 1.4% (2005), 0.9% (2006), 0.5% (2007), resulted positive for C. trachomatis; out of 533 females processed with PCR, 1.3% (2005), 1.5% (2006) and 1.2% (2007), resulted positive. However, in the male subjects we found an increased positivity of Chlamydia detection on urethral swabs by using PACE 2: 4.8% (2005), 1.9% (2006) and 2.9% (2007), compared to urine specimen processed by PCR: 1% (2005), 1.4% (2006) and 0% (2007). Even if PCR should be considered a most promising tool for routine diagnosis of Chlamydia infection, Gen Probe allowed us to better identify Chlamydia trachomatis (in 4.8% of urethral swabs compared to urine) leading to a hypothesis that extracellular EB forms of Chlamydia could be absent in urine in persistent infectious.

The association of chronic hepatitis B and myopathy

In two patients with chronic hepatitis B and myopathy, muscle biopsy showed necrosis and scarce inflammatory infiltrates. CD8+ cells surrounded some non-necrotic fibers. Hepatitis B virus (HBV) DNA and antigens were found inside intact muscle fibers. Major histocompatibility complex class I antigens were coexpressed with viral antigens. In one patient, symptoms improved during antiviral therapy. HBV can infect muscle fibers and an immune-mediated response to viral antigens may cause muscle injury.

Experimental and theoretical studies of the vibrational spectra of cis-1-bromo-2-fluoroethene

The gas-phase infrared spectrum of cis-1-bromo-2-fluoroethene has been studied at low resolution in the range 200-6500 cm(-1), leading to a complete assignment of the fundamentals, except the lowest vibrational mode nu9 predicted at 167 cm(-1). The remaining vibrational structure has been mainly interpreted in terms of first overtone or two quanta combination bands. Isotopic (79/91)Br shift has been observed only in the nu8 fundamental. The equilibrium structure and the quadratic force field have been investigated theoretically at CCSD(T) level of theory employing Dunning's correlation consistent triple-zeta basis set. Cubic and semidiagonal quartic force field have been calculated using second-order Møller-Plesset perturbation theory and Ahlrich' split valence (SV) contracted basis set. After a minor scaled quantum mechanical (SQM) adjustment of the quadratic force constants, the vibrational analysis, based on the second-order perturbation theory, has been carried out with the calculated force constants.

Role of biological markers in the clinical outcome of colon cancer

We investigated a number of biological markers, evaluated under strict intralaboratory quality control conditions, in terms of their role in predicting clinical outcome of patients with colon cancer treated with 5-FU-containing regimens. Colon cancer tissue from 263 patients enrolled onto two randomised clinical trials were studied for their cytofluorimetrically determined DNA content and their immunohistochemically evaluated microvessel density, vascular endothelial growth factor expression, thymidylate synthase expression and tumour lymphocyte infiltration. Disease-free survival and overall survival of patients were analysed as a function of the different variables. At a median follow up of 57 months, age, gender and Dukes' stage showed an impact on disease-free survival, whereas no biological marker emerged as an indicator of better or worse disease-free survival. Only histological grade and Dukes' stage were found to influence overall survival. The different biological variables, studied with particular attention for determination reliability, proved to have no impact on the clinical outcome of patients with colon cancer. Therefore, other markers must be identified to complement clinico-pathological variables in the management of this disease.

Rovibrational Analysis of the nu(2) Band of Diazirine-d(2)

The gas-phase IR spectrum of the nu(2) (A(1), 1610.33 cm(-1)) band of the deuterated isotopomer of diazirine, D(2)CN(2), a three-membered ring compound which belongs to the molecular symmetry point group C(2v), has been studied at a resolution of about 0.005 cm(-1). This vibrational mode which can be approximately described as N&dbond;N stretching is widely perturbed. This is due to various interactions with the tetrad consisting of the binary combinations nu(6) + nu(7) (A(1)), nu(7) + nu(9) (A(2)), nu(5) + nu(6) (B(2)), and nu(5) + nu(9) (B(1)), which form a relatively isolated pentad together with nu(2) in the wavenumber region 1560-1610 cm(-1). A simultaneous upper state analysis of nu(2) from a pentad model including these resonances has been performed and a set of spectroscopic parameters has been obtained. Since the four combination bands of the pentad are dark states, only band centers could be determined; in addition for nu(5) + nu(9) and nu(7) + nu(9) also the term (B - C)/2 has been obtained. A number of Coriolis interaction constants and the vibrational resonance (with nu(6) + nu(7)) parameter have been calculated as well. Copyright 2001 Academic Press.

Nuclear Quadrupole Tensors for (35)Cl and (37)Cl in cis-1-chloro-2-fluoroethylene Obtained by Detection of Perturbation-Allowed DeltaJ = 2 and DeltaJ = 3 Transitions

The nuclear quadrupole hyperfine structure in rotational transitions of cis-1-chloro-2-fluoroethylene was measured for both (35)Cl and (37)Cl containing isotopomers in the millimeter-wave region. Near degeneracies of the 9(3,7) and 10(2,9) levels of (35)ClHC&dbond;CFH and of the 19(9,10/11) and 17(10,7/8) levels of (37)ClHC&dbond;CFH cause strong perturbations of the hyperfine patterns and give rise to perturbation-allowed DeltaJ = 2 and DeltaJ = 3 transitions. Lamb-dip measurements of such perturbed hyperfine patterns and of forbidden DeltaJ = +2 and perturbation-enhanced DeltaJ = 0 transitions of (35)ClHC&dbond;CFH provided an accurate determination of chi(ab), the off-diagonal element of the inertial nuclear quadrupole tensor. For (37)ClHC&dbond;CFH, chi(ab) was determined for the first time thanks to the observation of perturbed hyperfine patterns and of forbidden DeltaJ = +3 and DeltaJ = -2 transitions. Additional measurements of hyperfine structures led to improved values for the diagonal elements of the chi tensor of both (35)Cl and (37)Cl. Moreover, the complete inertial nuclear quadrupole tensor was evaluated from the field gradient at the chlorine nucleus computed by using the Multi-Configuration Self-Consistent Field (MCSCF) approach and employing basis sets of triple-zeta quality: very good agreement with the experiment was obtained. Copyright 2000 Academic Press.

Disease-free survival advantage of adjuvant cyclophosphamide, methotrexate, and fluorouracil in patients with node-negative, rapidly proliferating breast cancer: a randomized multicenter study

PURPOSE

According to one of the most recent key scientific questions concerning the use of biomarkers in clinical trials, we investigated whether node-negative breast cancer patients, defined as high-risk cases on the basis of tumor cell proliferation, could benefit from cyclophosphamide, methotrexate, and fluorouracil (CMF) adjuvant therapy.

PATIENTS AND METHODS

Two hundred eighty-one patients with negative nodes and rapidly proliferating tumors, defined according to thymidine labeling index (TLI), were randomized to receive six cycles of CMF or no further treatment after surgery +/- radiotherapy.

RESULTS

The 5-year disease-free survival (DFS) was 83% for patients treated with CMF compared with 72% in the control group (P: =.028). Adjuvant treatment reduced both locoregional and distant metastases. When clinical outcome was analyzed in cell kinetic subgroups characterized according to tertile criteria, compared with patients in the control arm, 5-year DFS was significantly higher after adjuvant CMF in patients with TLI values in the second (78% v 88%, respectively; P: =.037) and third tertiles (58% v 78%, respectively; P: =.024).

CONCLUSION

The results from this randomized clinical study indicate that patients with node-negative, rapidly proliferating tumors significantly benefit from adjuvant CMF.

Tobacco smoking among high school students in Romagna (Italy) and evaluation of a prevention campaign

The aim of this study was to investigate the smoking habits of a sample of second year high school students in Romagna (Northern Italy) by means of an anonymous self-administered questionnaire and the efficiency of a previous health education campaign. A sample of 2,691 16-year-old pupils (74% of the school population of this age) was randomly selected. Of these, 863 (32.1%) had participated in a prevention campaign while attending middle school. 19.1% of the students who had taken part in the campaign were smokers compared to 23.2% of those who had not. The students' smoking habits were found to be influenced by the type of school and by the role models (parents, siblings, friends, teachers). The campaign appears to have had good results, especially in places where it was carried out on a wide scale. Suggestions are made for making such campaigns more efficient.

High-Resolution Analysis of the nu(4) Absorption Band of CH(2)(79)BrF

The gas-phase infrared spectrum of the nu(4) fundamental band of CH(2)(79)BrF was recorded in the 1010-1116 cm(-1) wavenumber region using a TDL spectrometer. In this first high-resolution investigation of the synthesized (79)Br isotopic form, more than 10 200 transitions of this a/b-hybrid band centered at 1068.5385 cm(-1) were assigned and, using the Watson's A-reduced Hamiltonian in the I(r)-representation, a reliable set of molecular constants for the excited state v(4) = 1 was determined. From ground state combination differences having rotational quantum numbers J and K(a) up to 97 and 21, respectively, improved and extended ground state rotational and centrifugal distortion constants were calculated as well. Comparison between the observed and calculated band intensities in appropriate regions of the spectrum gave an estimate of the transition dipole-moment ratio along the a and b axes as ||Deltaµ(a)/Deltaµ(b) || = 2.0 +/- 0.2, in agreement with the predicted theoretical value of 1.99. Copyright 2000 Academic Press.

Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff

A survey was carried out into the smoking habits and exposure to passive smoking among health staff in the hospitals of Faenza, Forli and Rimini (Emilia-Romagna, Northern Italy), 2453 subjects answered anonymously a 41 question questionnaire. 53% of the subjects were professionals nurses, 16% doctors, 15% maintenance staff, 10% ancillary staff, 1% non-medical graduates, 2% were administrators and 3% were assigned to the category ¿other'. Of the subjects answering the questionnaire 39% were smokers, 19% ex-smokers and 42% non smokers. The highest number of smokers was found among women (41%) compared to men (37%) and among ancillary staff (48%) compared to nurses (41%) and doctors (31%). The males were mostly heavy smokers (> or = 20 cigarettes/d) and smoked strong cigarettes (> or = 12 mg/cig condensate content). The females were mostly light smokers (< 10 cigarettes/d) and smoked light cigarettes (1-6 mg/cig condensate content). A high percentage of subjects (87%) smoked at work especially in areas reserved for staff. 43% and 26% of shift workers and non-shift workers tended not to modify their habit when on morning or afternoon shifts. During night shifts the majority of them increased their tobacco consumption. Around 87% of hospital employees stated they were exposed to passive smoking inside the hospital especially in cooking areas, at information desks and corridors. Nurses, ancillaries and maintenance staff were those most exposed and for a greater number of hours per day compared to doctors. Almost all subjects were aware of the harm caused by passive smoking. 56% of smokers, 65% of ex-smokers and 72% of non smokers said they were willing to participate in future campaigns to limit smoking in their hospitals.

High-Resolution Infrared Spectrum of Vinyl Fluoride at 500 cm-1

The infrared spectrum of vinyl fluoride (CH2=CHF) has been investigated in the region 390-590 cm-1 at room temperature and at a resolution of 0.0016 cm-1 using a Fourier transform spectrometer. The rovibrational analysis of the spectral features allowed us to assign about 11 000 lines (J </= 60) of the nu9 ab-type band centered at 483.0666 cm-1 and more than 700 lines (J </= 40) of the 2nu9 - nu9 ab-type hot band, the bandcenter of which is located at 485.6687 cm-1. The experimental data provided the rotational and centrifugal distortion constants for the vibrational excited states v9 = 1 and 2 employing Watson's A-reduction Hamiltonian in the Ir representation. Moreover, band origins, harmonic frequency, and anharmonicity factor have been obtained from the vibrational analysis of the fundamental and the associated hot band. Copyright 1997Academic Press

[A proposal for monitoring smoking prevention programs with the use of indicators]

Health administrators are aware that the adoption of prevention programs of proven efficacy does not, by itself, guarantee good results as several factors can reduce effectiveness in a specific contest. Outcome evaluation and performance monitoring is thus growing, also with the aim of a more efficient resource use. On these premises, we describe a proposal for performance monitoring of smoking prevention programs, developed from literature and original data from the authors. The system is made of three components: a) five questions to assess smoking behavior (internal coherence, (Cronbach alpha = 0.731; k ranging from 0.39 to 0.76): b) two indicators (smoking prevalence and precentage of students reached): c) theorical and practical (number to sample according to population size) information for homogeneous and efficient cluster sampling. Performance is evaluated on account of three possible determinants of the results and explicit criteria are given to reach five possible decisions. The system was tested in five Health Districts of the Emilia Romagna Region with a population of 6370 8th class students and guided further planning and implementation. Further implementation and use of the system will give us information about the utility of this proposal, that could also be adopted as a model for the evaluation of other school prevention programs.

A randomized trial on breast self-examination in Faenza (northern-Italy)

AIMS AND BACKGROUND

The aim of this randomized controlled trial was to compare two methods for teaching breast self-examination: theoretical and practical session versus mailed material.

METHODS

A random sample of women aged 20-64 years was drawn from the demographic file of the city of Faenza (Northern-Italy). Of 825 sampled eligible women, 168 declined participation, 657 were randomly assigned, after completing a pretest questionnaire aimed at evaluating practice and quality of breast self-examination. Individualised instruction was administered to the treatment group invited to be taught breast self-examination in a medical practice setting. The control group received mailed information about breast self-examination. One year later, 443 women completed the posttest questionnaire.

RESULTS

As far as concerns the first outcome of the trial (change in practice of breast-self examination) our study showed, after adjusting for lost-to-follow-up, no difference between the treatment and the control group. The analysis performed to evaluate the second outcome (change in quality of breast self-examination practice) showed that women of the treatment group improved the quality of breast self-examination practice more than the control group (Wilcoxon test, z = 2.4, P < 0.01). The same results have been confirmed by multiple regression analyses taking into account all potential confounders. No selection bias affected these results.

CONCLUSION

Theoretical and practical sessions resulted in an improved quality of examination technique than did mailed material.

Phase III randomized study of fluorouracil, epirubicin, and cyclophosphamide v fluorouracil, doxorubicin, and cyclophosphamide in advanced breast cancer: an Italian multicentre trial

From February 1983 to January 1985, 497 patients with advanced breast cancer were randomly allocated to receive either epirubicin or doxorubicin in the following combination chemotherapy regimen: fluorouracil (5-FU) 500 mg/m2 intravenous (IV) on days 1 and 8; epirubicin or doxorubicin 50 mg/m2 IV on day 1; cyclophosphamide 500 mg/m2 IV on day 1 (FEC or FAC). Cycles were repeated every 21 days until progression or to cumulative doses of 700 mg/m2 for epirubicin and 550 mg/m2 for doxorubicin. Dose reductions were applied according to the standard criteria. Activity was evaluated in 443 patients (222 in the FEC arm and 221 in the FAC arm). The two experimental groups were comparable in age, performance status, menopausal status, histology, previous treatments, and site of the disease. The overall response rate (complete response and partial response [CR + PR]) was not significantly different: 53.6% for FEC and 56.5% for FAC. The median time to progression was 273 days for FEC and 314 days for FAC; the median survival time was 591 and 613 days, respectively. Leukopenia, anemia, nausea, and vomiting were significantly lower in patients treated with FEC. As for cardiotoxicity, four cases of congestive heart failure (CHF) were recorded among patients treated with FAC while only one was observed in the FEC group. These results indicate that epirubicin in a combination chemotherapy regimen is as active as doxorubicin and is significantly less toxic.