Pattern of recurrence in patients with endometrial cancer: A retrospective study

INTRODUCTION

Endometrial cancer (EC) known prognostic factors are not sufficient to predict either outcome or recurrence rate/site: to investigate EC recurrence patterns according to ESMO-ESGO-ESTRO risk classes, could be beneficial for a more tailored adjuvant treatment and follow-up schedule.

METHODS

758 women diagnosed with EC, and a 5-years follow-up, were enrolled: they were divided into the ESMO-ESGO-ESTRO risk classes (low LR, intermediate IR, intermediate-high I-HR, and highrisk HR) and surgically treated as recommended, followed by adjuvants therapies when appropriate.

RESULTS

Higher recurrence rate (RR) was significantly detected (p < 0,001) in the HR group (40,3%) compared to LR (9,6%), IR (16,7%) and I-HR (17,1%). Recurrences were detected more frequently at distant sites (64%) compared to pelvic (25,3%) and lymph nodes (10,7%) recurrences (p < 0,0001): only in LR group, no differences were detected between local and distant recurrences. 5-Year distant-free (LR 99%, IR 94%,I-HR 86%, HR 88%) and local-free survivals (LR 99%, IR 100%,I-HR 98%, HR 95%) significantly differ between groups (p < 0,0001 and p = 0,003, respectively). Adjuvant therapy modifies RRs only in LR group (p = 0,01).

CONCLUSION

To identify biological factors to stratify patients at higher risk of relapse is needed. Distant site relapse could be the main reason of endometrial cancer failure follow-up, independently or in addition to their risk class prognosis.

Qualitative profile of degummed guar (Cyamopsis tetragonoloba L.) seeds grown in a Mediterranean area for use as animal feed

Guar (Cyamopsis tetragonoloba L.) is an interesting summer legume multipurpose crop used for the extraction of seed gum, due to its galactomannan content, and the high-protein by-product, (germ and hull) used for animal feed. The aim of this study was to assess qualitative traits of degummed seeds, named guar meal, of six guar varieties from India, South Africa and USA, grown in a Mediterranean environment (Sicily, Southern Italy), in order to explore their suitability for livestock, and comparing them with the marketed Indian products of guar meals, Churi and Korma. After harvest, seeds were manually degummed and proximate composition was analysed using the official method of analyses, total phenols and tannins by UV spectrophotometry and fatty acids by GC-FID. Qualitative profile of degummed guar seeds (DGS) was significantly (p < .05) influenced by the genotype. Among DGS, Matador showed a high (p < .05) content of protein (518 g/kg), lipids (59.4 g/kg) and the lowest (p < .05) NDF level (181 g/kg) compared to the other varieties. Total phenol content of DGS showed similar values among varieties (2.57 mg gallic acid/g, on average) and with those of guar meal Korma 50%-53% (2.89 mg gallic acid/g) and Korma 56%-58% (2.94 mg gallic acid/g). Tannins were below the instrumental limit of quantification (1.5 mg/g of catechin equivalents) in DGS, as well as in the marketed products. Fatty acid composition was significantly influenced (p < .05) by the genotype. Matador showed the significant highest content of polyunsaturated fatty acids (PUFA) of the n6 series (45.2 g/100 g), whereas India showed the significant (p < .05) highest content of PUFA of the n3 series (3.55 g/100 g), and the significant (p < .05) highest level of n3/n6 PUFA ratio (0.08), and the best (p < .05) Atherogenic Index (0.19) and Thrombogenic Index (0.46). This study shows the interesting nutritional characteristics of degummed guar seeds, underlining that, if the future of the guar gum industries depends largely on the utilization of guar seed meal, this product can be considered a valuable feed resource and a way to increase the income of guar production.

Comparison of nutritional and antinutritional traits among different species (Lupinus albus L., Lupinus luteus L., Lupinus angustifolius L.) and varieties of lupin seeds

In order to promote the use of lupin in pig nutrition, in this research the nutritional characteristics (i.e. dietary fibre, alkaloid and fatty acid profile) and the in vitro gas production of 12 lupin varieties grown in the Mediterranean basin and belonging to three lupin species (Lupinus albus, Lupinus angustifolius and Lupinus luteus) were assessed. Four varieties of L. albus (Asfer, Lublanc, Lutteur and Multitalia) were grown in South Campania. Three varieties of L. luteus (Dukat, Mister and Taper), three of L. angustifolius (Jindalee, Sonet and Wonga) and two of L. albus (Rosetta and Luxor) were grown in Eastern Sicily. Lupinus albus varieties showed interesting nutritional and dietetic characteristics (i.e. high protein and low fibre content); the lipid fraction, rather elevated, is well represented by monounsaturated fatty acids (544 g/kg), whereas saturated fatty acids (SFAs) are less represented (167 g/kg) and the n-3/n-6 ratio (0.510) is the most favourable. Lupinus luteus varieties presented the most remarkable dietetic aspects, in terms of polyunsaturated fatty acid (PUFA) content (569 g/kg), n-6 PUFA series (490 g/kg), UFA/SFA (5.24) and PUFA/SFA (3.56) ratios and atherogenic (0.059) and thrombogenic (0.100) indices and very low alkaloid content (1.07 mg per 100 g). Lupinus angustifolius varieties showed the least interesting nutritional and dietetic characteristics: low protein and fat content, high fibre level, high SFA amount (248 g/kg) and the lowest favourable nutritional indices (IA: 0.164 and IT: 0.334). Regarding the fermentation process, in L. albus, the tendency to increase the rate of gas production during the early stages of fermentation suggests that the high presence of alkaloids did not affect the in vitro degradability, production of short-chain fatty acids and fermentation process, probably due to their concentration and/or water solubility. Lupinus angustifolius and L. luteus showed intermediate and slightly worse in vitro fermentation patterns respectively. From a nutritional and dietetic point of view, lupin may represent an interesting alternative to soya bean in pig feeding.

Analysis of the Influence of Lunar Cycle on the Frequency of Spontaneous Deliveries: A Single-centre Retrospective Study

Background Man, since ancient times, has been convinced of, and has researched scientific evidence that the barometric and gravitational forces play an important role in structural and biological variation of the planets, influencing the various forms of life. In particular, the synergistic relationships between variations in atmospheric pressure and gravitational forces on human gestation period have been the subject of rigorous observations and statistical calculations, which have not led to a universal conclusion in literature.Objectives The aim of our work was to check whether there is a higher incidence of spontaneous deliveries, during the periods of full Moon than during the other phases of the Moon.Methods We performed a retrospective analysis of 327 non-induced vaginal deliveries in a year, divided by month. We subsequently analyzed the incidence of these deliveries during periods of full Moon Vs other lunar phases.Results We evidenced a statistically significant difference between the annual total spontaneous deliveries happened in full Moon periods Vs all other Moon phases (T= 2,3946; p=0,0256). However, we reported a discordant trend of deliveries in full Moon period, depending on each considered month.Conclusion Since these differences were found both in increase and decrease, it is unacceptable the assumption of a linear correlation between periods of full Moon and increased frequency of spontaneous deliveries. For this reason, our data allow us to conclude that there is no need to increase the number of doctors and midwives in obstetric units during these periods.Kathmandu University Medical Journal Vol.12(4) 2014; 233-237

Management of the second phase of labour: perineum protection techniques

The obstetric experience alongside scientific evidences in literature indicate several management techniques during the expulsive period of labour to minimize obstetric complications. Among the various methods that can be used for the protection of the perineum during the expulsive phase, some are performed prepartum (perineum massage), while most are used during childbirth. Among the second group, progressively increasing importance is assumed by the manual techniques to protect the perineum (using the "hands-on" and "hands-off") and by episiotomy. These techniques, when used in accordance to the guidelines, may favour the reduction of adverse outcomes for both the mother and the newborn, both immediately after birth and after a longer time. The midwife should be aware of the evidences in literature so that a critical analysis of the available techniques can be made and put in action during the expulsive phase in order to protect the mother and the foetus from any unfavourable outcomes. Currently, clinical evidence in literature is directing obstetric and medical staff towards a careful analysis of the maternal-foetal parameters, in order to achieve a precise assessment of the risks factors of intrapartum and postpartum outcomes. Increasingly, there is the need for close collaboration between the midwife and medical staff to ensure proper personalized assistance based on the peculiar characteristics of the woman and the fetus.

Post-partum management in a patient affected by thrombotic thrombocytopenic purpura: case report and review of literature

Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially lethal syndrome characterized by severe thrombocytopenia, microangiopathic haemolytic anaemia, and aspecific neurologic symptoms. This syndrome is the result of an abnormal intravascular platelet aggregation which induces transient ischemia in various organs, especially in the central nervous system. Platelet aggregation causes also fragmentation of erythrocytes, thus leading to the characteristic anaemia. The exact cause of TTP is unknown, but a large body of evidence suggest that this syndrome might be due to acquired (immunological) or congenital ADAMTS13 deficiency. The dysregulation of ADAMTS 13 activity could promote massive release of high molecular weight multimers of von Willebrand factor (VWF) from endothelium and, as a consequence, could cause intravascular platelet aggregation. Pregnancy is commonly associated with numerous metabolic, immunological, and haemostatic changes which could increase thrombotic risk: during pregnancy, in fact, it is generally observed an increase of procoagulant activity and a decrease of fibrinolytic activity; moreover, at the end of pregnancy, it is not rare to find thrombocytopenia. All these reasons lead us to consider pregnancy itself as a triggering event for the onset of TTP. The authors describe a case of TTP occurred during puerperium, in a patient who underwent caesarean section.

Cytogenetic analysis of epithelial ovarian cancer's stem cells: an overview on new diagnostic and therapeutic perspectives

Ovarian cancer is one of the most frequent solid tumor that shows clearly biphasic behaviour in response to chemotherapy, with the majority of patients who achieved complete remission after the first cycle of chemotherapy, and subsequently present a relapse which, in most cases, leads to death. Epithelial ovarian cancer (EOC) arises as a consequence of genetic alterations that affect the cells of the ovarian surface, which leads to changes that occur through the activation of oncogenes and inactivation of tumor suppressor genes. The progression of EOC is characterized by a series of combined epigenetic aberrations, including the most important of those determined by the loss of methylation of certain regions of DNA encoding genes such as Ras-association domain-containing family 1 [(RASSF1A) tumor suppressor], death-associated protein kinase [(DAPK) protein kinase associated with the regulation of apoptosis], human sulfa- tase-I [(hSulf-1) sulfatase, which plays a key role in the regulation of apoptosis], breast cancer 1 gene [(BRCA1) tumor suppressor gene, involved in the processes of DNA repair], and HOXAI0 (gene required to promote many transcription factors). To date, accumulating evidence suggests that the initial clinical response is due primarily to the therapeutic efficacy of chemotherapy against differentiated can- cer cells that constitute the bulk of the tumor, whereas the high rate of recurrence is thought to be due to remaining drug-resistant cells, biologically distinct, identified as cancer stem cells (CSC). Current efforts are focusing on genetic and cytological definition of CSC, to guide the development of new diagnostic, and therapeutic perspectives.

Meat quality of buffalo young bulls fed faba bean as protein source

Sixteen Italian Mediterranean Buffalo young bulls were divided into two groups fed isoprotein and isoenergy diets and only differing for protein source of concentrate: faba bean (FB) vs soybean (SB). Animals were slaughtered at 350 kg BW. Meat from FB group showed significantly lower fat, protein, cholesterol and saturated fatty acids than SB group. Significant differences were also found between the three muscles analysed [Longissimus thoracis (LT), Semitendinosus (ST) and Iliopsoas plus Psoas minor (IP)]. ST showed the most favourable fatty acids profile: lower SFA, higher PUFA, MUFA, ω-3, ω-6, CLA and, consequently, lower values for both atherogenic and thrombogenic indexes. Results showed that faba bean can be used as a protein source alternative to soybean in the diet of young buffalo bulls for the production of high quality meat.

Multicentric infiltrative lipoma in a farmed Mediterranean seabass Dicentrarchus labrax: a pathological and biochemical case study

A tumour diagnosed as multicentric infiltrative lipoma affecting a single farmed seabass is described. The fish had 3 masses on the lateral side of its back, deforming the skin surface. The masses showed a tendency to invade the underlying musculature. Histologically, the neoplasm consisted of differentiated adipocytes. Biochemically, the neoplastic tissue showed lower values of monounsaturated fatty acids and higher values of polyunsaturated fatty acids compared with adjacent normal muscular tissue, particularly of the n3 series, such as eicosapentanoic (C20:5n3) and docosahexanoic (C22:6n3) acids. Data obtained suggest a metabolic disturbance in the lipid component of the muscular tissue metabolic pathway, which could be the starting point to promote lipoma formation. This is the first report of lipoma in Mediterranean seabass.