rubrica

Registri di patologia

  • Emanuele Crocetti1

  1. UO Epidemiologia clinica e descrittiva, ISPO Firenze
Emanuele Crocetti -

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Ricerca bibliografica periodo dal 16 novembre 2013 – 1 febbraio 2014

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Stringa: (("registries"[MeSH Terms] OR "registries"[All Fields] OR "registry"[All Fields]) OR ("registries"[MeSH Terms] OR "registries"[All Fields])) AND (("italy"[MeSH Terms] OR "italy"[All Fields]) OR italian[All Fields]) AND "humans"[MeSH Terms] AND ("2013/11/16"[PDat] : "2014/02/01"[PDat])
1. Vergallo R(1), Ren X(2), Yonetsu T(1), Kato K(1), Uemura S(3), Yu B(2), Jia H(4), Abtahian F(1), Aguirre AD(5), Tian J(4), Hu S(4), Soeda T(1), Lee H(6), McNulty I(1), Park SJ(7), Jang Y(8), Prasad A(9), Lee S(10), Zhang S(11), Porto I(12), Biasucci LM(13), Crea F(13), Jang IK(14). Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: a 3-vessel optical coherence tomography study. Am Heart J. 2014 Jan;167(1):59-67. doi: 10.1016/j.ahj.2013.10.011. Epub 2013 Oct 19.
Author information: (1)Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA. (2)Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. (3)First Department of Medicine, Nara Medical University, Nara, Japan. (4)Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. (5)Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (6)Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA. (7)Asan Medical Center, Seoul, Republic of Korea. (8)Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea. (9)Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. (10)Department of Medicine, Queen Mary Hospital, Hong Kong University, Hong Kong, China. (11)LightLab Imaging, Inc/St Jude Medical, Westford, MA. (12)Cardiovascular and Neurological Department, San Donato Hospital, Arezzo Italy. (13)Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (14)Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ijang@partners.org.

Abstract BACKGROUND: Recent studies described different clinical and underlying plaque characteristics between patients with and without plaque rupture presenting with acute coronary syndrome (ACS). In light of the systemic nature of atherosclerosis, we hypothesized that nonculprit plaques might also express different morphological features in these 2 groups of patients. METHODS: Thirty-eight patients with ACS who underwent 3-vessel optical coherence tomography imaging were identified from the Massachusetts General Hospital Optical Coherence Tomography Registry. Based on culprit plaque morphology, the study population was divided into 2 groups: patients with plaque rupture at the culprit lesion (group 1) and patients with nonruptured plaque at the culprit lesion (group 2). Prevalence and features of nonculprit plaques were compared between the 2 groups. RESULTS: A total of 118 nonculprit plaques were analyzed. Patients in group 1 (n = 17) had nonculprit plaques with higher prevalence of thin-cap fibroatheroma (52.9% vs 19.0%, P = .029) and disruption (35.3% vs 4.8%, P = .016) compared with patients in group 2 (n = 21). Nonculprit plaques in group 1 showed wider maximum lipid arc (198.9° ± 41.7° vs 170.2° ± 41.9°, P = .003), greater lipid length (7.8 ± 4.4 mm vs 5.1 ± 2.4 mm, P = .003), higher lipid index (1196.9 ± 700.5 vs 747.7 ± 377.3, P = .001), and thinner fibrous cap (107.0 ± 56.5 μm vs 137.3 ± 69.8 μm, P = .035) compared with those in group 2. CONCLUSIONS: The present study showed distinctive features of nonculprit plaques between patients with ACS caused by plaque rupture and patients with ACS caused by nonruptured plaques. Patients with plaque rupture had increased pancoronary vulnerability in nonculprit plaques, suggesting that a more aggressive treatment paradigm aiming at the stabilization of vulnerable plaques may offer additional benefit to these patients.

2. Romagnoli E, De Vita M, Burzotta F, Cortese B, Biondi-Zoccai G, Summaria F, Patrizi R, Lanzillo C, Lucci V, Cavazza C, Tarantino F, Sangiorgi GM, Lioy E, Crea F, Rao SV, Trani C. Radial versus femoral approach comparison in percutaneous coronary intervention with intraaortic balloon pump support: the RADIAL PUMP UP registry. Am Heart J. 2013 Dec;166(6):1019-26. doi: 10.1016/j.ahj.2013.09.009. Epub 2013 Oct 10.
Author information: Policlinico Casilino, Rome, Italy; SS. Filippo e Nicola Hospital, Avezzano, Italy. Electronic address: enromagnoli@gmail.com.

Abstract BACKGROUND: The role of intraaortic balloon pump (IABP) during percutaneous coronary intervention (PCI) in high-risk acute patients remains debated. Device-related complications and the more complex patient management could explain such lack of clinical benefit. We aimed to assess the impact of transradial versus transfemoral access for PCI requiring IABP support on vascular complications and clinical outcome. METHODS: We retrospectively analyzed 321 consecutive patients receiving IABP support during transfemoral (n = 209) or transradial (n = 112) PCI. Thirty-day net adverse clinical events (NACEs) (composite of postprocedural bleeding, cardiac death, myocardial infarction, target lesion revascularization, and stroke) were the primary end point, with access-related bleeding and hospital stay as secondary end points. RESULTS: Cardiogenic shock and hemodynamic instability were the most common indications for IABP support. Cumulative 30-day NACE rate was 50.2%, whereas an access site-related bleeding occurred in 14.3%. Patients undergoing transfemoral PCI had a higher unadjusted rate of NACEs when compared with the transradial group (57.4% vs 36.6%, P < .01), mainly due more access-related bleedings (18.7% vs 6.3%, P < .01). Such increased risk of NACEs was confirmed after propensity score adjustment (hazard ratio 0.57 [0.4-0.9], P = .007), whereas hospital stay appeared comparable in the 2 groups. CONCLUSIONS: In this observational registry, high-risk patients undergoing PCI and requiring IABP support appeared to have fewer NACEs if transradial access was used instead of transfemoral, mainly due to fewer access-related bleedings. Given the inherent limitations of this retrospective work, including the inability to adjust for unknown confounders, further controlled studies are warranted to confirm or refute these findings.

3. Lorenzano S, Ahmed N, Falcou A, Mikulik R, Tatlisumak T, Roffe C, Wahlgren N, Toni D; SITS Investigators. Does sex influence the response to intravenous thrombolysis in ischemic stroke?: answers from safe implementation of treatments in Stroke-International Stroke Thrombolysis Register. Stroke. 2013 Dec;44(12):3401-6. doi: 10.1161/STROKEAHA.113.002908. Epub 2013 Oct 30.
Collaborators: Ahmed N, Wahlgren N. Author information: From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (S.L., A.F., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); International Clinical Research Center, Neurology Department, St. Anne's Hospital, Brno, Czech Republic (R.M.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); and Stroke Research Offices, Royal Infirmary, Keele University, North Staffordshire, United Kingdom (C.R.).

Abstract BACKGROUND AND PURPOSE: Women are more likely to have a worse outcome after an acute stroke than men. Some studies have suggested that women also benefit less from intravenous thrombolysis after an acute ischemic stroke, but others found no sex differences in safety and efficacy. We aimed to evaluate differences in 3-month outcome between sexes in intravenous tissue-type plasminogen activator-treated patients registered in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. METHODS: A total of 45 079 patients treated with intravenous alteplase were recorded from 2002 to 2011. Main outcome measures were symptomatic intracerebral hemorrhage, functional independence (modified Rankin Scale score, 0-2), and mortality at 3 months. RESULTS: Among 25 777 (57.2%) men and 19 302 (42.8%) women, we found no difference in the rate of symptomatic intracerebral hemorrhage (P=0.13), a significantly higher likelihood of functional independence at 3 months in men (P<0.0001) and a higher mortality in women when compared with men (P<0.00001). After adjustment for confounding variables, we did not observe any difference between sexes in functional outcome (odds ratio, 1.03; 95% confidence interval, 0.97-1.09; P=0.39), whereas male sex was related to a higher risk of mortality (odds ratio, 1.19; 95% confidence interval, 1.10-1.29; P=0.00003) and symptomatic intracerebral hemorrhage (odds ratio, 1.25, 95% confidence interval, 1.04-1.51; P=0.02). CONCLUSIONS: Data from Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register suggest that intravenous thrombolysis may modify the observed survival and recovery advantage for men expected in the natural course of an ischemic stroke, with a possible larger beneficial treatment effect in women when compared with men.

4. Badaloni C, Ranucci A, Cesaroni G, Zanini G, Vienneau D, Al-Aidrous F, De Hoogh K, Magnani C, Forastiere F; SETIL Study Group. Air pollution and childhood leukaemia: a nationwide case-control study in Italy. Occup Environ Med. 2013 Dec;70(12):876-83. doi: 10.1136/oemed-2013-101604. Epub 2013 Sep 18.
Collaborators: Magnani C, Mattioli S, Miligi L, Ranucci A, Rondelli R, Salvan A, Masera G, Rizzari C, Bisanti L, Zambon P, Greco A, Cannizzaro S, Gafà L, Luzzatto LL, Benvenuti A, Michelozzi P, Kirchmayer U, Cocco P, Galassi C, Celentano E, Guarino E, Assennato G, de Nichilo G, Merlo DF, Bocchini V, Mosciatti P, Minelli L, Chiavarini M, Cuttini M, Casotto V, Torregrossa MV, Valenti RM, Forastiere F, Haupt R, Lagorio S, Risica S, Polichetti A, Bochicchio F, Nuccetelli C, Biddau P, Aricò M, De Salvo GL, Locatelli F, Pession A, Varotto S, Poggi V, Massaglia P, Monetti D, Targhetta R, Bernini G, Pannelli F, Sampietro G, Schilirò G, Pulsoni A. Author information: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.

Abstract OBJECTIVES: Leukaemia is the most common cancer in children, but its aetiology is still poorly understood. We tested the hypothesis that traffic-related air pollution is associated with paediatric leukaemia because of chronic exposure to several potential carcinogens. METHODS: The Italian SETIL study (Study on the aetiology of lymphohematopoietic malignancies in children) was conducted in 14 Italian regions. All incident cases of leukaemia in children aged ≤10 years from these regions (period 1998-2001) were eligible for enrolment. Two controls per case, matched on birth date, gender and region of residence were randomly selected from the local population registries. Exposure assessment at birth residence included traffic indicators (distance to main roads and length of main roads within 100 m) and estimates of pollutants concentrations (particulate matter -PM2.5 and PM10- and gases -NO2 and O3-) from national dispersion model and land use regression models. The association between the exposure variables and leukaemia was assessed by logistic regression analyses. RESULTS: Participation rates were 91.4% among cases and 69.2% in controls; 620 cases (544 acute lymphocytic and 76 acute non-lymphocytic leukaemia) and 957 controls were included. Overall, when considering the residence at birth, 35.6% of cases and 42.4% of controls lived along busy roads, and the mean annual PM10 levels were 33.3 (SD=6.3) and 33.4 µg/m(3) (SD=6.5), respectively. No association was found, and all ORs, independent of the method of assessment and the exposure windows, were close to the null value. CONCLUSIONS: Using various exposure assessment strategies, air pollution appears not to affect the incidence of childhood leukaemia.

Breve commento a cura di E. Crocetti
Lo studio di Chiara Badaloni e del gruppo SETIL (Studio sulla Eziologia dei Tumori Infantili Linfoemopoietici) affronta un tema di grande interesse e attualità considerando la recente definizione della IARC dell’inquinamento atmosferico come carcinogeno di Gruppo 1. Nello studio viene valutata la possibile relazione tra inquinamento da traffico veicolare e leucemia infantile (età <=10 anni). Lo studio, di disegno caso controllo, ha riguardato 747 casi (a fonte AIEOP) e 1.509 controlli (dalla popolazione generale) elegibili in 14 regioni italiane; hanno partecipato 620 casi e 957 controlli. La residenza alla nascita è stata georeferenziata; l’esposizione per ciascun punto geografico è stata definita secondo tre classi di distanza da strade di diversa grandezza e intensità di traffico; sono stati usati modelli National dispersion (MINNI) e Land use regression (LUR) per stimare la concentrazione di PM2.5, PM10, diossido di azoto e ozono. I risultati delle analisi di regressione logistica (complessivi, 0-4 anni, solo con residenza stabile e per singolo indicatore di esposizione o inquinante) non hanno mostrato OR significativi. Gli autori discutono i risultati anche alla luce della letteratura e dei possibili punti di forza e debolezza dello studio concludendo sul fatto che la relazione causale studiata non appare sostenuta.

5. Colaci M, Giuggioli D, Vacchi C, Lumetti F, Iachetta F, Marcheselli L, Federico M, Ferri C. Breast cancer in systemic sclerosis: results of a cross-linkage of an Italian Rheumatologic Center and a population-based Cancer Registry and review of the literature. Autoimmun Rev. 2014 Feb;13(2):132-7. doi: 10.1016/j.autrev.2013.09.006. Epub 2013 Oct 6.
Author information: Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy. Electronic address: michelecolaci@virgilio.it.

Abstract OBJECTIVE: Increased frequency of few types of cancer in systemic sclerosis (SSc) has been reported in the literature; in particular, breast carcinoma has been proposed as one of the most frequent malignancy in SSc patients, even though data are not univocal. The aim of the present study was to retrospectively evaluate the prevalence of breast cancer in our SSc series, compared with sex-/age-matched general population of the same geographical area, and the possible correlations with SSc features, including X-ray exposure for clinical investigations. A review of the world literature about this topic was also done. METHODS: Clinical records of 318 consecutive SSc patients, 31 M and 287 F, age 51.5±14.5 SD years, disease duration 10±6.5 SD years, referred to our Rheumatology Unit between January 2002 and December 2012 were evaluated. RESULTS: Twelve (3.8%) cases of breast cancer were recorded, including 11/287 females (3.8%) and 1/31 (3.2%) male patients. Considering the subgroup of 202 SSc patients resident in the Province of Modena compared with data of the local Tumor Registry, the incidence of breast cancer observed in our SSc series is significantly higher than expected (SIR 2.1; 95% interval of confidence: 1.13-3.90; p<0.01). On the whole, the comparison between SSc patients with cancer and those without did not show any significant differences with regard to SSc clinical features, including the X-ray exposure. Of note is the relatively shorter disease duration at the time of breast cancer detection (median 2.5years, range 1-21; disease duration of mean 10±6.5 SD years in the entire cohort). The review of the literature revealed that the observed incidence of breast cancer in our case series is comparable to the few studies reporting the highest percentages of this malignancy. CONCLUSIONS: A significant increase of breast cancer incidence compared to sex-age-matched general population from the same geographic area was observed. Moreover, a close temporal relationship between SSc and breast cancer onset was found, independently from clinical, serological, and instrumental features of SSc. The possible pathogenetic link between this systemic autoimmune disease and complicating breast cancer, as well as the results of previous studies, are discussed.

6. Jonker FH, Trimarchi S, Muhs BE, Rampoldi V, Montgomery DG, Froehlich JB, Peterson MD, Bartnes K, Gourineni V, Ramanath VS, Braverman AC, Nienaber CA, Isselbacher EM, Eagle KA; IRAD Investigators. The role of age in complicated acute type B aortic dissection. Ann Thorac Surg. 2013 Dec;96(6):2129-34. doi: 10.1016/j.athoracsur.2013.06.056. Epub 2013 Sep 24.
Author information: Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy. Electronic address: jonkerfrederik@hotmail.com.

Abstract BACKGROUND: Complicated acute type B aortic dissection (cABAD) generally requires urgent intervention. Advanced age is a risk factor for mortality after thoracic aortic intervention, including surgery for aortic dissection. The purpose of this study was to investigate the exact impact of increasing age on the management and outcomes of cABAD. METHODS: We analyzed the outcomes of 583 patients with cABAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2012. All patients with cABAD were categorized according to age by decade and management type (medical, surgical, or endovascular treatment), and outcomes were subsequently investigated in the different age groups. RESULTS: The mean age of the cohort was 63.4 ± 14.2 years, 36% of patients (n = 209) were greater than 70 years of age and 64% (n = 374) were less than 70 years. The utilization of surgery and endovascular techniques progressively decreased with patient age, while the rate of medical management significantly increased with age (p < 0.001). The in-hospital mortality rates for complicated patients younger than 70 years versus 70 years or more were 10.1% versus 30.0% for endovascular treatment (p = 0.001), 17.2% versus 34.2% for surgical treatment (p = 0.027), and 14.2% versus 32.2% for medical treatment (p = 0.001). Age 70 years or greater was a predictor of in-hospital mortality in multivariate analysis (odds ratio 2.37, 95% confidence interval: 1.23 to 4.54, p = 0.010). CONCLUSIONS: Advanced age has a dramatic impact on the management and outcomes of patients with cABAD. A nonsignificant trend toward lower mortality after endovascular management was observed, both for younger patients and for elderly patients.

7. Danzi GB, Valenti R, Migliorini A, Parodi G, Vergara R, Antoniucci D. Percutaneous coronary intervention for multiple chronic total occlusions. Am J Cardiol. 2013 Dec 15;112(12):1849-53. doi: 10.1016/j.amjcard.2013.08.012. Epub 2013 Sep 21.
Author information: Division of Cardiology, Careggi Hospital, Florence, Italy.

Abstract No data exist about successful percutaneous coronary intervention (PCI) and clinical outcome in patients with multiple coronary chronic total occlusions (CTOs). The aim of this study was to determine the impact on cardiac mortality of PCI of multiple CTOs. The Florence CTO PCI registry includes patients treated with drug-eluting stent for at least 1 CTO. From this registry, we examined consecutive patients with ≥2 CTOs. Patients were stratified into successful PCI of all attempted CTOs and partially successful PCI (1 CTO PCI successful) or failed PCI (no CTO PCI success) groups. The primary end point of the study was cardiac mortality. Of 1,035 patients with CTO, 120 (11.6%) underwent PCI for ≥2 CTOs for a total of 249 CTOs. CTO PCI was successful in 195 CTOs (78.3%), and in 76 patients (63.3%), PCI was successful in all attempted lesions, whereas in 34 patients, CTO PCI was partially successful and in 10, completely unsuccessful. Cardiac mortality at 12 months was lower in the CTO PCI success group than CTO PCI failure or partial success group (1.3% vs 11.3%; p = 0.025). The 2-year survival rate was lower in patients with a complete coronary revascularization compared with those with incomplete revascularization (96 ± 3% vs 78 ± 7%; p = 0.002); completeness of revascularization was inversely related to the risk of death (hazard ratio 0.10; p = 0.029). In patients with multiple CTOs, a successful PCI of all CTOs was associated with increased survival and completeness of revascularization was a strong predictor of survival.

8. Del Gobbo A, Moltrasio F, Young RH, Rosai J. Involvement of the testis and related structures by Rosai-Dorfman disease: report of 2 new cases and review of the literature. Am J Surg Pathol. 2013 Dec;37(12):1871-5. doi: 10.1097/PAS.0b013e31829e2509.
Author information: *Department of Pathology, Università degli Studi di Milano ∥Centro Diagnostico Italiano, Milan †Department of Pathology, Università degli Studi di Milano Bicocca, Monza, Italy ‡Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Integrated Oncology LabCorp, New York, NY. This report describes 2 new cases of testicular involvement by Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, and reviews the clinical and pathologic features of the other cases documented in the literature (4 cases) or included in the sinus histiocytosis with massive lymphadenopathy registry (7 cases). Our patients were 42 and 68 years of age, respectively, reflecting the usual middle-age of all the previously reported cases in this location, except for 1, which occurred in a child. Five cases were bilateral, and other sites, such as lymph nodes, kidney, skin, and adrenal gland, were involved in 8 cases. The histories were noteworthy in 2 of the cases, inasmuch as 1 patient had chronic lymphocytic leukemia, and another had a B-cell lymphoma. On gross examination, the testicular masses did not exhibit specific diagnostic features, whereas microscopic examination revealed the typical population of histiocytes, with abundant eosinophilic cytoplasm often exhibiting so-called emperipolesis. The differential diagnosis includes non-neoplastic conditions such as granulomatous orchitis, hematolymphoid disorders, a variety of metastatic tumors, and germ cell tumors.
9. Tolenaar JL, Harris KM, Upchurch GR Jr, Evangelista A, Moll FL, di Eusanio M, Eagle K, Trimarchi S; IRAD investigators. The differences and similarities between intramural hematoma of the descending aorta and acute type B dissection. J Vasc Surg. 2013 Dec;58(6):1498-504. doi: 10.1016/j.jvs.2013.05.099. Epub 2013 Sep 21.
Author information: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, Milan, Italy.

Abstract INTRODUCTION: Aortic intramural hematoma type B (IMHB) is a variant of acute aortic syndrome, which presents with symptoms similar to classic type B aortic dissection (ABAD). However, the natural history of IMHB is not well understood. The purpose of this study was to better characterize IMHB, comparing its clinical characteristics, treatment, and in-hospital and long-term outcomes to those with classic ABAD. METHODS: A total of 107 IMHB and 790 ABAD patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1996 and June 2012 were analyzed. Accordingly, differences in presentation, diagnostics, therapeutic management, and outcomes were assessed. RESULTS: As compared with the ABAD, IMHB presented predominantly in males (62% vs 33%; P < .001) at older age (69 ± 12 vs 63 ± 14; P < .001). IMHB patients more often had chest pain (80% vs 69%; P = .020) and periaortic hematoma (22% vs 13%; P = .020) and were more often treated medically (88% vs 62%; P < .001), with surgical/endovascular interventions being reserved for more complicated patients. Overall in-hospital mortality was 10% (IMHB, 7% vs ABAD, 11%; P = NS). Six out of seven IMHB deaths occurred during medical treatment, two due to aortic rupture. During follow-up in IMHB, patient mortality was 7%, and no adverse events, including progression to an aortic dissection or aortic rupture, were observed. Imaging showed significantly more aortic enlargement at the level of the descending aorta in ABAD patients (39% vs 61%; P = .034). CONCLUSIONS: Most IMHB patients can be treated medically, and aortic enlargement is less common during follow-up, which may suggest that IMHB may have a slightly more benign course compared with classic ABAD in the acute setting.

10. Minicozzi P, Berrino F, Sebastiani F, Falcini F, Vattiato R, Cioccoloni F, Calagreti G, Fusco M, Vitale MF, Tumino R, Sigona A, Budroni M, Cesaraccio R, Candela G, Scuderi T, Zarcone M, Campisi I, Sant M. High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease. Eur J Cancer. 2013 Dec;49(18):3881-8. doi: 10.1016/j.ejca.2013.08.004. Epub 2013 Sep 3.
Author information: Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

Abstract PURPOSE: We investigated the effect of fasting blood glucose and body mass index (BMI) at diagnosis on risk of breast cancer death for cases diagnosed in five Italian cancer registries in 2003-2005 and followed up to the end of 2008. METHODS: For 1607 Italian women (≥15 years) with information on BMI or blood glucose or diabetes, we analysed the risk of breast cancer death in relation to glucose tertiles (≤84.0, 84.1-94.0, >94.0 mg/dl) plus diabetic and unspecified categories; BMI tertiles (≤23.4, 23.5-27.3, >27.3 kg/m(2), unspecified), stage (T1-3N0M0, T1-3N+M0 plus T4anyNM0, M1, unspecified), oestrogen (ER) and progesterone (PR) status (ER+PR+, ER-PR-, ER and PR unspecified, other), age, chemotherapy and endocrine therapy, using multiple regression models. Separate models for ER+PR+ and ER-PR- cases were also run. RESULTS: Patients often had T1-3N0M0, ER+PR+ cancers and received chemotherapy or endocrine therapy; only 6% were M1 and 17% ER-PR-. Diabetic patients were older and had more often high BMI (>27 kg/m(2)), ER-PR-, M1 cancers than other patients. For ER+PR+ cases, with adjustment for other variables, breast cancer mortality was higher in women with high BMI than those with BMI 23.5-27.3 kg/m(2) (hazard ratio (HR)=2.9, 95% confidence interval (CI) 1.2-6.9). Breast cancer mortality was also higher in women with high (>94 mg/dl) blood glucose compared to those with glucose 84.1-94.0mg/dl (HR=2.6, 95% CI 1.2-5.7). CONCLUSION: Our results provide evidence that in ER+PR+ patients, high blood glucose and high BMI are independently associated with increased risk of breast cancer death. Detection and correction of these factors in such patients may improve prognosis.

11. Gaita F, Corsinovi L, Anselmino M, Raimondo C, Pianelli M, Toso E, Bergamasco L, Boffano C, Valentini MC, Cesarani F, Scaglione M. Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function. J Am Coll Cardiol. 2013 Nov 19;62(21):1990-7. doi: 10.1016/j.jacc.2013.05.074. Epub 2013 Jul 10.
Author information: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: fiorenzo.gaita@unito.it. Comment on J Am Coll Cardiol. 2013 Nov 19;62(21):1998-9.

Abstract OBJECTIVES: The aim of this study was to compare the prevalence of silent cerebral ischemia (SCI) and cognitive performance in patients with paroxysmal and persistent atrial fibrillation (AF) and controls in sinus rhythm. BACKGROUND: Large registries have reported a similar risk for symptomatic stroke in both paroxysmal and persistent AF. The relationship among paroxysmal and persistent AF, SCI, and cognitive impairment has remained uncharted. METHODS: Two hundred seventy subjects were enrolled: 180 patients with AF (50% paroxysmal and 50% persistent) and 90 controls. All subjects underwent clinical assessment, neurological examination, cerebral magnetic resonance, and the Repeatable Battery for the Assessment of Neuropsychological Status. RESULTS: At least 1 area of SCI was present in 80 patients (89%) with paroxysmal AF, 83 (92%) with persistent AF (paroxysmal vs. persistent, p = 0.59), and 41 (46%) controls (paroxysmal vs. controls and persistent vs. controls, p < 0.01). The number of areas of SCI per subject was higher in patients with persistent AF than in those with paroxysmal AF (41.1 ± 28.0 vs. 33.2 ± 22.8, p = 0.04), with controls reporting lower figures (12.0 ± 26.7, p < 0.01 for both). Cognitive performance was significantly worse in patients with persistent and paroxysmal AF than in controls (Repeatable Battery for the Assessment of Neuropsychological Status scores 82.9 ± 11.5, 86.2 ± 13.8, and 92.4 ± 15.4 points, respectively, p < 0.01). CONCLUSIONS: Patients with paroxysmal and persistent AF had a higher prevalence and number of areas of SCI per patient than controls and worse cognitive performance than subjects in sinus rhythm.

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