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Objectives Mammography screening is generally accepted in women aged 50–69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. Methods We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (Results We identified 10 RCTs including 616,641 women aged 38–75. Mammography reduced BC mortality in women aged 50–69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66–0.90, high certainty) and 70–74 (RR 0.77, 95%CI 0.54–1.09, high certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76–1.02, moderate certainty). Mammography reduced stage IIA+ in women 50–69 (RR 0.80, 95%CI 0.64–1.00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI 18–27%) and 17% (95%CI 15–20%) in under 50s and 50–69, respectively ( moderate certainty). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes ( low certainty). Conclusions For women 50–69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.

Introduction/Background In developed countries, endometrial cancer is the fourth most common cancer in women. ESGO guidelines propose appropriate strategies based on risk factors. Lymphadenectomy is a staging procedure and even if it does not seem to have a therapeutic role, it is crucial for tailoring adjuvant therapy. The aim of the study is to verify the reliability of expert transvaginal sonographer (TVS) and frozen section (FS) to assess myometrial infiltration ( Methodology To verify the accuracy of expert TVS and intraoperative frozen section to evaluate myometrial infiltration, 364 consecutive patients affected by EC were prospectively followed in 3 centres of the Oncological Network of Piemonte and Valle d’Aosta from 01/2016 to 10/2018. Definitive pathological report sensitivity, specificity, PPV, NPV, LR + LR- of TVUS and FS are obtained. The results were evaluated overall and by centre. Results TVUS by expert ultra-sonographer has obtained a diagnostic accuracy with sensitivity 76% specificity 73% PPV 66% NPP 82%. The variability observed between hospitals: centre A sensitivity 76% specificity 86% PPV 85% NPP 82%; centre B sensitivity 60% specificity 75% PPV 59% NPP 76%; centre C sensitivity 95% specificity 58% PPV 58% NPP 95%. The overall FS examination has the following values: sensitivity 86% specificity 97% PPV 95% NPP 92%. Stratifying by centres: A sensitivity 91% specificity 96% PPV 95% NPP 93%; B sensitivity 87% specificity 97% PPV 93% NPP 95%; C sensitivity 85% specificity 100% PPV 100% NPP 91%. Patients who add FS to TVUS had a reclassification improvement of 7.5%. Conclusion FS remains the most reliable method in the ‘real world’ to assess myometrial infiltration and to direct the staging procedures in endometrial cancer. The variability of FS among centres belonging to an oncological network is lower than what observed for TVUS. Disclosure Prof. Paolo Zola has received grants from Astrazeneca, Roche, Pharmamar and Tesaro.

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population- based breast cancer screening programmes based on mammography every other year for women aged 50 to 69 years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population- based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population- based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged. (C) 2016 The Authors. Published by Elsevier Inc.

RESUMEN Introducción: el síndrome metabólico (SM) es una entidad clínica con alteraciones vasculares y metabólicas que predisponen a la enfermedad cardiovascular (ECV). El estado nutricional es un factor predominante en la evolución del SM y el riesgo de ECV. Objetivo: analizar el estado nutricional a través de indicadores antropométricos y alimentarios en pacientes con SM. Métodos: estudio observacional, de corte transversal. Participaron 41 personas de ambos sexos (20 hombres y 21 mujeres), entre 30 y 60 años, que asistieron a consulta ambulatoria del Servicio de Cardiología y Clínica Médica de la Clínica Universitaria Reina Fabiola (CURF) y del Servicio de Cardiología No Invasiva del Hospital Nacional de Clínicas (HNC), durante el periodo 2015-2016. Se realizó toma de indicadores antropométricos para determinar el estado nutricional (índice de masa corporal o IMC), circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD). Las variables alimentarias incluidas fueron valor calórico total (VET), consumo de colesterol (CCol) y consumo de sodio (CS). El estudio cuenta con la aprobación del Comité de Ética del CURF y HNC. Para estimar el VET, el consumo de colesterol y de sodio se utilizó el programa informático Interfood v.1.3. El análisis de los datos se llevó a cabo con el programa InfoStat. Para analizar si existían diferencias por sexo, se utilizó el test de Wilcoxon para variables continuas y Kruskal Wallis para las categóricas. Resultados: el 93% de los pacientes presentaron exceso de peso (el 61% con IMC superior a 30kg/mts2). En relación a CC, el 75% de las mujeres y 86% de hombres presentaron riesgo cardiovascular muy aumentado. La media de PAS fue 131,18±18,96 mmHg y la de PAD fue 79,88±12,29 mmHg. El VET fue 2828,45±1255,42 Kcal, el consumo promedio de colesterol fue 380,09±191mg y el de sodio fue 2072,26±1195,44 mg, siendo estas ingestas superiores a las recomendadas. Al analizar las comparaciones por sexo, no se encontraron diferencias estadísticamente significativas para las variables en estudio. Conclusión: estos resultados preliminares resaltan el perfil de riesgo para el desarrollo de ECV de los pacientes con SM. Se necesita continuar profundizando el estudio de estas poblaciones, para aportar evidencia que contribuya a la promoción de hábitos saludables y la prevención de patologías crónicas vinculadas a la alimentación y nutrición.

Background: There is still lack of consensus on the benefit-harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health-related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. Results: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false-positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false-positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.

Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes. post-print 163 KB

International guidelines recommend assessing women's satisfaction with breast cancer screening programmes; however, validated tools are needed. A systematic review to identify and evaluate the quality of validated instruments for screening satisfaction, from 01/1965 until 11/2017 was performed. From 3283 individual citations, six instruments were identified. Evaluation of the MammoGraphy Questionnaire using the COSMIN checklist resulted in 'good' to 'excellent' scores in most assessed domains, while the other tools were mostly 'poor'/'fair' quality or did not provide enough information for assessment. Nevertheless, substantial changes in screening processes and programmes have been implemented in recent years. Thus, further development work is needed.

Description The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. Methods An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. Recommendations This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.

Fumonisins B1 ,B 2 y B3 (FB1 ,F B 2 y FB3), are a group of toxins produced by different mold species, Fusarium moniliforme and Fusarium proliferatum being the most important ones. Its compounds were tested in chromosome aberrations (CA), sister chromatid exchange (SCE), and micronucleus (MN) in human lymphocytes, and, in Allium cepa (onion), the chromosomal aberrations (CA) assay was used. Moreover, the presence of fumonisins and their producer moulds was determined in different food substrata in Cordoba city, Argentina. Cytogenetic studies using FB1 ,F B 2 and FB3 levels gave positive results for the higher concentrations (5 and 10 lg/g) with FB1. As regards the cytogenetic aspect of FB1, we found an increase in the incidence of genetic damage measured by chromosomal aberrations, sister chromatid exchange, micronuclei and chromosomal aberrations in Allium cepa. These results indicate that human lymphocytes cells and plants cells (Allium cepa) have a very sensitive cellular response to the mycotoxin fumonisin B1 as observed at the highest concentrations. � 2005 Elsevier Ltd. All rights reserved.

Background Infections and hypotension are serious complications that develop during hemodialysis (HD) treatment. Adenosine (ADO), a strong hypotensive and immunosuppressive agent, may participate in these two HD complications, because high concentrations of ADO metabolites are found in dialyzed human plasma. ADO, which is released by endothelial cells, is quickly transformed into inosine (INO) by plasmatic ADO deaminase (ADA) and mononuclear cell ADO deaminase (MCADA). In plasma, the degradation of ADO into INO and its uptake by red blood cells (RBC) are both very rapid, resulting in the short half-life of ADO in blood. Methods Using liquid chromatography, we evaluated ADO and INO plasma concentrations before and after HD session. Results Before the HD session, ADO and INO plasma concentrations were higher in hemodialyzed patients than in controls and in peritoneally dialyzed patients. At the end of the HD session, ADO plasma concentration was increased. ADO plasma concentration for the undialyzed patients was in the same range as that of the controls. Before HD, ADA activity was higher in hemodialyzed patients (559±349 IU) than in controls (219±48 IU), and the activity rose during the session (665±135 IU). ADA activity in the undialyzed patients (222±80 IU) was in the same range as that of the controls (219±48 IU). Before the HD session, the MCADA activity (247±144 IU) was lower than in controls (624±99 IU). HD did not modify ADO RBC uptake. ADO inhibited mononuclear cell proliferation and interferon-γ production in humans. Finally, as much as 50 μM INO does not inhibit ADO uptake by RBC and does not modify ADA and MCADA activities. Conclusions These data indicate that chronic HD inhibited MCADA activity and increased ADO plasma concentration. Both high ADO plasma concentration and low MCADA activity may be involved in dialysis-induced immune system failure and thereby favor infectious diseases.

Several problems concerning air quality in urban areas with special regard to benzene pollution from motor vehicle traffic are described. Some medical and regulatory aspects relative to the exposure of population and specific classes of workers are given particular stress. Benzene concentrations measured in the metropolitan area of Milan in an extensive monitoring campaign are presented together with historical carbon monoxide (CO) measurements realized by the Milan air pollution network. Starting from these two series of values a typical ratio between CO and benzene has been calculated and it has been found to be consistent with literature data. A risk assessment hypothesis has been performed using a simple model based on both kinds of data mentioned above.

A study was carried out on human subjects of various ages and backgrounds who had been drinking water containing more than 0.13 mg/l (0.13 ppm) arsenic for a period of at least 20 years. The main aim was not only to correlate the frequency of sister-chromatid exchanges in the lymphocytes with the amount of arsenic in water and urine but also to correlate the frequency of SCE with sex and age. In addition, family background regarding skin alterations or other arsenic-related symptoms was explored, so that individual health conditions could be assessed. External factors such as exposure to other chemical or contaminating agents (pesticides, battery manufacturing plants, foundries) were also taken into consideration. The data on sister-chromatid exchanges (282 exposed and 155 control individuals) showed that arsenic at concentrations used by our population (0.13 mg/l) induced a significantly elevated response. Other health effects of arsenic at these concentrations were found, e.g., hyperkeratosis, melanosis, actinic keratosis, basal cell carcinoma.

Ochratoxin A (OTA) is a toxin produced by Aspergillus and Penicillum moulds. Since OTA has not yet been evaluated in plant systems, this paper focused on describing the controversial effect OTA in an Allium root test model, which has known sensitivity to genotoxins and could be useful in toxin screening. Analyses of root growth and the root meristematic zone in response to OTA treatment were undertaken. The results show OTA toxicity to root growth at a concentration of 10 ug.ml(-1) associated with inhibition of proliferation activity. Cytological changes observed in the Allium chromosome aberrations assay, at a concentration of 5.0 ug.ml(-1), showed that OTA was able to induce genotoxicity at the chromosome level. These results indicate that plants cells (Allium cepa) are very sensitive to the mycotoxin OTA, as observed at the highest concentration. Under these conditions, OTA produced toxicity and cytogenetic injury. Evidence in vitro and in vivo indicates that OTA can induce damage at the DNA level.

The effect of lead on Allium cepa L. at concentrations of 0.1, 1.0, 10, 50, 100 and 200 ppm were studied. Analysis focused on root growth, frequency of mitosis in a meristematic zone, and chromosomal aberrations. It was observed that lead reduces root growth and the frequency of mitotic cells in meristematic zones, and increases the frequency of aberrant cells. The intensity of the effects is a function of lead concentration.

Ten persons occupationally exposed to ethylene oxide (EO), used in the sterilization of medical instruments, were studied at a hospital. The estimated concentration to which they were exposed was 60–69 ppm, TWA. Peripheral blood samples from 10 workers and 10 controls of the same age and sex were taken to determine the frequency of sister-chromatid exchanges (SCE) and chromosomal aberrations (CA). The mean frequencies of SCE/cell (X = S) were 13.27 for the exposed workers and 6.05 for controls. Chromosome aberration frequencies in exposed individuals were significantly increased compared with controls. A significant relationship between the frequencies of SCE and CA and EO exposure was demonstrated. Blood chemistry parameters such as urea, creatinine, uric acid, lactic dehydrogenase, glutamic oxaloacetic and pyruvic transaminases, luteinizing gonadotropin and follicle stimulating gonadotropin and thyrotropin were also measured and found to be within the normal range.

We studied the reproductive function of 32 male farm sprayers who were exposed to 2,4-D. Sperm analysis was made after 4 days of sexual inactivity. Parameters analyzed were volume, sperm count, mobility and morphology. Exposure level was estimated by measuring the concentration of 2,4-D in the urine. Significant levels of asthenospermia, necrospermia and teratospermia were found in exposed workers compared with unexposed controls. Over time, asthenospermia and necrospermia diminished but the abnormal spermatozoa (teratospermia) continued.

To confirm rates of infections from a previous survey in chronic hemodialysis patients; to get information about incidents and manipulations of vascular access-site, number and reasons of hospitalisation; to asses a relationship between the frequency of vascular access-site infections (VASI) and quality of care during the procedures of vascular access-site use.Prospective, multicenter survey performed from February 2000 to January 2001, including all patients underwent chronic hemodialysis in 5 participating centers. Standardized definitions used and different clinical and biological risk factors recorded.429 patients for a total of 4273 dialysis months (DM) were enrolled. 245 infections in 164 infected patients were reported. The overall rate was 5.73 infections per 100 DM (18 VASI, 25 bacteraemia, 84 respiratory, 29 urinary tract, 1 endocarditis and 88 other infections). 50% of infections were microbiologically documented. 19 of 21 antibiotics resistant microorganisms were meticillin resistant Staphylococcus aureus. Compared to the incidence rate of fistula (0.05 per 1000 days of follow-up) or prosthesis related VASI (0.11), the incidence rate of catheter related VASI (0.65) was significantly higher. Poor hygiene and duration of catheter use were the significant risk factors for VASI showed by logistic analysis regression. VASI and bacteraemia occurred more frequently after incident or manipulation of the vascular access-site. The decrease of VASI between the 2 periods of survey was significantly higher in centers having reduced the catheter use and implemented written protocols.This second period of surveillance has confirmed the frequency of infections rate in chronic hemodialysis patients and particularly bacteraemia and VASI. This study has allowed to establish risk factors for infections and showed that VASI in hemodialysis are related to factors in part preventable.

Subjects which had been consuming drinking water with a high vanadium content, namely, 0.34 mg/l (0.34 ppm), for at least 10 years were investigated. Research was aimed at correlating the frequency of sister chromatid exchange (SCE) and chromosomal aberrations (CA) in human lymphocytes with vanadium values in water and urine. A questionnaire was administered to each subject to find any other vanadium-related symptom. Data collected on both SCE and CA suggest that vanadium at concentrations affecting population under study (i.e. 0.34 mg/l) does not induce a significantly higher response., Fil: Lerda, Daniel Enrique. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentina

We report the case of a 36 year-old-patient, hemodialyzed for idiopathic membranous glomerulonephritis, who suffers from type I membranoproliferative glomerulonephritis five years after a successful kidney transplantation. Etiologic evaluation evidenced chronic viral hepatitis C complicated by type III cryoglobulinemia. If hepatitis C induced membranoproliferative glomerulonephritis has yet been described among non transplanted patients, it is at our knowledge, the first observation in a renal transplant recipient.

We here report two additional cases of HIV associated nephropathy ; the clinical and pathological features of these renal parenchymal complications are characteristic.