A high saturated fat diet (HFD) induces obesity and insulin resistance (IR). IR has been linked to alterations and increased saturation in the phospholipid composition of skeletal muscles. We aimed to determine whether HFD feeding affects fatty acid (FA) membrane profile in a muscle fiber-type specific manner. We measured phospholipid FAs and expression of FA synthesis genes in oxidative soleus (SOL) and glycolytic extensor digitorum longus (EDL) muscles from rats fed either standard chow (SLD) or a HFD. The HFD increased fat mass, plasma insulin and leptin levels. Compared with EDL, SOL muscles preferentially accumulated C18 over C16 FAs and n-6 over n-3 polyunsaturated FAs (PUFAs) on either diet. With the HFD, SOL muscles contained more n-9 monounsaturated FAs (MUFAs) and n-6 PUFAs, and less n-7 MUFAs and n-3 PUFAs than EDL muscles, and had lower unsaturation index, a pattern known to be associated with IR. Stearoyl-CoA desaturase1 (SCD1) expression was ~13-fold greater in EDL than in SOL muscles but did not change with the HFD in either muscle. The expression of Elongase-5 was higher, and that of Elongase-6 (Elovl6) was lower in EDL compared with SOL muscles with both diets. In EDL muscles, the expression of Elovl6 was lower in the HFD than in the SLD. The pattern of FA uptake, expression and diet-induced changes in FA desaturating and elongating enzymes maintained higher FA unsaturation in EDL muscles. Accordingly, the fiber-type composition of skeletal muscles and their distribution may be important in the development and progression of obesity and IR.

The clinical significance of micropapillary growth pattern in ductal carcinoma in situ is controversial and the impact of nuclear grading in terms of recurrence of this lesion is yet to be clarified. Our aim was to evaluate, on a series of micropapillary in situ carcinomas, the histological features correlated with recurrence and whether the micropapillary subtype had a different behavior from other non-micropapillary ductal carcinoma in situ. We collected 55 cases of micropapillary in situ carcinomas from four institutions. All cases were reviewed for nuclear grade, extent, necrosis, microinvasion and tested for estrogen and progesterone receptors, Ki67, HER2, EGFR and p53 expression. Clinical data, type of surgery and follow up were obtained for all patients. Our results showed that the nuclear grade is crucial in determining the biology of micropapillary carcinoma in situ, so that the high nuclear grade micropapillary ductal carcinoma in situ more frequently overexpressed HER2, showed higher proliferation index, displayed necrosis and microinvasion and was more extensive than low/intermediate nuclear grade. Logistic regression analysis confirmed the high nuclear grade (Odds ratio: 6.86; CI: 1.40-33.57) as the only parameter associated with elevated risk of local recurrence after breast-conserving surgery. However, the recurrence rate of 19 micropapillary carcinoma in situ, which were part of a cohort of 338 consecutive ductal carcinoma in situ, was significantly higher (log-rank test, P-value=0.019) than that of non-micropapillary, independently of the nuclear grade. In conclusion, although nuclear grade may significantly influence the biological behavior of micropapillary ductal carcinoma in situ, micropapillary growth pattern per se represents a risk factor for local recurrence after breast-conserving surgery.Modern Pathology advance online publication, 13 November 2009; doi:10.1038/modpathol.2009.169.

GOALS: To evaluate the survival characteristics of patients with duodenal gastrointestinal stromal tumors (GISTs). BACKGROUND: GISTs represent the most common mesenchymal neoplasms. However, duodenal GISTs are relatively rare, and few studies have been performed with a focus on duodenal GISTs. STUDY: We collected the data of 41 GIST patients including 7 duodenal cases. Clinicopathologic findings and recurrence-free survival (RFS) of duodenal GIST patients were analyzed. RESULTS: The proportion of having any symptoms was 86% in duodenum, 32% in stomach, and 56% in other GISTs (P=0.034), and the most common symptoms of duodenal GISTs were melena and anemia. The 2-year RFS rates were 51.4% in duodenal GISTs, 78.4% in stomach GISTs, and 100% in other GISTs, and duodenal GISTs showed poorer RFS than nonduodenal GISTs (hazard ratio, 5.1; log-rank P=0.019). Particularly, in low-risk and intermediate-risk group, the hazard ratio of recurrence was 12.3 (log-rank P=0.010). Multivariate Cox analysis showed symptom (P=0.007), mitotic index (P=0.011), and tumor location (P=0.043) were significant prognostic factors of recurrence. CONCLUSIONS: RFS of duodenal GISTs was worse than nonduodenal GISTs.

Within this survey, conducted by the Italian Breast Screening Network (Gruppo Italiano per lo Screening Mammografico, GISMa), individual data are collected yearly on more than 50% of all screen-detected operated lesions in Italy. In 2006, results showed overall good diagnosis and treatment quality and an improving trend over time. Critical issues were identified in waiting times, compliance with recommendations on not performing frozen section examination on small lesions and on performing specimen X-ray. Pre-operative diagnosis reached the acceptable target, but there is a large variation between Regions and programmes. The sentinel lymph node technique (SLN) was performed on the axilla in more than 70% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN in ductal carcinoma in situ deserves further investigation. The detailed results have been distributed to regional and local screening programmes, also by means of an online database, in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making audit effective in producing quality improvement with a shortening of waiting times.

A 57-year-old man was admitted to our hospital with dysphagia. Endoscopic examination revealed a wide 0- II c 2/3- circumferential growth with negative iodine staining in the middle-third of the esophagus (25 approximately 32 cm from the incisors). Biopsy examination revealed moderately differentiated squamous cell carcinoma of the esophagus. The depth of invasion was suspected to be not beyond the mucosa (m2), and computed tomography and ultrasonography revealed neither lymph node nor distant metastasis. Esophagectomy or chemoradiation (CRT) was indicated according to the Japanese guidelines for the treatment of esophageal cancer, because endoscopic mucosal resection (EMR) would have been difficult due to the large width of the lesion (2/3 circumferential growth). Chemotherapy was administered with the combined regimen of nedaplatin+adriamycin+5-fluorouracil (NAF) because the patient desired strongly. After completion of two cycles, the cancer lesion disappeared entirely, as determined both clinically and pathologically by endoscopic examination with biopsy, without any major toxicity. At present, 3 years after the chemotherapy, the patient remains free of any evidence of recurrence.

The indirect bonding technique is pivotal for success in lingual orthodontics. There are different laboratory techniques available for indirect positioning and bonding of lingual brackets. Different approaches are presented and described to perform a clinical application. Le collage indirect est un point clé du succès en orthodontie linguale. Différentes techniques permettent de positionner les attaches sur les modèles au laboratoire. La transposition en bouche via le collage indirect nécessite des procédures exigeantes et précises.

Bonding is a major component of our therapeutic arsenal. We routinely bond attachments to enamel as well as to other surfaces including dentin, ceramic, acrylic, steel, amalgam, and gold, especially for adult patients. This procedure poses certain technical problems for which adapted and specific technical protocols can provide solutions. Le collage est une composante majeure de notre arsenal thérapeutique. Nous collons sur l'émail comme sur les autres surfaces (dentine, céramique, résine, acier, amalgame, or...) de façon routinière, notamment chez l'adulte. Cela pose alors des problèmes techniques, qui trouvent leurs solutions dans des protocoles techniques adaptés et spécifiques.

Enamel conditioning (elimination of dental plaque and creation of an irregular surface) is an essential step before bonding of orthodontic brackets. The most popular procedure in our practice is bonding with resin which requires enamel etching in order to get enough shear bond strength. Many studies have tried to evaluate the effects of enamel bonding using the acid-etching procedure as well as the changes caused by detachment of brackets. Thanks to the development of other adhesives such as glass ionomer cements which chemically bind to the enamel, new enamel conditioning methods appeared, in particular sandblasting with aluminium oxide particles. This technique is a mechanical preparation of the tooth that avoids the harmful effects of acid products. By suitably choosing the parameters of sandblasting (pressure, time and quantity of powder), enamel loss is lower than with the acid-etch procedure and the surface of the enamel seems less affected. However the bond strength remains superior to the values required for treatment. The presented results indicate that enamel sandblasting can be considered as an alternative for the acid-etching technique currently used in orthodontic practice because it creates sufficient strength and respects enamel thickness better. La préparation de l'émail (élimination de la pellicule acquise exogène et création d'un micro-relief) est une étape indispensable avant tout collage d'attaches orthodontiques. Le produit le plus couramment utilisé en clinique orthodontique est la résine composite dont l'adhésif nécessite un mordançage à l'acide, afin d'obtenir des forces d'adhésion suffisantes. De nombreuses études ont cherché à objectiver les répercussions du mordançage sur l'émail, ainsi que les altérations conséquentes au décollage des attaches. Grâce au développement d'autres adhésifs comme les verres ionomères qui se lient chimiquement à l'émail, de nouveaux moyens de préparation amélaire sont apparus, notamment le sablage avec de la poudre d'oxyde d'alumine calibrée. Celui-ci consiste en une préparation mécanique de la dent, ce qui évite les effets néfastes des agents mordançants. En choisissant convenablement les différents paramètres de sablage (pression, temps et quantité de poudre), l'état de surface de l'émail semble moins altérée par rapport à une préparation par mordançage et l'adhésion des attaches reste supérieure aux valeurs minimales requises pour un traitement. Les résultats obtenus selon différentes études présentées indiquent donc que le sablage amélaire peut constituer une alternative crédible à la préparation par mordançage et permettre un collage efficace tout en étant plus respectueux de l'épaisseur de l'émail.

Mastery of the bonding stage of treatment is clearly a critical step in the clinical practice of orthodontics. There is such a wide variety of products available in orthodontics that a reasoned assessment of bonding systems is a practical necessity. Composite plastics, associated with hydrophobic or hydro-compatible adhesive systems, and the CVIMAR represent the two principal types of bonding agents used in dentistry. They are categorized according to their constituents into a wide range of products whose nuanced differences are sometimes difficult to discern. This paper first focuses on the development of the composition of the various materials, a depiction of the fundamental parameters of adhesion, and a detailed terminology to help the reader reach a basic understanding. Bonding systems are designed to fulfill the requirements of specific clinical situations. A description of their modes of adhesion, of their composition, and of their advantages and disadvantages will be presented in the second part of this article. La maîtrise de l'étape de collage se révèle décisive dans notre pratique clinique. La diversité des produits disponibles en orthodontie oblige à un état des lieux régulier des systèmes de collage. Les résines composites, associées à des systèmes adhésifs hydrophobes ou hydrocompatibles, et les Ciments Verres Ionomères Modifiés par Adjonction de Résine (CVIMAR) représentent les deux grandes familles de colle utilisées par les professionnels. Elles se déclinent, selon les variations de leur composition, en un panel de produits dont il est parfois difficile d'en appréhender les nuances. L'évolution historique de la composition des différents matériaux, la connaissance des paramètres fondamentaux de l'adhésion et une terminologie détaillée apportent un premier éclairage. Chaque système de collage répond à des impératifs cliniques spécifiques. Une description de leur mode d'adhésion, de leur composition, des avantages et des inconvénients sera présentée dans une seconde partie de cet article.

OBJECTIVE: Determinants of long-term outcome of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who received neoadjuvant chemotherapy (NAC) are not clear. The purpose of this study was to explore the prognostic factors of HER2-positive breast cancer patients administered NAC. METHODS: A retrospective analysis of 125 HER2-positive breast cancer patients treated by NAC using an anthracycline plus taxane with (HCN group, n = 54) or without trastuzumab (non-HCN group, n = 71) was performed. The clinical parameters, including the pathological complete remission (pCR) rate, disease-free survival (DFS) and organ-specific recurrence-free survival, were measured. RESULTS: According to the results of the univariate analyses, age, clinical stage, pCR and axillary lymph node status were the factors significantly associated with the DFS. The inclusion of trastuzumab in the NAC regimen did not yield a significant difference in the DFS. Only the axillary lymph node status and age were found to be the significant factors affecting the DFS in a multivariate model. There were no significant differences in the patient/tumor characteristics between the HCN and non-HCN groups except for the pCR rate (50% in the HCN group vs. 24% in the non-HCN group) and the median follow-up time (738 days in the HCN group vs. 1579 days in the non-HCN group). Within the first 2 years from the initiation of NAC treatment, the central nervous system (CNS) was the most common site of first recurrence in the HCN group, whereas no cases of CNS metastasis were observed in the non-HCN group. CONCLUSIONS: The pathological axillary node status and age were found to be the significant prognostic factors in HER2-positive breast cancer patients who received NAC. The pattern of recurrence may be different between HCN-treated and non-HCN-treated patients.