The Bronchopulmonary Dysplasia score: A predictive model for bronchopulmonary dysplasia or death in high-risk preterm infants.

AIM: Progressive respiratory deterioration in infants at high risk of bronchopulmonary dysplasia (BPD) is associated with patent ductus arteriosus (PDA) exposure. This study aimed to design an early predictive model for BPD or death in preterm infants using early echocardiographic markers and clinical data. METHODS: Infants born with gestational age (GA) ≤ 29 weeks and/or birth weight (BW) < 1500 g at Cork University Maternity Hospital, Ireland were retrospectively evaluated. Those with echocardiography performed between 36 h and 7 days of life were eligible for inclusion. Exclusion criteria were pulmonary hypertension and major congenital anomalies. The primary outcome was a composite of BPD and death before discharge. RESULTS: The study included 99 infants. A predictive model for the primary outcome was developed, which included three variables (BW, Respiratory Severity Score and flow pattern across the PDA), and yielding an area under the curve of 0.98 (95% CI 0.96-1.00, p < 0.001). Higher scores were predictive of the primary outcome. A cut-off of -1.0 had positive and negative predictive values of 89% and 98%, and sensitivity and specificity of 98% and 88%, respectively. CONCLUSION: Our prediction model is an accessible bedside tool that predicts BPD or death in premature infants.

Assessing the accuracy of conventional gadolinium-enhanced breast MRI in measuring the nodal response to neoadjuvant chemotherapy (NAC) in breast cancer.

Management of the axilla in the era of neoadjuvant chemotherapy for breast cancer is evolving. The aim of this study is to determine if conventional gadolinium-enhanced breast MRI can aid in evaluation of the response to neoadjuvant chemotherapy in the axilla. A retrospective review of a prospectively maintained database of patients undergoing neoadjuvant chemotherapy for breast cancer was performed. Pre and post-neoadjuvant chemotherapy MRI reports for node-positive patients were examined in conjunction with demographic data, treatment type, and final histopathology reports. One-hundred and fourteen patients with breast cancer undergoing neoadjuvant chemotherapy were included in the study. The sensitivity of magnetic resonance imaging in detecting nodal response post-neoadjuvant chemotherapy was 33.93% and the specificity was 82.76%. Magnetic resonance imaging had a positive predictive value of 65.52% and a negative predictive value of 56.47%. MRI was found to be most specific in the detection of triple-negative cancer response. Specificity was 100% in this group and sensitivity was 75%. Magnetic resonance imaging has a relatively high specificity in detecting nodal response post-neoadjuvant chemotherapy but has a low sensitivity. Alone it cannot be relied upon to identify active axillary malignancy post-neoadjuvant chemotherapy. However, given its increased specificity among certain subgroups, it may have a role in super-selecting patients suitable for sentinel lymph node biopsy post-neoadjuvant chemotherapy.

Health Literacy Influences Men's Active and Passive Cancer Information Seeking.

BACKGROUND: For cancer prevention information to be effective, it must be accessible to its target populations. Prevalence of inadequate health literacy (HL) is high, but there is a dearth of information on the impact of HL on men's cancer information seeking. OBJECTIVE: We investigated (1) men's cancer information seeking behaviors, (2) the effect of HL on men's cancer information seeking behavior, and (3) men's preferences for cancer information, considering their HL level. From a national perspective, we investigated men's information seeking behavior from the Irish Cancer Society (ICS), the largest provider of cancer information in Ireland. METHODS: Men from adult literacy classes and men's groups were invited to complete a questionnaire. General and ICS-specific cancer information seeking behavior was investigated. Univariate and multivariate logistic regression models were conducted with "ever" seeking cancer information from any source, and actively seeking and passively acquiring ICS information as dependent variables. KEY RESULTS: Overall, 259 men completed the questionnaire and 44% had inadequate HL. About one-half of responders reported "ever" actively looking for cancer information. In the study group, 19% actively sought and 67% passively acquired ICS-specific information. In multivariate analysis, the odds of actively seeking (2.93; 95% CI [1.05, 8.15]) or passively acquiring (4.7; 95% CI [1.99, 11.05]) ICS-specific cancer information was significantly higher among those with adequate versus inadequate HL, respectively. HL was not significantly associated with odds of "ever" cancer information seeking in multivariate analysis (odds ratio 1.81; 95% CI [0.90, 3.63]). Men want information about cancer prevention. Suggested future cancer information sources differed by HL levels. General practitioners and the Internet were the preferred source for men with inadequate (53.3%) and adequate HL (57%), respectively. CONCLUSIONS: Men both passively acquire and actively seek cancer prevention information. Multimodal dissemination of cancer prevention information is necessary to reach a wide cross-section of men, including those with inadequate HL. This could potentially lower men's cancer burden and reduce gender inequalities in cancer mortality. [HLRP: Health Literacy Research and Practice. 2019;3(3):e147-e160.]. PLAIN LANGUAGE SUMMARY: Most men get cancer prevention information by coming across it passively in their daily lives, instead of actively looking for this information. Men with low health literacy are less likely to obtain cancer information both passively and actively. Men want this information. Organizations need to make this information available in many places and formats (e.g., Internet, doctor, television, sports clubs).

Information Needs of Patients With Breast Cancer at Years One, Three, and Five After Diagnosis.

INTRODUCTION: The information needs of breast cancer patients at diagnosis have been studied extensively. However, with cancer survival improving, the era of cancer care has entered a more chronic phase with an associated paucity of data related to longer term information requirements. The aim of the present study was to assess and compare the information needs of breast cancer patients during the first 5 years after the diagnosis. PATIENTS AND METHODS: A total of 105 follow-up consecutive patients presenting to a tertiary referral breast cancer center from August to October 2017 were recruited. The patients were divided into groups by the years after the diagnosis (1, 3, and 5 years). Each patient completed the Toronto Information Needs Questionnaire for Breast Cancer. RESULTS: The number of patients in each group was as follows: 23 at 1 year, 38 at 3 years, and 44 at 5 years after the initial diagnosis. The median Toronto Information Needs Questionnaire for Breast Cancer score was 4.15 on a 5-point Likert scale of breast cancer information needs (1, not important to 5, extremely important). No difference was found in the median scores at 1, 3, and 5 years. Information pertaining to the disease process was rated as most important (median, 4.50), and information regarding the psychosocial aspect of disease was ranked lowest (median, 3.75). CONCLUSION: The information needs of patients with breast cancer remain high throughout the follow-up period after the diagnosis. In an era of prolonged survival, attention to the information needs of patients at follow-up examinations is as important as at the time of diagnosis and treatment.

A Randomized Controlled Trial of End-Tidal Carbon Dioxide Detection of Preterm Infants in the Delivery Room.

OBJECTIVE: To compare the ability of qualitative versus quantitative methods of end-tidal carbon dioxide (EtCO2) detection to maintain normocarbia during face mask ventilation (FMV) of preterm infants (<32 weeks) in the delivery room. STUDY DESIGN: Preterm infants <32 weeks were randomly assigned to the use of a disposable PediCap EtCO2 detector (Covidien, Dublin, Ireland) (qualitative) or a Microstream side stream capnography device (Covidien) (quantitative) for FMV in the delivery room, via a NeoPuff T-piece resuscitator (Fisher and Paykel, Auckland, New Zealand). The primary outcome was the presence of normocarbia, based on partial pressure of CO2 (PaCO2) readings obtained in the neonatal intensive care unit within an hour of birth. Normocarbia was defined as a PaCO2 measure between 37.5 and 60 mm Hg (5-8 kPa). RESULTS: Of the 59 infants included, 59% (35/59) were within the PaCO2 target range within an hour of birth. There was no difference in the primary outcome; 64% (21/33) of infants in the quantitative group were within the PaCO2 range compared with 54% (14/26) in the qualitative group (P = .594); and 93% of participants <28 weeks' gestation were within the PaCO2 normocarbic range (90% [9/10] in quantitative group and 100% [5/5] in the qualitative group [P = 1]). There was no difference in the intubation rate, days of ventilation, or bronchopulmonary dysplasia rates between the 2 groups. CONCLUSIONS: Quantitative or qualitative EtCO2 detection methods are both feasible for FMV in the delivery room. Although there was no difference in the incidence of normocarbia, the use of either form of EtCO2 monitoring should be considered during newborn stabilization, especially in infants less than 28 weeks' gestation. TRIAL REGISTRATION: ISRCTN: ISRCTN10934870.

Optimal Scoring of Brightfield Dual-Color In Situ Hybridization for Evaluation of HER2 Amplification in Breast Carcinoma: How Many Cells Are Enough?

OBJECTIVES: The purpose of this study was to determine the optimum number of cells that should be counted when scoring human epidermal growth factor receptor 2 (HER2) brightfield dual-color in situ hybridization (BDISH), including cases with HER2/chromosome 17 (Chr17) ratios in the 1.80 to 2.20 range. METHODS IN TOTAL,: 131 cases of breast carcinoma with HER2 immunohistochemistry and BDISH were included. For cases with a HER2/Chr17 ratio of less than 1.80 or more than 2.20 (n = 115), BDISH scoring was performed for 60 cells using three tumor fields, and for cases with a HER2/Chr17 ratio of 1.80 to 2.20 (n = 16), scoring was performed for 120 cells using six tumor fields. Mean HER2/Chr17 ratio and HER2 copy number were calculated for cumulative cell counts. RESULTS: The HER2 status as determined by the HER2/Chr17 ratio or HER2 copy number was unchanged following counting of additional cells in 100% of cases with ratio of less than 1.80 or more than 2.20. The HER2 status of two cases with ratios of 1.80 to 2.20 changed from positive to negative following counting of 120 cells. CONCLUSIONS: Our findings support recommendations to score 20 nuclei in conjunction with careful assessment of immunohistochemistry and scan of the BDISH slide to identify areas of heterogeneity. Scoring of additional cells/fields is likely not of benefit and might be a disadvantage since the scorer moves out of the area of strongest signal.

Predicting 2-y outcome in preterm infants using early multimodal physiological monitoring.

BACKGROUND: Preterm infants are at risk of adverse outcome. The aim of this study is to develop a multimodal model, including physiological signals from the first days of life, to predict 2-y outcome in preterm infants. METHODS: Infants <32 wk gestation had simultaneous multi-channel electroencephalography (EEG), peripheral oxygen saturation (SpO2), and heart rate (HR) monitoring. EEG grades were combined with gestational age (GA) and quantitative features of HR and SpO2 in a logistic regression model to predict outcome. Bayley Scales of Infant Development-III assessed 2-y neurodevelopmental outcome. A clinical course score, grading infants at discharge as high or low morbidity risk, was used to compare performance with the model. RESULTS: Forty-three infants were included: 27 had good outcomes, 16 had poor outcomes or died. While performance of the model was similar to the clinical course score graded at discharge, with an area under the receiver operator characteristic (AUC) of 0.83 (95% confidence intervals (CI): 0.69-0.95) vs. 0.79 (0.66-0.90) (P = 0.633), the model was able to predict 2-y outcome days after birth. CONCLUSION: Quantitative analysis of physiological signals, combined with GA and graded EEG, shows potential for predicting mortality or delayed neurodevelopment at 2 y of age.

Patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer.

AIMS AND OBJECTIVES: To investigate patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer and the relationship between bowel symptom experiences and the self-care strategies used. BACKGROUND: Earlier diagnosis of rectal cancer allows for less invasive surgical treatments such as sphincter-saving procedures to be performed. Although a permanent stoma is generally not required, patients experience changes in bowel function following this surgery. However, limited research exists on patients' bowel symptom experiences and the self-care strategies used to manage symptoms following sphincter-saving surgery of rectal cancer. DESIGN: Quantitative descriptive correlational. METHODS: A convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected (April 2010-December 2010) using the Illness Perception Questionnaires, the Difficulties of Life Scale and a researcher developed Self-care Strategy Measure. The research was underpinned by the Symptom Management Theory. FINDINGS: Relating to the four most effective self-care strategies used respondents reporting more bowel symptom were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times. Females, respondents with high timeline cyclical scores and respondents with high physiological responses scores were more likely to use protective clothing. Respondents reporting more bowel symptom and with high social responses scores were more likely to use bowel medication. Females were more likely to wear incontinence pads. CONCLUSION: This research provides insights into the daily bowel symptom experiences of patients following sphincter-saving surgery for rectal cancer. It demonstrates the range of self-care strategies that individuals use to manage their bowel symptoms and the self-care-strategies that were most effective for them. RELEVANCE TO CLINICAL PRACTICE: Patients should be encouraged to report on-going bowel problems following sphincter-saving surgery for rectal cancer. Supportive care for patients should be comprehensive and tailored to meet individual needs.

Cord blood proteins and multichannel-electroencephalography in hypoxic-ischemic encephalopathy.

OBJECTIVE: To explore the association between multiple umbilical cord blood proteins and severity of hypoxic-ischemic encephalopathy as defined by continuous multichannel electroencephalography. DESIGN: A prospective case-control cohort study, which was divided into separate exploratory and validation cohorts. SETTING: A single tertiary neonatal intensive care facility. PATIENTS: The study recruited full-term infants with perinatal asphyxia and controls. Identical procedures were used to recruit a representative exploratory sample (n = 30) and a subsequent validation cohort (n = 100). INTERVENTION: All had umbilical cord blood drawn and biobanked at delivery, continuous multichannel electroencephalography commenced in the first 24 hours, and a modified Sarnat score assigned. Analysis of 37 potential cord blood protein markers of hypoxic-ischemic encephalopathy was performed using Luminex multiplex assays. MEASUREMENTS AND RESULTS: Cord blood from 130 infants was analyzed. Interleukin-16 and interleukin-6 significantly differentiated between a moderate-severely abnormal and normal-mildly abnormal electroencephalography background in both exploratory (p = 0.005 and p = 0.016, respectively) and validation cohorts (p = 0.039 and p = 0.024, respectively). To develop a predictive model for a moderate-severely abnormal electroencephalography, stepwise regression analysis was used to combine these analytes with current standard clinical markers of asphyxia (pH, base deficit, and 10-min Apgar). Only Apgar score and interleukin-16 remained in the model, which was highly predictive of an abnormal electroencephalography (area under the curve [AUC] = 0.956, p < 0.001, positive predictive value = 89%, and negative predictive value = 94%). CONCLUSIONS: Cord blood interleukin-6 and interleukin-16 were associated with electrographic grade of hypoxic-ischemic encephalopathy. To predict an abnormal electroencephalography, interleukin-16 and 10-minute Apgar used in combination performed better than current markers.

The effect of changes of model for end-stage liver disease score during waiting time on post-liver transplant mortality.

OBJECTIVE: Model for End-Stage Liver Disease (MELD) score is found to be a robust predictor of mortality while on waiting list for liver transplantation. However, studies have shown inconsistent results for transplant MELD as a predictor of posttransplant mortality. AIM: To find whether utilization of MELD at listing, at transplant, or Δ MELD while waiting can predict outcome at a national transplant center, which is not part of an organ sharing network. METHOD: Retrospective analysis of patients listed for liver transplantation at the New Zealand Liver Transplant Unit (NZLTU) with calculation of MELD score at the time of listing and at transplant with/without adjustment points for hepatocellular carcinoma (HCC). RESULTS: Between 1998 and 2005, 264 adult patients were listed for liver transplantation. Median age at transplant was 49 years (range 16-70) and 65% were male. The most common etiology was viral hepatitis (50%). A total of 48 patients (20%) had known HCC. MELD scores (adjusted and nonadjusted) at listing and at transplantation were similar across all primary liver diseases (P = 0.88, 0.93, respectively). Adjusted MELD scores were significantly higher in patients listed for HCC compared to those without HCC (P < 0.001; hazard ratio 1.33; 95% confidence interval = 1.21-1.46). MELD scores at transplant did not correlate with either 3 or 12 months mortality (P = 0.336, 0.228, respectively). This finding was consistent whether the change of MELD during waiting time was >1 point or less (P = 0.67). Waiting time does not appear to influence posttransplant survival (P = 0.75). CONCLUSION: In a country with a single transplant center and organ retrieval organization, the addition of MELD score to current minimal listing criteria does not improve prioritization of patients on the waiting list or predict posttransplant survival. Also, adjusting MELD score for HCC would unfairly disadvantage patients listed without HCC.

How safe is open abdominal aortic aneurysm surgery for octogenarians in New Zealand?

BACKGROUND: Abdominal aortic aneurysm (AAA) is an important cause of mortality for the aged, a group that has been denied surgery in the past for fear of peri-operative mortality. Is this attitude still justified? METHODS: Analysis of prospectively gathered data from a vascular database. RESULTS: 10.9% of all open AAA operations were in patients older than 79 years with an 8% mortality rate compared to 3% for younger patients. For fit elderly patients with ASA scores less than 3, mortality was just under 4%. Renal failure and wound dehiscence were more common in the elderly. CONCLUSION: When endovascular repair is not possible in a fit elderly patient, open surgery can be performed with acceptable results.

Gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003.

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated Gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182,000 people in Southern New Zealand. Data collected included patient contacts (in- and outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P < 0.0001) with inflammatory bowel disease, other diseases of the colon, anus and rectum and iron studies related disorders decreasing significantly but liver disease and constipation increasing linearly over time. The use of endoscopy services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our findings have implications for the recruitment and training of the next generation of gastroenterologists.

Barrett's esophagus: a retrospective analysis of 13 years surveillance.

BACKGROUND AND AIMS: The incidence of esophageal adenocarcinoma has increased significantly. Barrett's esophagus (BE), a known precursor, has a high prevalence but only few patients with this condition progress to malignancy--surveillance and screening programs are controversial and lack proven efficacy. This retrospective analysis reviews the 13-year outcome for patients entered into a surveillance program. METHODS: Data from patients with histologically proven Barrett's esophagus (1992-2003) that participated in a surveillance program were identified and analyzed retrospectively until 2005. RESULTS: 404/536 patients had Barrett's esophagus confirmed histologically of which 212 (53%) were followed in a surveillance program (mean 3.95 years per patient). This resulted in 749 gastroscopies (3.5/patient). Histologically, Barrett's mucosa was seen in 54%, low-grade dysplasia in 18%, ulcerations in 9%, high-grade dysplasia in 2%. No metaplasia was seen in 13%, no biopsy was obtained in 3%. Nine of 212 patients (4.3%) under surveillance developed esophageal cancer; two presented with symptoms, requiring gastroscopy outside the surveillance program (1/2 was operated successfully, one had advanced disease). In seven asymptomatic patients, cancer was detected on routine endoscopy; curative esophagectomy was performed in six. All patients who developed cancer were male and all but one patient had dysplasia or ulcerations on index endoscopy. CONCLUSION: During 13 years of Barrett's surveillance, 88% of all adenocarcinoma occurred in a subset of only 11% patients. To stratify surveillance for Barrett's esophagus, programs could focus on male patients with dysplasia or ulcerations on index endoscopy. However, the cost-effectiveness of this remains unproven.

E-cadherin expression and bromodeoxyuridine incorporation during development of ovarian inclusion cysts in age-matched breeder and incessantly ovulated CD-1 mice.

BACKGROUND: Female CD-1/Swiss Webster mice subjected to incessant ovulation for 8 months and 12-month breeder mice both developed ovarian inclusion cysts similar to serous cystadenomas. The majority of cysts appeared to be dilated rete ovarii tubules, but high ovulation number resulted in more cortical inclusion cysts. We hypothesized that comparison of inclusion cyst pathology in animals of the same age, but with differences in total lifetime ovulation number, might allow us to determine distinguishing characteristics of the two types of cyst. METHODS: Ovaries from breeder mice (BR) or females subjected to incessant ovulation (IO) were compared at 6-, 9- and 12-months of age. Ovaries were serially sectioned and cysts characterized with regard to location and histology, E-cadherin immunoreactivity and rates of BrdU incorporation. RESULTS: Inclusion cysts developed with age in BR and IO ovaries. The majority of cysts were connected to the ovarian hilus. Two cortical inclusion cysts were observed in ten IO ovaries and one in ten BR ovaries. Low or no E-cadherin immuno-staining was seen in the OSE of all mice studied. Conversely, strong membrane immuno-staining was observed in rete ovarii epithelial cells. Variable E-cadherin immunoreactivity was seen in cells of hilar inclusion cysts, with strong staining observed in cuboidal ciliated cells and little or no staining in flat epithelial cells. Two of the three cortical cysts contained papillae, which showed E-cadherin immuno-staining at the edge of cells. However hilar and cortical cysts were not distinguishable by morphology, cell type or E-cadherin immunoreactivity. BrdU incorporation in cyst cells (1.4% [95% CI: 1.0 to 2.1]) was greater than in OSE (0.7% [95% CI: 0.4 to 1.2]) and very few BrdU-labeled cells were observed in rete ovarii at any age. Incessant ovulation significantly increased BrdU incorporation in OSE of older animals. CONCLUSION: These experiments confirm ovarian inclusion cysts develop with age in the CD-1 mouse strain, irrespective of total ovulation burden. We conclude longer periods of incessant ovulation do not lead to significant changes in inclusion cyst formation or steroidogenesis in CD-1 mice and inclusion cyst type can not be distinguished by morphology, cell proliferation rate or E-cadherin immunoreactivity.