Automated analysis of fetal cardiac function using color tissue Doppler imaging

OBJECTIVE

To evaluate the feasibility of automated analysis of fetal myocardial velocity recordings obtained by color tissue Doppler imaging (cTDI).

METHODS

This was a prospective cross-sectional observational study of 107 singleton pregnancies ≥ 41 weeks of gestation. Myocardial velocity recordings were obtained by cTDI in a long-axis four-chamber view of the fetal heart. Regions of interest were placed in the septum and the right (RV) and left (LV) ventricular walls at the level of the atrioventricular plane. Peak myocardial velocities and mechanical cardiac time intervals were measured both manually and by an automated algorithm and agreement between the two methods was evaluated.

RESULTS

In total, 321 myocardial velocity traces were analyzed using each method. It was possible to analyze all velocity traces obtained from the LV, RV and septal walls with the automated algorithm, and myocardial velocities and cardiac mechanical time intervals could be measured in 96% of all traces. The same results were obtained when the algorithm was run repeatedly. The myocardial velocities measured using the automated method correlated significantly with those measured manually. The agreement between methods was not consistent and some cTDI parameters had considerable bias and poor precision.

CONCLUSIONS

Automated analysis of myocardial velocity recordings obtained by cTDI was feasible, suggesting that this technique could simplify and facilitate the use of cTDI in the evaluation of fetal cardiac function, both in research and in clinical practice. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Recruitment of patients into head and neck clinical trials: acceptability of studies to patients from perspective of the research team

We reviewed longitudinal recruitment data to assess recruitment into head and neck cancer trials, and to identify factors that could influence this and affect their acceptability to patients. We retrieved data from the prospective computerised database (2009-2016) to measure acceptability to patients using the recruitment:screening ratio, and compared observational with interventional studies, single specialty (or site) with multispecialty (or site) studies, and "step-up" randomisation with "non-inferiority" randomisation designs. A total of 1283 patients were screened and 583 recruited. The recruitment:screening ratio for all National Institute for Health Research (NIHR) portfolio studies combined was 0.47 (486/1133). Studies that involved treatment by several specialties or at several sites had a significantly adverse impact on acceptability (p=0.01). Recruitment into non-inferiority randomised controlled studies was lower than that into step-up randomised studies (p=0.06). The complexity of a study's design did not compromise recruitment. Treatment across several specialties or several sites and perceived non-inferiority designs, reduced the acceptability of some trials.

Abstract P6-11-08: Chemotherapy-induced peripheral neuropathy and quality of life among breast cancer survivors

Introduction: Breast cancer survivors are at risk for long-term chemotherapy-induced peripheral neuropathy (PN), which has few treatment options and can affect quality of life. We examined 1) the presence and severity of PN and its correlates among 442 metastatic (MBC) and 238 breast cancer (BC) survivors who received chemotherapy, and 2) provider communication, preparation, and confidence in managing treatment side effects (SEs). Methods: MBC and BC survivors enrolled in the Cancer Support Community's Cancer Experience Registry reported history of chemotherapy-induced PN and how disruptive (0=not at all; 4=very much) PN was to daily life. Participants also reported cancer-related distress (CancerSupportSource®, a 25-item measure with a 4-item depression/anxiety risk subscale) and quality of life (QoL; PROMIS-29). We examined the association between PN history, PN disruption, distress, risk for depression/anxiety, and worse QoL (PROMIS subscales >1SD from norms) with multivariate linear and logistic regression, adjusting for metastatic disease and number of comorbidities. We also explored associations between PN disruption, provider communication, preparation, and confidence in managing SEs. Results: Mean age was 55y (SD=10); 89% non-Hispanic White; 43% had ≥2 comorbidities. More MBC patients (66%) experienced PN than BC (54%; chi2=8.9, p<.01). Severity of PN disruption did not differ by metastatic disease; 30% of all participants indicated PN was quite a bit or very disruptive to daily life. Experiencing PN was associated with greater distress (beta=6.6, p<.001) and increased likelihood of risk for depression/anxiety (OR=1.77, 95% CI=1.26-2.48). The odds for worse sleep disturbance, pain interference, physical function, social role function, depression, fatigue, and anxiety were greater among those experiencing PN than not (n=266; ORs: 6.95-1.90 respectively; ps<.05). After controlling for metastatic status and number of comorbidities in separate regression analyses, greater PN disruption was associated with greater distress and risk for depression/anxiety (semipartial rs=.12-.19, p<.01) and poorer QoL (semipartial rs=.22-.34, ps<.05), except for sleep disturbance where the relationship was not linear. Many survivors wished they received more help managing short-term SEs (39%) and long-term SEs (55%). Nearly one-third (32%) noted their provider had not suggested ways to cope with SEs and 33% were not confident in their ability to cope with SEs. Greater PN disruption was associated with wanting more help managing short-term SEs (n=121; p<.05) and not being counseled on ways to cope with SEs by the health care team (p<.05). Conclusion: Chemotherapy-induced peripheral neuropathy is associated with poorer functional outcomes and symptom burden among breast cancer survivors, whether or not their breast cancer has metastasized. Many survivors do not feel confident in coping with side effects and want more support in side effect management, yet a substantial proportion note their provider did not discuss coping strategies with them. Without effective pharmacologic intervention for PN, providers are encouraged to assess and refer survivors to appropriate supportive services, and PN should be considered as a meaningful endpoint in clinical studies.

Citation Format: Zaleta AK, Miller MF, Johnson J, McManus S, Buzaglo JS. Chemotherapy-induced peripheral neuropathy and quality of life among breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-08.

Evaluation of the Osteoinductive Capacity of Canine Demineralized Bone Matrix in Heterotopic Muscle Sites of Athymic Rats

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in epaxial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this study confirm that DBM, derived from canine sources, does possess significant osteoinductive ability since histological examination revealed the presence of new cartilage, bone, or both, at 21/24 implantation sites. The osteogenesis induced by canine DBM continued as an active, cumulative process throughout the six week investigation period. The mean percentage of total induced osteogenic components including new, live cartilage, woven bone, lamellar bone and bone marrow cellular elements, was significantly greater after six weeks than after two weeks of implantation (p <0.01). Comparison of histomorphometric point counts at two, four and six weeks of implantation supported the conclusion that bone for mation as induced by canine DBM, proceeds primarily via an endochondral ossification pathway. Although the amount of calcium deposited in tissues harvested from DBM implanted sites tended to increase as implantation time lengthened, there was not a statistically significant correlation between calcium content and the level of osteogenic activity seen histologically (r = 0.32, p = 0.13).

The osteoinductive capacity of canine demineralized bone matrix (DBM), implanted in ep-axial muscle sites of athymic rats, was evaluated using calcium content and histomorphometry at two, four and six weeks after implantation. Results of this investigation confirm that DBM, derived from canine sources, does possess significant osteo-inductive ability and that bone formation proceeds primarily via a pathway of endochondral ossification.

International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction

Background

The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.

Methods

The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.

Results

A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P &lt; 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.

Conclusion

The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.