Hyperthermic intraperitoneal chemotherapy for treating ovarian cancer

ABSTRACT

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for decades as a treatment for disseminated abdominal malignancies, including pseudomyxoma peritonei and peritoneal mesothelioma. HIPEC had been used to treat recurrent ovarian cancer only when curative options were lacking, but new data indicate that it may be suitable as a primary treatment for patients with late-stage epithelial ovarian cancer, increasing the recurrence-free time interval and improving quality of life. However, treatment can be challenging because of patient trauma from surgery, combined with the toxicity and high temperature of the chemotherapeutic agents. This article reviews HIPEC and its targeted intraoperative and postoperative management.

Clinical determinants of early spontaneous conversion to sinus rhythm in patients with atrial fibrillation

Background

The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously.

Objective

To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF.

Methods

An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared.

Results

We enrolled 943 patients (age 69 ± 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF <24 h [odds ratio (OR) 7.7, 95% confidence interval (CI) 3.5–17.2, p < 0.001], left atrial volume index <42 ml/m² (OR 1.8, 95% CI 1.2–2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2–5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91–0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0–1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6–3.9, p < 0.001) were independent determinants of early SCV.

Conclusion

Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.

Detection of atrial fibrillation recurrences after ablation: long-term intermittent versus short continuous heart rhythm monitoring

Background

Catheter based ablation therapy is an established treatment in patients with symptomatic atrial fibrillation (AF). Currently, the detection of AF recurrences after AF ablation is most frequently performed by short continuous heart rhythm monitoring, such as Holter monitoring. Our aim is to evaluate the effectiveness and accurateness of long-term intermittent rhythm monitoring using a single-lead ECG (AliveCor Kardia®) compared to short continuous monitoring with Holter for the detection of AF recurrences after ablation.

Methods

We conducted a prospective study of patients after AF ablation between May 2017 and October 2019. As standard of care, patients underwent Holter monitoring (minimum 24 hours) at 3, 6 and 12 months after ablation. At the same time patients were instructed to use an AliveCor Kardia (ACK) monitor to record a 30-second ECG three times a day and in case of symptoms for a period of four weeks. The primary endpoint was the difference in proportion of AF recurrences detected by ACK compared to Holter. Secondary endpoint was the sensitivity and specificity of ACK algorithm. Further, patients were asked to complete a questionnaire on the System Usability Scale to evaluate the usability for both ACK and Holter.

Results

Out of 126 post-ablation patients, 115 (91%) patients (35 female, age 63±8 years) transmitted their ACK recordings and were included in this analysis. A total of 7838 ECGs were assessed. The mean AKC usage time was 27+11 days, mean number of recordings 68+28 per patient. Our primary endpoint, the proportion of detection of recurrent AF, was almost twice as high in ACK (24%) than in Holter (14%, p&lt;0.05). The ACK algorithm categorized 80% as normal sinus rhythm, 10% as possible AF, 10% as unclassified and 0.6% as unreadable. According to the interpretation of the researchers' team, 38 (0.5%) ECGs were uninterpretable and in 98% of the unclassified ECGs by ACK, the researchers' team was able to establish a diagnosis. The ACK diagnostic algorithm displayed a sensitivity of 95% and specificity of 98% for AF detection. The ACK diagnostic algorithm had a high likelihood of misclassifying premature atrial contractions and sinus rhythm accompanied by artifacts as AF (6.8% and 11% of all recordings assessed by AKC as AF, respectively). Based on the System Usability Scale, patients rated ACK as more acceptable in daily usage than Holter (75.0% versus 58.6% had an overall score above 70%, respectively).

Conclusions

ACK effectively and accurately detects AF recurrences in patients who underwent AF ablation and has a high patients' acceptability compared to Holter monitoring. Long-term intermittent rhythm monitoring may provide a promising tool for rhythm follow-up after AF ablation procedures.

Interpretation of ACK recordings

Funding Acknowledgement

Type of funding source: None

Efficacy and safety of expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis

STUDY QUESTION

Is expectant management (EM) of tubal ectopic pregnancy (EP) an effective and safe treatment strategy when compared to alternative interventions?

SUMMARY ANSWER

There is insufficient evidence to conclude EM yields a difference in the resolution of tubal EP, the avoidance of surgery or time to resolution of tubal EP when compared to intramuscular methotrexate in stable patients with β-hCG <1500 IU/l.

WHAT IS ALREADY KNOWN

The utilisation of medical and surgical management for EP is well established. EM aims to allow spontaneous resolution of the EP without intervention.

STUDY DESIGN SIZE AND DURATION

We performed a systematic review and meta-analysis, searching Ovid MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, OpenGrey.eu, Google Scholar, cross-referencing citations and trial registries to 15 December 2019. There were no limitations placed on language or publication date. Search terms included tubal EP and EM as well as variations of these terms.

PARTICIPANTS/MATERIALS SETTING AND METHOD

We considered studies that included patients with tubal EP, EM as a comparator, and that were randomised controlled trials (RCTs). The primary outcome was resolution of tubal EP. Secondary outcomes included avoidance of surgery and the time to resolution of EP. Two reviewers independently selected the studies, assessed bias and extracted data. Relative risk (RR) and mean difference with 95% CI were assessed using a random effects model. The certainty of evidence was scored according to Grading of Recommendations Assessment, Development and Evaluation guidelines.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 920 studies were screened. Five studies were eligible for inclusion in the systematic review. Two RCTs comparing methotrexate to EM were identified as being eligible for inclusion in meta-analysis. No RCTs comparing surgery to EM were identified. Compared with EM, there was insufficient evidence that methotrexate yields a difference on resolution of tubal EP (RR 1.04, 95% CI 0.88-1.23, P = 0.67; two RCTs, moderate-certainty evidence), avoiding surgery (RR 1.10, 95% CI 0.94-1.29, P = 0.25; two RCTs, low-certainty evidence) or the time to resolution of tubal EP (-2.56 days (favouring EM), 95% CI -7.93-2.80, P = 0.35; two RCTs, low-certainty evidence).

LIMITATIONS REASONS FOR CAUTION

Only two RCTs with a total of 103 patients were eligible for inclusion in this meta-analysis. Further RCTs comparing EM to medical and surgical management are needed and these should also report adverse events. Patient preference should also be evaluated.

WIDER IMPLICATIONS OF THE FINDINGS

We found insufficient evidence of differences in terms of resolution, avoidance of surgery and time to resolution between expectant and medical management. Given the imprecision in the effect estimates as demonstrated by the wide CIs, resulting in the downgrading of certainty of evidence for all outcomes in this meta-analysis, larger RCTs comparing interventions for tubal EP are needed. Caution should be exercised when trying to decide between EM and methotrexate to treat tubal EP.

STUDY FUNDING/COMPETING INTERESTS

There was no funding for this study. NICM receives funding from various sources; none specifically supported this research. M.L. reports grants from Australian Women and Children's Research Foundation, outside the submitted work. M.A.: As a medical research institute, NICM Health Research Institute receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. This systematic review was not specifically supported by donor or sponsor funding to NICM. M.A. reports a partnership grant with Metagenetics outside the submitted work. G.C. reports grants from Australian Women and Children's Research Foundation, personal fees from Roche and GE Healthcare, outside the submitted work. The remaining authors report no conflicts of interest.

PROSPERO REGISTRATION NUMBER

CRD42020142736.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

Management and outcomes of primary vaginal Cancer

OBJECTIVE

To analyze clinical characteristics and survival of patients with primary vaginal cancer.

METHODS

Retrospective analysis of patients with primary squamous, adenocarcinoma and adenosquamous cell carcinoma of the vagina identified from the Mayo Clinic Cancer Registry between 1998 and 2018.

RESULTS

A total of 124 patients were identified: stage I, 39 patients; stage II, 44, stage III, 20 and stage IV, 21. Patients with stage III and IV were older as compared to stage I and II. (mean ages 61 vs 67) (p = 0.024). Squamous cell carcinoma made up 71% of tumors. History of other malignancy was present in 24% patients. Median follow-up time was 60 months (range 1-240). Five-year PFS in stage I, II, III and IV was 58.7%, 59.4%, 67.3% and 31.8%, respectively (p = 0.039). Five-year DSS was 84.3%, 73.7%, 78.7% and 26.5% respectively (p < 0.001). Advanced stage, tumor size >4 cm, entire vaginal involvement, and lymph node (LN) metastasis were poor prognosticators in univariate analysis. Primary surgery in stage I/II patients had similar survival outcomes as compared to primary radiation, but post-operative RT rate was 55%. Brachytherapy alone was associated with a high local recurrence (80%) in stage I/II patients. The addition of brachytherapy had improved 5-year PFS and DSS than EBRT alone in patients with stage III/IVA. (p < 0.001).

CONCLUSION

Surgery or radiation is effective treatment for vaginal cancer stage I and II. The addition of brachytherapy to external pelvic radiation increases survival in stages III-IV.

Survival outcomes in patients with cervical cancer treated with open versus robotic radical hysterectomy: Our surgical pathology interrogation

OBJECTIVE

To compare the survival outcomes and surgical radicality between women who underwent open versus robotic radical hysterectomy (RH) for early cervical cancer.

METHODS

In this institutional retrospective study, patients with clinical stage IA2- IIA (FIGO 2009) squamous cell, adenocarcinoma and adenosquamous carcinoma of the cervix who underwent either open or robotic RH between 2000 and 2017 were identified. Parametrial width and vaginal length were re-measured from pathology slides. An inverse propensity score weighting model was used to adjust selection bias.

RESULTS

A total of 333 patients were included (181 open, 152 robotic). The median follow-up time was 130 months for the open group and 53 months for the robotic group. There were 31 (17.1%) recurrences in the open and 21 (13.8%) in the robotic group. The 5-year progression-free survival (PFS) for the robotic and open group were 79.0% and 90.5%, respectively (HR 2.37, 95% CI 1.40-4.02). Five-year overall survival (OS) were 85.8% and 95.3%, respectively (HR 3.17, 95% CI 1.76-5.70). The mean parametrial width was similar between the open and robotic groups (2.5 vs 2.4 cm, p = 0.99). Unique recurrences (38.1%, 8/21) were noted in the robotic group: 2 port-site, 4 peritoneal, and 2 carcinomatosis. The time to vaginal recurrence was shorter in the robotic group than the open group (p = 0.001).

CONCLUSION

Patients who underwent robotic RH had inferior PFS and OS compared to open surgery. Surgical radicality according to pathology measurements was similar between the two approaches.

Optothermotronic effect as an ultrasensitive thermal sensing technology for solid-state electronics

The thermal excitation, regulation, and detection of charge carriers in solid-state electronics have attracted great attention toward high-performance sensing applications but still face major challenges. Manipulating thermal excitation and transport of charge carriers in nanoheterostructures, we report a giant temperature sensing effect in semiconductor nanofilms via optoelectronic coupling, termed optothermotronics. A gradient of charge carriers in the nanofilms under nonuniform light illumination is coupled with an electric tuning current to enhance the performance of the thermal sensing effect. As a proof of concept, we used silicon carbide (SiC) nanofilms that form nanoheterostructures on silicon (Si). The sensing performance based on the thermal excitation of charge carriers in SiC is enhanced by at least 100 times through photon excitation, with a giant temperature coefficient of resistance (TCR) of up to -50%/K. Our findings could be used to substantially enhance the thermal sensing performance of solid-state electronics beyond the present sensing technologies.

Differential immunomodulation of T-cells by immunoglobulin replacement therapy in primary and secondary antibody deficiency

Patients with primary or secondary antibody deficiency (PAD or SAD) are at increased risk of recurrent infections that can be alleviated by immunoglobulin replacement therapy (IRT). In addition to replenishing antibody levels, IRT has been suggested to modulate immune response in patients with antibody deficiency. Although both commonly treated with IRT, the underlying causes of PAD and SAD vary greatly, suggesting differential modulation of T-cell function that may lead to different responses to IRT. To explore this, peripheral blood mononuclear cells (PBMCs) were sampled from 17 PAD and 14 SAD patients before and 2–10 months after initiation of IRT, and analyzed for changes in T-cell phenotype and function. Proportions of CD4, CD8, Treg, or memory T-cells did not significantly change post-IRT compared to pre-IRT. However, we report distinct modulation in T-cell function between PAD and SAD patients post-IRT. Upon α-CD3/CD28 stimulation, proportion of IFN-γ+ CD4 and CD8 T-cells increased in SAD (p = 0.005) but not PAD patients post-IRT compared to baseline. Interestingly, total T-cell proliferation was reduced post-IRT in both PAD and SAD patients, although the reduction in proliferation was primarily due to reduced CD4 T-cell proliferation in PAD (p = 0.025) in contrast to CD8 T-cells in SAD (p = 0.042). In summary, even though IRT provides patients with passive humoral immunity-mediated protection in PAD and SAD, our findings suggest that IRT immunomodulation of T-cells is different in T-cell subsets depending on underlying immunodeficiency.

Uncovering sperm metabolome to discover biomarkers for bull fertility

Background

Subfertility decreases the efficiency of the cattle industry because artificial insemination employs spermatozoa from a single bull to inseminate thousands of cows. Variation in bull fertility has been demonstrated even among those animals exhibiting normal sperm numbers, motility, and morphology. Despite advances in research, molecular and cellular mechanisms underlying the causes of low fertility in some bulls have not been fully elucidated. In this study, we investigated the metabolic profile of bull spermatozoa using non-targeted metabolomics. Statistical analysis and bioinformatic tools were employed to evaluate the metabolic profiles high and low fertility groups. Metabolic pathways associated with the sperm metabolome were also reported.

Results

A total of 22 distinct metabolites were detected in spermatozoa from bulls with high fertility (HF) or low fertility (LF) phenotype. The major metabolite classes of bovine sperm were organic acids/derivatives and fatty acids/conjugates. We demonstrated that the abundance ratios of five sperm metabolites were statistically different between HF and LF groups including gamma-aminobutyric acid (GABA), carbamate, benzoic acid, lactic acid, and palmitic acid. Metabolites with different abundances in HF and LF bulls had also VIP scores of greater than 1.5 and AUC- ROC curves of more than 80%. In addition, four metabolic pathways associated with differential metabolites namely alanine, aspartate and glutamate metabolism, β-alanine metabolism, glycolysis or gluconeogenesis, and pyruvate metabolism were also explored.

Conclusions

This is the first study aimed at ascertaining the metabolome of spermatozoa from bulls with different fertility phenotype using gas chromatography-mass spectrometry. We identified five metabolites in the two groups of sires and such molecules can be used, in the future, as key indicators of bull fertility.

Results of a phase 2 trial of ribociclib and letrozole in patients with either relapsed estrogen receptor (ER)-positive ovarian cancers or relapsed ER-positive endometrial cancers

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Background: Single agent aromatase inhibitor (AI) therapy is associated with limited clinical activity in ovarian cancer (OC) and endometrial cancers (EC). AI therapy was associated with a progression free survival (PFS) at 12 weeks of only 20% in relapsed OC (Bowman et al, 2002) and a median PFS of 1 month in relapsed EC (Rose et al, 2000). In Estrogen Receptor (ER) positive metastatic breast cancer, clinical studies had shown a significant prolongation of PFS with the addition of the cyclin kinase 4/6 inhibitor ribociclib to AI (Hortobagyi et al, 2016). Here, we report the results of a phase 2 clinical trial of the combination of ribociclib and letrozole in patients with relapsed ER positive OC or EC. Objectives: Primary endpoint was the proportion of patients with relapsed ER positive OC or EC alive and progression-free after 12 weeks of therapy (PFS12) with the combination of ribociclib given at a dose of 400 mg orally daily and letrozole 2.5 mg orally daily. A PFS of 45% was considered a favorable result based on the data referenced above from Bowman et al. Methods: Eligibility criteria included patients with relapsed ER positive OC or EC, with measurable disease, not previously treated with ribociclib or AIs. Xenografts were created from CT guided tumor biopsies at baseline to assess feasibility. Results: A total of 40 patients were enrolled (20 with OC and 20 with EC) ) with a median age of 61 years (range: 30-82) and 64.5 (range: 52-75) in the OC and EC groups respectively. Among the OC patients, 17 had high grade serous carcinomas and 3 had low grade serous carcinomas. 11 EC patients had endometrioid cancers (3 with grade 1 tumors) and 9 had high grade serous tumors. Ten out of 20 OC patients and 11/20 EC patients were alive and progression-free at 12 weeks (PFS12 of 50 and 55%, respectively). The most common grade 3 or higher adverse events (occurring in at least 5 pts) were leukopenia (18%), lymphopenia (18%), neutropenia (13%), and fatigue (13%). 34 tumor biopsies were suitable for injection into mice and 44% engrafted. ER expression persisted through multiple passages in mice. Two of three EC PDX models exhibited improved PFS with letrozole/ribociclib compared to letrozole alone. Conclusions: The combination of ribociclib and letrozole is associated with a promising 50% and 55% PFS12 in patients with ER positive relapsed OC or EC respectively. Creation of xenograft tumor models from CT guided biopsies of OC and EC tumors was feasible. Clinical trial information: NCT02657928.

153 Sperm metabolomic landscape associated with bull fertility

Sub-fertility fertility in bulls decreases the efficiency and profitability of cattle production because AI allows a single bull to inseminate thousands of cows. In recent decades, there has been a general decline in fertility of bulls, even among those exhibiting normal sperm motility and morphology. Despite advances in technology and knowledge, molecular, cellular and physiological mechanisms underlying the causes of low fertility in bulls are currently unclear. Therefore, the objective of this study was to identify sperm metabolites associated with fertility in Holstein bulls. The metabolome of sperm from 10 mature bulls with high fertility (HF, n=5) and low fertility (LF, n=5) was identified by gas chromatography coupled to mass spectrometry. Bull fertility was based on the sire conception rates deviating from the average. Statistical analysis was performed by using MetaboAnalyst 3.0 (http://www.metaboanalyst.ca/). A total of 22 metabolites were detected and categorized according to their major chemical classes, including amino acids, peptides/analogues, carbohydrates/carbohydrate conjugates, fatty acids, steroids/steroid derivatives, keto acids and derivatives, carboxylic acids, and other organic and inorganic compounds. Organic acids and derivatives as well as fatty acids were the major compounds in bull spermatozoa. Seven organic acids and derivatives were detected, including benzoic acid, carbonate, carbamate dimethyl, carbamate trimethyl, lactic acid, oxalic acid, and urea. Five fatty acids were identified including oleic acid, oleanitrile, nonanoic acid, and palmitic acid. Oleic acid, phosphoric acid, phosphine, carbamate trimethyl, and glycerol were the most abundant metabolites in bull sperm, whereas benzoic acid, acetic acid, l-serine, carbamate, and 2-ketobutyric acid were the least predominant metabolites present in bull sperm. Multivariate analysis (partial least squares-discriminant analysis) of the sperm metabolome showed a clear separation between HF and LF bulls. Variable importance in projection (VIP) score demonstrated that metabolites with VIP &gt;1.5 were gamma-aminobutyric acid (VIP=2.01), carbamate trimethyl (VIP=1.88), benzoic acid (VIP=1.86), and lactic acid (VIP=1.81). Abundance ratios of gamma-aminobutyric acid, carbamate trimethyl, benzoic acid, and lactic acid was greater in HF bulls compared with LF animals. According to univariate analysis, abundance ratios of gamma-aminobutyric acid (P=0.03) and carbamate trimethyl (P=0.047) were greater in HF than in LF bulls. Gamma-aminobutyric acid was positively correlated with carbamate trimethyl (r=0.94; P&lt;0.0001) and benzoic acid (r=0.74; P=0.0139). Benzoic acid was positively correlated with carbamate trimethyl (r=0.75; P=0.0107) and carbamate dimethyl (r=0.68; P=0.0274). The identified metabolites can serve as potential markers to evaluate semen quality and predict bull fertility.

Cytology of the fallopian tube: A screening model for high-grade serous carcinoma

Ovarian cancer is a heterogeneous disease having the highest gynecologic fatality in the United States with a 5-year survival rate of 46.5%. Poor overall prognosis is mostly attributed to inadequate screening tools, and the majority of diagnoses occur at late stages of the disease. Due to genetic and biological underpinnings, ovarian high-grade serous carcinomas (HGSC) have etiologic evidence in the distal fallopian tube. Fallopian tube screening modalities are aggressively investigated, but few describe cytological characteristics of benign tubal specimens to help in the comparative detection of HGSC precursor cells. Here, we describe fimbrial cytomorphological and nuclear features of tubal specimens (n = 75) from patients clinically indicated for salpingectomy, bilateral or unilateral salpingo-oophorectomy, and hysterectomies for any diagnosis other than ovarian or peritoneal cancer. Fallopian tube histology was used as the diagnostic reference. A total of 75 samples had benign diagnoses. The benign cytological characteristics of fimbrial tubal specimens included ciliated cells in clustered arrangements with mild nuclear membrane irregularity, mild anisonucleosis, round and/or oval nuclei, hyperchromatic chromatin, and mild nuclear membrane irregularity. In contrast, none of the cytology samples had spindle-shaped nuclei, significantly marked anisonucleosis (n = 1), nor had hypochromasia as a characteristic feature. These cytological characteristics could be a potential area of distinction from HGSC precursor cells. Our study establishes cytomorphological characteristics of nonmalignant tubal cells which help underscore the importance of distinguishing malignant HGSC precursors through fimbrial brush sampling in minimally invasive approach.

Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope

Background

In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients.

Methods

We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure.

Results

Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD.

Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%).

Conclusion

Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.

Electronic supplementary material

The online version of this article (doi: 10.1007/s12471-017-0970-7) contains supplementary material, which is available to authorized users.

68 GROWTH AND MARKET QUALITY OF PIGS BORN FROM MAGNETIC NANOPARTICLE-TREATED BOAR SPERMATOZOA

Sperm ejaculates contain a heterogeneous population of nonviable and viable spermatozoal cells. Ejaculates with high concentrations of poor quality or damaged spermatozoa can greatly impair the overall fertility of males. Recently, a novel technique termed nanopurification has been developed (Feugang et al. 2015 IVF Reprod. Med. Genet. 3, 2) to noninvasively target and remove poor quality spermatozoa from boar semen. Such removal will enrich insemination doses with high quality spermatozoa to enhance fertility successes. However, effects associated with offspring born from nanopurified semen and possible meat quality assurance have yet to be extensively studied. The objective of this study was to measure the growth performance and market characteristics of pigs born from standard or nanopurified spermatozoa. Boar semen was obtained in insemination doses from a local stud and was mixed with (nanopurified) magnetic nanoparticles (iron-oxide) specifically designed to interact with acrosome-reacted and apoptotic spermatozoa. After incubation, mixed semen were placed under an electromagnetic field trapping moribund sperm to allow collection of intact and viable spermatozoa. Six gilts were bred with standard non-purified (control; n = 3) or nanopurified (n = 3) semen, with subsequent pregnancies leading to full-term birth of viable offspring. At weaning, pigs of equal sexes (5 male and 5 female) were randomly selected from control (n = 10) and nanopurified (n = 10) litters. Pigs were fed and measured until market weight, at which meat quality and carcass characteristics were assessed. Data (mean ± SEM) were analysed with Student’s t-test and SAS software (SAS Institute Inc., Cary, NC, USA). The threshold of significance was set as P < 0.05. Patterns of growth between groups were comparable up to market size (P > 0.05). Standard pork quality parameters (lean carcass weight, loin eye area, percentage of lean cuts, loin and ham colouring, etc.) revealed no significant differences between groups (P > 0.05). Dressing percentage was found higher in the nanopurified group compared with control, with a 1.5% increase (P < 0.05). Marbling score tended to be significantly higher in the nanopurified group (2.7 ± 0.15) when compared with the control (2.3 ± 0.15). Findings indicate that sperm nanopurification does not impair growth of offspring and could ultimately lead to a higher pork carcass quality. Additional research is being conducted to confirm current findings and identify further effects of nanopurification regarding offspring and carcass quality. This work was supported by USDA-ARS Grant #58–6402–3-018.

Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam

SETTING

Hanoi Lung Hospital, Hanoi, Viet Nam.

OBJECTIVE

To compare the accuracy of CellScopeTB, a manually operated mobile digital fluorescence microscope, with conventional microscopy techniques.

DESIGN

Patients referred for sputum smear microscopy to the Hanoi Lung Hospital from May to September 2013 were included. Ziehl-Neelsen (ZN) smear microscopy, conventional light-emitting diode (LED) fluorescence microscopy (FM), CellScopeTB-based LED FM and Xpert(®) MTB/RIF were performed on sputum samples. The sensitivity and specificity of microscopy techniques were determined in reference to Xpert results, and differences were compared using McNemar's paired test of proportions.

RESULTS

Of 326 patients enrolled, 93 (28.5%) were Xpert-positive for TB. The sensitivity of ZN microscopy, conventional LED FM, and CellScopeTB-based LED FM was respectively 37.6% (95%CI 27.8-48.3), 41.9% (95%CI 31.8-52.6), and 35.5% (95%CI 25.8-46.1). The sensitivity of CellScopeTB was similar to that of conventional LED FM (difference -6.5%, 95%CI -18.2 to 5.3, P = 0.33) and ZN microscopy (difference -2.2%, 95%CI -9.2 to 4.9, P = 0.73). The specificity was >99% for all three techniques.

DISCUSSION

CellScopeTB performed similarly to conventional microscopy techniques in the hands of experienced TB microscopists. However, the sensitivity of all sputum microscopy techniques was low. Options enabled by digital microscopy, such as automated imaging with real-time computerized analysis, should be explored to increase sensitivity.

The role of IL-1β in Pseudomonas aeruginosa in lung infection

This mini-review examines the role of the pro-inflammatory cytokine interleukin (IL)-1β in the interaction of Pseudomonas aeruginosa and the host immune system during lung infection. Different studies show that the reduction of the inflammatory response, especially a decrease in IL-1β, leads to a better outcome in acute lung infection with this bacterium. This includes a higher survival rate, reduced damage to the lung tissue and, in particular, a better clearance of the airways and the tissue of the lungs from P. aeruginosa.

Cost-effectiveness of adjuvant therapy for treatment of stage II colon cancer in patients with diabetes

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Background: The decision to treat stage II colon cancer patients with adjuvant chemotherapy involves assessment of life expectancy, risk for recurrent disease, and the potential benefit and likelihood of adverse effects from treatment. This is a challenging task, particularly for patients with pre-existing chronic illnesses such as diabetes, which may increase side effects and potentially lessen response to chemotherapy.

Methods: We use the Archimedes Model to analyze cost effectiveness of adjuvant therapy in stage II colon cancer patients with pre-existing diabetes. The Archimedes Model is a large-scale, integrated mathematical model of human physiology, diseases, and healthcare systems, including pathways relating to diabetes, cardiovascular disease, and cancers of the breast, lung, and colon. The colon cancer model is built using the SEER, ACCENT databases and meta-analyses of clinical trials. Costs relating to colon cancer, diabetes and its complications are based on Medicare reimbursement rates. We simulate a trial in which stage II colon cancer patients are subjected to two treatment strategies: no treatment vs. adjuvant chemotherapy by FOLFOX regimen. We report incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life year (QALY) gained, of adjuvant therapy compared with no treatment.

Results: Cost effectiveness is strongly dependent on a patient's tumor profile, age and duration of diabetes. For instance, adjuvant therapy saves ∼0.2 QALYs per person in stage IIA patients who are 75 and older and have been diagnosed with diabetes >10 years, at an ICER of >$150,000/QALY gained. In contrast, it saves 1.1 QALYs per person in stage IIB patients aged 60-65, recently diagnosed with diabetes, at an ICER of <$30,000/QALY gained. Results are sensitive to assumptions on efficacy and side effects of chemotherapy in diabetic patients, as well as cost of adjuvant therapy.

Conclusions: The current study suggests that the decision to proceed with adjuvant chemotherapy requires careful assessment of severity of diabetes in stage II colon cancer patients with pre-existing diabetes.

No significant financial relationships to disclose.

Antithrombotic drug prescription in atrial fibrillation and its rationale among general practitioners, internists and cardiologists in The Netherlands--The EXAMINE-AF study. A questionnaire survey

The objective of the EXAMINE-AF study was to record and compare antithrombotic treatment in patients with atrial fibrillation (AF) in daily clinical practice of general practitioners, internists and cardiologists in the Netherlands. Eighty-six general practitioners, 93 internists and 99 cardiologists responded to postal questionnaires and enrolled 1596 patients: 365, 351 and 880 respectively. A cardiologist was indicated to be the main treating physician for AF in 82% of all patients; current antithrombotic treatment was initiated in 80% by a cardiologist. Of all patients, 84% were at high risk for stroke and therefore were eligible for oral anticoagulation treatment, but only 64% actually received this. Cardiologists instituted appropriate antithrombotic treatment best, compared with general practitioners and internists (70% vs. 58% and 55%; p < 0.001). Positive predictive factors for oral anticoagulation prescription were previous stroke/transient ischaemic attack (OR, 2.31; 95% CI, 1.33-4.02) and heart failure (OR, 1.72; 95% CI, 1.23-2.42). Contraindications for oral anticoagulation (OR, 0.46; 95% CI, 0.32-0.68), treatment by a general practitioner (OR, 0.29; 95% CI, 0.20-0.42) or internist (OR, 0.24; 95% CI, 0.15-0.39) were important factors for withholding treatment. Antithrombotic treatment in AF patients is well instituted in primary and secondary care in the Netherlands. Cardiologists play a key role in the diagnosis and management of the majority of AF patients, even in those regularly attending other physicians. Factors for oral anticoagulation prescription are heart failure, physician specialty and contraindications. Availability of guidelines seems instrumental for application of appropriate antithrombotic treatment.