The impact of the multi-disciplinary molecular tumour board and integrative next generation sequencing on clinical outcomes in advanced solid tumours

Background

The integration of next-generation sequencing (NGS) comprehensive gene profiling (CGP) into clinical practice is playing an increasingly important role in oncology. Therefore, the HKU-HKSH Multi-disciplinary Molecular Tumour Board (MTB) was established to advance precision oncology in Hong Kong. A multicenter retrospective study investigated the feasibility of the HKU-HKSH MTB in determining genome-guided therapy for treatment-refractory solid cancers in Hong Kong.

Methods

Patients who were presented at the HKU-HKSH MTB between August 2018 and June 2022 were included in this study. The primary study endpoints were the proportion of patients who receive MTB-guided therapy based on genomic analysis and overall survival (OS). Secondary endpoints included the proportion of patients with actionable genomic alterations, objective response rate (ORR), and disease control rate (DCR). The Kaplan-Meier method was used in the survival analyses, and hazard ratios were calculated using univariate Cox regression.

Findings

122 patients were reviewed at the HKU-HKSH MTB, and 63% (n = 77) adopted treatment per the MTB recommendations. These patients achieved a significantly longer median OS than those who did not receive MTB-guided therapy (12.7 months vs. 5.2 months, P = 0.0073). Their ORR and DCR were 29% and 65%, respectively.

Interpretation

Our study demonstrated that among patients with heavily pre-treated advanced solid cancers, MTB-guided treatment could positively impact survival outcomes, thus illustrating the applicability of NGS CGPs in real-world clinical practice.

Funding

The study was supported by the Li Shu Pui Medical Foundation. Dr Aya El Helali was supported by the Li Shu Pui Medical Foundation Fellowship grant from the Li Shu Pui Medical Foundation. Funders had no role in study design, data collection, data analysis, interpretation, or writing of the report.

Complicated and uncomplicated pregnancies: women's perception of risk

OBJECTIVE

To compare the perception of risk of women with complicated and uncomplicated pregnancies and to determine the relationship between biomedical, psychosocial, and demographic risk factors and women's personal perceptions of pregnancy risk.

DESIGN

A descriptive, correlational study.

SETTING

Antenatal units and outpatient clinics of two tertiary care teaching hospitals in western Canada.

PATIENTS/PARTICIPANTS

A convenience sample of 105 women having a complicated pregnancy requiring hospitalization for more than 48 hours and 103 women with no known complications and no hospitalization during the pregnancy.

MAIN OUTCOME MEASURE

Perception of risk during pregnancy.

RESULTS

Women with complicated pregnancies perceived their overall risk and risk for specific pregnancy outcomes as significantly higher than women with uncomplicated pregnancies. State anxiety and biomedical risk were positively related to perception of risk, but there was no relationship between stress, self-esteem, or social support and perception of risk. The strongest predictors of self-perception of pregnancy risk were the biomedical risk score and state anxiety.

CONCLUSION

Women with complicated pregnancies perceive their risks as higher than women with uncomplicated pregnancies. Both biomedical and psychosocial factors play a role in influencing risk perception. Nursing assessment of the pregnant woman should include discussion with her of her perception of risk.

Histological findings in a case of alobar holoprosencephaly diagnosed at 10 weeks of pregnancy

A case of alobar holoprosencephaly diagnosed at 10 + 3 weeks' gestation by transabdominal and transvaginal ultrasound examination followed by histological confirmation is presented. The diagnosis was based on two sonographic criteria: intracranial finding of a single ventricle with a mantle and no visible midline structures but fusion of the thalami and corpus striatum, and facial abnormalities, including hypotelorism and proboscis. The fetal karyotype was triploidy. The ultrasound findings were confirmed by pathological examination. The histological findings of proboscis, single lens and single ventricle with neural tissue remnants are presented.

Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving

OBJECTIVE

To evaluate the impact of a school-based interdisciplinary health behavior intervention on diet and physical activity among children in grades 4 and 5.

DESIGN

A quasiexperimental field trial with 6 intervention and 8 matched control schools. Outcomes were assessed longitudinally using preintervention (fall 1995) and follow-up (spring 1997) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity. Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997.

PARTICIPANTS

Longitudinal data were collected from 479 students initially in grade 4 in Baltimore, Md, public schools; 91% were African American. Repeated 24-hour recall measures in 1997 were collected for a random subsample of 336 students. Cross-sectional survey data were collected from all grade 5 students in 1995,1996, and 1997 (n = 2103).

INTERVENTION

The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math, science, language arts, and social studies classes. Materials provided links to school food services and families and provided training and wellness programs for teachers and other staff members. Intervention materials focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake, as well as reducing television viewing and increasing physical activity.

MAIN OUTCOME MEASURES

Dietary intake and physical activity measured via repeated 24-hour recall were primary end points, with additional food frequency and activity measures.

RESULTS

The 24-hour recall measures indicated that, after controlling for baseline covariates, the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools (-1.4%; 95% confidence interval [CI], -2.8 to -0.04; P = .04 and -0.60%; 95% CI, -1.2 to -0.01; P = .05). There was an increase in fruit and vegetable intake (0.36 servings/4184 kJ; 95% CI, 0.10-0.62; P=.01), in vitamin C intake (8.8 mg/4184 kJ; 95% CI, 2.0-16; P=.01), and in fiber consumption (0.7 g/4184 kJ; 95% CI, 0.0-1.4; P=.05). Television viewing was marginally reduced (-0.55 h/d; 95% CI, -1.04 to 0.04; P=.06). Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat.

CONCLUSION

Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing.

First-trimester ultrasound diagnosis of holoprosencephaly: three case reports

We present three cases of fetal holoprosencephaly diagnosed by transabdominal and transvaginal ultrasound examinations at 10 and 13 weeks' gestation. The diagnosis was based on two sonographic criteria: first, the intracranial finding of a single ventricle with a cerebral mantle and no visible midline structures but fusion of the thalami and corpus striatum; and, second, facial abnormalities, including hypotelorism. The ultrasound findings were confirmed by embryoscopy before abortion in one case and by pathological examination after abortion in two cases. Chromosome study of the three fetuses showed trisomy 18, triploidy and mosaic 18p deletion and duplication.

Development of in vitro performance tests and evaluation of nonabsorbable monofilament sutures for cardiovascular surgery

There have been reports suggesting that polypropylene (PP) monofilament sutures are associated with mechanical failure. To overcome this problem, a new monofilament suture made from polyvinylidene fluoride, under the trade name of Teflene, has been developed. Few studies have measured the in vitro properties of Teflene sutures, and those that have, have been limited to a few tensile properties of the straight suture such as tensile strength, elongation, and creep behavior. The in vitro performance properties of Teflene sutures were evaluated and compared with those of commercial sutures made from PP such as Prolene and Surgilene in four sizes, 2-0, 3-0, 4-0, and 5-0. The performance properties of sutures included both the physical properties of straight sutures, such as suture diameter, tensile strength, elongation, surface roughness, coefficient of friction, bending stiffness, and tissue drag, and the knot characteristics, such as knot pull strength, knot run-down, and knot security. Existing standard test methods and testing instruments were used if available to measure certain suture properties such as diameter, tensile strength, knot pull strength, and some physical properties. The other novel test methods and unique accessory devices needed to perform the tests for measuring tissue drag, knot run-down, coefficient of friction, and knot security were developed in the authors' laboratories, and the comparative results are reported for the first time. From the test results, Teflene sutures were found in general to possess equivalent characteristics to those of existing PP commercial sutures, but some differences also were observed, such as greater elongation and less knot run-down. These differences may give them a unique feel and handling performance, especially in terms of making a knot, sliding it into position, and causing less damage to adjacent tissue.

The role of lifestyle in preventing low birth weight

Lifestyle behaviors such as cigarette smoking, weight gain during pregnancy, and use of other drugs play an important role in determining fetal growth. The relationship between lifestyle risk factors and low birth weight is complex and is affected by psychosocial, economic, and biological factors. Cigarette smoking is the largest known risk factor for low birth weight. Approximately 20% of all low birth weight could be avoided if women did not smoke during pregnancy. Reducing heavy use of alcohol and other drugs during pregnancy could also reduce the rate of low birth weight births. Pregnancy and the prospect of pregnancy provide an important window of opportunity to improve women's health and the health of children. The adoption before or during pregnancy of more healthful lifestyle behaviors, such as ceasing to smoke, eating an adequate diet and gaining enough weight during pregnancy, and ceasing heavy drug use, can positively affect the long-term health of women and the health of their infants. Detrimental lifestyles can be modified, but successful modification will require large-scale societal changes. In the United States, these societal changes should include a focus on preventive health, family-centered workplace policies, and changes in social norms.