Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces

BACKGROUND

Colonization of near-patient surfaces in hospitals plays an important role as a source of healthcare-associated infections. Routine disinfection methods only result in short-term elimination of pathogens.

AIM

To investigate the efficiency of a newly developed antimicrobial coating containing nanosilver in long-term reduction of bacterial burden in hospital surfaces to close the gap between routine disinfection cycles.

METHODS

In this prospective, double-blinded trial, frequently touched surfaces of a routinely used treatment room in an emergency unit of a level-I hospital were treated with a surface coating (nanosilver/DCOIT-coated surface, NCS) containing nanosilver particles and another organic biocidal agent (4,5-dichloro-2-octyl-4-isothiazolin-3-one, DCOIT), whereas surfaces of another room were treated with a coating missing both the nanosilver- and DCOIT-containing ingredient and served as control. Bacterial contamination of the surfaces was examined using contact plates and liquid-based swabs daily for a total trial duration of 90 days. After incubation, total microbial counts and species were assessed.

FINDINGS

In a total of 2880 antimicrobial samples, a significant reduction of the overall bacterial load was observed in the NCS room (median: 0.31 cfu/cm²; interquartile range: 0.00-1.13) compared with the control coated surfaces (0.69 cfu/cm²; 0.06-2.00; P < 0.001). The nanosilver- and DCOIT-containing surface coating reduced the relative risk of a critical bacterial load (defined as >5 cfu/cm²) by 60% (odds ratio 0.38, P < 0.001). No significant difference in species distribution was detected between NCS and control group.

CONCLUSION

Nanosilver-/DCOIT-containing surface coating has shown efficiency for sustainable reduction of bacterial load of frequently touched surfaces in a clinical setting.

Electric-Field-Controlled Cold Dipolar Collisions between Trapped CH_{3}F Molecules

Reaching high densities is a key step toward cold-collision experiments with polyatomic molecules. We use a cryofuge to load up to 2×10^{7} CH_{3}F molecules into a boxlike electric trap, achieving densities up to 10^{7}/cm^{3} at temperatures around 350 mK where the elastic dipolar cross section exceeds 7×10^{-12}  cm^{2}. We measure inelastic rate constants below 4×10^{-8}  cm^{3}/s and control these by tuning a homogeneous electric field that covers a large fraction of the trap volume. Comparison to ab initio calculations gives excellent agreement with dipolar relaxation. Our techniques and findings are generic and immediately relevant for other cold-molecule collision experiments.

Treatment of end-stage peripheral artery disease by Neuromodulation

BACKGROUND: Neuromodulation is a therapeutic option to improve limb salvage in end-stage peripheral arterial disease (PAD), but there is no consensus on indication for spinal cord stimulation (SCS) in PAD patients. OBJECTIVE: The aim of this study was to present end-stage PAD patient outcomes treated with SCS. METHODS: This study is a retrospective analysis based on a local prospective registry. Neuromodulation was performed there was: [1] no revascularisation option, [2) no septicaemia, [3) Rutherford stage 4–6. The primary endpoint of the study was limb salvage. Secondary endpoints were improvement in pain symptoms (assessed using a visual anlog scale/VAS) and improvement in walking distance. RESULTS: Limb salvage was reached in 30/34 patients (88%). Patients reported a significant reduction in pain on the 10-point VAS scale from baseline (median = 7.5, IQR = 7–8) to follow-up at 2 years (median = 0, IQR 0–2.75), p <  0.001. Walking distance also improved from preoperative (median = 50 m, IQR = 20–50 m) to follow-up at 2 years (median = 150 m, IQR 50–272 m), p <  0.001. RESULTS: SCS implantation in patients with end-stage PAD can enable limb salvage in a high percentage of cases and increase mobility due to pain reduction. The role of microcirculation in these improvements needs to be investigated in further studies.

Prevalence and time course of arrhythmia-induced cardiomyopathy in patients with newly diagnosed heart failure and concomitant tachyarrhythmia – the TACHY-HF pilot trial

Background

Arrhythmias may often be a result of heart failure, but they can also cause left-ventricular systolic dysfunction (LVSD), thereby presenting as arrhythmia-induced cardiomyopathy (AIC). AIC-diagnosis is established retrospectively when LVSD normalizes or improves significantly over time following rhythm restoration. However, the prevalence and most importantly the time course of this relevant disease remain unclear and hence merit investigation to enable the correct diagnosis.

Purpose

Therefore, our aim was to evaluate a) the occurrence of AIC in this clinical relevant cohort of patients with newly diagnosed and otherwise unexplainable LVSD and concomitant tachycardia and b) the time needed to fulfill the diagnostic criteria of AIC in order to facilitate a diagnostic algorithm.

Method

We prospectively screened patients hospitalized for newly diagnosed and otherwise unexplainable LVSD (i.e. left ventricular ejection fraction (LVEF) &lt;50%) and coexisting tachyarrhythmia (atrial fibrillation/flutter + heart rate (HR) &gt;100/min) in 3 cardiological centers. Coronary angiography and cardiac magnetic resonance imaging were performed to exclude other causes for LVSD. Patients underwent a rhythm control strategy in accordance to the local clinical pathways. LVEF was assessed by echocardiography at presentation and at follow-up (FU) visits after 2, 4, and 6 months. Patients who lost sinus rhythm (SR) during FU were excluded. Patients with any increase of ≥15% in absolute EF or an EF ≥50% with an improvement of ≥10% after 6 months of FU were assigned to the AIC-group, which is a common definition of AIC. All others were assigned to an idiopathic DCM-group as final comparator.

Results

68 patients were eligible, 18 of them were excluded: 1 lost to follow-up, 1 PCI, 2 COVID-19, 1 diagnosed cancer, 1 withdraw consent and 12 lost SR. Thus, our sample consists of a total of 50 patients. At presentation, mean±SD HR was 121±17/min. After rhythm therapy, HR normalized (67±10/min) and LVEF increased in both groups, see fig. 1. Surprisingly, only 9 patients did not fulfill the AIC-criteria in this specific collective resulting in a prevalence of 82% (95%-CI: 68% – 92%). This high prevalence of AIC underlines the importance of the disease. 2 and 4 months after rhythm intervention, 58% and 73% of patients fulfilled AIC-criteria (fig. 2). The sensitivity for detection of AIC by echocardiographic LVEF-measurement at months 2 and 4 of FU was 65% and 86% with a specificity of 100%, emphasizing that a FU of 6 months is necessary to certainly distinguish between AIC and idiopathic DCM.

Conclusion

The prevalence of AIC in patients with newly diagnosed and otherwise unexplainable LVSD with concomitant tachycardia is 82%. Analysis of the time course of AIC clearly suggests that the final diagnosis cannot be established before 6 months after successful rhythm restoration. These results may help to improve diagnosis of AIC in daily clinical practice.

Funding Acknowledgement

Type of funding sources: None.

Exploiting metabolic acidosis in solid cancers using a tumor-agnostic pH-activatable nanoprobe for fluorescence-guided surgery

Cancer cell metabolism leads to a uniquely acidic microenvironment in solid tumors, but exploiting the labile extracellular pH differences between cancer and normal tissues for clinical use has been challenging. Here we describe the clinical translation of ONM-100, a nanoparticle-based fluorescent imaging agent. This is comprised of an ultra-pH sensitive amphiphilic polymer, conjugated with indocyanine green, which rapidly and irreversibly dissociates to fluoresce in the acidic extracellular tumor microenvironment due to the mechanism of nanoscale macromolecular cooperativity. Primary outcomes were safety, pharmacokinetics and imaging feasilibity of ONM-100. Secondary outcomes were to determine a range of safe doses of ONM-100 for intra-operative imaging using commonly used fluorescence camera systems. In this study (Netherlands National Trial Register #7085), we report that ONM-100 was well tolerated, and four solid tumor types could be visualized both in- and ex vivo in thirty subjects. ONM-100 enables detection of tumor-positive resection margins in 9/9 subjects and four additional otherwise missed occult lesions. Consequently, this pH-activatable optical imaging agent may be clinically beneficial in differentiating previously unexploitable narrow physiologic differences.

It is well known that the pH of tumor tissue is lower than that of the corresponding normal adjacent tissue. Here, the authors report a clinical trial of a pH activatable nanoparticle for imaging tumours.

A case report of cholinesterase inhibitor poisoning: cholinesterase activities and analytical methods for diagnosis and clinical decision making

Suicidal ingestion of organophosphorus (OP) or carbamate (CM) compounds challenges health care systems worldwide, particularly in Southeast Asia. The diagnosis and treatment of OP or CM poisoning is traditionally based on the clinical appearance of the typical cholinergic toxidrome, e.g. miosis, salivation and bradycardia. Yet, clinical signs might be inconclusive or even misleading. A current case report highlights the importance of enzymatic assays to provide rapid information and support clinicians in diagnosis and rational clinical decision making. Furthermore, the differentiation between OP and CM poisoning seems important, as an oxime therapy will most probably not provide benefit in CM poisoning, but—as every pharmaceutical product—it might result in adverse effects. The early identification of the causing agent and the amount taken up in the body are helpful in planning of the therapeutic regimen including experimental strategies, e.g. the use of human blood products to facilitate scavenging of the toxic agent. Furthermore, the analysis of biotransformation products and antidote levels provides additional insights into the pathophysiology of OP or CM poisoning. In conclusion, cholinesterase activities and modern analytical methods help to provide a more effective treatment and a thorough understanding of individual cases of OP or CM poisoning.

[After the reform is before the reform : Results of the amendment processes of mental health law in German federal states]

BACKGROUND

On the basis of mental health law, which differs between the federal states in Germany, courts can order the involuntary commitment of people with severe mental disorders in psychiatric hospitals, if they present a danger to themselves or to others. Due to decisions of the highest courts, these laws have been subject to revision since 2011. The aim of this paper is to analyze and compare the results of the revision processes in order to define the need for action for federal and state legislature.

MATERIAL AND METHODS

Research of the current status of the revision processes in the federal states and a comparative analysis. The state laws were compared on the basis of selected particularly relevant areas with respect to human rights and treatment.

RESULTS

In spite of the revisions the state laws are extremely heterogeneous and in many states do not fully comply with the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) or the highest courts' decisions.

CONCLUSION

The state laws should be harmonized, particularly where they restrict basic and human rights, e. g. regarding prerequisites and objectives of involuntary commitment and coercive measures.

A conceptual framework for an oral cancer awareness campaign in Northern Germany - Challenges in campaign development and assessment

Initial impetus for action: Oral cancer is still an underestimated disease in terms of incidence as well as mortality rates; it requires urgent prevention and early detection. At present, there is no best-practice systematic approach to raising awareness and informing the public about about this type of cancer in Germany. This article describes a framework that covers the significant stages of conceptual development and campaign design to promote oral cancer awareness in Germany. Solution: The challenges of the development, as well as evaluation of an oral cancer awareness campaign are shared in this article. Four key stages of the campaign are defined: (1) mass media, (2) target groups, (3) health care professionals, and (4) epidemiology. For each section, the following levels of assessment are proposed: (a) campaign development (formative assessment), (b) controlling and optimising campaign implementation (process assessment) and (c) measuring outcomes (summative assessment). Outcome: A process-oriented assessment concept for each of the four campaign sections was developed and merged to form a matrix, which includes each of the above sections regarding the prevention and early detection of oral cancer, as well as the three stages of campaign assessment. Future implications and learning points: The conceptual framework demonstrated that systematic planning and evaluation of different components helped to describe and evaluate an oral cancer campaign: For future campaigns, the use of a matrix covering different campaign targets as well as the entire campaign process, is recommended as a basis for campaign design and evaluation.

Abstract P2-14-29: Image guided surgery for tumor detection in breast cancer using the PH activated micellar tracer ONM-100: The SHINE study

Background: Currently, no reliable intra-operative tumor detection and margin assessment technologies during breast conserving surgery are available. Fluorescence-guided surgery (FGS) using tumor specific fluorescent tracers can improve intra-operative tumor detection. However, a major limitation is the lack of broad tumor applicability due to complex oncogenotypes and histologic phenotypes. A strategy to overcome this challenge is targeting metabolic vulnerabilities that are more ubiquitous and regarded as generic hallmarks of cancer. The extracellular environment of tumors is relatively acidic compared to healthy tissue due to aerobic glycolysis, the so-called Warburg effect. ONM-100, a micellar polymer tracer labeled with the fluorescent imaging dye Indocyanine Green (ICG), has an exquisitely pH-sensitive binary on/off mechanism. The micelles dissociate in acidic environments causing the unquenching and fluorescent activation of the ICG dye. As most solid cancer types are acidotic, ONM-100 acts as a generic tracer targeting a broad range of tumors. This proof of concept, first in-human study, investigates the safety and feasibility of ONM-100 as an intra-operative fluorescent tracer in breast cancer (BC) patients.

Methods: In this phase 1 study, the pH-activated fluorescent tracer ONM-100 was administered 24±8h prior to surgery in a dose escalation scheme ranging from 0.1 mg/kg to 0.8 mg/kg in groups of 3 patients each. Patients with biopsy proven BC were included. Patients that had undergone neoadjuvant therapy were excluded. Blood was drawn up to day 10 to assess safety and pharmacokinetic data. Intra-operative images were collected of the tumor before and after excision and of the wound bed. Immediately after excision ex vivo fluorescence images were obtained from the serially sliced specimen and the formalin fixated paraffin embedded tissue blocks. Fluorescence images were correlated with histopathological assessment on Hematoxylin and Eosin (H/E) stained sections.

Results: In this ongoing clinical trial, 4 patients with BC were enrolled between March and May 2018. No tracer related (serious) adverse events were observed. A strong and sharply demarcated fluorescent signal in tumor tissue was observed in all 4 patients with in- and ex vivo imaging (median Contrast to Noise Ratio 6.5; IQR 7.25), which correlated with areas of tumor involvement on histopathology. In one BC patient, an intra-operatively unnoticed tumor positive margin was detected using fluorescence imaging. Additionally, a BC satellite lesion was detected, which was otherwise missed by the pathologist.

Conclusion: Preliminary results of this ongoing first in-human study with the pH-activated tracer ONM-100 shows that ONM-100 is well tolerated and safe and allows fluorescent tumor visualization both in- and ex vivo. Here, we provide the first data that this pH-sensitive optical tracer can be used as a tracer for FGS and for margin detection. Further analysis on microscopic biodistribution of ONM-100 is currently being performed and possibilities for metastatic lymph node detection will be explored.

Citation Format: Steinkamp PJ, Voskuil FJ, Koller M, van der Vegt B, Doff JJ, Zhao T, Hartung J, Jayalakshmi Y, Sumer BD, Gao J, Witjes MJ, van Dam GM. Image guided surgery for tumor detection in breast cancer using the PH activated micellar tracer ONM-100: The SHINE study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-29.

Clostridium difficile infection is associated with graft loss in solid organ transplant recipients

Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea in solid organ transplant recipients (SOT). We aimed to assess incidence, risk factors, and outcome of CDI within the Swiss Transplant Cohort Study (STCS). We performed a case-control study of SOT recipients in the STCS diagnosed with CDI between May 2008 and August 2013. We matched 2 control subjects per case by age at transplantation, sex, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors and evaluate outcome of CDI. Two thousand one hundred fifty-eight SOT recipients, comprising 87 cases of CDI and 174 matched controls were included. The overall CDI rate per 10 000 patient days was 0.47 (95% confidence interval ([CI] 0.38-0.58), with the highest rate in lung (1.48, 95% CI 0.93-2.24). In multivariable analysis, proven infections (hazard ratio [HR] 2.82, 95% CI 1.29-6.19) and antibiotic treatments (HR 4.51, 95% CI 2.03-10.0) during the preceding 3 months were independently associated with the development of CDI. Despite mild clinical presentations, recipients acquiring CDI posttransplantation had an increased risk of graft loss (HR 2.24, 95% CI 1.15-4.37; P = .02). These findings may help to improve the management of SOT recipients.

Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression

BACKGROUND

Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L.

METHODS

The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data.

RESULTS

A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011.

CONCLUSIONS

While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.

An international study to revise the EORTC questionnaire for assessing quality of life in lung cancer patients

BACKGROUND

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-LC13 was the first module to be used in conjunction with the core questionnaire, the QLQ-C30. Since the publication of the LC13 in 1994, major advances have occurred in the treatment of lung cancer. Given this, an update of the EORTC QLQ-LC13 was undertaken.

METHODS

The study followed phases I to III of the EORTC Module Development Guidelines. Phase I generated relevant quality-of-life issues using a mix of sources including the involvement of 108 lung cancer patients. Phase II transformed issues into questionnaire items. In an international multicenter study (phase III), patients completed both the EORTC QLQ-C30 and the 48-item provisional lung cancer module generated in phases I and II. Patients rated each of the items regarding relevance, comprehensibility, and acceptance. Patient ratings were assessed against a set of prespecified statistical criteria. Descriptive statistics and basic psychometric analyses were carried out.

RESULTS

The phase III study enrolled 200 patients with histologically confirmed lung cancer from 12 centers in nine countries (Cyprus, Germany, Italy, Israel, Spain, Norway, Poland, Taiwan, and the UK). Mean age was 64 years (39 - 91), 59% of the patients were male, 82% had non-small-cell lung cancer, and 56% were treated with palliative intent. Twenty-nine of the 48 questions met the criteria for inclusion.

CONCLUSIONS

The resulting module with 29 questions, thus currently named EORTC QLQ-LC29, retained 12 of the 13 original items, supplemented with 17 items that primarily assess treatment side-effects of traditional and newer therapies.

Daylight photodynamic therapy versus cryosurgery for the treatment and prophylaxis of actinic keratoses of the face - protocol of a multicenter, prospective, randomized, controlled, two-armed study

BACKGROUND

Photodynamic therapy with daylight (DL-PDT) is efficacious in treating actinic keratosis (AK), but the efficacy of field-directed, repetitive DL-PDT for the treatment and prophylaxis of AK in photodamaged facial skin has not yet been investigated.

METHODS/DESIGN

In this multicenter, prospective, randomized, controlled, two-armed, observer-blinded trial, patients with a minimum of 5 mild-to-moderate AK lesions on photodamaged facial skin are randomly allocated to two treatment groups: DL-PDT with methyl aminolevulinate (MAL) and cryosurgery. In the DL-PDT group (experimental group), 5 treatments of the entire face are conducted over the course of 18 months. After preparation of the lesion and within 30 min after MAL application, patients expose themselves to daylight for 2 h. In the control group, lesion-directed cryosurgery is conducted at the first visit and, in the case of uncleared or new AK lesions, also at visits 2 to 5. The efficacy of the treatment is evaluated at visits 2 to 6 by documenting all existing and new AK lesions in the face. Cosmetic results and improvement of photoaging parameters are evaluated by means of a modified Dover scale. Primary outcome parameter is the cumulative number of AK lesions observed between visits 2 and 6. Secondary outcome parameters are complete clearance of AK, new AK lesions since the previous visit, cosmetic results independently evaluated by both patient and physician, patient-reported pain (visual analogue scale), patient and physician satisfaction scores with cosmetic results, and patient-reported quality of life (Dermatology Life Quality Index). Safety parameters are also documented (adverse events and serious adverse events).

DISCUSSION

This clinical trial will assess the efficacy of repetitive DL-PDT in preventing AK and investigate possible rejuvenating effects of this treatment. (Trial registration: ClinicalTrials.gov Identifier: NCT02736760).

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02736760 . Study Code Daylight_01. EudraCT 2014-005121-13.

Abstract P4-01-01: Phase II in-human dose escalation study of the optical molecular imaging tracer bevacizumab-800cw for molecular fluorescence guided surgery in primary breast cancer patients

Introduction

Molecular Fluorescence Guided Surgery (MFGS) might be used for intraoperative detection of positive resection margins in breast conserving surgery (BCS) for the treatment of breast cancer. Currently, the presence of tumor positive resection margins can only be assessed ex vivo by histopathological analysis of the excised tissue, which takes up to 5 working days. The current study defined the optimal dose of the near-infrared (NIR) optical imaging tracer bevacizumab-800CW to enable intraoperative detection and image-guided pathology of tumor positive resection margins in breast cancer patients.

Methods

Molecular Fluorescence Guided Surgery during BCS was performed in subjects treated for primary breast cancer. The NIR optical imaging tracer bevacizumab-800CW targeting vascular endothelial growth factor A was administered intravenously three days prior to surgery in four escalating dose groups (4.5mg, 10mg, 25mg and 50mg). NIR fluorescent signals were detected real-time using an intraoperative fluorescence camera system (SurgVision BV). Standardized ex vivo analyses of tumor-to-normal ratios (TNR) were performed to define the optimal tracer dose using a BlackBox imaging system (SurgVision BV) for imaging fresh bread loaf slices, a NIR fluorescence flatbed scanner (Odyssey, Li-Cor) for imaging 10µm slices of formalin-fixed paraffin-embedded (FFPE) blocks, NIR Confocal Laser Endomicroscopy (CLE, Mauna Kea Technologies) and multi-diameter single fiber reflectance and single fiber fluorescence (MDSFR/SFF) spectroscopy quantification to enable correction for the influence of tissue optical properties on fluorescence in tumor and normal breast tissue.

Results

Currently, 12 subjects have been included and analyzed in four dosing groups. All tumors showed specific tracer uptake at macroscopic and microscopic level during ex vivo analyses, confirmed by histopathology. Quantification of NIR fluorescent signals showed higher TNRs by increasing doses up to 25mg. No further increase in TNR was seen in the 50mg dose group. CLE showed the feasibility of visualization of the tracer accumulation in tumor tissue compared to normal tissue at a microscopic level. MDSFR/SFF spectroscopy objectively confirmed the dose dependency up to 25mg.

Conclusion and future perspective

Intravenous administration of bevacizumab-800CW in doses up to 50mg is safe and highly tumor specific, showing a plateau of TNR at 25mg and 50mg. Further expansion of the dosing cohorts of 10mg and 25mg with additional seven patients per group will be performed to establish the optimal dose for MFGS during BCS for an upcoming phase III multicenter randomized controlled trial. By enabling MFGS during BCS the surgical treatment of primary breast cancer patients might be optimized by a reduced need for re-excision surgery and thereby reducing the risk of co-morbidity, psychological burden, poor cosmesis and healthcare costs.

Citation Format: van Dam GM, Koller M, Qiu SQ, Linssen MD, de Vries J, Jansen L, Kelder W, de Jong JS, Jorritsma-Smit A, van der Vegt B, Robinson DJ, Nagengast WB. Phase II in-human dose escalation study of the optical molecular imaging tracer bevacizumab-800cw for molecular fluorescence guided surgery in primary breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-01-01.

Reducing stigma in high school youth

OBJECTIVE

We evaluated 21 contact-based education interventions in 5047 Canadian high school students and identified student characteristics associated with success.

METHODS

We used a one-group pretest/posttest design with standardized instruments to measure changes in behavioural intent. Variability across interventions was assessed using meta-analysis, and a mixed-effects logistic regression was used to identify student characteristics.

RESULTS

Interventions were heterogeneous (I(2)  = 62.4%) but generally successful. The odds of getting an A grade was 2.57 times greater on the posttest than the pretest (95% CI = 2.18, 3.03). Males were less likely to achieve a passing score overall; however, males who self-disclosed a mental illness were more likely to pass. Three percent of students experienced a large drop in social acceptance following the intervention. These were more likely to be male [OR = 1.5 (95% CI = 1.0, 2.1)].

CONCLUSION

Contact-based education is a promising practice for reducing stigma in high school students, although the field would benefit from fidelity criteria to reduce variation across interventions. Males and females react differently to antistigma programming; particularly those with self-reported mental illnesses and a small proportion may become more intolerant.

Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation

Originally, the treatment method of choice for distal radial fractures (DRF) has been a non-operative approach with six to eight weeks of plaster casting. The introduction of volar locking plate systems at the beginning of the 21 st century has pushed trends towards open reduction and internal fixation (ORIF). While the introduction of fixed angle locking plates together with the increasing knowledge on wrist function and related variable outcomes has led to consensus that operative fixation in instable DRF is the treatment method of choice, there is no agreement on a postoperative care of these injuries. The authors will discuss the available evidence for current concepts of postoperative treatment of DRFs following fixed angle fixation under socioeconomical, biomechanical and burden of disease aspects. Further, relevant randomized controlled trials are evaluated with regard to applied postoperative treatment regimes and related risks for complications.

[Patient-centredness in health services research]

This paper provides a sketch of key research areas within health services research focusing on patient-centredness. The evaluation of patient-reported outcomes (PROs) is increasingly required for evaluating interventions in clinical trials and in routine health care. Often, however, it is un-clear which PROs are best suited for a particular research question. One of the most commonly used PRO is the construct of quality of life (QoL), which has become an established outcome in clinical trials and is also named as a health goal in the German Social Code of Law. The concept of patient empowerment implies that autonomy and room for manoeuver of the individual patient should be strengthened. However, it is un-clear how the concept is best operationalised. One prerequisite for patient empowerment in routine health care is the development and implementation of evidence-based patient information. Another prominent research area focuses on the role of self-help and patient organisations in health services. Topics of interest are aims and activities of self-help organisations, potentials and challenges of integrating self-help into professional health services, effects of organised self-help support on patients and barriers of use.

Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry

The proliferation marker Ki-67 is one of the most controversially discussed parameters for treatment decisions in breast cancer patients. The purpose of this study was to evaluate the routine use and value of Ki-67 as a prognostic marker, and to analyze the associations between Ki-67 and common histopathological parameters in the routine clinical setting. Data from the clinical cancer registry Regensburg (Bavaria, Germany) were analyzed. Within the total data pool of 4,692 female patients, who had been diagnosed between 2005 and 2011, in 3,658 cases Ki-67 was routinely determined. Thus, a total of 3,658 patients with invasive breast cancer were included in the present study and used for statistical analysis. Ki-67 expression was associated with the common histopathological parameters. The strongest correlation was found between grading and Ki-67 (P < 0.001). In terms of survival analyses, Ki-67 was categorized into five categories (reference category Ki-67 ≤15 %) due to a nonlinear relationship to overall survival (OS). In multivariable analysis, Ki-67 was an independent prognostic parameter both for disease-free survival (DFS) (Ki-67 > 45 %, HR = 1.96, P = 0.001) as well as for OS (Ki-67: 26-35 %, HR = 1.71, P = 0.017; Ki-67: 36-45 %, HR = 2.05, P = 0.011; Ki-67 > 45 %, HR = 2.06, P = 0.002) independent of common clinical and histopathological factors. The 5-year DFS (OS) rate was 86.7 % (89.3 %) in patients with a Ki-67 value ≤15 % compared to 75.8 % (82.8 %) in patients with a Ki-67 value >45 %. Based on the data from a large cohort of a clinical cancer registry, it was demonstrated that Ki-67 is frequently determined in routine clinical work. Ki-67 expression is associated with common histopathological parameters, but is an additional independent prognostic parameter for DFS and OS in breast cancer patients. Future work should focus on standardization of Ki-67 assessment and specification of its role in treatment decisions.