Changes in overlap of subjective and objective cognition over time in epilepsy surgery candidates

PURPOSE

Subjective and objective cognition often show weak overlap in persons with epilepsy (PWE). Over- as well as underestimation may occur. In particular after epilepsy surgery, objective memory decline is often not subjectively reported. Additionally, studies on how concordance of subjective and objective cognition changes over time are missing. Therefore, we study the extent of concordance in operated and non-operated PWE over time.

METHODS

Candidates for resective epilepsy surgery were assessed between 03/18 and 12/20 (T1) with self-report questionnaires and underwent a neuropsychological examination. For 21 operated as well as 27 non-operated PWE follow-up data was obtained one to three years later (T2). Concordance of attention and memory were compared between groups and time points. Moreover, reliable change was calculated and compared between groups.

RESULTS

Of the total sample, 42 % rated their attention performance realistically and 25 % showed memory concordance. Differences in patterns of over- and underestimation between groups and over time occurred for attention, but not for memory. Overestimation of memory was more frequent in operated than non-operated PWE, especially at T2 (67% vs. 11 %). In the operated group, we mainly observed reliable improvement in subjective cognition and decline in objective memory, whereas non-operated PWE showed more frequently decline of simple attention. Reliable subjective and objective change did not co-occur.

CONCLUSION

Concordance of subjective and objective cognition is low. Over- as well as underestimation may persist over time. Domain-specific perspectives are necessary. Tendencies of operated PWE to develop overestimation of memory after surgery should be considered in neuropsychological interventions.

Atypical ductal hyperplasia on vacuum-assisted breast biopsy: a scoring system to predict the risk of upgrade to malignancy

RATIONALE AND OBJECTIVES

Our multicentric study analysed clinical, radiologic and pathologic features in patients with atypical ductal hyperplasia (ADH) diagnosed with vacuum-assisted biopsy (VAB), to identify factors associated with the risk of upgrade, to develop a scoring system to support decision making.

MATERIALS AND METHODS

Patients with ADH on VAB under stereotactic/tomosynthesis guidance (2012-2022) were eligible. Inclusion criteria were availability of surgical histopathological examination of the entire lesion or radiologic follow-up (FUP) ≥ 24 months. VAB results were compared with surgical pathological results or with imaging FUP evolution to assess upgrade. A backward stepwise linear regression was used to identify predictors of upgrade. The discriminatory power of the model was calculated through the area under the receiver operating curve (ROC-AUC); the Hosmer-Lemeshow test was used to assess model calibration. The points system was developed based on the selected risk factors, and the probability of upgrade associated with each point total was determined.

RESULTS

112 ADH lesions were included: 91 (91/112, 81.3%) underwent surgical excision with 20 diagnosis of malignancy, while 21 (21/112, 18.7%) underwent imaging FUP with one interval change (mean FUP time 48 months). Overall upgrade rate was 18.7% (21/112). Age, menopausal status, concurrent breast cancer, BIRADS classification and number of foci of ADH were identified as risk factors for upgrade. Our model showed an AUC = 0.85 (95% CI 0.76-0.94). The points system showed that the risk of upgrade is < 2% when the total score is ≤ 1.

CONCLUSION

Our scoring system seemed a promising easy-to-use decision support tool for management of ADH, decreasing unnecessary surgeries, reducing patients' overtreatment and healthcare costs.

Cardiac, possible cardiac, and likely non-cardiac origin of chest pain : A hitherto underestimated parameter in German chest pain units

BACKGROUND

Current guidelines emphasize the diagnostic value of non-cardiac or possibly cardiac chest pain. The goal of this analysis was to determine whether German chest pain units (CPUs) adequately address conditions with "atypical" chest pain in existing diagnostic structures.

METHOD

A total of 11,734 patients from the German CPU registry were included. The analyses included mode of admission, critical time intervals, diagnostic steps, and differential diagnoses.

RESULTS

Patients with unspecified chest pain were younger, more often female, were less likely to have classic cardiovascular risk factors and tended to present more often as self-referrals. Patients with acute coronary syndrome (ACS) mostly had prehospital medical contact. Overall, there was no difference between these two groups regarding the time from the onset of first symptoms to arrival at the CPU. In the CPU, the usual basic diagnostic measures were performed irrespective of ACS as the primary working diagnosis. In the non-ACS group, further ischemia-specific diagnostics were rarely performed. Extra-cardiac differential diagnoses were not specified.

CONCLUSION

The establishment of broader awareness programs and opening CPUs for low-threshold evaluation of self-referring patients should be discussed. Regarding the rigid focus on the clarification of cardiac causes of chest pain, a stronger interdisciplinary approach should be promoted.

Assessing the Underestimation of Adult Pertussis Disease in Five Latin American Countries

INTRODUCTION

Pertussis, a contagious respiratory disease, is underreported in adults. The study objective was to quantify underestimation of pertussis cases in adults aged ≥ 50 years in five Latin American countries (Argentina, Brazil, Chile, Mexico, Peru).

METHODS

A previously published probabilistic model was adapted to adjust the number of pertussis cases reported to national surveillance systems by successive multiplication steps (proportion of pertussis cases seeking healthcare; proportion with a specimen collected; proportion sent for confirmatory testing; proportion positive for pertussis; proportion reported to passive surveillance). The proportions at each step were added in a random effects model to produce a pooled overall proportion, and a final multiplier was calculated as the simple inverse of this proportion. This multiplier was applied to the number of cases reported to surveillance to estimate the number of pertussis cases. Monte Carlo simulation with 10,000 iterations estimated median as well as upper and lower 90% values. Input data were obtained from surveillance systems and published sources.

RESULTS

The estimated median underestimation factor for pertussis cases in adults ranged from 104 (90% limits 40, 451) in Chile to 114 (90% limits 39, 419) in Argentina. In all five countries, the largest estimated number of cases was in the group aged 50-59 years. The highest number per 100,000 population was in the group aged ≥ 90 years in most countries. The estimated median underestimation factor for pertussis hospitalizations was 2.3 (90% limits 1.8, 3.3) in Brazil and 2.4 (90% limits 1.8, 3.2) in Chile (data not available for other countries).

CONCLUSION

This analysis indicates that the number of pertussis cases in adults aged ≥ 50 years in five Latin American countries is approximately 100 times higher than the number captured in surveillance data. These results could support decision-making in the diagnosis, management, and prevention of pertussis disease in adults.

Investigation of critical factors influencing the underestimation of hearing loss predicted by the ISO 1999 predicting model

OBJECTIVE

To analyze factors influencing the underestimation of noise-induced permanent threshold shift (NIPTS) among manufacturing workers, providing baseline data for revising noise exposure standard.

DESIGN

A cross-sectional study was designed with 2702 noise-exposed workers from 35 enterprises from 10 industries. Personal noise exposure level(LAeq,8h) and noise kurtosis level were determined by a noise dosimeter. Questionnaires and hearing loss tests were performed for each subject. The predicted NIPTS was calculated using the ISO 1999:2013 model for each participant, and the actual measured NIPTS was corrected for age and sex. The factors influencing the underestimation of NIPTS were investigated.

RESULTS

The predicted NIPTS at each test frequency (0.5, 1, 2, 3, 4, or 6kHz) and mean NIPTS at 2, 3, 4, and 6kHz (NIPTS2346) using the ISO 1999:2013 model were significantly lower than their corresponding measured NIPTS, respectively (P < 0.001). The ISO model significantly underestimated the NIPTS2346 by 12.36 dB HL. The multiple linear regression analysis showed that noise exposure level, exposure duration, age, and kurtosis could affect the degree of underestimation of NIPTS2346. The generalized additive model (GAM) with (penalized) spline components showed nonlinear relationships between critical factors (age, exposure duration, noise level, and kurtosis) and the underestimated NIPTS2346.The underestimated NIPTS2346 decreased with an increase in exposure duration (especially over ten years). There was no apparent trend in the underestimated NIPTS2346 with age. The underestimated NIPTS2346 decreased with the increased noise level [especially > 90 dB(A)]. The underestimated NIPTS2346 increased with an increase in noise kurtosis after adjusting for the noise exposure level and exposure duration and ultimately exhibiting a linear regression relationship.

CONCLUSIONS

The ISO 1999 predicting model significantly underestimated the noise-induced hearing loss among manufacturing workers. The degree of underestimation became more significant at the noise exposure condition of fewer than ten years, less than 90 dB(A), and higher kurtosis levels. It is necessary to apply kurtosis to adjust the underestimation of hearing loss and consider the applying condition of noise energy metrics when using the ISO predicting model.

A Bayesian approach to correct the under-count of cancer registry statistics before population-based cancer registry program

Aim

This study aims to correct undercounts in cancer data before initiating a population-based cancer registry program, employing an innovative Bayesian methodology.

Background

Underestimation is a widespread issue in cancer registries within developing countries.

Methods

This secondary study utilized cancer registry data. We employed the Bayesian approach to correct undercounting in cancer data from 2005 to 2010, using the ratio of pathology to population-based data in the Golestan province as the initial value.

Results

The results of this study showed that the lowest percentage of undercounting belonged to Khorasan Razavi province with an average of 21% and the highest percentage belonged to Sistan and Baluchestan province with an average of 38%.The average age-standardized incidence rate (ASR) for all provinces of the country except Golestan province was equal to 105.72 (Confidence interval (CI) 95% 105.35-106.09) per 100,000 and after Bayesian correction was 137.17 (CI 95% 136.74-137.60) per 100,000. In 2010 the amount of ASR before Bayesian correction was 100.28 (CI 95% 124.39-127.09) per 100,000 for women and 136.49 (CI 95% 171.20-174.38) per 100,000 for men. Also, after implementing the Bayesian correction, ASR increased to 125.74 per 100,000 for women and 172.79 per 100,000 for men.

Conclusion

The study demonstrates the effectiveness of the Bayesian approach in correcting undercounting in cancer registries. By utilizing the Bayesian method, the average ASR after Bayesian correction with a 29.74 percent change was 137.17 per 100,000. These corrected estimates provide more accurate information on cancer burden and can contribute to improved public health programs and policy evaluation. Furthermore, this research emphasizes the suitability of the Bayesian method for addressing underestimation in cancer registries. It also underscores its pivotal role in shaping the trajectory of future investigations in this field.

Results of the Cologne Corona surveillance (CoCoS) study - a prospective population-based cohort study: incidence data and potential underestimation of new SARS-CoV-2 adult infections by health authorities

BACKGROUND

Current incidence estimates of SARS-CoV-2 in Germany rely to a large extent on case notifications. However, the large number of mild or asymptomatic infections is likely to result in underestimation. Population-based studies can provide valid estimates of the SARS-CoV-2 incidence and thus support health authorities to monitor the epidemiological situation and to initiate, maintain, strengthen or relax effective countermeasures.

METHODS

This study was conducted in Cologne, Germany. Six-thousand randomly drawn Cologne residents, 18 years of age or older, were contacted by mail in March 2021. Study envelopes contained a kit for self-administered saliva sample and access details to a questionnaire on sociodemographic characteristics, previous positive SARS-CoV-2 RT-qPCR and completed COVID-19 vaccinations. Participants were again invited for a second round in June 2021, while those who declined participation were replaced by additional randomly drawn Cologne residents in order to reach a total of 6000 potential participants again. The saliva samples were sent to the laboratory by mail and tested for SARS-CoV-2 using RT-qPCR. The incidence estimates were adjusted for sensitivity and specificity of the test procedure and compared with the official numbers of new SARS-CoV-2 cases in the adult Cologne population.

RESULTS

The first surveillance round in March 2021 (response rate: 34.08%, N = 2045) showed a SARS-CoV-2 seven-day incidence of 85 cases per 100,000 adult Cologne residents (95% CI: 9 to 319). In the same period, the officially registered cases were 125 per 100,000. The second surveillance round in June 2021 (response rate: 36.53%, N = 2192) showed a seven-day incidence of 27 per 100,000 adult Cologne residents (95% CI: 1 to 142), while the official figures for newly registered SARS-CoV-2 cases in the same period were 15 per 100,000.

CONCLUSIONS

The incidence estimates do not indicate relevant underestimation of new SARS-CoV-2 infections based on case notification. Regular use of the surveillance method developed here may nevertheless complement the efforts of the health authorities to assess the epidemiological situation.

TRIAL REGISTRATION

DRKS.de, German Clinical Trials Register (DRKS), Identifier: DRKS00024046 , Registered on 25 February 2021.

Evidence of underestimation in microplastic research: A meta-analysis of recovery rate studies

Research on microplastics in the environment is of high interest to many scientists and industries globally. Key to the success of this research is the accuracy, efficiency, reliability, robustness and repeatability of the method(s) used to isolate the microplastics from environmental media. However, with microplastics now being found in new complex media, many multifaceted methods have been developed to research the quantities of these pollutants. To validate new methods, recovery studies can be undertaken by spiking the test medium with known quantities of plastics. The method is typically run as normal, and the recovered plastics counted to give a recovery rate. A current issue in this field is that methods are rarely or poorly validated in this way. Here, we conducted a meta-analysis on 71 recovery rate studies. We found sediment was the most studied medium and saline solutions were the most used reagents. Polyethylene and polystyrene were the most used spiking polymers, which is relevant to the most common polymers in the environment. We found that recovery rates were highest from plant material, whole organisms and excrement (>88%), and lowest from fishmeal, water and soil (58-71%). Moreover, all reagents but water were able to recover more than 80% of the spiked plastics. We believe we are the first (to our knowledge) to provide an overarching indication for the underestimation of microplastics in the environment of approximately 14% across the studies we reviewed, varying with the methods used. Furthermore, we recommend that the quality, use and reporting of recovery rate studies should be improved to aid the standardisation and replication of microplastic research.

Factors associated with sleep state misperception in patients with obstructive sleep apnea

PURPOSE

Little is known regarding the prevalence of sleep state misperception and the factors related to this in patients with obstructive sleep apnea (OSA).

METHODS

This retrospective study included patients with OSA defined by an apnea-hypopnea index (AHI) of ≥ 5 and used the Insomnia Severity Index (ISI), the Epworth sleepiness scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Underestimation and overestimation of sleep state perception were defined as < 80% and > 120%, respectively, of the ratio between subjective and objective total sleep time. An ISI score > 14 indicated clinically significant insomnia and an AHI ≥ 30 indicated severe OSA. A multinomial logistic regression was conducted with the category of sleep state perception as an outcome variable.

RESULTS

Of the 707 patients with OSA, underestimation and overestimation of sleep state perception were noted in 22.5% and 10.6% of subjects, respectively. The median absolute differences (and percentages of the ratio) between subjective and objective total sleep time were 116 min (66.9%) and 87 min (127.3%) in the underestimated and overestimated perception groups, respectively. In the adjusted model, the underestimated group was more likely to have an ISI score > 14 (OR = 1.812, P = .006). The overestimated group was more likely to be older (OR = 1.025, P = .025) and has severe OSA (OR = 1.729, P = .035).

CONCLUSIONS

There are two patterns of sleep state misperception in patients with OSA: underestimation associated with comorbid insomnia symptoms and overestimation associated with severe OSA. These findings enhance understanding of the pathophysiology of sleep state misperception in patients with OSA.

Neglecting the neglected during the COVID-19 pandemic: the case of leptospirosis in Sri Lanka

The coronavirus disease 2019 (COVID-19) pandemic has disrupted global health systems and affected the transmission dynamics as well as the surveillance of other infectious diseases. This study described the probable effect of the COVID-19 pandemic on the surveillance and control of leptospirosis in Sri Lanka. With 8,579 reported cases and more than 800 estimated deaths, the Sri Lankan public health surveillance system documented the largest outbreak of leptospirosis in Sri Lankan history in 2020. This was the worst infectious disease outbreak Sri Lanka experienced in 2020, but it was neglected, primarily due to the COVID-19 pandemic.

An extended version of the MNA-SF increases sensitivity in identifying malnutrition among community living older adults. Results from the PRONUTRISENIOR project

BACKGROUND & AIMS

The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition and/or its risk among older adults. Its Screening section was proposed as a short form (MNA-SF) but studies comparing the two forms present controversial results. Our main aims were to study the agreement between MNA-SF and its full form (MNA-FF) among Portuguese older adults living in the community and to develop a more sensible version of the MNA-SF.

MATERIAL AND METHODS

This cross-sectional study used a convenience sample of 456 older adults (54.2% females) aged 65-92 years (mean = 73; SD = 6). Data analyzed included: nutritional status (MNA), social support (Fillenbaum's Social Network Index), level of independency in daily activities (Lawton e Brody's scale) and eating-related quality of life. Both MNA-FF and MNA-SF classify participants as malnourished, at risk of malnutrition or with normal nutrition status. Anthropometric assessments (weight, height, arm and calf perimeters) were carried out and BMI was computed.

RESULTS

The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted Cohen's k = 0.497; p < 0,001), and the sensitivity of the MNA-SF to detect malnutrition or its risk (as assessed by the MNA-FF) was 42.6% (despite a specificity of 98.8%). Participants classified as normal using the MNA-SF despite at risk using the MNA-FF present lower scores in two items from the Assessment section (number of full meals eaten daily and amount of fluid consumed per day). These were included in MNA-SF to obtain an extended short-version (MNA-SF8). The difference between the ROC curves for MNA-SF and MNA-SF8 justifies the preferential use of the MNA-SF8 with an estimated cut-off of 14 points, which showed high sensitivity (91.8%) and specificity (79.9%).

CONCLUSIONS

The addition of two items to the MNA-SF provides a more sensible tool to detect the risk of malnutrition among older adults. General eating-related questions seem relevant to assess malnutrition in this age group.

Prediction of Underestimation Using Contrast-Enhanced Spectral Mammography in Patients Diagnosed as Ductal Carcinoma In Situ on Preoperative Core Biopsy

BACKGROUND

To assess the performance of contrast-enhanced spectral mammography (CESM) for the prediction of DCIS underestimation in comparison with mammography, breast US, and breast MRI.

PATIENTS AND METHODS

We prospectively enrolled patients diagnosed with DCIS on preoperative core biopsy. Visibility, lesion type, and extent on each imaging modality, CESM gray values (CGV) were evaluated. Pathologic features of core biopsy and surgery were recorded. Chi-square or Fisher's exact test were used for univariate analysis. Multivariate logistic regression analysis was used to find independent predictors for DCIS underestimation and receiver operating characteristic (ROC) curve analysis was performed.

RESULTS

A total of 113 lesions in 108 patients were analyzed (50 pure DCIS; 63 underestimated DCIS). Visibility on mammography, breast US, CESM, and breast MRI were 44%, 76%, 58%, and 80% for pure DCIS, and 73%, 81%, 86%, and 92% for underestimated DCIS. Tumor extents on surgical pathology of pure and underestimated DCIS were 1.11 ± 1.35 cm and 2.61 ± 2.09 cm. On multivariate analysis, nuclear grade and suspected invasion on core biopsy, visibility on mammography, and extent on breast MRI were independent factors for the model 1, whereas nuclear grade on core biopsy, extent on CESM, and mean CGV on MLO-recombined image were independent factors for the model 2. Area under ROC curve (AUC) was 0.843 for model 1 including breast MRI, whereas AUC was 0.823 for model 2 including CESM, which didn't show a significant difference (P = .968).

CONCLUSION

For detecting underestimated DCIS, CESM was superior to mammography and breast US, and comparable to breast MRI.

Understanding norovirus reporting patterns in England: a mixed model approach

BACKGROUND

Norovirus has a higher level of under-reporting in England compared to other intestinal infectious agents such as Campylobacter or Salmonella, despite being recognised as the most common cause of gastroenteritis globally. In England, this under-reporting is a consequence of the frequently mild/self-limiting nature of the disease, combined with the passive surveillance system for infectious diseases reporting. We investigated heterogeneity in passive surveillance system in order to improve understanding of differences in reporting and laboratory testing practices of norovirus in England.

METHODS

The reporting patterns of norovirus relating to age and geographical region of England were investigated using a multivariate negative binomial model. Multiple model formulations were compared, and the best performing model was determined by proper scoring rules based on one-week-ahead predictions. The reporting patterns are represented by epidemic and endemic random intercepts; values close to one and less than one imply a lower number of reports than expected in the given region and age-group.

RESULTS

The best performing model highlighted atypically large and small amounts of reporting by comparison with the average in England. Endemic random intercept varied from the lowest in East Midlands in those in the under 5 year age-group (0.36, CI 0.18-0.72) to the highest in the same age group in South West (3.00, CI 1.68-5.35) and Yorkshire & the Humber (2.93, CI 1.74-4.94). Reporting by age groups showed the highest variability in young children.

CONCLUSION

We identified substantial variability in reporting patterns of norovirus by age and by region of England. Our findings highlight the importance of considering uncertainty in the design of forecasting tools for norovirus, and to inform the development of more targeted risk management approaches for norovirus disease.

Estimating pertussis incidence in general practice using a large Australian primary care database

BACKGROUND

While pertussis is notifiable in most countries, notifications typically underestimate the true pertussis burden. We explored the incidence of pertussis in general practice in Australia.

METHODS

Using MedicineInsight, a large longitudinal electronic medical record database of general practice (primary care) encounters which includes >1.5 million patients, we first defined a cohort of active patients and then used free-text search algorithms to identify patients with pertussis-related encounters. We defined and identified pertussis-related encounters in four patient categories: pertussis-associated (category 1), potential pertussis (category 2), epidemiologically-linked pertussis (category 3), and symptoms consistent with pertussis (category 4). Incident pertussis-related encounter rates per 100,000 active patients were calculated from Jan 2008 to Aug 2015.

RESULTS

Estimated mean annual pertussis incidence increased as definitions were expanded, from 94.3 (category 1 patients only) to 148.8 (categories 1+2+3 patients combined) per 100,000 active patients per year. Monthly time-series corresponding to the first three categories were highly correlated (Pearson's r > 90% for each pair), but each was poorly correlated with category 4. For categories 1+2+3, the highest incidence was among 0-4 and 5-9 year olds. Incidence was 30% higher in females than males (i.e. 184.5 vs 139.8 per 100,00 active patients for categories 1-3 patients combined). Pertussis-associated incidence (category 1) was similar to national pertussis notification rates. Categories 2 and 3 added 25% and 33%, respectively, on average relative to category 1 incidence. The estimated incidence from categories 1+2+3 together were on average 64% higher than national pertussis notification rates.

CONCLUSION

We provide comprehensive estimates of pertussis-related incidence in general practice (primary care), well in excess of notified pertussis incidence in Australia. This highlights the utility of MedicineInsight data in providing a greater understanding of the burden of medically-attended pertussis infections.

Modeling the underestimation of COVID-19 infection

Estimation of the undocumented cases of COVID-19 is critical for understanding the epidemic potential of the disease and informing pandemic response. The COVID-19 pandemic originated from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus similar to severe acute respiratory syndrome (SARS) that was formerly identified in 2003. The contagiousness, dynamics of the pathogen, and mobility of the general population incurred the occurrence of underestimation of infection (i.e., the unidentified cases and the gap with the identified cases) that was potentially substantial in magnitude, which was supposed to connect with subsequent cyclical outbreaks in practice. We employed a Susceptible-Infected-Removed-Contained (SIR-C) mathematical model to infer critical epidemiological characteristics associated with COVID-19, then asymptotically simulated the peak sizes and peak dates of the identified and unidentified cases, the underestimation, and the dynamics of the gap. The simulation outcomes indicated that unidentified peak dates in practice could predate the reported peak dates for a variable period of weeks or months. In comparison, the saturation sizes of infection remained at commensurate levels. The curve of the initial exponential-like outbreak for the undocumented cases would flatten when the gap between concurrent identified cases and unidentified cases decreased. The rate of non-pharmaceutical containment could impact the trend of disease transmission ceteris paribus, and the greater the rate the larger reduction of infections. When the rate reached a certain level of threshold, the undocumented curve would shift from flattening effect to decaying effect. A similar trend was observed when it applied to the rate of pharmaceutical containment measures ceteris paribus. The results were sensitive to the duration of infection (DOI), it manifested that greater values of DOI were associated with greater peak sizes and greater peak dates for both documented and undocumented cases. Conditional on assumptions, calibration of DOI from 8 days to 18 days would increase the unidentified peak size by nearly 56% and the peak date by almost 18 days.

Orthopaedic patients underestimate their body weight too: a cross-sectional study

INTRODUCTION

The relation between a large body mass and comorbidity, certain types of cancers and musculoskeletal disorders has been extensively documented. However, a high proportion of overweight patients appears unaware of the medical risks of their condition and frequently underestimates their body weight. This observation is prevalent across numerous medical specialties and settings.

METHODS

This study analysed the misperception of obesity status in a cohort of 1137 patients attending an orthopaedic clinic by means of self-completed questionnaires and objective biometrics.

RESULTS

Patients displayed a poor estimation of the self-body mass index (34.6%), especially among larger individuals, with 45.15% of pre-obese and 21.17% of obese patients previously attempting weight-loss. A direct association between low educational achievement and obesity rates was observed in orthopaedic patients.

DISCUSSION

Obesity is a well-known contributor to many conditions, including musculoskeletal diseases. Despite this association, many obese patients consider their body mass as normal. Misperception of self-body weight has been documented in many medical specialities, and this study confirms the same scenario in orthopaedic patients.

CONCLUSION

The association between self-image distortion and obesity observed in this study may assist in the evaluation and management of obesity cases in orthopaedic clinics.

Economic burden of work injuries and diseases: a framework and application in five European Union countries

BACKGROUND

Estimates of the economic burden of work injuries and diseases can help policymakers prioritize occupational health and safety policies and interventions in order to best allocate scarce resources. Several attempts have been made to estimate these economic burdens at the national level, but most have not included a comprehensive list of cost components, and none have attempted to implement a standard approach across several countries. The aim of our study is to develop a framework for estimating the economic burden of work injuries and diseases and implement it for selected European Union countries.

METHODS

We develop an incidence cost framework using a bottom-up approach to estimate the societal burden of work injuries and diseases and implement it for five European Union countries. Three broad categories of costs are considered-direct healthcare, indirect productivity and intangible health-related quality of life costs. We begin with data on newly diagnosed work injuries and diseases from calendar year 2015. We consider lifetime costs for cases across all categories and incurred by all stakeholders. Sensitivity analysis is undertaken for key parameters.

RESULTS

Indirect costs are the largest part of the economic burden, then direct costs and intangible costs. As a percentage of GDP, the highest overall costs are for Poland (10.4%), then Italy (6.7%), The Netherlands (3.6%), Germany (3.3%) and Finland (2.7%). The Netherlands has the highest per case costs (€75,342), then Italy (€58,411), Germany (€44,919), Finland (€43,069) and Poland (€38,918). Costs per working-age population are highest for Italy (€4956), then The Netherlands (€2930), Poland (€2793), Germany (€2527) and Finland (€2331).

CONCLUSIONS

Our framework serves as a template for estimating the economic burden of work injuries and diseases across countries in the European Union and elsewhere. Results can assist policymakers with identifying health and safety priority areas based on the magnitude of components, particularly when stratified by key characteristics such as industry, injury/disease, age and sex. Case costing can serve as an input into the economic evaluation of prevention initiatives. Comparisons across countries provide insights into the relevant performance of health and safety systems.

Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios

While surveillance can identify changes in COVID-19 transmission patterns over time and space, sections of the population at risk, and the efficacy of public health measures, reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases. Our primary objective was to estimate the percentage of cases reported in the general community, considered as those that occurred outside of long-term care facilities (LTCFs), in specific provinces and Canada as a whole. We applied a methodology using the delay-adjusted case fatality ratio (CFR) to all cases and deaths, as well as those representing the general community. Our second objective was to assess whether the assumed CFR (mean = 1.38%) was appropriate for calculating underestimation of cases in Canada. Estimates were developed for the period from March 11th, 2020 to September 16th, 2020. Estimates of the percentage of cases reported (PrCR) and CFR varied spatially and temporally across Canada. For the majority of provinces, and for Canada as a whole, the PrCR increased through the early stages of the pandemic. The estimated PrCR in general community settings for all of Canada increased from 18.1% to 69.0% throughout the entire study period. Estimates were greater when considering only those data from outside of LTCFs. The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07% on March 11th, 2020 to 2.00% on September 16th, 2020. Therefore, the true CFR in the general community in Canada was likely less than 2% on September 16th. According to our analysis, some provinces, such as Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, and Saskatchewan reported a greater percentage of cases as of September 16th, compared to British Columbia, Ontario, and Québec. This could be due to differences in testing rates and criteria, demographics, socioeconomic factors, race, and access to healthcare among the provinces. Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study. The estimates provide context to the summative state of the pandemic in Canada, and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.

Inaccuracies in survey reporting of alcohol consumption

BACKGROUND

Alcohol consumption estimates in public health predominantly rely on self-reported survey data which is likely to underestimate consumption volume. Surveys tend to ask specifically about standard drinks and provide a definition or guide in an effort to gather accurate estimates. This study aimed to investigate whether the inclusion of the term standard drinks with pictorial guide is associated with an adjustment in self-reported alcohol volume.

METHODS

A web-based survey was administered with AUDIT-C questions repeated at the beginning and end of the survey with and without the standard drink term and guide. The order in which respondents were presented with the different question types was randomised. Two cohorts of university/college students in NSW Australia (n = 122) and the US Pacific Northwest (n = 285) completed the survey online.

RESULTS

Australian students did not adjust their responses to questions with and without the standard drink term and pictorial guide. The US students were more likely to adjust their responses based on the detail of the question asked. Those US students who drank more frequently and in greater volume were less likely to adjust/apply a conversion to their consumption.

CONCLUSIONS

This study supports previous findings of the inaccuracy of alcohol consumption volume in surveys, but also demonstrates that an assumption of underestimation cannot be applied to all individual reports of consumption. Using additional questions to better understand drink types and serving sizes is a potential approach to enable accurate calculation of underestimation in survey data.

A small, stainless-steel sieve optimized for laboratory beaker-based extraction of microplastics from environmental samples

Removing non-plastic materials is a mandatory process for studying microplastics in environmental samples, and non-plastic materials, both inorganic and organic matter, are often removed chemically through sequential processes. In the multiple chemical treatment processes, the samples need to be collected and the reagent removed at the end of each chemical treatment before the samples are again exposed to a different reagent in a separate container. This leads to a loss of microplastics to some extent. Here, we developed a new, yet simple, small sieve made of stainless-steel that can fit in a laboratory beaker (e.g. 200 ml volume), allowing it to be transferred as-is between chemical treatments of environmental samples, even being soakable in a beaker of acid solution. The collection rates of microplastics were significantly higher in the small stainless-steel sieve than the commonly used filter method for different size of microplastic particles. The use of the new sieve means the processes of rinsing off and filtering samples can be abbreviated throughout the entire process of non-plastic matter removal from environmental samples, contributing to a lower chance of microplastic loss. The time consumed in the sieve method was also significantly lower than for the filtering method due to the elimination of the collection and rinsing steps, thus the use of this sieve can reduce processing time for the samples. The new method is innovative in terms of reducing both the microplastic loss and processing time during chemical treatment processes. •The method developed allows the lower chance of microplastic loss during chemical digestion process•The method reduces the time of sequential processes during chemical digestion.

Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens

Background

Risk assessment and therapeutic options are challenges when counselling patients with an atypical ductal hyperplasia (ADH) to undergo either open surgery or follow-up only.

Methods

We retrospectively analyzed a series of ADH lesions and assessed whether the morphological parameters of the biopsy materials indicated whether the patient should undergo surgery. A total of 207 breast biopsies [56 core needle biopsies (CNBs) and 151 vacuum-assisted biopsies (VABs)] histologically diagnosed as ADH were analyzed retrospectively, together with subsequently obtained surgical specimens. All histological slides were re-analyzed with regard to the presence/absence of ADH-associated calcification, other B3 lesions (lesion of uncertain malignant potential), extent of the lesion, and the presence of multifocality.

Results

The overall underestimation rate for the whole cohort was 39% (57% for CNB, 33% for VAB). In the univariate analysis, the method of biopsy (CNB vs VAB, p = 0.002) and presence of multifocality in VAB specimens (p = 0.0176) were significant risk factors for the underestimation of the disease (ductal carcinoma in situ or invasive cancer detected on subsequent open biopsy). In the multivariate logistic regression model, the absence of calcification (p = 0.0252) and the presence of multifocality (unifocal vs multifocal ADH, p = 0.0147) in VAB specimens were significant risk factors for underestimation.

Conclusions

Multifocal ADH without associated calcification diagnosed by CNB tends to have a higher upgrade rate. Because the upgrade rate was 16.5% even in the group with the lowest risk (VAB-diagnosed unifocal ADH with calcification), we could not identify a subgroup that would not require an open biopsy.

Underestimation of large distances in active and passive locomotion

Our ability to estimate distances, be it verbally or by locomotion, is exquisite at close range (action space). At distances above 100 m (vista space), verbal estimates continue to be quite accurate, whereas locomotor estimates have been found to be grossly underestimated. Until now, however, the latter have been performed on a treadmill, which might not translate to real-world walking. We investigated if the motor underestimation found on the treadmill holds up in a natural environment. Observers viewed pictures of objects at distances between 10 and 245 m and were asked to reproduce these distances in a blindfolded walking task (using passive movement or an active production method). Active and passive locomotor judgments underestimated far distances above 100 m. We conclude that underestimation of large distances does not depend on the medium (treadmill vs. real-world) but rather on the sensory modality and effort involved in the task.

The usefulness of fluorodeoxyglucose-PET/CT for preoperative evaluation of ductal carcinoma in situ

Purpose

PET/CT is useful in preoperative evaluation of invasive breast cancer (IBC) to predict axillary metastasis and staging workup. The usefulness is unclear in cases of ductal carcinoma in situ (DCIS) diagnosed at biopsy before surgery, which sometimes is upgraded to IBC after definitive surgery. The aim of this study is to find out the usefulness of PET/CT on DCIS as a preoperative evaluation tool.

Methods

We investigated 102 patients preoperatively diagnosed with DCIS who subsequently underwent definitive surgery between 2010 and 2015. The uptake of ¹⁸F-fluorodeoxyglucose was graded by visual and semiquantitative methods. We analyzed the maximum standardized uptake value (SUVmax) of each patient with clinicopathologic variables. We determined optimal cutoff values for SUVmax by receiver operating characteristic curve analysis.

Results

Fifteen cases out of 102 cases (14.7%) were upgraded to IBC after surgery. The SUVmax was higher in patients upgraded to IBC (mean: 2.56 vs. 1.36) (P = 0.007). The SUVmax was significantly higher in patients who had symptoms, palpable masses, lesions over 2 cm in size and BI-RAD category 5. Both visual and semiquantitative analysis were significant predictors of IBC underestimation. SUVmax of 2.65 was the theoretical cutoff value in ROC curve analysis in predicting the underestimation of IBC. The underestimation rate was significantly higher in patients with SUVmax >2.65 (P < 0.001), over the moderate enhanced uptake on visual analysis (P < 0.001).

Conclusion

PET/CT can be used as a complementary evaluation tool to predict the underestimation of DCIS combined with the lesion size, palpable mass, symptomatic lesion, and BI-RAD category.

Dual-energy X-ray absorptiometry underestimates in vivo lumbar spine bone mineral density in overweight rats

Dual-energy X-ray absorptiometry (DXA) is currently the most widely used technique for measuring areal bone mineral density (BMD). However, several studies have shown inaccuracy, with either overestimation or underestimation of DXA BMD measurements in the case of overweight or obese individuals. We have designed an overweight rat model based on junk food to compare the effect of obesity on in vivo and ex vivo BMD and bone mineral content measurements. Thirty-eight 6-month old male rats were given a chow diet (n = 13) or a high fat and sucrose diet (n = 25), with the calorie amount being kept the same in the two groups, for 19 weeks. L1 BMD, L1 bone mineral content, amount of abdominal fat, and amount of abdominal lean were obtained from in vivo DXA scan. Ex vivo L1 BMD was also measured. A difference between in vivo and ex vivo DXA BMD measurements (P < 0.0001) is evidenced with an underestimation of in vivo BMD by (8.47 ± 10.54)%. This difference was found for the chow and high fat, high sucrose diets (P = 0.008), and a significant interaction between in vivo measurements, ex vivo measurements, and diet was observed (P = 0.030). Also, the data show a positive significant correlation of ex vivo BMD with body weight, perirenal fat, abdominal fat, and abdominal lean. Multiple linear regression analysis shows that body weight, abdominal fat, and abdominal lean were independently related to ex vivo BMD. DXA underestimated lumbar in vivo BMD in overweight rats, and this measurement error is related to body weight and abdominal fat. Therefore, caution must be used when one is interpreting BMD among overweight and obese individuals.

Severe underestimation of pertussis related hospitalizations and deaths in the Netherlands: A capture-recapture analysis

OJECTIVE

Despite vaccination, pertussis has remained endemic, sometimes leading to severe disease. We aimed to quantify the completeness of reporting (CoR) of pertussis hospitalizations and deaths in the Netherlands.

STUDY DESIGN

CoR was estimated using capture-recapture analyses. Hospitalizations (2007-2014) from the National Registration Hospital Care (hospital data) were matched to the notifiable Infectious Disease case registry (notifications) providing (month and) year of birth, gender and postal code. Deaths (1996-2014) from Statistics Netherlands (death registry) were matched to notifications using gender, age, year of death and notification date. Cases <2years (y) and ≥2y were analysed separately. Chao's estimator estimated the total population, which was used to calculate CoR.

RESULTS

Using strict matching criteria, we found 461 matches among 876 (hospital data) and 757 (notifications) hospitalizations <2y. The population estimate of hospitalized infants was 1446, resulting in CoR between 52% and 61%. For hospitalizations ≥2y (246; hospital data and 264; notifications) 43 matches were found, with a population estimate of 1512 and CoR between 16.5% and 22%. Among thirteen (death registry) and eight (notifications) deaths <2y, seven cases overlapped. The population estimate was 16. CoR of the two sources was 50-81%. With two (death registry) and eight (notifications) deaths ≥2y without overlap, the population estimate was 26 and CoR 8-31%.

CONCLUSION

Results showed substantial underestimation of pertussis hospitalizations and deaths. This has to be taken into account in evaluation of current and future immunization programs.

Comparing calculated LDL-C with directly measured LDL-C in healthy and in dyslipidemic children

BACKGROUND

LDL-C is one of the strongest markers for atherosclerosis and therapeutic decisions in children are based on its levels. Friedewald formula (FF) which is usually used for the calculation of LDL-C (cLDL-C); and Anandaraja's formula (AF) may under- or overestimate actual levels.

OBJECTIVE

To compare cLDL-C with directly measured LDL-C (dLDL-C) as a screening tool and to evaluate dyslipidemic children.

METHODS

The study population consisted of 1005 children, 2-18years, 688 of whom underwent lipid screening in a regular check-up (group A); and 317 were dyslipidemic (LDL-C ≥130mg/dl) (group B). A fasting serum lipid profile was assessed. LDL-C was measured using a homogenous assay and was calculated using FF and AF.

RESULTS

Each method of calculating LDL-C was highly correlated to dLDL-C. Using FF, cLDL-C was lower than dLDL-C in 75.6% (group A) and in 77.3% (group B) of children; the mean difference was significant in dyslipidemic group. Moreover, in group B, 25% of children with boundary high and 12% with high dLDL-C would be misclassified. Using AF, LDL-C was higher than dLDL-C; the mean difference was significant in group A. Based on cLDL-C, 52% of group A with borderline dLDL-C and 27.5% of group B children with boundary high dLDL-C would be considered as dyslipidemic and eligible for medication respectively.

CONCLUSIONS

Comparing two methods of calculated LDL-C with directly measured LDL-C. FF was more accurate as a screening tool while AF was more accurate in the evaluation and follow-up of the dyslipidemic group.

Do self-reported data reflect the real burden of lifetime exposure to sexual violence among females aged 13-24 years in Malawi?

BACKGROUND

Under most circumstances, the lifetime experience of sexual violence (SV) among girls and young women would likely increase with age. However, the empirical data from a retrospective study may not necessarily conform to this belief.

METHODS

Data from a nationally representative sample of females aged 13-24 years in Malawi in 2013 (n=1029) were analyzed. SV was defined as unwanted touching or attempted, pressured, or physically forced sex. The distribution of four types of SV among victims was compared between younger (13-18 years) and older (19-24 years) age groups. The strength of association between SV exposure and health outcomes was examined by age group.

RESULTS

The risk of experiencing SV during their lifetime was three times greater for younger than that for older age females (Hazard ratio=3.32). Among females who had experienced SV, older age females were more likely to report forced or pressured sex (41.2%) as their initial SV experience than younger age females (17.8%). The strength of association between the SV exposure and health outcomes did not differ by age group.

CONCLUSIONS

The self-report lifetime and childhood victimization to sexual violence may not necessarily higher among older than that among younger females. The current risk of exposure to sexual violence seems to influence the recall of lifetime and childhood victimization to a great extent. In order to make the field aware of this phenomenon, prevalence estimates from all three time frames (lifetime, childhood, and during the past 12 months) should be reported separately by age group.

Diagnosis of Columnar Cell Lesions and Atypical Ductal Hyperplasia by Ultrasound-Guided Core Biopsy: Findings Associated with Underestimation of Breast Carcinoma

The aim of the study described here was to determine underestimation rates and identify radiologic predictors of underestimation for columnar cell lesions (CCLs) and atypical ductal hyperplasia (ADH) detected by ultrasound-guided core needle biopsy. A total of 103 CCLs and ADH lesions in 100 patients diagnosed by ultrasound-guided core needle biopsy were evaluated. Breast sonographic and mammographic findings were reviewed, and underestimation rates were determined by surgical excision, percutaneous vacuum-assisted excision or 2-y imaging follow-up. All underestimated lesions were ductal carcinoma in situ, and the underestimation rates of flat epithelial atypia (FEA), FEA + ADH and ADH were 5.9% (1/17), 44.4% (4/9) and 27.3% (12/44), respectively. There was no underestimation of CCLs without atypia. The presence of calcifications on ultrasound was significantly associated with underestimation (p = 0.010). Therefore, except for CCLs without atypia, all other lesions may require excision, especially when calcification is present on ultrasound or when FEA + ADH is found.

Secular trends in the prevalence of weight misperception among Korean adults, 2001-2013

We examined trends in the prevalence of weight misperception among Korean adults from 2001 to 2013. Data were derived from four Korea National Health and Nutrition Examination Surveys conducted in 2001, 2005, 2009, and 2013. Weight perception was classified as "correct perception" if the weight status based on body mass index (BMI) and the respondent's body shape perception (BSP) were consistent and "weight misperception" if the weight status based on BMI and the respondent's BSP were inconsistent. Two of five Korean adults incorrectly recognised their weight status. The weight misperception rate in women increased over time (p for trend=0.003), but there was no significant difference in the male weight misperception rate over time (p for trend=0.179). The weight misperception rate in respondents>60 years old decreased in both men and women (p for trend<0.05), but women showed an increasing weight misperception rate in all other age groups (p for trend<0.001). There was no change in the weight misperception rate in men with increasing age (p>0.05). In respondents with a normal weight, the weight misperception rate increased over time in both men and women (males, p for trend=0.003; women, p for trend<0.001), but overweight men (p for trend<0.001) and obese men and women showed a decreasing rate of weight misperception (men, p for trend=0.006: women, p for trend<0.001). The results of this study suggest that health policy efforts are necessary to change the perception of healthy weight status for women, among whom the prevalence of weight misperception is increasing.

Estimating average alcohol consumption in the population using multiple sources: the case of Spain

Background

National estimates on per capita alcohol consumption are provided regularly by various sources and may have validity problems, so corrections are needed for monitoring and assessment purposes. Our objectives were to compare different alcohol availability estimates for Spain, to build the best estimate (actual consumption), characterize its time trend during 2001–2011, and quantify the extent to which other estimates (coverage) approximated actual consumption.

Methods

Estimates were: alcohol availability from the Spanish Tax Agency (Tax Agency availability), World Health Organization (WHO availability) and other international agencies, self-reported purchases from the Spanish Food Consumption Panel, and self-reported consumption from population surveys. Analyses included calculating: between-agency discrepancy in availability, multisource availability (correcting Tax Agency availability by underestimation of wine and cider), actual consumption (adjusting multisource availability by unrecorded alcohol consumption/purchases and alcohol losses), and coverage of selected estimates. Sensitivity analyses were undertaken. Time trends were characterized by joinpoint regression.

Results

Between-agency discrepancy in alcohol availability remained high in 2011, mainly because of wine and spirits, although some decrease was observed during the study period.

The actual consumption was 9.5 l of pure alcohol/person-year in 2011, decreasing 2.3 % annually, mainly due to wine and spirits. 2011 coverage of WHO availability, Tax Agency availability, self-reported purchases, and self-reported consumption was 99.5, 99.5, 66.3, and 28.0 %, respectively, generally with downward trends (last three estimates, especially self-reported consumption). The multisource availability overestimated actual consumption by 12.3 %, mainly due to tourism imbalance.

Conclusions

Spanish estimates of per capita alcohol consumption show considerable weaknesses. Using uncorrected estimates, especially self-reported consumption, for monitoring or other purposes is misleading. To obtain conservative estimates of alcohol-attributable disease burden or heavy drinking prevalence, self-reported consumption should be shifted upwards by more than 85 % (91 % in 2011) of Tax Agency or WHO availability figures. The weaknesses identified can probably also be found worldwide, thus much empirical work remains to be done to improve estimates of per capita alcohol consumption.

Electronic supplementary material

The online version of this article (doi:10.1186/s12963-016-0090-4) contains supplementary material, which is available to authorized users.

Risk of the preoperative underestimation of tumour size of lung cancer in patients with idiopathic interstitial pneumonias

OBJECTIVES

Sublobar resection of lung cancer (LC) is a valuable procedure in patients with idiopathic interstitial pneumonias (IIPs). Having adequate surgical margins is the key to successful sublobar resection, and evaluation of the precise extent of LC is mandatory. However, tumour extent in IIPs is difficult to evaluate. This study assessed the risk of underestimating tumour size by preoperative computed axial tomography (CAT) scan in LC patients with IIPs.

METHODS

A retrospective study was performed on 1221 patients who underwent surgical resection of primary LC at our institute between 2009 and 2013. Review of CAT findings revealed that 136 (11.1%) patients were complicated with IIPs. The discrepancy between radiological and pathological tumour dimensions was measured and underestimation was defined as 10 mm or more in pathological tumour dimension. The rate and cause of preoperative underestimation were also compared between patients with and without IIPs. Univariate and multivariate analyses were performed using a logistic regression model to predict underestimation of the preoperative tumour size.

RESULTS

Maximum tumour dimension was underestimated in 14 (10.3%) patients with IIPs and 35 (3.2%) patients without IIPs. A multivariable analysis revealed that IIP was the only predictive factor for tumour size underestimation identified in this study (hazard ratio = 3.52, P = 0.017). Underestimation of tumour size in patients with IIPs was mainly due to extension of tumour cells in the honeycomb lung.

CONCLUSIONS

IIPs pose a high risk for underestimating tumour size of LCs in preoperative measurements. Thus, tumour extent should be assessed carefully in order to maintain adequate surgical margins.

A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer

BACKGROUND

The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer.

METHODS

Initial EUS examinations for treatment-naïve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups.

RESULTS

The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5-92.5 %] and 62.9 % (95 % CI, 60.5-66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156-4.349)].

CONCLUSIONS

The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.

Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy

OBJECTIVES

To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses.

METHODS

This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis.

RESULTS

The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (P<0.001). On multivariate analysis, the mean (Odds ratio [OR]=1.021, P=0.001), maximum (OR=1.015, P=0.008), and minimum (OR=1.028, P=0.001) elasticity values were independently associated with histologic underestimation. The patients' age, lesion size, and final assessment category on US of the upgrade group were higher than those of the non-upgrade group (P=0.046 for age; P=0.021 for lesion size; P=0.030 for US category), but these were not independent predictors of histologic underestimation on multivariate analysis.

CONCLUSION

Breast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB.

Preoperatively diagnosed ductal carcinoma in situ: risk prediction of invasion and effects on axillary management

BACKGROUND

Preoperatively diagnosed ductal carcinoma in situ (DCIS) has the potential to have occult invasion. The predictors of invasive carcinoma underestimation in patients with DCIS diagnosed by preoperative percutaneous biopsy were identified and the effects of underestimation on axillary management were evaluated.

METHODS

Medical records of 280 patients preoperatively diagnosed as DCIS who underwent surgery were retrospectively analyzed. The patients were divided into non-invasive and invasive carcinoma groups according to the final pathological diagnosis. Risk predictors of invasive carcinoma underestimation and axillary lymph node (ALN) metastasis were analyzed. The axillary status estimated by pathological diagnosis and one-step nucleic acid amplification (OSNA) assay was evaluated.

RESULTS

The presence of an invasive carcinoma was overlooked in 104 (37.1 %) patients. A clinically palpable mass was an independent risk predictor of invasive carcinoma underestimation by multivariate analysis. There was no risk predictor of ALN metastasis. No ALN metastasis was seen in non-invasive carcinoma group. Six (6.2 %) patients in invasive carcinoma group had macro- or micrometastasis in sentinel lymph nodes (SLNs). Non-SLN metastasis was observed in 3 patients of them. Fourteen patients with only isolated tumor cells (ITCs) or only OSNA-positive SLNs had no metastasis in non-SLNs.

CONCLUSIONS

SLN biopsy and, if necessary, subsequent ALN dissection (ALND) should be performed in patients with DCIS who have a risk predictor of underestimation. ALND can be avoided in patients who have histologically negative or ITC-positive SLNs, regardless of the presence of invasion on final pathological diagnosis.

Health and social impacts of COPD and the problem of under-diagnosis

This article deals with the prevalence and the possible reasons of COPD underestimation in the population and gives suggestions on how to overcome the obstacles and make the correct diagnosis in order to provide the patients with the appropriate therapy. COPD is diagnosed in later or very advanced stages. In Italy the rate of COPD under-diagnosis ranges between 25 and 50% and, as a consequence, the patient does not consult his doctor until the symptoms have worsened, mainly due to exacerbations. A missed diagnosis influences the timing of therapeutic intervention, thus contributing to the evolution into more severe stages of the illness. An incisive intervention to limit under-diagnosis cannot act only in remittance (passive diagnosis), but must be the promoter for a series of preventive actions: primary, secondary and rehabilitative. To reduce under-diagnosis, some actions need to be taken, such as screening programs for smokers subjects, use of questionnaires aimed to qualify and monitor the disease severity, spirometry, early diagnosis. There is a consensus regarding diagnoses based on screening of at-risk subjects and symptoms, rather than screening of the general population. In practice, all individuals over 40 years of age with risk factors should make a spirometry test. Screening actions on a national scale can be the following: compilation of questionnaires in waiting rooms of doctor’s offices or performing simple maneuvers to evaluate the expiratory force at pharmacies. It is now widely recognized that COPD is a complex syndrome with several pulmonary and extrapulmonary components; as a result, the airway obstruction as assessed by FEV₁ by itself does not adequately describe the complexity of the disease and FEV₁ cannot be used alone for the optimal diagnosis, assessment, and management of the disease. The identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful subgroups (phenotypes) can guide therapy more effectively. In conclusion, we firmly believe that an early and correct diagnosis can influence positively the progress of the disease (lowering the lung function impairment), decrease the risk of exacerbations, relieve symptoms and increase the patients’ quality of life leading also to a decrease in costs associated to the exacerbations and hospitalization of the patient.

Role of FDG-PET/CT in prediction of underestimation of invasive breast cancer in cases of ductal carcinoma in situ diagnosed at needle biopsy

BACKGROUND

The aim of this study was to evaluate the significance of FDG-PET/CT for predicting the underestimation of invasive breast cancer in cases of DCIS at needle biopsy.

PATIENTS AND METHODS

Of 83 consecutive cases with diagnoses of DCIS at primary needle biopsy who underwent curative surgery between 2010 and 2013, the association between the SUVmax on FDG-PET/CT before excision and the underestimation of invasive breast cancer was examined.

RESULTS

There were 29 (34.9%) cases diagnosed to have invasive breast cancer at excision. Receiver operating characteristics curve analysis showed the cutoff value of the SUVmax to predict underestimation of invasive breast cancer was 1.6. The rates of underestimation were 61.5% for patients with a tumor of SUVmax > 1.6 and 11.4% for patients with a tumor of SUVmax ≤ 1.6 (P < .001). A high value of SUVmax was significantly associated with symptomatic presentation (P < .001), palpability (P < .001), mass formation (P = .013), high Breast Imaging Reporting and Data System category (P = .011), and core needle biopsy (P = .007). In multivariate analysis, high SUVmax was only a significant predictive factor of underestimation of invasive breast cancer (hazard ratio, 11.7; 95% confidence interval, 3.70-37.0; P < .001).

CONCLUSION

SUVmax on FDG-PET/CT is useful for predicting the underestimation of invasive breast cancer in cases of DCIS at needle biopsy.