Current practice and surgical outcomes of neoadjuvant chemotherapy for early breast cancer : UK NeST study

Funding Information: This work was funded by a grant from the Association of Breast SurgeryPeer reviewedPublisher PD

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

Abstract: Background: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes

Order-disorder behaviour in 0.9Ba([Zn0.60Co0.40](1/3)Nb-2/3)O-3-0.1Ba(Ga0.5Ta0.5)O-3 microwave dielectric resonators

0.9Ba([Zn0.60Co0.40](1/3)Nb-2/3)O-3-0.1Ba(Ga0.5Ta0.5)O-3 (BCZN-BGT) ceramic resonators (quality factor, Q = 32,000 at the rate of 3.05 GHz, relative permittivity, epsilon(r) = 35 and temperature coefficient of the resonant, tau(f) = 0) have been fabricated which are suitable in terms of cost and performance for base stations supporting third generation architecture. The new compounds are perovskite structured (a = 4.09 angstrom) but exhibit no superlattice reflections at any heat treatment temperature according to X-ray diffraction (XRD). However, annealing and quenching of samples followed by transmission electron microscopy and Raman spectroscopy revealed an order-disorder phase transition at similar to 1200 degrees C. Annealing below this temperature (1100 degrees C) gave rise to discrete +/- 1/3{hkl}(p) and diffuse (1/2){hkl}(p) superlattice reflections in the same (p) zone axis electron diffraction patterns and the presence of F-2g and A(1g) modes in Raman spectra. It is proposed that +/- 1/3{hkl}(p) reflections result from 1:2 long-range ordered domains of BCZN whereas the diffuse 1/2{hkl}(p) reflections arise from short range fee ordered BGT rich regions at the 1:2 domain boundaries. A short-range ordered fee superlattice was observed in samples quenched from above the order-disorder phase transition (> 1200 degrees C) which was accompanied by the presence of only the A(1g) mode in Raman spectra

Relationship between microwave and lattice vibration properties in Ba(Zn1/3/Nb2/3)O3-based microwave dielectric ceramics

The dielectric properties of (1 - x)Ba(Zn1/3Nb 2/3)O3-xBa (Ga1/2Ta1/2)O3 (BZN-xBGT) microwave (MW) ceramics, with x between 0 and 0.2, and those of 0.9Ba(Zn0.6Co0.4)1/3Nb2/3O 3-0.1Ba(Ga0.5Ta0.5)O3 (BZCN-BGT) were studied at MW, terahertz (THz) and infrared (IR) frequencies at temperatures from 10 to 300 K. At room temperature, the temperature coefficient of resonance frequency (τf) near 3 GHz decreases from 28 ppm K-1 in undoped BZN to 2 ppm K-1 in BZN-0.2BGT and reduces to zero in BZCN-BGT. The addition of BGT to BZN depresses the dielectric Q value, but incorporation of Co improves the Q values, yielding Q ∼ 30 000 at 3 GHZ in BZCN-BGT. The relative permittivity (ε′) exhibits only limited variation with composition (ε′ values in the range 34.4-36.0). IR and THz spectra as well as the low-temperature MW dielectric measurements revealed a weak dielectric relaxation below phonon frequencies, possibly arising from charges caused by inhomogeneous distribution of the B-site ions with differing valences. The IR reflectivity spectrum of BZN-0.2BGT is significantly different (smeared) compared with other compositions, which may be caused by disorder on the B sites and by an amorphous phase at the grain boundaries