Vascular endothelial growth factor in children with neuroblastoma: a retrospective analysis

BACKGROUND: Despite aggressive therapy, advanced stage neuroblastoma patients have poor survival rates. Although angiogenesis correlates with advanced tumour stage and plays an important role in determining the tumour response to treatment in general, clinical data are still insufficient, and more clinical evaluations are needed to draw conclusions. The aim of this study was to evaluate vascular endothelial growth factor (VEGF) expression in patients with neuroblastoma, determine whether it correlates with other prognostic factors and/or therapeutic response, and to assess should VEGF be considered in a routine diagnostic workup. ----- MATERIALS AND METHODS: VEGF expression was determined by immunohistochemistry using anti-VEGF antibody in paraffin embedded primary tumour tissue from 56 neuroblastoma patients. Semiquantitative expression of VEGF was estimated and compared with gender, age, histology, disease stage, therapy, and survival. Statistical analyses, including multivariate analysis, were performed. ----- RESULTS: VEGF expression correlated with disease stage and survival in neuroblastoma patients. Combination of VEGF expression and disease stage as a single prognostic value for survival (P-value = 0.0034; odds ratio (OR) (95%CI) = 26.17 (2.97-230.27) exhibited greater correlation with survival than individually. Hematopoietic stem cell transplantation significantly improved survival of the advanced stage patients with high VEGF expression. ----- CONCLUSION: VEGF expression should be considered in a routine diagnostic workup of children with neuroblastoma, especially in those more than 18 months old and with advanced disease stage. High VEGF expression at the time of disease diagnosis is a bad risk prognostic factor, and can be used to characterize subsets of patients with an unfavourable outcome

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Bone morphogenetic proteins and receptors are over-expressed in bone-marrow cells of multiple myeloma patients and support myeloma cells by inducing ID genes

We assessed the expression pattern and clinical relevance of BMPs and related molecules in multiple myeloma (MM). MM bone-marrow samples (n=32) had increased BMP4, BMP6, ACVR1 and ACVR2A, and decreased NOG expression compared with controls (n=15), with BMP6 having the highest sensitivity/specificity. Within MM bone-marrow, the source of BMPs was mainly CD138(+) plasma-cell population, and BMP6 and ACVR1 expression correlated with plasma-cell percentage. Using myeloma cell lines NCI H929 and Thiel we showed that BMPs induced ID1, ID2 and IL6, and suppressed CDKN1A and BAX gene expression, and BAX protein expression. Finally, BMPs partially protected myeloma cells from bortezomib- and TRAIL-induced apoptosis. We concluded that BMPs may be involved in MM pathophysiology and serve as myeloma cell biomarkers

Erfahrungen mit dem teilimplantierbaren Knochenleitungshö̈rgerä̈t Bonebridge: Computer-assistierte prä̈operative 3D-Planung und audiologische Ergebnisse bei Erwachsenen und Kindern

Einleitung: Bei der Platzierung des BC-FMT des Knochenleitungsimplantates Bonebridge (BB) (MED-EL, Innsbruck, Österreich) im Mastoid sollte eine Imprimierung der Dura und des Sinus sigmoideus möglichst vermieden werden, was besonders bei kleinen Mastoidvolumina, wie z.B. bei Kindern, bei Fehlbildungen und nach multiplen Voroperationen eine Herausforderung darstellen kann.Methode: Wir entwickelten eine computerassistierte präoperative 3D-Planungsmethode basierend auf feinschichtigen Schläfenbein-CT-Aufnahmen. Dabei lassen sich 3D-Modelle des Schläfenbeins und des Implantats frei justieren und mit 2D-Schichten im Sinne einer "virtuellen Chirurgie" überlagern. Intraoperativ wird die optimale Implantatlage anhand von determinierten Landmarken übertragen.Seit 07/2012 erfolgten 22 BB-Implantationen, darunter bei 7 Kindern < 16 Jahren. (MW = 34,2 Jahre ± 23,4 SD; Min. 5, Max. 76 Jahre).Die audiologischen Daten wurden präoperativ, ca. 1 Monat und 3 Monate post-OP erhoben.Ergebnisse: Die Implantation konnte jeweils korrekt wie geplant erfolgen. Bei 2 Patienten wurden zusätzlich Epithesenanker implantiert.In einigen Fällen ergab die 3D-Planung kein ausreichendes Mastoidvolumen, sodass keine BB-Implantation erfolgte.Audiologisch zeigte sich 3 Monate post-OP eine sign. Verbesserung des Hörens in Ruhe (Freiburger Einsilber, 65 dB SPL) und im Störschall (OLSA) sowie ein Benefit beim Richtungshören und bei der Schalllokalisation.Schlussfolgerungen: Eine individuelle präoperative radiologische Planung ist in allen Fällen sinnvoll und speziell bei Kindern, bei Fehlbildungen oder nach multiplen Voroperationen sowie bei simultaner Implantation von Epithesenankern aus unserer Sicht dringend anzuraten. Die audiologischen Ergebnisse entsprechen denen von perkutanen Knochenleitungsimplantaten.Der Erstautor gibt keinen Interessenkonflikt an