Early breastfeeding cessation: validation of Breastfeeding Assessement Score (BAS) on an Italian validation cohort of women

Introduction The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of the numerous benefits of breastfeeding for the mother and the child 2,3. A prognostic approach to identify the mothers at risk of early breastfeeding cessation is needed to provide preventive support to these women. The BAS1, elaborate in Kansas, is a score useful for this approach. Aim of the study To assess the accuracy of the BAS1, in an Italian validation cohort of women. Methods This is a bicentric, prospective study. Italian and healthy mothers who gave birth to a single child from 25th June 2008 to 15th January 2009, with a gestational age of at least 35 weeks, were included. Exclusion criteria, on the convenience sample, were: mothers with a non-Italian background, preterm delivery (<35 weeks) or twin birth.The authors have calculated the BAS on 386 women just before hospital discharge, at least 48 hours post-delivery age, in Mangiagalli and in S. Gerardo hospitals. The primary outcome measured was how many women stopped the breastfeeding, and it was assessed using structured follow-up telephone interviews after 4 weeks. The predictive value of the BAS1 is ok, if it identifies the 80% of the women that stop to breastfeed. This study was carried out from 25th June 2008 to 15th February 2009. Results For a cut point of 8, recommended by the authors of the BAS1, 119 mother-infant pairs were categorized at high risk to early breastfeeding cessation, with a RR 5,24. The BAS has a sensibility of 0.69, a specificity of 0.79, a positive predictive value of 43% and a negative predictive value of 91%. Conclusions / discussion The intrinsic properties of the BAS1 are strong, but the study cannot validate this score because in the studied population, there is a low sensibility versus the authors expectation. Practical relevance Italian midwives need to individualize the mothers at risk of early breastfeeding cessation, for a special support. Research implications This study confirms the necessity to identify a score for the Italian population

No evidence of association between prothrombotic gene polymorphisms and the development of acute myocardial infarction at a young age

Background : we investigated the association between 9 polymorphisms of genes encoding hemostasis factors and myocardial infarction in a large sample of young patients chosen because they have less coronary atherosclerosis than older patients, and thus their disease is more likely to be related to a genetic predisposition to a prothrombotic state Methods and Results : this nationwide case-control study involved 1210 patients who had survived a first myocardial infarction at an age of 45 years who underwent coronary arteriography in 125 coronary care units and 1210 healthy subjects matched for age, sex, and geographical origin. None of the 9 polymorphisms of genes encoding proteins involved in coagulation (G-455A -fibrinogen: OR, 1.0; CI, 0.8 to 1.2; G1691A factor V: OR, 1.1; CI, 0.6 to 2.1; G20210A factor II: OR, 1.0; CI, 0.5 to 1.9; and G10976A factor VII: OR, 1.0; CI, 0.8 to 1.3), platelet function (C807T glycoprotein Ia: OR, 1.1; CI, 0.9 to 1.3; and C1565T glycoprotein IIIa: OR, 0.9; CI, 0.8 to 1.2), fibrinolysis (G185T factor XIII: OR, 1.2; CI, 0.9 to 1.6; and 4G/5G plasminogen activator inhibitor type 1: OR, 0.9; CI, 0.7 to 1.2), or homocysteine metabolism (C677T methylenetetrahydrofolate reductase: OR, 0.9; CI, 0.8 to 1.1) were associated with an increased or decreased risk of myocardial infarction Conclusions : this study provides no evidence supporting an association between 9 polymorphisms of genes encoding proteins involved in hemostasis and the occurrence of premature myocardial infarction or protection against it

Early breastfeeding cessation: validation of Breastfeeding Assessement Score (BAS) on an Italian validation cohort of women

Introduction The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of the numerous benefits of breastfeeding for the mother and the child 2,3. A prognostic approach to identify the mothers at risk of early breastfeeding cessation is needed to provide preventive support to these women. The BAS1, elaborate in Kansas, is a score useful for this approach. Aim of the study To assess the accuracy of the BAS1, in an Italian validation cohort of women. Methods This is a bicentric, prospective study. Italian and healthy mothers who gave birth to a single child from 25th June 2008 to 15th January 2009, with a gestational age of at least 35 weeks, were included. Exclusion criteria, on the convenience sample, were: mothers with a non-Italian background, preterm delivery (<35 weeks) or twin birth.The authors have calculated the BAS on 386 women just before hospital discharge, at least 48 hours post-delivery age, in Mangiagalli and in S. Gerardo hospitals. The primary outcome measured was how many women stopped the breastfeeding, and it was assessed using structured follow-up telephone interviews after 4 weeks. The predictive value of the BAS1 is ok, if it identifies the 80% of the women that stop to breastfeed. This study was carried out from 25th June 2008 to 15th February 2009. Results For a cut point of 8, recommended by the authors of the BAS1, 119 mother-infant pairs were categorized at high risk to early breastfeeding cessation, with a RR 5,24. The BAS has a sensibility of 0.69, a specificity of 0.79, a positive predictive value of 43% and a negative predictive value of 91%. Conclusions / discussion The intrinsic properties of the BAS1 are strong, but the study cannot validate this score because in the studied population, there is a low sensibility versus the authors expectation. Practical relevance Italian midwives need to individualize the mothers at risk of early breastfeeding cessation, for a special support. Research implications This study confirms the necessity to identify a score for the Italian population

Influence of mechanical hemolysis of blood on two D-dimer immunoassays.

Although there is broad information about the influence of spurious hemolysis on several laboratory tests, less is known on the bias produced on D-dimer testing. Four different pools were obtained from primary blood tubes, and each of them was divided into four aliquots. The first nonhemolyzed was centrifuged, the plasma was separated and then tested for hemolysis index and D-dimer. The second (hemolyzed aliquot A), third (hemolyzed aliquot B) and fourth (hemolyzed aliquot C) aliquots were mechanically hemolyzed by aspirating whole blood one, two and three times through a fine needle. The plasma was then separated and tested for hemolysis index and D-dimer. D-dimer was quantified by HemosIL AcuStar D-dimer and HemosIL D-dimer HS for ACL TOP. Undetectable hemolysis was present in aliquot nonhemolyzed (<0.5 g/l), whereas the concentration of cell-free hemoglobin significantly increased from hemolyzed aliquot A (5.5-7.0 g/l hemoglobin) to hemolyzed aliquot B (11.5 and 15.0 g/l hemoglobin) and hemolyzed aliquot C (20-22 g/l hemoglobin). The plasma concentration of D-dimer decreased from aliquots nonhemolyzed to hemolyzed aliquot C, achieving clinical significance fromhemolyzed aliquot A and hemolyzed aliquot B when measured with D-dimer HS for ACL TOP and AcuStar D-dimer, respectively. The decrease with AcuStar D-dimer was -5 \ub1 3% in hemolyzed aliquot A, -7 \ub1 3% in hemolyzed aliquot B, and -9 \ub1 3% in hemolyzed aliquot C, whereas the decrease with D-dimer HS for ACL TOP was -5 \ub1 3% in hemolyzed aliquot A, -8 \ub1 3% in hemolyzed aliquot B and -9 \ub1 3% in hemolyzed aliquot C. The similar trend towards decreasing values observed when measuring D-dimer with chemiluminescent and turbidimetric immmunoassays on four heterogeneous plasma pools suggest that the hemolysis interference is more likely to be biological than analytical. The modest bias observed in samples with frank hemolysis (i.e. cell-free hemoglobin of 11.5 g/l) confirms that both methods are robust against this type of interference, so that test results might be released in the majority of mildly hemolyzed samples

Sample collection and platelet function testing: influence of vacuum or aspiration principle on PFA-100 test results.

As for other tests of hemostasis, the investigation of platelet function is highly vulnerable to a broad series of preanalytical variables, which span from patient preparation to the final analysis of the specimen and issuance of test results. In particular, there remains much controversy about the influence of manual or vacuum aspiration of blood into primary collection tubes on platelet function testing. Accordingly, we investigated this for the PFA-100. In 12 healthy volunteers, a sample labeled as 'BD-V' was drawn into a 2.7\u200aml BD Vacutainer tube, whereas two additional samples were collected from the opposite arm into 5.0\u200aml Sarstedt S-Monovette tubes by vacuum (SD-V) or manual aspiration (SD-A). All sample were tested on PFA-100 with collagen and ADP (CADP) or collagen and epinephrine (CEPI). The values of both CEPI and CADP obtained in SD-A samples were significantly lower than those obtained in SD-V and BD-V tubes, whereas those of the two evacuated tubes did not significantly differ. On average, CEPI values were prolonged by 11% in SD-V and 13% in BD-V, whereas those of CADP were prolonged by 14% in SD-V and 10% in BD-V, respectively. These findings suggests that the lower shear stress generated by the manual aspiration of blood into the primary collection tube would prevent spurious hyper-activation of platelets, thus, preserving the integrity of their function for subsequent testing on PFA-100. This study underscores the need to define or validate local reference ranges for the PFA-100 based on the collection tube used. Different reference ranges of both CEPI and CADP may also be advisable when venous blood samples are collected with manual aspiration or vacuum principle

Influence of Residual Platelet Count on Routine Coagulation, Factor VIII, and Factor IX Testing in Postfreeze-Thaw Samples.

he use of frozen-thawed samples rather than fresh samples for specialized coagulation testing is becoming commonplace, thereby creating novel risks that may jeopardize the quality of hemostasis testing. Residual platelets (PLTs) in frozen plasma are most critical as freezing-induced activation and injury may impair routine and specialized testing after thawing. The aim of this study was to verify the impact of postcentrifugation PLT count in postfreeze-thawed samples on activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, factor VIII (FVIII) activity testing, and factor IX (FIX) activity testing. These parameters were herein assessed in postfreeze-thaw paired plasma samples collected from 15 healthy volunteers and subjected to 4 different centrifugation forces (i.e., 3,000, 1,500, 1,000, and 500g), using data obtained with centrifugation force of 1,500g as the gold standard, in agreement with current recommendations. Compared with reference samples, PLT counts in fresh aliquots were indistinguishable in specimens centrifuged at 1,000g, significantly lower in those centrifuged at 3,000g and significantly higher in those centrifuged at 500g. In all cases except samples centrifuged at 3,000g, the PLT count was significantly decreased in postfreeze-thaw compared with paired fresh specimens. In postfreeze-thaw plasma, APTT was not influenced by residual PLT count. The results of PT and fibrinogen were consistently altered in samples centrifuged at 1,000 and 500g, though the correlation with the reference measures remained clinically acceptable. Data obtained for FVIII and FIX activities revealed a positive bias in all postfreeze-thaw plasmas, achieving statistical significance in samples centrifuged at 3,000g. We conclude that alteration of centrifuge speeds away from the recommended 1,500g may influence the level of residual PLTs in sample centrifuged at lower speeds such as 500g, and therefore may make these specimens unsuitable for hemostasis testing in postfreeze-thawed plasma samples. In addition, although the changes seen in FVIII and FIX in samples centrifuged at 3,000g may reflect non-PLT-related effects, such changes should also be considered in this setting

Epidermal growth factor receptor and Kras gene expression: reliability of mutational analysis on cytological samples.

Epidermal growth factor receptor (EGFR) and Kras gene mutations are crucial for discriminating patients responsive to anti-EGFR drugs in non-small cell lung cancer (NSCLC) and colorectal cancer (CRC), respectively. The majority of NSCLCs come to clinical attention at an advanced stage when surgery is no longer recommended and a considerable number of them are diagnosed by cytology only. A large number of metastatic CRCs are also diagnosed by imaging and minimally invasive techniques such as fine-needle aspiration biopsy. Here, we report our experience in the mutation analysis of EGFR and Kras on cytological material obtained from superficial and deep lesions of NSCLC and CRC. Our series included 63 cytological specimens from primary or metastatic lesions of 42 NSCLCs and 21 CRCs. The cytological material was adequate for the mutation analysis in 39/42 (93\%) NSCLCs and in 20/21(95\%) CRCs. EGFR and Kras mutations were found in 9 (23\%) and 9 (23\%) NSCLC cases, respectively. Kras mutations were found in 9/20 (45\%) CRC specimens. Histological samples from the primary tumors were available in 9/42 NSCLCs and in 17/21 CRCs. The agreement of EGFR and Kras mutational status in cytological vs. histological samples was 100\% for NSCLC and 88\% for CRC. Our results suggest that standard cytology provides adequate material for the assessment of EGFR and Kras mutational status in NSCLC and CRC patients and could be specifically indicated in patients not eligible for surgery but candidate to anti-EGFR therapy

Self-assembling of Mn12 molecular nanomagnets on FIB-patterned Au dot matrix

AbstractWe have developed a novel strategy to build arrays of magnetic nanodots on the 100 nm scale, which exploits the potentialities of both bottom-up and top-down approaches, by self-assembling sulfur-functionalized Mn12 single molecule magnets (SMMs) on patterned Au dot matrices nanofabricated by FIB (focus ion beam). In this way, we demonstrate the capability to assemble SMMs in ordered arrays, where the magnetic information can be easily addressed, being the single bit represented by a 2D distribution of few hundred Mn12 clusters, grafted on top of each 100 × 100 nm2 Au dot. Moreover, the chosen Mn12 functionalization is expected to favour a preferential orientation of the grafted molecule with the easy magnetization axis normal to the surface