A Retrospective Study of the Impact of 21-Gene Recurrence Score Assay on Treatment Choice in Node Positive Micrometastatic Breast Cancer

To assess clinical utility of the 21-gene assay (Oncotype DX® Recurrence Score®), we determined whether women with HER2(−)/ER+ pN1mi breast cancer with low (<18) Recurrence Scores results are given adjuvant chemotherapy in a lower proportion than those with high scores (≥31). This was a multicenter chart review of ≥18 year old women with pN1mi breast cancer, HER2(−)/ER+ tumors, ductal/lobular/mixed histology, with the assay ordered on or after 1 January 2007. One hundred and eighty one patients had a mean age of 60.7 years; 82.9% had ECOG performance status 0; 33.7% had hypertension, 22.7% had osteoporosis, 18.8% had osteoarthritis, and 8.8% had type-2 diabetes. Mean Recurrence Score was 17.8 (range: 0–50). 48.6% had a mastectomy; 55.8% had a lumpectomy. 19.8% of low-risk group patients were recommended chemotherapy vs. 57.9% in the intermediate-risk group and 100% in the high-risk group (p < 0.001). A total of 80.2% of the low-risk group were recommended endocrine therapy alone, while 77.8% of the high-risk group were recommended both endocrine and chemotherapy (p < 0.001). The Oncotype DX Recurrence Score result provides actionable information that can be incorporated into treatment planning for women with HER2(−)/ER+ pN1mi breast cancer. The Recurrence Score result has clinical utility in treatment planning for HER2(−)/ER+ pN1mi breast cancer patients

Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil.

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil

Single gas chromatography method with nitrogen phosphorus detector for urinary cotinine determination in passive and active smokers

Nicotine is a major addictive compound in cigarettes and is rapidly and extensively metabolized to several metabolites in humans, including urinary cotinine, considered a biomarker due to its high concentration compared to other metabolites. The aim of this study was to develop a single method for determination of urinary cotinine, in active and passive smokers, by gas chromatography with a nitrogen phosphorus detector (GC-NPD). Urine (5.0 mL) was extracted with 1.0 mL of sodium hydroxide 5 mol L-1, 5.0 mL of chloroform, and lidocaine used as the internal standard. Injection volume was 1 &#956;L in GC-NPD. Limit of quantification was 10 ng mL-1. Linearity was evaluated in the ranges 10-1000 ng mL-1 and 500-6000 ng mL-1, with determination coefficients of 0.9986 and 0.9952, respectively. Intra- and inter-assay standard relative deviations were lower than 14.2 %, while inaccuracy (bias) was less than +11.9%. The efficiency of extraction was greater than 88.5%. Ruggedness was verified, according to Youden's test. Means of cotinine concentrations observed were 2,980 ng mL-1 for active smokers and 132 ng mL-1, for passive smokers. The results revealed that satisfactory chromatographic separation between the analyte and interferents was obtained with a ZB-1 column. This method is reliable, precise, linear and presented ruggedness in the range evaluated. The results suggest that it can be applied in routine analysis for passive and active smokers, since it is able to quantify a wide range of cotinine concentrations in urine.<br>A nicotina é uma substância presente no cigarro capaz de causar dependência, sendo biotransformada em vários metabólitos nos seres humanos, dentre eles a cotinina urinária, que é considerada um indicador biológico de exposição à nicotina, devido a suas altas concentrações, comparado a outras matrizes. Assim, o objetivo deste estudo foi desenvolver um único método para determinação de cotinina urinária, em amostras de urina de fumantes ativos e passivos, através de cromatografia em fase gasosa com detector de nitrogênio- fósforo (CG-DNF). Para o preparo de amostras foram utilizados 5 mL de urina, 1 mL de hidróxido de sódio 5 mol L-1, 5 mL de clorofórmio, tendo como padrão interno a lidocaína. Na faixa de concentrações de 10-1000 ng mL-1 e 500- 6000 ng mL-1, o coeficiente de determinação foi 0,9986 e 0,9952, respectivamente e, o limite de quantificação foi 10 ng mL-1. A precisão intra- e interensaio apresentou desvio padrão relativo (%) menor que 14,2% e a inexatidão foi menor que +11,9%, com uma eficiência de extração de 88,5%. O método apresentou robustez, de acordo com o teste de Youden. As concentrações médias de cotinina observadas foram 2980 ng mL-1, para fumantes ativos e 132 ng mL-1, para fumantes passivos. Os resultados sugerem que o método é confiável, preciso, linear e apresentou robustez, na faixa avaliada, podendo ser aplicado na rotina para análises de amostras de fumantes ativos e passivos, pois é capaz de quantificar uma ampla faixa de concentrações de cotinina urinária