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Objectives: End tidal carbon dioxide (ETCO2) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO2 following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant's condition after birth).Design: Analysis of recordings of respiratory function monitoring.Setting: Two tertiary perinatal centres.Patients: Sixty-four infants, with median gestational age of 27 (range 23-34)weeks.Interventions: Respiratory function monitoring during resuscitation in the delivery suite.Main Outcome Measures: The time following intubation for ETCO2 levels to be initially detected and to reach 4 mm Hg and 15 mm Hg.Results: The median time for initial detection of ETCO2 following intubation was 3.7 (range 0-44) s, which was significantly shorter than the median time for ETCO2 to reach 4 mm Hg (5.3 (range 0-727) s) and to reach 15 mm Hg (8.1 (range 0-827) s) (both P<0.001). There were significant correlations between the time for ETCO2 to reach 4 mm Hg (r=-0.44, P>0.001) and 15 mm Hg (r=-0.48, P<0.001) and gestational age but not with the Apgar scores.Conclusions: The time for ETCO2 to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO2 monitoring. Capnography is likely to detect ETCO2 faster than colorimetric devices. [ABSTRACT FROM AUTHOR]

Background: Small for gestational age (SGA) infants are less likely to develop respiratory distress syndrome (RDS), but more likely to develop bronchopulmonary dysplasia (BPD) and have a higher mortality. Our aim was to focus on outcomes of those with a birth weight less than or equal to 750 g. Methods: The mortality, BPD severity, necrotising enterocolitis (NEC), home oxygen requirement and length of hospital stay were determined according to SGA status of all eligible infants in a 5-year period admitted within the first 24 h after birth. Results: The outcomes of 84 infants were assessed, and 35 (42%) were SGA. The SGA infants were more mature (P<0.001), had a lower birth weight centile (P<0.001) and a greater proportion exposed to antenatal corticosteroids (P=0.022). Adjusted for gestational age (GA), there was no significant difference in mortality between the two groups (P=0.242), but a greater proportion of the SGA infants developed severe BPD (P=0.025). The SGA infants had a lower weight z-score at discharge (−3.64 vs. −1.66) (P=0.001), but a decrease in z-score from birth to discharge was observed in both groups (median −1.53 vs. −1.07, P=0.256). Conclusion: Despite being more mature, the SGA infants had a similar mortality rate and a greater proportion developed severe BPD. [ABSTRACT FROM AUTHOR]

Objectives: To assess the work of breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD).Design: Randomised crossover study.Setting: Tertiary neonatal intensive care unit.Patients: Eighteen infants born at <32 weeks gestation who remained ventilated at or beyond 1 week after birth, that is, they had evolving or established BPD.Interventions: Infants received ventilation at volume targeting levels of 4, 5, 6 and 7 mL/kg each for 20 minutes, the levels were delivered in random order. Baseline ventilation (without volume targeting) was delivered for 20 minutes between each epoch of volume-targeting.Main Outcome Measures: Pressure-time product of the diaphragm (PTPdi), a measure of the work of breathing, at different levels of volume targeting.Results: The 18 infants had a median gestational age of 26 (range 24-30) weeks and were studied at a median of 18 (range 7-60) days. The mean PTPdi was higher at 4 mL/kg than at baseline, 5 mL/kg, 6 mL/kg and 7 mL/kg (all P≤0.001). The mean PTPdi was higher at 5 mL/kg than at 6 mL/kg (P=0.008) and 7 mL/kg (P<0.001) and higher at 6 mL/kg than 7 mL/kg (P=0.003). Only at 7 mL/kg was the PTPdi significantly lower than at baseline (P=0.001).Conclusions: Only a tidal volume target of 7 mL/kg reduced the work of breathing below the baseline and may be more appropriate for infants with evolving or established BPD who remained ventilator dependent at or beyond 7 days of age. [ABSTRACT FROM AUTHOR]

Background: Breast lesions closer than 2 cm to the chest wall are difficult to position in the field of view of dedicated breast PET (db-PET) systems. This inability to detect such lesions is a significant limitation of these systems. The primary objective of this study was to determine if modifications to the design of the imaging table and detector used for a db-PET system would enable improved visualization of breast tissue close to the chest wall. All studies were performed on a commercially available db-PET system (Mammi-PET). A central square section of the imaging table, containing the standard 180-mm circular aperture, was modified such that it could be removed and replaced by thinner sections with a larger aperture. Additional changes were made to the cover plate of the detector array and the patient mattress. A total of 60 patients were studied. After administration of F-18 FDG, 30 patients were imaged with a 220-mm-diameter aperture and the standard aperture, and 30 patients with a 200-mm aperture and the standard aperture. On all scans, the length of breast tissue in the field of view was measured as the greatest extent of tissue from the nipple back to the posterior edge of the breast. Image quality and patient comfort were recorded. Results: Averaged over both breasts, relative to the standard aperture, the increase in breast length was 12.5 + 7.7 mm with the 220-mm aperture, and 12.3 + 6.5 mm with the 200-mm aperture ( p < 0.05 for both apertures). In ~ 5% of cases, the larger apertures resulted in some degradation in image quality due to closer proximity to cardiac/hepatic activity. In 10-20% of cases, movement of the breast tissue was observed as the detector ring was moved to scan the anterior region of the breast. The patient survey indicated no significant difference in the comfort level between the standard aperture and either of the prototype apertures. Conclusions: Modifications to the image table and system resulted in a significant gain in the volume of breast tissue that could be imaged on the db-PET system and should allow better visualization of lesions close to the chest wall. [ABSTRACT FROM AUTHOR]

Background: Patient-derived xenografts (PDXs) are increasingly used in cancer research as a tool to inform cancer biology and drug response. Most available breast cancer PDXs have been generated in the metastatic setting. However, in the setting of operable breast cancer, PDX models both sensitive and resistant to chemotherapy are needed for drug development and prospective data are lacking regarding the clinical and molecular characteristics associated with PDX take rate in this setting.Methods: The Breast Cancer Genome Guided Therapy Study (BEAUTY) is a prospective neoadjuvant chemotherapy (NAC) trial of stage I-III breast cancer patients treated with neoadjuvant weekly taxane+/-trastuzumab followed by anthracycline-based chemotherapy. Using percutaneous tumor biopsies (PTB), we established and characterized PDXs from both primary (untreated) and residual (treated) tumors. Tumor take rate was defined as percent of patients with the development of at least one stably transplantable (passed at least for four generations) xenograft that was pathologically confirmed as breast cancer.Results: Baseline PTB samples from 113 women were implanted with an overall take rate of 27.4% (31/113). By clinical subtype, the take rate was 51.3% (20/39) in triple negative (TN) breast cancer, 26.5% (9/34) in HER2+, 5.0% (2/40) in luminal B and 0% (0/3) in luminal A. The take rate for those with pCR did not differ from those with residual disease in TN (p = 0.999) and HER2+ (p = 0.2401) tumors. The xenografts from 28 of these 31 patients were such that at least one of the xenografts generated had the same molecular subtype as the patient. Among the 35 patients with residual tumor after NAC adequate for implantation, the take rate was 17.1%. PDX response to paclitaxel mirrored the patients' clinical response in all eight PDX tested.Conclusions: The generation of PDX models both sensitive and resistant to standard NAC is feasible and these models exhibit similar biological and drug response characteristics as the patients' primary tumors. Taken together, these models may be useful for biomarker discovery and future drug development. [ABSTRACT FROM AUTHOR]

Background: Molecular breast imaging (MBI) performed with Tc sestamibi has been shown to be a valuable technique for the detection of breast cancer. Alternative radiotracers such as Tc maraciclatide may offer improved uptake in breast lesions. The purpose of this study was to compare relative performance of Tc sestamibi and Tc maraciclatide in patients with suspected breast cancer, using a high-resolution dedicated gamma camera for MBI. Women with breast lesions suspicious for malignancy were recruited to undergo two MBI examinations-one with Tc sestamibi and one with Tc maraciclatide. A radiologist interpreted MBI studies in a randomized, blinded fashion to assign an assessment score (1-5) and measured lesion size. Lesion-to-background (L/B) ratio was measured with region-of-interest analysis. Results: Among 39 analyzable patients, 21 malignant tumors were identified in 21 patients. Eighteen of 21 tumors (86%) were seen on Tc sestamibi MBI and 19 of 21 (90%) were seen on Tc maraciclatide MBI ( p = 1). Tumor extent measured with both radiopharmaceuticals correlated strongly with pathologic size (Tc sestamibi, r = 0.84; Tc maraciclatide, r = 0.81). The L/B ratio in detected breast cancers was similar for the two radiopharmaceuticals: 1.55 ± 0.36 (mean ± S.D.) for Tc sestamibi and 1.62 ± 0.37 (mean ± S.D.) for Tc maraciclatide ( p = 0.53). No correlation was found between the L/B ratio and molecular subtype for Tc sestamibi ( r = 0.12, p = 0.63) or Tc maraciclatide ( r = −0.12, p = 0.64). Of 20 benign lesions, 10 (50%) were seen on Tc sestamibi and 9 of 20 (45%) were seen on Tc maraciclatide images ( p = 0.1). The average L/B ratio for benign lesions was 1.34 ±0.40 (mean ±S.D.) for Tc sestamibi and 1.41 ±0.52 (mean ±S.D.) for Tc maraciclatide ( p = 0.75). Overall diagnostic performance was similar for both radiopharmaceuticals. AUC from ROC analysis was 0.83 for Tc sestamibi and 0.87 for Tc maraciclatide ( p = 0.64). Conclusions: Tc maraciclatide offered comparable lesion uptake to Tc sestamibi, in both malignant and benign lesions. There was good correlation between lesion extent and uptake measured from both radiopharmaceuticals. Tc maraciclatide offered a marginal (but not significant) improvement in sensitivity over Tc sestamibi. Our findings did not support an association between the uptake of either radiopharmaceutical and tumor molecular subtype. Trial registration: ClinicalTrials.gov, [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]