Positive Washings Research Articles

The Impact of Positive Peritoneal Cytology on the Survival of Endometrial Cancer Patients

Background: Since the revision of the FIGO staging of endometrial cancer in 2009, patients with positive peritoneal cytology are no longer upstaged to stage IIIA. However, several studies demonstrated poorer outcomes in patients with positive washings. We conducted a survival analysis with the aim of evaluating the impact of positive peritoneal cytology on the survival of EC patients. Methods: We performed a retrospective analysis of prospectively collected data on patients with endometrial cancer operated in our institution between 2008 and 2014. We analysed the impact of positive peritoneal cytology and other established prognostic factors on survival. Results: A total of 227 patients with a median follow-up of 6.9 years were included in the study. A total of 12.8% had positive peritoneal cytology. Positive peritoneal cytology was significantly associated with worse overall survival (HR 1.82; 95% CI 1.02–3.26; p 0.043) but not with worse recurrence-free survival (HR 1.64; 95% CI 0.92–2.93; p 0.091) in univariate analyses. In addition, tumour stage, histologic subtype, lymphovascular space invasion, grade, and the depth of myometrial invasion were all significant prognostic factors for overall survival in univariate analyses. In multivariate survival analysis, only the histologic subtype, tumour stage, and myometrial invasion remained in the model at the last step. Conclusions: Positive peritoneal cytology was associated with worse overall survival in our series of endometrial cancer patients. However, other traditional prognostic factors had a more important prognostic role for survival in a multivariate model.

Impact of hyperthermic intraperitoneal chemotherapy on gastric cancer survival: Peritoneal metastasis and cytology perspectives.

Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects. The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to increase survival rates in these patients. Despite these advancements, debates persist regarding the magnitude of survival improvement attributed to this treatment modality. The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis, and it took a comparative analysis of patients exhibiting positive and negative cytological findings. To compare the impact of HIPEC on survival in gastric cancer patients with peritoneal metastasis and positive or negative cytology. Between April 2013 and March 2020, 84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts: HIPEC (20 patients with peritoneal metastasis), cytology-positive (23 patients without peritoneal nodules but with positive wash cytology), and cytology-negative (41 patients with advanced gastric cancer, no peritoneal nodules, and negative wash cytology). The HIPEC cohort underwent gastrectomy with HIPEC, while the cytology-positive and cytology-negative groups received gastrectomy alone. The demographic, pathological, and survival data of the groups were compared. The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss. Nevertheless, the complication rates were consistent across all three groups. Median survival in the HIPEC group was 20.00 ± 4.89 months, with 1-year, 2-year, and 3-year overall survival rates of 73.90%, 28.70%, and 9.60%, respectively. These figures paralleled the survival rates of the cytology-positive group (52.20% at 1 year, 28.50% at 2 years, and 19.00% at 3 years). Notably, 47% of patients experienced peritoneal recurrence. HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis, mirroring the outcomes in cytology-positive patients. However, peritoneal recurrence remained high.

Molecular and pathologic data to guide selection of patients with endometrioid endometrial cancer for ovarian preservation

ObjectivesTo investigate the association of molecular and pathologic factors with concurrent or recurrent ovarian disease to guide ovarian preservation in endometrioid endometrial cancer.MethodsPatients with endometrial cancer ≤50 years of age...

The yield of diagnostic laparoscopy with peritoneal lavage in gastric adenocarcinoma: A retrospective cohort study

IntroductionDiagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer (GC). Evaluation of the value of DL is important given ongoing improvements in diagnostic imaging and treatment. As contemporary data from European centres are sparse, this retrospective cohort study aimed to assess the yield of DL in patients with potentially curable gastric cancer, and to identify predictive factors for peritoneal metastases. MethodsPatients with adenocarcinoma of the stomach, treated between January 2016 and December 2018, were identified from institutional databases of two high volume European Upper-GI centres. Patients who underwent a DL with peritoneal lavage for potentially curable disease after clinical staging with imaging (cT1-4N0-3M0) were included. The primary outcome was the proportion of patients with a positive DL, defined as macroscopic metastatic disease, positive peritoneal cytology washings (PC+) or locally irresectable disease. ResultsSome 80 of 327 included patients (24.5%) had a positive DL, excluding these patients from neoadjuvant treatment (66 of 327; 20.2%) and/or surgical resection (76 of 327; 23.2%). In 34 of 327 patients (10.3%), macroscopic metastatic disease was seen, with peritoneal deposits in 30 of these patients. Only 16 of 30 patients with peritoneal disease had positive cytology. Some 41 of 327 patients (12.5%) that underwent DL had PC+ in the absence of macroscopic metastases and five patients (1.5%) had an irresectable primary tumour. Diffuse type carcinoma had the highest risk of peritoneal dissemination, irrespective of cT and cN categories. ConclusionThe diagnostic yield of staging laparoscopy is high, changing the management in approximately one quarter of patients. DL should be considered in patients with diffuse type carcinoma irrespective of cT and cN categories.

OGC P11 Outcomes in patients with gastric cancer and positive peritoneal washings

Abstract Background The presence of positive cytological washings in the absence of overt peritoneal disease (P0C1) represents metastatic disease. Most centres advocate for neoadjuvant chemotherapy and full restaging including repeat laparoscopy and washings, with resection offered to those in whom restaging is negative. This approach was implemented at our institute in 2012 and when evaluated in 2015 was found to have very good results with 63% of patients resected and 90% 2-year survival. Since this time chemotherapy regimens have changed meaning this earlier approach requires additional scrutiny. Methods A retrospective review of a prospectively maintained database of all upper GI cancer patients treated at the Northern Oesophago-Gastric Unit (NOGU) was undertaken. All patients with adenocarcinoma of the stomach or gastroesophageal junction without metastases on imaging and who underwent staging laparoscopy between August 2012 and August 2022 were identified. Patients who had positive cytological washings without evidence of overt peritoneal disease were included in the analysis. Data were extracted including demographics, treatment data and oncological outcomes. Survival data were collected and patterns of recurrence determined. Results 630 patients underwent staging laparoscopy. Resectable P0C1 disease occurred in 55/630 (8.7%), and 48/55 commenced chemotherapy. Restaging occurred in 45/48 (93.8%) and 21/45 (46.7%) went on to have definitive surgery where 15/45 (33%) were resected. Recurrence occurred in 8/15 patients, 3 of which had peritoneal metastases. Median time to recurrence was 16 months (range: 6-34). A total of 9 patients died during follow up which occurred at a median of 14 months (range: 5 to 43). Overall median survival of the cohort was 28 months (range: 5 – 111), with survival of 60% and 25% at 2 and 5 years, respectively. Conclusions This study demonstrated 60% 2-year survival in patients treated with curative intent who initially had positive peritoneal cytology. We were not able to demonstrate a predominate pattern of peritoneal recurrence. Furthermore, 25% of patients survived for at least 5 years after surgery, indicating that this remains an acceptable approach to the management of P0C1 disease with current best practice chemotherapy regimens.

Preoperative hysteroscopy shortened progression-free survival in advanced FIGO stage in endometrial cancer: Ten year analysis.

To investigate the impact of preoperative hysteroscopy on progression-free survival (PFS) and disease-specific survival (DFS), and to explore the factors which contribute to poor clinical outcomes between hysteroscopy and dilation and curettage (D&C) in endometrial cancer (EC). A retrospective study was designed by collecting data from women diagnosed with EC through hysteroscopy or D&C from January 2010 to December 2019 in a tertiary hospital in China. A propensity score was used for 1:1 matching of advanced stage patients. Univariate and multivariate analysis were conducted to determine whether hysteroscopy was a prognostic factor in EC and to identify factors associated with its impact on PFS and DFS in different subgroups. Overall, 543 and 272 women who underwent D&C and hysteroscopy, respectively were included. Compared to D&C, preoperative hysteroscopy was related to reduced PFS and DFS, with a hazard ratio (HR) of 1.904 and 3.905, respectively. Hysteroscopy contributed to an increased risk of positive wash cytology (48.27% vs 24.13%), recurrence (48.28% vs 20.69%) and shorter PFS after matching in FIGO Stage I-IV EC, while there was no significance in positive ascites cytology (14.04% vs 13.45%), PFS and DFS in FIGO Stage I EC. Hysteroscopy was an independent predictive factor for poor prognosis in EC. Hysteroscopy appeared to be a safe diagnostic method as D&C in FIGO Stage I EC but was a risk factor for increased recurrence and reduced PFS in advanced stage disease. Its impact on DFS is uncertain.

Analysis of the utility of transbronchial lung biopsy culture under endobronchial ultrasonography with a guide-sheath

Transbronchial lung biopsy (TBLB) culture is not common in clinical practice, and TBLB culture for patients with mycobacterial disease provide limited value because the diagnostic accuracy of TBLB culture is very low. Recently, bronchoscopic devices have been further developed, such as endobronchial ultrasonography with a guide-sheath (EBUS-GS). Therefore, this study investigated the utility of TBLB culture obtained by using EBUS-GS compared to washing cultures. A total of 31 patients who underwent TBLB culture by using EBUS-GS (GS-TBLB) were collected retrospectively at Fukujuji Hospital from January 2018 to December 2022. The diagnostic accuracies of GS-TBLB culture and bronchial and device washing cultures (namely, washing culture) were compared. The patients comprised 13 individuals with nontuberculous mycobacteriosis, 7 with pulmonary aspergillosis, 6 with lung abscess, and 5 with pulmonary tuberculosis. The diagnostic accuracy of GS-TBLB culture was lower to that of TBLB culture than those of washing culture (n = 11 [35.5%] vs. n = 20 [64.5%], p = 0.016), and there was only one patient with positive GS-TBLB culture results and negative washing culture results. Comparing between patients with mycobacteria and non-mycobacteria, GS-TBLB culture positivity were no significant difference between patients with mycobacteria and non-mycobacteria (n = 6 [33.3%] vs. n = 5 [38.5%], p = 1.000), however, patients with mycobacteria diagnosed by washing culture more than those with non-mycobacteria (n = 15 [83.3%] vs. n = 5 [38.5%], p = 0.021). Our results demonstrate that the utility of TBLB culture for the diagnosis of pulmonary infections might provide limited value even if EBUS-GS is performed and lung tissue is successfully obtained.

Trends in use of radiation therapy, chemotherapy, and combination chemoradiotherapy in advanced uterine cancer before, during, and after GOG 258

ObjectiveTo explore the use of Gynecologic Oncology Group 258 (GOG 258) study regimens before, during, and after the study.MethodsPatients aged 18 years or older with endometrial cancer between 2004–2019 were...

The Effects of Adolescents' Perceived Handwashing Attitudes, Health Beliefs, and Internal Control on Handwashing Practices in the COVID-19 Pandemic Situation

This study aims to provide basic data for developing a hand washing education program to prevent infection by identifying the factors that affect hand washing practice for high school students who need to establish healthy lifestyles in the COVID-19 outbreak situation. Data collection was conducted from December 10 to 31, 2020 for 149 in high school students. The collected data were analyzed using the SPSS 20.0 program. As a result, internal control(p<.05) and hand washing attitude(p<.05) had a significant effect on dependent variables. the result of this study indicates that the internal control means a tendency to attribute the cause or effect of an action to internal factors, such as ability, attitude, and effort of one’s own, educational plans that can increase the hand washing practice rate by cultivating a positive hand washing attitude and improving internal control through education on the importance of personal quarantine should be prepared.

Laparoscopy with or without robotic assistance does not negatively impact long-term oncologic outcomes in patients with uterine serous carcinoma

ObjectivesWe sought to compare outcomes between minimally invasive surgery (MIS) and laparotomy in patients with clinical stage I uterine serous carcinoma (USC). MethodsPatients who underwent surgery for newly diagnosed USC between 11/1/1993 and 12/31/2017 were retrospectively identified and assigned to either the MIS cohort or the laparotomy cohort. Patients with conversion to laparotomy were analyzed with the MIS cohort. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables, respectively. Kaplan-Meier curves were used to estimate survival and compared using the log-rank test. ResultsIn total, 391 patients met inclusion criteria; 242 underwent MIS (35% non-robotic and 65% robotic-assisted laparoscopies) and 149 underwent laparotomy. Age, BMI, stage, and washings status did not differ between cohorts. Patients who underwent MIS were less likely to have lymphovascular space invasion (LVSI; 35.1% vs 48.3%), had fewer nodes removed (median, 9 vs 15), and lower rates of paraaortic nodal dissection (44.6% vs 65.1%). Rates of adjuvant therapy did not differ between cohorts.Median follow-up times were 63.0 months (MIS cohort) vs 71.0 months (laparotomy cohort; P = .04). Five-year PFS rates were 58.7% (MIS) vs 59.8% (laparotomy; P = .1). Five-year OS rates were 65.2% (MIS) compared to 63.5% (laparotomy; P = .2). On multivariable analysis, higher stage, deep myometrial invasion, and positive washings were associated with decreased PFS. Age ≥ 65 years, higher stage, LVSI, and positive washings were associated with shorter OS. ConclusionsMIS does not compromise outcomes in patients with newly diagnosed USC and should be offered to these patients to minimize surgical morbidity.

Molecular and pathologic data can guide selection of endometrioid endometrial cancer patients for ovarian preservation (239)

<b>Objectives:</b> To investigate the association of The Cancer Genome Atlas (TCGA) molecular subtype, <i>CTNNB1</i> (B-catenin) hotspot mutation, and pathologic factors with concurrent or recurrent ovarian disease in endometrial cancer (EC) patients (pts). <b>Methods:</b> EC pts aged ≤50 years were grouped by those electing oophorectomy (BO) versus ovarian preservation (OP) at staging surgery (January 2010-June 2021). ECs were classified as TCGA subtypes using a clinical tumor-normal next-generation sequencing (NGS) assay and immunohistochemistry data: <i>POLE</i> hotspot mutated, microsatellite instability-high (MSI-H), copy number high (CN-high), or copy number low (CN-low). <i>CTNNB1</i> hotspot mutations were classified. Germline data identified Lynch syndrome pts. Associations between molecular/pathologic features and concurrent ovarian disease (synchronous or metastatic) in BO pts were compared with Wilcoxon rank-sum and Fisher's exact tests. Associations with isolated ovarian recurrences in OP pts were examined with time to event outcomes. <b>Results:</b> Of 420 pts, 317 underwent BO, and 103 OP followed institutional guidelines (Table 1). Among BO pts with NGS (<i>n</i>=90), 14 (16%) had <i>POLE,</i> 22 (24%) MSI-H, six (7%) CN-high and 48 (53%) CN-low EC. Pathogenic <i>CTNNB1</i> mutations were present in 30/90 (33%) ECs. Of 102 pts with germline testing, 28 (28%) had Lynch syndrome. TCGA classification for OP pts with NGS (<i>n</i>=37) included six (16%) <i>POLE</i>, one (3%) MSI-H, one (3%) CN-high and 29 (78%) CN-low EC. Pathogenic <i>CTNNB1</i> mutations were present in 19/37 (51%) ECs. One of 23 (4%) pts with germline testing had Lynch syndrome. Of 317 BO pts, 27 (9%) had a concurrent ovarian disease. Among BO pts with NGS, concurrent ovarian tumors were diagnosed in 0/14 (0%) <i>POLE</i>, 2/48 (4%) CN-low, 10/22 (45%) MSI-H and 3/6 (50%) CN-high ECs (p<0.001). Concurrent ovarian disease was present in 1/37 (3%) hotspot <i>CTNNB1</i> mutated versus 9/58 (16%) wildtype/<i>CTNNB1</i> non-hotspot mutated ECs (p=0.15). Seven of 28 (25%) Lynch versus 7/74 (10%) non-Lynch syndrome pts had concurrent ovarian tumors (p=0.06). In BO pts, concurrent ovarian disease was associated with FIGO grade 2-3 versus grade 1 EC (20% vs 5%; p<0.001), positive versus negative lymphovascular space invasion (LVSI) (20% vs 7%; p=0.004), positive versus negative washings (28% vs 7%; p=0.016) and ≥50% versus <50% myoinvasion (24% vs 7%; p=0.006). Of 103 OP pts, four (4%) had isolated ovarian recurrences over a median follow-up of 17 months. Two pts had high-risk pathologic features and two had high-risk molecular features (CN-high EC and Lynch syndrome). <b>Conclusions:</b> Molecular and pathologic data improve risk stratification of pre-menopausal EC pts and enhance patient selection for ovarian preservation. In addition to Lynch syndrome, concurrent ovarian disease was seen more frequently in CN-high and MSI-H tumors or those with grade 2-3, LVSI, deep myoinvasion, and positive washings. Isolated ovarian recurrences may be independently associated with high-risk molecular features.

Sentinel lymph node biopsy compared with systematic lymphadenectomy in patients with uterine carcinosarcoma (536)

<b>Objectives:</b> To assess survival among patients with newly diagnosed uterine carcinosarcoma undergoing sentinel lymph node biopsy (SLN) alone and those undergoing systematic lymphadenectomy (LND). <b>Methods:</b> We identified all patients with newly diagnosed uterine carcinosarcoma who underwent primary surgical management at our institution from January 1996 to December 2019. Patients with gross extrauterine disease of any type were excluded. The SLN cohort underwent SLN biopsy alone, with bilateral SLNs identified. The systematic LND cohort did not undergo SLN biopsy. Progression-free survival (PFS) and overall survival (OS) were defined from the date of surgery to the event. Appropriate statistical testing was performed. <b>Results:</b> We identified 99 SLN and 100 LND patients. Median age and BMI were not different between the groups. Minimally invasive surgery was the approach in 56 (56.6%) SLN (56.6%) and 47 (47%) LND patients (p=0.2). There was no significant difference between cohorts with respect to the degree of myoinvasion (<50%, >50%), presence of lymphovascular space invasion (LVSI), stage, or positive washings. The median total node count was four (range: 1-13) for SLN and 19 (range: 2-50) for LN (p<0.001). Nodal metastasis was noted in 26 (26%) SLN and 21 (21%) LND (p=0.4). Postoperative therapy was given to 91 (92%) SLN and 87 (87%) LND (p=0.3). The type of postoperative therapy administered was as follows: none in eight (8%) SLN and 14 (14%) LND; chemotherapy with or without radiation (RT) in 86 (87%) SLN and 71 (71%) LND; RT alone in five (5%) SLN and 15 (15%) LND (p=0.02). Median follow-up was 51.3 months (range: 0.9-211.1) for the SLN cohort compared with 40.8 months (range: 0.5-269.1) for the LND cohort (p=0.3). The 4-year PFS was 62.4% (SE 5.3%) for SLN and 47.7% (SE 5.5%) for LND (p=0.07). The 4-year OS was 72.4% (SE 4.9%) for SLN and 62.2% (SE 4.2%) for LND (p=0.2). There was no difference in PFS or OS when adjusted for the type of postoperative therapy (chemotherapy with or without RT vs none/RT). An isolated nodal recurrence occurred in two (2%) SLN and four (4%) LND patients (p=0.2). <b>Conclusions:</b> There is no difference in PFS or OS among patients who have uterine carcinosarcoma and undergo SLN biopsy versus systematic LND. SLN biopsy adequately detects the presence of nodal metastasis in these patients. SLN biopsy alone does not compromise oncologic outcomes, and systematic LND is unnecessary in the setting of successful bilateral SLN mapping.

Off study utilization of an unpublished trial regimen: A real-world analysis of GOG258-eligible cohorts.

e18763 Background: Practice patterns in the management of advanced endometrial cancer are widely variable and treatment paradigms are rapidly changing given the evolving clinical trial landscape. Prior studies have demonstrated “medical reversals” where clinicians favor or utilize the experimental approach only to find inferiority on publication of results. The objective of this study was to examine the utilization of the GOG 258 arms-- (adjuvant chemotherapy (CT) vs chemoradiotherapy (CRT)-- for patients with advanced or high-risk endometrial cancer. Methods: Patients 18 years or older who underwent staging surgery with stage III/IVA endometrial carcinoma of any histology or stage I/II clear cell or serous histologies with positive washings diagnosed between 2004 and 2018 were identified in the National Cancer Database. Utilization of adjuvant CT and CRT were examined in the pre-GOG 258 era (before 2009), during GOG 258 enrollment (2010-2017), and after publication of results (2018). Two-sided Cochrane-Armitage test assessed trends over time. T-test and chi-square tests assessed differences in groups receiving CT alone vs CRT. Multivariable logistic regression assessed factors associated with receipt of CRT. Propensity score matching accounted for baseline differences in groups receiving CT vs CRT. Results: 40,028 patients were included. 16,342 (41%) received adjuvant CT and 23,686 (59%) received adjuvant CRT. The majority of patients (39,185, 98%) were advanced stage and 19,616 (49%) were endometrioid histology. 90% of patients receiving both CT and CRT received multiagent therapy. Utilization of CRT was 54% before GOG 258 opening, 60% during GOG 258 enrollment, and 67% after publication of results (p &lt; 0.001). Factors associated with receipt of CT alone were age greater than 70 (adjusted odds ratio [aOR] 0.68, 95% confidence interval [CI] 0.46-0.99), non-Hispanic Black race (aOR 0.84, CI 0.77-0.92), serous and clear cell histologies (aOR 0.68, CI 0.59-0.77; aOR 0.74, CI 0.57-0.95), living greater than 50 miles from treatment facility (aOR 0.84, CI 0.77-0.92), and receiving care in the Midwest, South, and West regions (aOR 0.84, CI 0.78-0.90; aOR 0.69, CI 0.64-0.76; aOR 0.72, CI 0.66-0.78). Compared to an academic medical center, receiving care at a comprehensive community cancer center was associated with receipt of CRT (aOR 1.2, CI 1.2-1.3). Compared to pre-GOG 258 opening in 2009, patients were more likely to receive CRT during GOG 258 enrollment (aOR 1.2, CI 1.1-1.3) and immediately after results announcement in 2018 (aOR 1.7, CI 1.5-1.8), despite results showing that CRT was not associated with longer relapse-free or overall survival. Conclusions: For patients with advanced endometrial cancer, there was significant use of both study arms with increases in CRT use during the study enrollment period and immediately after reporting of GOG 258 results, despite lack of benefit in the CRT arm.

Gastric and gastroesophageal junction cancer: Risk factors and prophylactic treatments for prevention of peritoneal recurrence after curative intent surgery.

AimRelapse after curative treatment for advanced gastric cancer, and especially peritoneal recurrence, is very common and has a dismal prognosis. The aim of this review is to summarize existing evidence regarding risk factors and prophylactic treatments intending to prevent peritoneal recurrence.MethodsA structured search of relevant studies was conducted in MEDLINE, Embase, and the Cochrane Library.ResultsThe main risk factors identified are advanced pathological T‐stage (pT ≥ 3), regional lymph node involvement, diffuse/poorly cohesive type tumor, poorly differentiated cancer, and positive peritoneal wash cytology. Systemic chemotherapy in the perioperative or adjuvant setting improves survival for the patients but despite this peritoneal recurrence remains a common and yet an unsolved clinical problem. Different approaches of intraperitoneal chemotherapy such as hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy have shown promising results as prophylactic treatments aiming to prevent peritoneal recurrence.ConclusionFuture studies are warranted to find safe and effective treatments to prevent peritoneal recurrence.

Evaluation of bladder washings cytology in diagnosis of neoplasms of urinary bladder

Urinary cytology functions as the primary screening and surveillance modality for the detection of urothelial neoplasia. To determine the significance of urinary bladder wash cytology in predicting various grades of urothelial carcinoma of urinary bladder along with their histological confirmation. The prospective study was conducted in Department of Pathology, PGIMS, Rohtak. A total of thirty-one urinary bladder washing samples (processed by Conventional method, Cytospin and Liquid based cytology) were taken prior to biopsy from clinically suspected patients of urinary bladder neoplasm. The cytological examination of bladder washings was reported according to The Paris System for Reporting Urinary Cytology and Bladder biopsies were reported according to WHO/ISUP grading of Urothelial Tumors 2004. All the data were statistically analysed using SPSS version 20.0 software. There was no significant difference in diagnostic accuracy among three techniques of processing bladder washings. Correlations of cytological diagnosis on bladder wash specimens with histopathological diagnosis were statistically significant and shared good agreement. A negative bladder wash cytology coupled with a negative cystoscopy is quite specific. A diagnosis of positive or suspicious bladder wash should be thoroughly investigated and followed closely. The Paris System is easy, reproducible, consistent ad has good histopathological correlation.

Effective anti-mycobacterial treatment for BCG disease in patients with Mendelian Susceptibility to Mycobacterial Disease (MSMD): a case series

BackgroundPost-vaccination BCG disease typically attests to underlying inborn errors of immunity (IEIs), with the highest rates of complications in patients with Mendelian susceptibility to mycobacterial disease (MSMD). However, therapeutic protocols for the management of BCG-osis (disseminated) and persistent BCG-itis (localized) are still controversial.MethodsTwenty-four Iranian patients with MSMD (BCG-osis or BCG-itis), followed from 2009 to 2020 in Tehran, were included in the study. Their medical records were retrospectively reviewed for demographics, clinical features, laboratory findings, and molecular diagnosis. The therapeutic protocol sheets were prepared to contain the types and duration of anti-mycobacterial agents.ResultsBCG disease either as BCG-itis (33.3%) or BCG-osis (66.7%) was confirmed in all patients by positive gastric washing test (54.2%), microbial smear and culture (58.3%), or purified protein derivative (PPD) test (4.2%). The duration between BCG-osis onset and MSMD diagnosis was 21.6 months.All except three patients were initiated on second-line anti-mycobacterial agents with either a fluoroquinolone (levofloxacin: 15 mg/kg/day, ciprofloxacin: 20 mg/kg/day, ofloxacin: 15 mg/kg/day), aminoglycoside (amikacin: 10–15 mg/kg/day, streptomycin: 15 mg/kg/day), and/or macrolide (clarithromycin: 15 mg/kg/day) along with oral rifampin (10 mg/kg/day), isoniazid (15 mg/kg/day), and ethambutol (20 mg/kg/day). Three patients showed a clinical response to rifampin, despite in vitro resistance. Fourteen (58.3%) patients received also adjuvant subcutaneous IFN-γ therapy, 50 µ/m2 every other day. At the end of survey, most patients (n = 22, 91.7%) were alive and two patients died following BCG-osis and respiratory failure.ConclusionsWe recommend the early instigation of second-line anti-mycobacterial agents in MSMD patients with BCG disease.

Full-Scale trial of the REFLUX™ flotation cell

A 2 m diameter REFLUX™ Flotation Cell was fed at roughly 210 m3/h, equivalent to a flux of 1.9 cm/s, about twice the maximum rate used in conventional flotation cells. The coal feed slurry had 59–64 wt% head ash and nominal size range −0.100 mm (Sauter mean size 0.004 mm). The air, wash water and underflow rates were 180 m3/h, 65 m3/h and 235 m3/h respectively, giving a positive downwards wash water bias flux of 0.2 cm/s. Product ashes of 11–15 wt% were obtained at combustible recoveries of 58–75 %, with results on or better than the tree curve. These initial results demonstrate that the beneficial hydrodynamics seen at laboratory scale are realised at full-scale. Also demonstrated is the use of a novel oil-agglomeration technique to obtain detailed performance versus size data, showing that high hydrophobic recoveries were being obtained at sizes down to 0.001 mm.

Sentinel lymph node biopsy alone compared to systematic lymphadenectomy in patients with uterine carcinosarcoma

ObjectiveTo assess survival among patients diagnosed with uterine carcinosarcoma (CS) who underwent sentinel lymph node (SLN) biopsy alone vs. systematic lymph node dissection (LND). MethodsWe identified newly diagnosed CS patients who underwent primary surgical management from January 1996–December 2019. The SLN cohort underwent SLN biopsy alone with bilateral SLNs identified. The systematic LND cohort did not undergo SLN biopsy. ResultsNinety-nine patients underwent SLN biopsy, and 100 patients underwent systematic LND. There was no difference by age, stage, body mass index, myoinvasion (<50%, ≥50%), lymphovascular space invasion, or positive washings. Eighty-five SLN (85.9%) and 15 LND (15%) underwent minimally invasive surgery (P < 0.001). The median total node count was four (range, 1–13) for SLN and 19 (range, 2–50) for LND (P < 0.001). Nodal metastasis occurred in 23 (23.2%) SLN and in 22 (22%) LND (P = 0.4). Postoperative therapy was administered to 85 (85.9%) SLN and 71 (71%) LND (P = 0.02). Median follow-up was 33 months (range, 1–205) for SLN and 55.3 months (range, 1–269) for LND (P = 0.001). The three-year progression-free survival (PFS) was 62.9% (SE 5.2%) for SLN and 52.3% (SE 5.3%) for LND (P = 0.13). The three-year overall survival (OS) was 72.1% (SE 5.1%) for SLN and 71.6% (SE 4.6%) for LND (P = 0.68). An isolated nodal recurrence occurred in two (2%) SLN and four (4%) LND (P = 0.26). ConclusionsThere is no difference in PFS or OS among CS patients who undergo SLN biopsy vs. systematic LND. SLN biopsy detects nodal metastasis without compromising oncologic outcomes.

Transfusion Strategy for Rare Anti-LW Antibody Autoimmune Hemolytic Anemia Patients with Neonatal Hemolytic Disease

To analyze the causes of positive irregular antibody screening test and incompatibility of cross matching in one patient with autoimmune hemolytic anemia complicated with neonatal hemolytic disease, and to accurately identify the type of antibodies in patients, and to select a reasonable strategy for blood transfusion. One children was enrolled, blood group positive and reverse typing, Rh typing, direct anti-human globulin test, free test, dispersal test and cross matching test were carried out by test tube method and microcolumn gel card; irregular antibodies were identified by the reaction of DTT treatment and untreated panel cells with patients' plasma. The blood group of the patient was RhD positive B and irregular antibody screening positive, while the blood group of the mother was RhD positive O and irregular anti-screening negative, the result showed that the anti-LW detected in the plasma of the patient was autoantibody and ABO neonatal hemolytic disease (ABO-HDN) was present. Both O type RhD positive washing RBCs and B type RhD negative RBCs were transfused effectively. Irregular antibodies in patients are anti-LW antibodies, and transfusion of homotype RhD negative suspended erythrocytes after the exclusion of ABO-HDN shows a better effect.

The potential of school-based WASH programming to support children as agents of change in rural Zambian households

BackgroundWater, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviors will disseminate this information to their families. This is most prominent in school-based programs, which rely on students to act as “agents of change” to translate impact from school to home. However, there is little evidence to support or contradict this assumption.MethodsWe conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to measure the impact of WASH UP!, a school-based WASH program designed by the creators of Sesame Street. WASH UP! is an educational program that uses stories and interactive games to teach students in grades 1–4 about healthy behaviors, such as washing hands and using the latrine. We completed in-person interviews with grade 1 and 4 students (N = 392 and 369, respectively), their teachers (N = 24) and caregivers (N = 729) using structured surveys containing both open- and closed-ended questions. We measured changes in knowledge and whether students reported sharing WASH-related messages learned in school with their caregivers at home.ResultsStudent knowledge increased significantly, but primarily among students in grade 1. Overall rates of students reporting that they shared messages from the curriculum with their caregivers rose from 7 to 23% (p < 0.001). Students in grade 4 were 5.2 times as likely as those in grade 1 to report sharing a WASH-related message with their caregivers (ARR = 5.2, 95% C.I. = (2.3, 8.9); p < 0.001).ConclusionsAlthough we measured only modest levels of student dissemination of WASH UP! messages from the school to the home, students in grade 4 showed significantly more promise as agents of change than those in grade 1. Future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than a single approach for a wide range of ages and contexts.