Automatic detection of chest compressions for the assessment of CPR-quality parameters

AIM

Accurate chest compression detection is key to evaluate cardiopulmonary resuscitation (CPR) quality. Two automatic compression detectors were developed, for the compression depth (CD), and for the thoracic impedance (TI). The objective was to evaluate their accuracy for compression detection and for CPR quality assessment.

METHODS

Compressions were manually annotated using the force and ECG in 38 out-of-hospital resuscitation episodes, comprising 869 min and 67,402 compressions. Compressions were detected using a negative peak detector for the CD. For the TI, an adaptive peak detector based on the amplitude and duration of TI fluctuations was used. Chest compression rate (CC-rate) and chest compression fraction (CCF) were calculated for the episodes and for every minute within each episode. CC-rate for rescuer feedback was calculated every 8 consecutive compressions.

RESULTS

The sensitivity and positive predictive value were 98.4% and 99.8% using CD, and 94.2% and 97.4% using TI. The mean CCF and CC-rate obtained from both detectors showed no significant differences with those obtained from the annotations (P>0.6). The Bland-Altman analysis showed acceptable 95% limits of agreement between the annotations and the detectors for the per-minute CCF, per-minute CC-rate, and CC-rate for feedback. For the detector based on TI, only 3.7% of CC-rate feedbacks had an error larger than 5%.

CONCLUSION

Automatic compression detectors based on the CD and TI signals are very accurate. In most cases, episode review could safely rely on these detectors without resorting to manual review. Automatic feedback on rate can be accurately done using the impedance channel.

Abstract P5-13-14: Breast cancer in very young patient is a more aggressive entity independent from breast cancer subtype

BACKGROUND AND OBJECTIVES: Breast cancer in very young patients (< 35 years) (BCVY) is an uncommon disease and when it occurs it usually has aggressive biological characteristics. Whether this effect is due to an overrepresentation of aggressive breast cancer subtypes in younger patients or not remains an issue of controversial. The objective of this study was to identify potential differences in the molecular and clinical features of breast carcinomas from patients < = 35 years versus a cohort of older counterparts previously matched by breast cancer subtype.

METHODS: We performed a retrospective analysis of a prospectively maintained database that included 424 patients diagnosed with an invasive breast carcinoma from 1995 to 2012 at Hospital Clinico of Valencia. We selected 89 patients separated in two groups, the study group with very young women ≤ 35 years old and with no BRCA mutation or unknown and a second group with women older than 50 years. Data related to clinical and pathological features from both groups such as tumor size, nodal status, histological grade, Ki 67 labeling oestrogen and progesterone receptor and HER2 overexpression were obtained from medical records and we used the statistic model of chi-squared to compare the two groups.

RESULTS: Of the 89 patients, 43 patients ≤ 35 year were included in the study group (median age 31.4 years, standard deviation (SD): 3.82) and 46 patients >50 years were included in the control group (median age 66.4 years, SD: 10.00). Ductal carcinoma was the most common histological subtype in both groups (88.4% of BCVY and 78.3% of the old woman). The majority of tumors were ER and PR positive in both groups, but younger women had a higher proportion of HER2 positive tumors, although the result was not significant. By subtype 57.4% of BCVY presented an immunohistochemical luminal subtype, compared to 71.7% in older patients. Triple negative and HER2 profiles were 11.6% and 34.8% in youngest versus 15.2% and 13.04% in older women respectively. No statistically significant differences were found in terms of breast cancer subtype (p = 0.279)). However, BCVY had a higher pathological grade (56% younger patients had grade IIII vs 26% in oldest, p = 0.002), higher proportion of Ki67 >30% (32.5% of youngest versus 17.4% in older women, p = 0.008), larger tumors (16.3% of BCVY had size tumor > 5 cm, versus 2.2% in controls, p<0.0001) and more frequent nodal involvement (39.5% in young women vs 28.2% in oldest, p = 0.0264).

CONCLUSIONS: Patients diagnosed with breast cancer at ≤ 35 years present more aggressive tumors compared to older patients. These data suggest that BCVY is a distinct entity, further studies to confirm these findings are needed.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-14.

Abstract P4-07-04: A distinctive miRNA profile highlights breast cancer in very young women (BCVY) as a new molecular subgroup

Background: Although less frequent (1% of all breast cancer) than in older women, breast cancer (BC) in very young women (BCVY),(≤35 years old) often exhibits larger tumor sizes, high pathological grade, high proliferation percentage, nodal involvement, and greater HER2+ percentage, usually associated with a poorer prognosis. BC and BCVY might arise as different disease entities derived from different underlying mechanisms.

MicroRNAs (miRNAs) are short RNA molecules with post-transcriptional regulatory function, usually silencing targeted mRNAs. Recently, miRNA profiling has arisen as major approaching study technique, demonstrating a widespread miRNA deregulation in various tumor types.

In this study we offer a miRNA profile of a subset of BCVY patients and evaluate whether there are any miRNA deregulated pointing out some pathway to better understand the ongoing mechanism and characterize BCVY as a new molecular entity.

Material and methods: We performed a comprehensive study of miRNA expression using miRNA Affymetrix 2.0 array. We extracted RNA from FFPE tumor tissue of both 44 BC patients ≤35years (BCVY) and 46 older than 45years in two age groups (45-65 and >65), we used normal breast tissue as control and evaluated the differences in expression of each age group. We tried to validate most interesting miRNA by qRT-PCR. We performed enrichment analysis of multiple miRNA target genes (DIANA mirpath) to search for putative pathways that could be deregulated by the miRNAs.

Results: We obtained a differential and unique miRNA expression profile of 121 miRNAs (p-value<0.05), 96 of those with FDR<0.05. After hierarchical clustering, samples were unsupervised grouped according to their age, neither by subtype nor by tumor characteristics. Of the 11 miRNA selected for validation, we were able to validate differences in the expression of 6 miRNAs: miR-1228*, miR-3196, miR-1275, miR-92b, miR-139, miR-1207, moreover, all of the miRNAs maintained the expression's trend. The validated miRNAs pointed out pathways related with cell motility and invasion (adherens junction, chondroitin sulfate biosynthesis, cell adhesion molecules) and cell proliferation (calcium signaling, wnt signaling).

Conclusion: We performed a comprehensive study of the miRNA expression on a total of 89 BC patients, detecting a differential molecular profile in BCVY patients, suggesting that there might be a different underlying mechanism and that BCVY could be identified as a different entity.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-04.

Position document: IgE-mediated allergy to egg protein

Egg is the food that most often causes allergy in young Spanish children, with an incidence of 2.4-2.6% in the first 2 years of life. The prevalence of sensitisation and allergy to egg is greater in children with allergy to cow's milk and in those suffering atopic dermatitis. The protein component from egg white is the cause of the allergic response in child. The major allergens in egg white are ovomucoid and ovalbumin. Most of the allergic reactions affect the skin, followed by gastrointestinal and respiratory systems. Egg allergy is one of the most common causes of severe anaphylaxis. The diagnosis of egg allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which represents the gold standard for confirming the diagnosis. The treatment of egg allergy is based on the avoidance of egg protein intake. A subgroup of egg-allergic patients are tolerant to cooked egg. In these cases, only uncooked egg must necessarily be avoided. Maintaining a diet with strict egg avoidance is difficult, and transgressions are relatively common. The patient, family, and school environment should receive education and training in the avoidance of egg and in the management of possible allergic reactions. With an avoidance diet, up to 15-20% of children will remain allergic and the severity of the reactions will increase over the years. In these more severe cases of egg-allergy, it becomes more difficult to adhere to the avoidance diet over the years, with a significant decrease in patient quality of life. Oral tolerance induction can be regarded as a therapeutic option for IgE-mediated egg allergy. The anti-IgE, omalizumab, might become another genuine therapeutic option for food allergy, not only to prevent allergic reactions after a contact with egg, but also as a complementary treatment to oral tolerance induction for egg allergy, with the purpose of reducing adverse reactions. The administration of influenza vaccine to children with egg allergy is safe in children that do not manifest severe reactions after egg intake, and in children who tolerate cooked egg. The triple viral vaccine (MMR) can be given to egg-allergic children in their usual vaccination centre, with no added risk. Different medicinal products can be formulated with egg proteins, and therefore should be avoided in children with egg allergy.

Fused in Sarcoma (FUS) gene mutations are not a frequent cause of essential tremor in Europeans

FUS/TLS (denoting fused in sarcoma/translocated in liposarcoma [MIM 137070]) codifies an RNA binding protein. Mutations in this gene cause amyotrophic lateral sclerosis (ALS; MIM 608030). Essential tremor (ET [MIM 190300]) is the most frequent movement disorder. Despite its strong familiar aggregation, recently a whole exome sequencing study has identified FUS mutations as a cause of familial ET. To determine whether mutations in FUS are also common in other populations, we sequenced FUS gene in 178 unrelated Spanish subjects with ET. We detected only an intronic single-pair nucleotide deletion (c.1293-37delC), which was predicted to affect mRNA splicing. However, leukocyte mRNA analysis showed no changes in FUS expression. In conclusion, coding or splicing FUS mutations are not a frequent cause of ET in the Spanish population.

Occurrence of pharmaceutical compounds in wastewater and sludge from wastewater treatment plants: removal and ecotoxicological impact of wastewater discharges and sludge disposal

The occurrence of sixteen pharmaceutically active compounds in influent and effluent wastewater and in primary, secondary and digested sludge in one-year period has been evaluated. Solid-water partition coefficients (Kd) were calculated to evaluate the efficiency of removal of these compounds from wastewater by sorption onto sludge. The ecotoxicological risk to aquatic and terrestrial ecosystems, due to wastewater discharges to the receiving streams and to the application of digested sludge as fertilizer onto soils, was also evaluated. Twelve of the pharmaceuticals were detected in wastewater at mean concentrations from 0.1 to 32 μg/L. All the compounds found in wastewater were also found in sewage sludge, except diclofenac, at mean concentrations from 8.1 to 2206 μg/kg dm. Ibuprofen, salicylic acid, gemfibrozil and caffeine were the compounds at the highest concentrations. LogKd values were between 1.17 (naproxen) and 3.48 (carbamazepine). The highest ecotoxicological risk in effluent wastewater and digested sludge is due to ibuprofen (risk quotient (RQ): 3.2 and 4.4, respectively), 17α-ethinylestradiol (RQ: 12 and 22, respectively) and 17β-estradiol (RQ: 12 and 359, respectively). Ecotoxicological risk after wastewater discharge and sludge disposal is limited to the presence of 17β-estradiol in digested-sludge amended soil (RQ: 2.7).

Influenza A H1N1/2009 infection in pediatric solid organ transplant recipients

AIM AND METHOD

The aim of this study was to describe the clinical characteristics and outcome of pandemic influenza A H1N1/2009 (pH1N1) infection, in a retrospective cohort of pediatric patients with kidney and/or liver transplant and confirmed pH1N1 infection from June to December 2009, diagnosed in 2 Spanish teaching hospitals.

RESULTS

Forty-nine patients were included. Pneumonia was diagnosed in 4 patients (8.2%), and 3 of them required respiratory support. There were no related deaths.

CONCLUSION

Antiviral treatment within 48 h was associated with a lower likelihood of pneumonia (0/38, 0%) than treatment started after 48 h (4/11, 36.3%) (P < 0.01).

Degradation and environmental risk of surfactants after the application of compost sludge to the soil

In this work, the degradation of anionic and non-ionic surfactants in agricultural soil amended with sewage sludge is reported. The compounds analysed were: linear alkylbenzene sulphonates (LAS) with a 10-13 carbon alkylic chain, and nonylphenolic compounds (NPE), including nonylphenol (NP) and nonylphenol ethoxylates with one and two ethoxy groups (NP1EO and NP2EO). The degradation studies were carried out under winter (12.7°C) and summer (22.4°C) conditions in Andalusia region. The concentration of LAS was reduced to 2% of the initial concentration 100 day after sludge-application to the soil. The half-life time measured for LAS homologues were ranged between 4 and 14days at 12.7°C and between 4 and 7 days at 22.4°C. With regard to NPE compounds, after 8 and 4days from the beginning of the experiment at 12.7 and 22.4°C, respectively, their concentration levels were increased to 6.5 and 13.5mg/kgdm (dry matter) as consequence of the degradation of nonylphenol polyethoxylates. These concentration levels were reduced to 5% after 63 and 70 days for 12.7°C and 22.4°C, respectively. The half-life times measured for NPEs were from 8 to 16 days at 12.7°C and from 8 to 18 days at 22.4°C. Environmental risk assessment revealed that for LAS homologues no environment risk could be expected after 7 and 8 days of sludge application to the soil for 22.4 and 12.7°C, respectively; however, potential toxic effects could be observed for the nonylphenolic compounds during the first 56 days after sludge application to the soil.