Developing a core outcome set for the health outcomes for children and adults with congenital oesophageal atresia and/or tracheo-oesophageal fistula: OCELOT task group study protocol

INTRODUCTION

Heterogeneity in reported outcomes of infants with oesophageal atresia (OA) with or without tracheo-oesophageal fistula (TOF) prevents effective data pooling. Core outcome sets (COS) have been developed for many conditions to standardise outcome reporting, facilitate meta-analysis and improve the relevance of research for patients and families. Our aim is to develop an internationally-agreed, comprehensive COS for OA-TOF, relevant from birth through to transition and adulthood.

METHODS AND ANALYSIS

A long list of outcomes will be generated using (1) a systematic review of existing studies on OA-TOF and (2) qualitative research with children (patients), adults (patients) and families involving focus groups, semistructured interviews and self-reported outcome activity packs. A two-phase Delphi survey will then be completed by four key stakeholder groups: (1) patients (paediatric and adult); (2) families; (3) healthcare professionals; and (4) researchers. Phase I will include stakeholders individually rating the importance and relevance of each long-listed outcome using a 9-point Likert scale, with the option to suggest additional outcomes not already included. During phase II, stakeholders will review summarised results from phase I relative to their own initial score and then will be asked to rescore the outcome based on this information. Responses from phase II will be summarised using descriptive statistics and a predefined definition of consensus for inclusion or exclusion of outcomes. Following the Delphi process, stakeholder experts will be invited to review data at a consensus meeting and agree on a COS for OA-TOF.

ETHICS AND DISSEMINATION

Ethical approval was sought through the Health Research Authority via the Integrated Research Application System, registration no. 297026. However, approval was deemed not to be required, so study sponsorship and oversight were provided by Alder Hey Children's NHS Foundation Trust. The study has been prospectively registered with the COMET Initiative. The study will be published in an open access forum.

Functional expression of sv40 in normal human prostatic epithelial and fibroblastic cells - differentiation pattern of nontumorigenic cell-lines

To study mesenchymal-epithelial interactions associated with the normal and pathological human prostate, we have developed a model of well differentiated human prostate epithelial and fibroblastic cells. Normal human prostatic cells, either of epithelial or fibroblastic origins were successfully transfected with SV40 and strains with extended lifespan were selected until the crisis was reached, within 20 and 30 passages for the epithelial and fibroblastic cells, respectively. Only a few clones emerged from the crisis: PNT1A (Cussenot et al: J Urol 143: 881-886, 1991), PNT1B and PNT2 epithelial cell lines. Successful immortalisation was achieved only with SV40 expressing both large T and small t oncogenes, while attempts to immortalise with a vector expressing SV40 large T alone have given a few strains showing no extended lifespan and no cells which overcame the crisis. A PNT2 subclone named PNT2-LSD which developed spontaneously (less serum dependent) was selected, characterised and included in the analysed series. The epithelial cell lines displayed a differentiation pattern which has been classified as follows (from high to low): PNT2>PNT2-LSD>PNT1A>PNT1B. Differentiation features studied were (i) the colony-forming ability of the PNT2 and PNT2-LSD compared to PNT1A and PNT1B, (ii) their respective doubling time of 39, 29, 30 and 28 hours, (iii) their decreasing serum dependency, (iv) the expression of cytokeratin 19 (a feature of well differentiated luminal cells of the glandular prostate) for PNT2 and PNT2-LSD. Furthermore, the mesenchymal derived pflsv1 cells were confirmed to be of fibroblastic nature. None of the cell lines analysed showed any tumourigenicity in nude mice over a period of 12 months. Serum deprivation and direct steroid withdrawal during the culture triggered cell death by apoptosis, an event which could be overcome by EGF stimulation, particularly for the well differentiated PNT2 cells. This interesting characteristic, which is similar to the high apoptotic rate observed ipl vivo for normal prostate, particularly after castration should lead, together with the other properties of these cell lines, to a better understanding of the biology of the different cell compartments involved in the progression of prostate towards neoplasia.

Analysis of prostate tissue DNA for the presence of human papillomavirus by polymerase chain reaction, cloning, and automated sequencing

We have analysed the DNA from 24 prostate tissue biopsies, spanning a range of Gleason grading from benign to grade 5 and mixed randomly with cervical cancer samples of known human papillomavirus (HPV) status, for the prevalence of HPV DNA, in a double-blind study to ensure complete objectivity. Polymerase chain reactions (PCR) were performed using general E1 open reading frame primers for HPV under low stringency conditions, in addition to reactions containing primers specific for HPV16, E2, and E6 open reading frames under higher, more stringent PCR conditions. The presence of cellular DNA was verified by the use of primers for hypoxanthine guanine phosphoribosyl transferase. DNA bands were not detected in the prostate biopsies using the HPV16-specific primers under high-stringency PCR conditions, however a predominant band in the 400 bp region was observed in 15 of the prostate biopsies using the general primers and the low annealing temperature of 40 degrees C. This fragment was excised and cloned into the pT7 blue vector and the sequence of the insert determined. Although the cloned sequences initiated and terminated with the two authentic PCR primers, they did not contain a significant HPV-related open reading frame. Our results indicate that HPV type 16 and closely related types, as detected by the general primer pair, are unlikely initiators of prostate carcinogenesis within our population.

Cytofluorometric analysis of the DNA content in ovarian carcinoma and its relationship to patient survival

Forty-one patients with epithelial malignancies of the ovary treated at the Medical College of Wisconsin Affiliated Hospitals from 1976 to 1984 had paraffin embedded tissue available for review. Of the 41 patients, 40 had adequate material to provide 50 micron sections that were evaluated with flow cytometry to determine DNA content. Tumor- and patient-related parameters were then correlated with the results of flow cytometry. Overall survival at 5 years in these patients was 43%, and relapse-free survival was 50%. Forty percent of the tumors were diploid, and 60% were aneuploid. Five-year survival for diploid patients was 74% with a relapse-free survival of 71%. Corresponding overall and relapse-free survivals for aneuploid patients were 22% and 35%, respectively. Distribution of the patients by histology, stage, and grade was equal between the diploid and aneuploid groups. All patients were treated with whole abdominal plus concomitant pelvic boost irradiation; total doses to the whole abdomen ranged from 10 Gy to 46 Gy (1000 to 4600 cGy) with the median dose being 37.5 Gy. Approximately 40% of the patients received chemotherapy, which usually consisted of a single agent (Alkeran, Burroughs Welcome, Research Triangle Park, NC). This retrospective study of patients with ovarian cancer treated with radiation therapy suggests the possibility that determinations of DNA ploidy may be useful in selecting patients whose poor prognosis dictates that a more aggressive therapy be used.

Identification of mycobacterial infections

How accurately is it possible to distinguish different types of mycobacterial infections in human populations with the skin-test antigens available today? In this paper the authors outline some of the problems that must be faced in interpreting the results of skin tests in populations containing individuals infected with a voriety of strains, many as yet unidentified. Illustrations drawn from experimental studies in guinea-pigs show that the accuracy of identification depends on the composition of the population tested and the antigens used. Preliminary results of testing with multiple mycobacterial antigens in human populations give promise of leading eventually to recognition of the infections that are of importance in man.