Hepatopulmonary Syndrome and Portopulmonary Hypertension in Children: Recent Advances in Diagnosis and Management

Pulmonary vascular disease is an important complication of portosystemic shunting in children and adults with chronic liver diseases and cirrhosis, extrahepatic portal vein obstruction/thrombosis or congenital portosystemic shunts (CPSSs).1 Two major types of pulmonary vascular disease in this context are hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH),1 both of which may indicate the need for liver transplantation.2 The hallmark of HPS is intrapulmonary vascular dilatation (IPVD) and shunting leading to an increased alveolar-arterial gradient and, generally, hypoxemia (Table I).

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Reply

Magnetic resonance imaging (MRI) at term equivalent to predict the developmental outcome of the preterm infant has been shown consistently to be a stronger prognostic tool than cranial ultrasound examination, neurologic examination, or clinical factors. This finding relates to the fact that MRI more fully defines the extent of neuropathology, particularly white matter abnormalities, cerebellar hemorrhage, and impaired brain growth related to preterm birth. These neonatal MRI abnormalities are associated with a range of neurodevelopmental outcomes across childhood, as shown in longitudinal studies, including that by Anderson et al.

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Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

To assess neurodevelopmental outcomes among participants with biliary atresia with their native liver at ages 12 months (group 1) and 24 months (group 2), and to evaluate variables predictive of neurodevelopmental impairment.

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Potential Impact on Development: More Evidence for Risk-Appropriate Neonatal Care

Organization of regional perinatal services according to the capabilities of each facility and coordination among facilities has been considered optimal maternal and neonatal care since the publication of the first version of Toward Improving the Outcome of Pregnancy in 1976.1 The view that the outcome of preterm or ill newborns is better when their care is appropriate to their gestational age, complexity, or severity of illness is supported by the American Academy of Pediatrics through a policy statement defining levels of neonatal care; this is promoted jointly with the American College of Obstetricians and Gynecologists in Guidelines for Perinatal Care.

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A Simple, Rapid, and Quantitative Assay to Measure Repair of DNA-protein Crosslinks on Plasmids Transfected into Mammalian Cells

The goal of this protocol is to quantify the repair of defined DNA-protein crosslinks on plasmid DNA. Lesioned plasmids are transfected into recipient mammalian cell lines and low-molecular weight harvested at multiple time points post-transfection. DNA repair kinetics are quantified using strand-specific primer extension followed by qPCR.

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A Mouse Model of Intestinal Partial Obstruction

Intestinal obstructions are a partial or complete blockage of the intestine that can cause severe abdominal pain, nausea, vomiting, and preventing the passage of stool. This procedure for creating intestinal partial obsructions in mice is reliable in studying the mechanisms underlying pathological cell growth and death in the intestine.

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Clinical and economic burden associated with stage III to IV triple-negative breast cancer: A SEER-Medicare historical cohort study in elderly women in the United States

BACKGROUND

The current study was performed to describe patient characteristics, treatment patterns, survival, health care resource use (HRU), and costs among older women in the United States with advanced (American Joint Committee on Cancer stage III/IV) triple-negative breast cancer (TNBC) in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.

METHODS

Women who were aged ≥66 years at the time of diagnosis and diagnosed with advanced TNBC between January 1, 2007, and January 1, 2011, in the SEER-Medicare database and who were followed for survival through December 31, 2013, were eligible. Patient demographic and clinical characteristics at the time of diagnosis, subsequent treatment patterns, and survival outcomes were analyzed. HRU and costs for the first 3 months after diagnosis, the last 3 months of life, and the time in between are summarized. All analyses were stratified by American Joint Committee on Cancer stage of disease.

RESULTS

There were 1244 patients newly diagnosed with advanced TNBC; the majority were aged ≥75 years (61% with stage III disease and 57.4% with stage IV disease) and white (>70% of patients in both disease stage groups). The most common treatment approaches were surgery combined with chemotherapy for patients for stage III disease (50.6%) and chemotherapy alone or with radiotherapy for patients with stage IV disease (31.3%). Diverse chemotherapy regimens were administered for each line of therapy; nevertheless, the medications used were consistent with national guidelines. Patients with stage III and stage IV disease were found to have a similar mean number of hospitalizations and outpatient visits, but mean monthly costs were greater for patients with stage IV disease at all 3 time points. The mean cost per patient-month (in 2013 US dollars) was $4810 for patients with stage III disease and $9159 for patients with stage IV disease.

CONCLUSIONS

Among older women with advanced TNBC, significant treatment variations and considerable HRU and costs exist. Further research is needed to find effective treatments with which to reduce the clinical and economic burden of this disease. Cancer 2018. © 2018 American Cancer Society.

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