Ultrasound assessment of cervical status compared to the Bishop score - predicting the success of labor induction using a machine learning-based model.

OBJECTIVE: The main aim of this study was to develop a machine-learning-based model for predicting the success of labor induction (IOL). To that end, the clinical and ultrasound parameters that affect the successfulness of labor induction were assessed. Then, a new ultrasound scoring system (USS) was developed and assessed. PATIENTS AND METHODS: This prospective observational study included 192 term women who underwent induction of labor. First, a wide range of clinical and ultrasound pre-induction parameters were recorded. The induction was initiated by endocervical administration of dinoprostone gel (for Bishop score ≤5) or intravenous oxytocin (for Bishop score ≥6). After evaluating ultrasound parameters, we created an ultrasound scoring system and compared it with the Bishop score and clinical parameters. Finally, a comprehensive model using machine learning algorithms for predicting the success of the induction of labor was developed. RESULTS: In terms of clinical parameters, this study found that IOL correlates with parity, body mass index (BMI) (both at p<0.05), and the Bishop score (p<0.001). All ultrasound parameters were statistically significant (p<0.05) apart from the posterior cervical angle. However, compared to the Bishop score, the new USS showed a slightly lower sensitivity (0.55 compared to 0.64) but much higher specificity (0.75 compared to 0.44) at a cut-off of 1.66. The proposed model, which can predict 83% of the events correctly, encompasses the Bishop score, USS, and clinical parameters. CONCLUSIONS: The findings imply that the model developed in this study, which takes into account clinical parameters (parity, BMI), the ultrasound parameters and the Bishop score and uses machine learning algorithms, yields better results than models using other parameters.

Nipple-sparing mastectomy in patients with BRCA1/2 mutations and variants of uncertain significance.

BACKGROUND: Nipple-sparing mastectomy (NSM) is associated with improved cosmesis and is being performed increasingly. Its role in BRCA mutation carriers has not been well described. This was a study of the indications for, and outcomes of, NSM in BRCA mutation carriers. METHODS: BRCA mutation carriers who underwent NSM were identified. Details of patient demographics, surgical procedures, complications, and relevant disease stage and follow-up were recorded. RESULTS: A total of 177 NSMs were performed in 89 BRCA mutation carriers between September 2005 and December 2013. Twenty-six patients of median age 41 years had NSM for early-stage breast cancer and a contralateral prophylactic mastectomy. Mean tumour size was 1·4 (range 0·1-3·5) cm. Sixty-three patients of median age 39 years had prophylactic NSM, eight of whom had an incidental diagnosis of ductal carcinoma in situ. There were no local or regional recurrences in the 26 patients with breast cancer at a median follow-up of 28 (i.q.r. 15-43) months. There were no newly diagnosed breast cancers in the 63 patients undergoing prophylactic NSM at a median follow-up of 26 (11-42) months. All patients had immediate breast reconstruction. Five patients (6 per cent) required subsequent excision of the nipple-areola complex for oncological or other reasons. Skin desquamation occurred in 68 (38·4 per cent) of the 177 breasts, and most resolved without intervention. Debridement was required in 13 (7·3 per cent) of the 177 breasts, and tissue-expander or implant removal was necessary in six instances (3·4 per cent). CONCLUSION: NSM is an acceptable choice for patients with BRCA mutations, with no evidence of compromise to oncological safety at short-term follow-up. Complication rates were acceptable, and subsequent excision of the nipple-areola complex was rarely required.

Follow-up in colorectal cancer patients: a cost-benefit analysis.

BACKGROUND: No conclusive evidence exists concerning the effectiveness of follow-up programs after curative surgery for colorectal cancer, and presently cost-benefit analyses have not indicated that follow-up strategies increase survival or quality of life. METHODS: Five hundred five patients who survived curative surgery for stage I-III colorectal adenocarcinoma were closely followed for at least 4 years. RESULTS: One hundred forty-one (28%) patients had recurrence. Of these, 32 underwent one or more surgical procedures for cure, whereas 109 could only benefit from palliation. Eighteen were cured. The mean survival of all recurrent cases was 44.4 months. Of those operated on with curative intent, the mean survival was 69.3 months compared with 37.1 months in those operated on with palliative intent. Of those 18 patients who were cured by reoperative surgery, the average survival was 81.4 months. The overall follow-up cost was $1,914,900 (U.S.) for the 505 patients; $13,580 (U.S.) for each recurrence, $59,841 (U.S.) for each case treated for cure, and $136,779 (U.S.) for those effectively cured. CONCLUSIONS: Careful postoperative monitoring is expensive yet effective when one considers that one-quarter of the detected recurrences were suitable for potentially curative second surgery; however, only 3.6% of the original group were effectively cured. Follow-up programs should be tailored according to the stage and site of the primary to reduce costs.

Laparoscopic cholecystectomy in the inner-city hospital.

Laparoscopic cholecystectomy (LCCY) has become the treatment of choice for patients undergoing elective CCY. Inner-city hospitals treat a large number of patients with advanced or acute disease, and the ability to perform LCCY in this patient population is unclear. The records of the first 107 patients undergoing LCCY were reviewed. There were 96 women and 11 men with a mean age of 42 years (range 14-86 years). Twenty-seven (42%) of the patients were admitted through the emergency room and were operated upon urgently, whereas 35 (58%) underwent elective LCCY. More than two-thirds of the patients were either uninsured or covered by Medicaid. In the urgent group, 38% had gallstone pancreatitis, 41% had abnormal LFTs, and 26% had a WBC > 13,000. A total of 70% of these patients were discharged within 48 hours after LCCY. The conversion rate was 9% and was similar between urgent and elective LCCY. In summary, acute biliary tract pathology accounted for one-half of the patients undergoing LCCY in our hospital. In conclusion, LCCY can be performed in this group of patients with low morbidity, especially if the need for liberal conversion to open CCY is recognized.