BackgroundDelayed diagnosis of critical congenital heart disease (CCHD) carries a serious risk of mortality, morbidity, and handicap. As echocardiography is commonly used to diagnose congenital heart disease (CHD), echocardiographic investigations in newborns may be helpful in detecting CCHD earlier and with higher sensitivity than when using other screening methods. The present study aimed to evaluate the effectiveness of echocardiographic screening for CCHD in a tertiary care center.MethodsA retrospective chart review was conducted among newborns delivered at Hamamatsu University Hospital between June 2009 and May 2016. The study included consecutive newborns who underwent early echocardiographic screening (within the first 5 days of life) performed by pediatric cardiologists, were born at ≥36 weeks of gestation, had a birthweight ≥2300 g, and were cared for in the well-baby nursery. Newborns admitted to the neonatal intensive care unit, as well as those with prenatal diagnosis of CHD and/or clinical symptoms or signs of CHD were excluded. Four CHD outcome categories were defined: critical, serious, clinically significant, and clinically non-significant.ResultsA total of 4082 live newborns were delivered during the study period. Of 3434 newborns who met the inclusion criteria and had complete echocardiography data, 104 (3.0%) were diagnosed as having CHD. Among these, none was initially diagnosed as having critical or serious CHD. Of the 95 newborns who continued follow-up with a cardiologist, 61 (64%) were determined to have non-significant CHDs that resolved within 6 months of life. Review of excluded newborns revealed nine cases of critical or serious CHD; among these newborns, six were diagnosed prenatally and three had some clinical signs of CHD prior to hospital discharge.ConclusionsIn our tertiary care center, echocardiography screening within the first 5 days of life did not help improve CCHD detection rate in newborns without prenatal diagnosis or clinical signs of CHD. Echocardiographic screening may be associated with increased rate of false-positives (defects resulting in clinically non-significant CHDs) in newborns without prenatal diagnosis or suspicion of CHD.

To establish whether serum bilirubin levels vary in healthy term neonates according to seasonal variations and meteorological factors, we retrospectively studied 3344 healthy term neonates born between 2013 and 2018. Total serum bilirubin (TSB) levels were measured on the fourth day after birth. The monthly and seasonal variations in TSB levels and clinical and meteorological effects on TSB levels were assessed. In the enrolled neonates, the median TSB level was 195 µmol/L. The TSB level peaked in December and was the lowest in July, but the variation was not statistically significant. The TSB level was significantly higher in the cold (October to March) than in the warm season (April to September; p = 0.01). The comparison between seasonal differences according to sex showed TSB levels were significantly higher in the cold than in the warm season in male infants (p = 0.001), whereas no significant difference was observed in female infants. A weakly negative but significant association existed between TSB levels and the mean daily air temperature (r = −0.07, p = 0.007) in only the male population; the female population showed no significant correlation between TSB levels and meteorological parameters. The season of birth is an etiological factor in neonatal jaundice, with an additional influence from sex.

Background: Neonatal jaundice can be influenced by many factors. Several studies have suggested that the severity of neonatal jaundice may vary with the season, but conclusive data on this issue are currently lacking. The aim of the present study was to establish whether serum bilirubin levels vary in healthy term neonates according to seasonal variation and meteorological factors.Methods: We retrospectively studied 3,344 healthy term neonates born between 2013 and 2018. Using the capillary technique, total serum bilirubin (TSB) levels were measured on the fourth day after birth. The monthly and seasonal variations in TSB levels and clinical and meteorological effects on TSB levels were assessed.Results: In the enrolled neonates, the median gestational age was 39.4 weeks, median birthweight was 3,025 g, and median TSB level was 195 µmol/L. The TSB level peaked in December and was the lowest in July, but the variation was not statistically significant. The TSB level was significantly higher in the cold season (October to March) than in the warm season (April to September; p=0.01). Comparing the seasonal differences according to sex, TSB levels were significantly higher in the cold season in male infants (p=0.001), whereas no significant difference was observed in female infants. In only the male population did a weakly negative but significant association exist between TSB levels and daily mean air temperature (r=-0.07, p=0.007); in the female population, no significant correlation was found between TSB levels and meteorological parameters.Conclusions: Season of birth appears to be an etiological factor in neonatal jaundice, with an additional influence of sex. However, the contradictions observed in various studies highlight the need for further research on this topic.

Background: Although axillary lymph node (AxLN) status, the most important prognostic factor in primary breast cancer patients, is used to tailor systemic therapy, precise staging of AxLN status before primary systemic therapy remains difficult. Sophisticated computational tools, especially nomograms, are used to predict the AxLN status. However, their prediction ability is limited by the requirement for datasets without any defects and their ability to deal with only a limited number of features. The aim of this study was to develop a novel mathematical algorithm to predict the AxLN status that can handle datasets with a large number of features containing missing values as are frequently observed in clinical datasets. Methods: Pathological-, physical-, and diagnostic-image features (mammography and ultrasonography) from patients with primary invasive breast cancer who initially underwent sentinel lymph node biopsy or had undergone axillary lymph node dissection were used for training (n=168). Data resampling, feature-selection based on a support vector machine, an alternative decision tree (ADTree), and data ensemble methods were integrated to predict AxLN metastasis from the large number of clinicopathological variables. Even in the absence of data points, the ADTree method can be used to calculate a certain range of classification probabilities. After development of the prediction model, we validated the model using an independent validation dataset (n=56). Results: The developed model contained 14 variables and exhibited high accuracy; the area under the receiver operating characteristics curve was 0.89 (95% CI, 0.84 — 0.94) and 0.86 (95% CI, 0.76 — 0.95) for the training-and validation dataset, respectively. Bootstrap analyses yielded 0.90 ± 0.026 for training and 0.85 ± 0.053 for validation; the missing value replacement test showed 0.86 ± 0.011 for training and 0.83 ± 0.020 for validation. Conclusions: The model permitted the accurate prediction of AxLN metastasis even in datasets with missing values. Furthermore, it incorporates a combination of clinicopathological variables that can be obtained non-invasively for their prediction. Thus, it may become a valuable tool for the development of treatment strategies. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-21.

Purpose: This study aimed to determine the effects of the relationship between rumination patterns and social support on menopausal symptoms in breast cancer patients receiving adjuvant hormonal therapy. Methods:The cross-sectional study included 160 patients aged 20 and above with breast cancer receiving adjuvant hormonal therapy, who visited one of the two hospitals identified for the study. Patients were divided into two groups based on their age: 54 years old or less and 55 years old or more. Rumination patterns (Expanded Response Styles Questionnaire), social support (Social Support Scale by Fukuoka, 2000), menopausal symptoms (simplified menopause index: SMI), and basic attributes were assessed using written questionnaires.Results: The study reply rate was 82.5%, and the valid response rate was 78.8%. Mean differences of SMI scores were found between the age groups. Weak or moderate correlations were found between negative rumination and SMI in each age group using multiple group analysis. The results indicated that negative rumination decreased the perception of social support in the younger group. On the other hand, facing the fact of rumination was correlated with more social support in the older group.Conclusion: Patients should be provided appropriate support based on age and rumination patterns and encouraged to receive social support. Confirmation of the availability of support for each patient is necessary.