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PubMed2001

Prognostic Significance of the Labeling of Adnab-9 in Pancreatic Intraductal Papillary Mucinous Neoplasms.

First described as a distinct entity in the early1980s (1), pancreatic ductal neoplasms with mucinhypersecretion have been increasingly recognized.This motivated the World Health Organization(WHO) reclassification proposal in 1996 (2), which separated them from mucinous cystic neoplasms.These tumors are now (3) termed intraductal papillarymucinous neoplasms (IPMN). Despite a burgeoningvolume of recent literature devoted to thiscondition, little is known of the pathogenesis ofIPMN,which is believed to constitute 10% of mucinproducingpancreatic tumors and 1% of pancreaticcancers (4). IPMN presents diagnostic and therapeuticchallenges to the clinician because it representsa histologic spectrum of morphology, from thebenign adenoma to invasive carcinoma. The initialhistological and morphological features of IPMN oftenunderestimate its invasive potential (5), and may notaccurately predict survival. Conversely, it may oftenbe difficult to differentiate benign from malignantlesions (5-7). In the most advanced stages, when aninvasive carcinoma is present, IPMN can be indistinguishablefrom common pancreatic ductal cancer(PC), yet with aggressive surgical management, theprognosis for patients with IPMN is far better (6,7).The availability of a prognostic indicator, independentfrom the pathological stage, may help to directtherapy.

Journal Article↗
PubMed1992

[Borderline between Hodgkin and non-Hodgkin lymphomas with unfavorable clinical course: a clinical, histological and immunohistochemical analysis of 33 cases within the German Hodgkin Lymphoma Study].

Reevaluation of diagnostic biopsies from 502 patients who entered the German Hodgkin Therapy trial was performed by a panel of four pathologists. Classification revealed 90% of unambiguous Hodgkin-lymphomas (HL), 1.6% of Non-Hodgkin-lymphomas (NHL) and 8.4% of cases difficult to evaluate, reflecting to the well-known problem of the border between these 2 groups of lymphoma. As these cases had the worst prognosis, a second attempt of reclassification, including immunohistochemical studies, was made, resulting in final classifying of 25% of these cases as NHL, 50% as HL, and 25% as further unclassifiable. The most common differential diagnostic problem was separating pleomorphic nodular sclerosing HL from large cell NHL's and HL with rather few Hodgkin- or Reed-Sternberg-cells from Lennerts lymphoma or angioimmunoblastic lymphadenopathy. Immunohistochemistry was helpful for the differential diagnostic decisions in these individual cases. A very high percentage of these problem cases had initially entered the trial as lymphocyte depleted HL, and the large majority of deaths came from the large cell NHL group.

Diagnosis, Differential↗
PubMed2003

Performance indicators and validity of serum fructosamine assay as a diagnostic test in a screening program for diabetes mellitus.

OBJECTIVE: To evaluate the performance indicators and validity of fructosamine assay as a diagnostic tool in screening for Diabetes mellitus (DM). METHODS: Fasting plasma glucose (FPG) and serum fructosamine (FA) were compared in 1015 subjects aged >or= 25 years from different urban and rural areas in Mosul city, Northern Iraq. The subjects were classified into 5 groups: Group 1: Subjects with FPG < 6.1 mmol/L (n=883), Group 2: Subjects with impaired FPG 6.1-6.9 mmol/L (n=29), Group 3: New diabetics diagnosed solely by new 1997 American Diabetes Association (ADA) criteria with FPG 7.0-7.7 mmol/L (n=20), Group 4: New diabetics diagnosed according to old 1980-1985 World Health Organization (WHO) criteria with FPG >or= 7.8 mmol/L (n=23), and Group 5: Known diabetics (n=60). Subjects in groups 2 and 3 underwent a standard 75 gm oral glucose tolerance test (OGTT) as recommended by the WHO. Reclassification of subjects into 3 groups according to FPG or 2hPG, or both was carried out for all subjects. Group A (non-diabetics): Subjects with FPG < 6.1 mmol/L or 2hPG < 7.8 mmol/L, or both (n=910). Group B (Diabetics): Subjects with FPG >or= 7.8 mmol/L or 2hPG >or= 11.1 mmol/L, or both (n=92) including 60 known diabetics in group 5 and 23 new diabetics in group 4 in addition to 2 subjects in group 2 and 7 subjects in group 3. Group C (impaired glucose tolerance, IGT): Subjects with 2hPG between 7.8-11.1 mmol/L (n=13). RESULTS: Having all subjects had their serum FA being measured; the Receiver Operator Characteristic (ROC) curve was constructed on the data to determine the trade off between sensitivity and specificity of the FA test in the diagnosis of DM. This construction decided that serum FA value of 2.65 mmol/L would be the cutoff point, or the positivity criterion in the calculation of the validity parameters of FA test. Of 910 non-diabetics, 886 subjects had measured FA values within the 95th percentile, while 24 had FA higher than the cutoff point. Consequently, FA in non-diabetics yielded 886 (true negatives) and 24 (false positives). Of the 92 diabetics, 30 subjects had normal FA values, while 62 diabetics showed FA higher than the cutoff point. Consequently, FA in diabetics yielded 30 (false negatives) and 62 (true positives). Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate, positive likelihood ratio and negative likelihood ratio were 67.3%, 97.3%, 72.3%, 96.7%, 94.6%, 26 and 2.99. A highly significant correlation was observed between FPG and measured FA in non-diabetics (r=0.85, p<0.0001) and diabetics (r=0.92, p<0.0001). No significant correlation was observed between serum FA and albumin in non-diabetics (r= 0.14, p>0.05) and diabetics (r=0.08, p>0.05). CONCLUSION: Fructosamine test shows a moderate sensitivity with a high specificity as a diagnostic test for diabetes mellitus. The considerable overlap between diabetics and non-diabetics limit its usefulness. It is recommended that fructosamine test is not a suitable screening test for the disease. Measurement of plasma glucose (fasting or post-OGTT) remains the corner stone as a diagnostic test.

Adult↗
PubMed2003

[New fungal classification and their applications in medicine].

Fungi are gaining importance with the increased incidence of invasive, often fatal mycoses, in immunocompromised patients. In addition, the increased number of emerging opportunistic pathogens has prompted interest in studies pertaining to fungal classification. The traditional methods of identification and classification of these microorganisms are based on the morphology of the sexual and asexual reproductive structures. Recently, this system of classification has been shown incongruent with approaches that better establish phylogenetic relationships among these organisms. Novel aspects of fungal reclassification are described as follows: 1) the position of fungi in the historical classification systems, 2) the recognition of their polyphyly, based on comparative studies of nucleic acid sequences and on analysis of descent lines and, 3) the contribution of molecular phylogeny to medical mycology, including identification of mycotic agents, their molecular epidemiology, prevention of infection and methods of diagnosis.

Fungi↗
PubMed1992

Elliptic Fourier analysis of megakaryocyte nuclei in chronic myeloproliferative disorders.

Elliptic Fourier analysis was applied to megakaryocyte nuclei in bone marrow biopsies from 15 patients with chronic myelocytic leukemia with megakaryocyte predominance and from 15 patients with chronic megakaryocytic granulocytic myelosis. To assess the reliability of this procedure, the biopsies were evaluated also by the semiautomatic measurement of nuclear area and form factor, and both methods were compared with respect to the degree of morphologic differences obtained between these two types of chronic myeloproliferative disorders (CMPDs). Discriminant analysis revealed correct reclassification of all cases both for elliptic Fourier analysis and for semiautomatic planimetry, whereas discriminant scores were much higher for Fourier analysis. Thus, simple planimetric features such as nuclear area and form factor, in contrast to Fourier analysis, are not able to detect the full degree of morphologic differences between megakaryocyte nuclei in different CMPDs. Elliptic Fourier analysis therefore seems to be a useful procedure for the accurate description of such complicated structures as megakaryocyte nuclei in CMPD.

Analysis of Variance↗
PubMed1992

[Immunogenetic and molecular genetic studies on ocular diseases].

The immunogenetic mechanisms of various ocular diseases were investigated utilizing recently developed molecular biological and molecular genetic techniques. It was revealed that HLA-B 51 was closely associated with Behçet's disease. Investigation of genetic polymorphism of TNF-beta (tumor necrosis factor-beta) showed that 95% of Behçet's disease patients had the 10.5 kbp Nco I fragment. It was therefore concluded that the gene of susceptibility to Behçet's disease is located between HLA-B and TNF-beta loci on the short arm of chromosome 6. Similar studies of HLA-DNA typing in Harada's disease frequently seen in Japan showed that frequencies of HLA-DRB1 * 0405, HLA-DQA1 * 0301 and HLA-DQB1 * 0401 were significantly increased in patients compared with normal controls. These data suggested that those who have serine at position 57 of HLA-DR, glutamic acid at position 70 and aspertic acid at position 71 of HLA-DQ respond to certain unknown agents significantly more than those without them, thus leading to the development of Harada's disease. The same HLA association was observed between Harada's disease and sympathetic ophthalmia, and the immunogenetic mechanism was thought to be similar in both diseases. Recent immunogenetic and molecular genetic investigations on various ocular diseases have shed new light not only on the genetic individual susceptibility and biased racial differences, but also on the diagnosis of the ocular diseases, reclassification of disease entities according to HLA associations, and judgement of disease prognosis. Further progress of molecular medicine may make it possible to treat various intractable ocular diseases by gene therapy in the near future.

Amino Acid Sequence↗
PubMed1992

Early ontogeny of vocal behavior of Japanese infants in response to maternal speech.

Discriminant analysis was used to distinguish statistically between the comfort-state vocalizations uttered by Japanese infants following 5 different types of pitch contours of maternal speech. Ontogenetic changes of their vocal behaviors were investigated during the first 5 months of life. Structural variability in infant vocalizations across variants of maternal speech was found to be characterized by a set of quantifiable physical parameters. However, infant's age when a vocalization was recorded was not an important contributor. Successful attempts at cross-validation, in which the discriminant profiles derived from one sample of vocalizations were used to classify a second set of vocalizations, indicated that the result obtained was not an artifact of using the same data set to derive the profiles to test reclassification accuracy. Proportion of cross-validated vocalizations that were misclassified decreased as age increased. The results of the present study demonstrate that a statistically significant relation exists between acoustic features of maternal speech and those of following infant vocalizations, and that such a relation strengthens over age.

Female↗
PubMed1992

Computer-aided classification of malignancy in astrocytomas. I. The value of nuclear parameters obtained by automated black and white image analysis.

Ninety-three selected cases of astrocytomas including glioblastomas (astrocytomas grades 1-4) were evaluated by means of Feulgen-stained microscopic slides for nuclear parameters obtained by automated black and white image analysis (ABWIA). The goal was to determine to what extent nuclear features evaluated by ABWIA were applicable as classifiers for the computer-aided numerical classification of malignancy in astrocytomas. Before the automated evaluation, all tumours had been subjectively graded according to the Mayo Clinic grading rules as delineated by Ringertz. Twenty-three nuclear parameters were evaluated and tested for their classification impact. With a model of five parameters (number of nuclei per area, mean of the convex form factor, extinction sum, extinction variation, and full-width-half-maximum of the extinction distribution) the highest reclassification rate of 75% correctly reclassified cases was obtained. Although this is a good result for a classification using only nuclear parameters, it is too poor for practical application. Thus, nuclear parameters evaluated by ABWIA alone are insufficient for numerical classification models assessing the malignant expression of astrocytomas.

Astrocytoma↗
PubMed2004

Glutamine: metabolism and application in nutrition support.

Glutamine is the most abundant free amino acid in the body. It is avidly consumed by rapidly dividing cells, such as those lining the gut, because its 5-carbon skeleton can provide energy whilst the nitrogen molecules support the synthesis of nucleic acids. Patients who are maintained using conventional solutions of parenteral nutrients become depleted in glutamine, which has led to the reclassification of glutamine as a conditionally essential nutrient. Unfortunately, glutamine is unstable in solution and produces toxic byproducts on decomposition. This means that solutions of nutrients containing glutamine have a relatively short half-life, which has led to the commercialisation of stable dipeptides containing glutamine. Although it is evident that glutamine enhances nitrogen metabolism, there is a lack of consistent evidence from the initial clinical trials demonstrating that supplementation with glutamine has specific clinical advantages. The next few years will witness the performance of larger scale clinical trials and the results of these studies should define a more certain role for glutamine in routine clinical practice.

Drug Stability↗
PubMed2004

[Drug-resistant partial epilepsy: medico-social aspects of adults in France].

In this article, we describe the social and economic aspects of adult epileptic patients in France. The different measures to facilitate their reintegration and employment are presented. The missions of the COTOREP (Technical Commission for Professional Orientation and Reclassification) include the identification of a disability rate, the recognition of status as a disabled worker, and orientation to an individually adapted job, e.g. in a specialized center. The COTOREP provides information and training. For patients with major disabilities, the commission can decide on admission in a specialized institution. The COTOREP but also the French national Social Security propose allocations and financial assistance for patients with low income or who have a work inaptitude. In this text, we also describe the general French laws for the protection of adult patients which include measures not specific for epileptic patients.

Adult↗
PubMedDate not supplied

Serum TSH variability in normal individuals: the influence of time of sample collection.

Difficulty in treatment decisions can arise when TSH levels measured on the same patient on the same day but at different times show considerable variability. This study was a prospective, observational evaluation of 100 consecutive adult patients who had serum TSH tests ordered by attending physicians at an outpatient clinic. Early morning fasting serum TSH levels were compared to late morning non-fasting serum TSH levels in the same patients on the same day The late morning non-fasting TSH tests declined in 97 of 100 subjects by an average of 26.39% when compared to early morning, fasting, TSH test results. This lead to reclassification of 6% of patients from presumptive subclinical hypothyroidism to "normal." Since the time of day of phlebotomy or the fasting or non-fasting status of the patient, or both, can significantly affect serum TSH test results, the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement. Further studies are needed to determine the independent effects of the time of phlebotomy and fasting/non-fasting status on TSH levels.

Aged↗
PubMedDate not supplied

[Determination of species belonging to the Lactobacillus genus with the use of RAPD-typing].

The numeric analysis of 14 strains of lactobacilli investigated by 57 phenotypical characteristics, has resulted in formation of three clusters: group L. delbrueckii, L. plantarum and the modular group formed by strains of various species. The API-testing, 16S rRNA sequencing and RAPD-typing with primers 5'-AGCAGCGTGG-3' and LP3-ST 5'-TGGTCCGAGC-3' have been carried out for several strains which position in a dendrogram did not correspond to their species diagnosis. The obtained data have allowed the reclassification of the strain L. delbrueckii subsp. bulgaricus B-1923T as L. plantarum B-1923T, L. agilis B-2603 as L. fermentum B-2603, L. amylophilus 30/4/(2) as L. plantarum 30/4/(2). Strain L. confusus 39T, identified by the phenotypical characteristics and data of API-testing as L. fermenturm, was reclassified on the basis of the phylogenetic analysis and RAPD-typing, as L. pentosus 39T.

Bacterial Typing Techniques↗
PubMed2001

A method for classification of HIV exposure category for women without HIV risk information.

An increasing number of cases of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among women is reported to state and territorial health departments without exposure risk information (i.e., no documented exposure to HIV through any of the recognized routes of HIV transmission). Because surveillance data are used to plan prevention and other services for HIV-infected persons, developing methods to accurately estimate exposure risk for HIV and AIDS cases initially reported without risk information and assisting states to analyze and interpret trends in the HIV epidemic by exposure risk category is important. In this report, a classification model using discriminant function analysis is described. The purpose of the classification model is to develop a proportionate distribution of exposure risk category for cases among women reported without risk information. The distribution was estimated based on behavioral and demographic data obtained from interviews with HIV-infected women; the interviews were conducted in 12 states during 1993-1996. Variables used in the analysis were alcohol abuse, noninjection-drug use, and crack use; year of HIV/AIDS diagnosis; age; employment; and region. As a result of the classification procedure, nearly all cases among women with no reported risk were classified into an exposure risk category: 81%, heterosexual contact; and 16%, injection-drug use. These proportions are higher than the current redistribution fractions (calculated from risk reclassification patterns and weighted by demographic characteristics) and reflect the increasing proportion of cases among women attributable to heterosexual contact with an infected partner. This report provides one method that could be applied to HIV surveillance data at the national level to estimate the proportion of cases in exposure risk categories. However, because the study in this report is limited in sample size and geographic representativeness, other models are also needed for adjusting risk exposure data at the national, state, and local levels.

Adult↗
PubMed2005

Molecular diagnosis of synovial sarcoma: RT-PCR detection of SYT-SSX1/2 fusion transcripts in paraffin-embedded tissue.

BACKGROUND: Synovial sarcomas comprise up to 10 percent of malignant soft tissue tumors, and most are characterized by the chromosomal translocation t(X;18) (pl 1.2;q11.2), which results in the expression of SYT-SSX fusion transcripts. These tumors include two major histological subtypes, biphasic and monophasic. Diagnosing biphasic synovial sarcomas does not usually pose a problem, whereas the monophasic spindle-cell form can be difficult to distinguish from other spindle-cell neoplasms using histological and immunohistochemical profiles only. MATERIAL/METHODS: We investigated the presence of SYT-SSX1/2 chimeric RNA in tumors from 7 patients. We applied amplification of the specific fusion transcripts by reverse transcriptase-polymerase chain reaction (RT-PCR) in fresh, frozen tumors. We also developed a method useful for RT-PCR SYT-SSX fusion transcript detection in formalin-fixed, paraffin-embedded tissue. RESULTS: We found that both histological subtypes of synovial sarcoma were SYT-SSX positive. Moreover, we observed a correlation between histological subtype and type of SYT-SSX fusion transcript. Biphasic synovial sarcoma expressed the SYT-SSX1 fusion transcript, whereas the monophasic subtype expressed the SYT-SSX2 fusion transcript. CONCLUSIONS: The detection of SYT-SSX1/2 fusion transcripts by RT-PCR is a valuable diagnostic marker of synovial sarcoma which can be used for the reclassification of cases whose diagnosis is difficult by routine methods.

Adult↗
PubMed2005

Detection of occult high graded microsatellite instabilities in MMR gene mutation negative HNPCC tumors by addition of complementary marker analysis.

BACKGROUND: Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant tumor syndrome predisposing to predominantly colorectal and endometrial cancer. In 90% of the cases, molecular analyses reveal microsatellite instabilities due to germline mutations in DNA mismatch repair (MMR) genes, mainly MLH1, MSH2, among these tumors. PATIENTS AND METHODS: Tumors from 40 HNPCC index patients (31 Amsterdam positive, 9 Bethesda positive; 21 females, 19 males; mean age 48.0 +/- 13.2 years) were examined. In contrast to the classical constellation, their tumors revealed only a microsatellite stable (MSS, n=31)--or low instable (MSI-L, n=9)--tumor phenotype following the international reference panel of 5 microsatellites. No MLH1 and MSH2 mutations were detectable. Complementary microsatellites (BAT40, D10S197, D13S153, D18S58, MYCL1) were investigated by PCR and fragment analysis to find other instabilities which might hint to the MIN-pathway of the tumors. RESULTS: Due to ten microsatellites in total tumors were now reclassified in 4 MSI-H (10%), 24 MSI-L (60%) and 12 in MSS (30%) phenotypes. The mean age of onset for CRCs was the lowest in the MSI-H group with 45.7 +/- 9.6 years (vs. 48.7 +/- 14.3 and 49.0 +/- 12.9 years in MSI-L and MSS group). MSI-H-and MSI-L tumors were often localized in the proximal colon (50 and 52%), whereas MSS tumors were preferentially localized in the distal colon (77%). - CONCLUSION: Complementary microsatellites help to subdive "non-classical" HNPCC in subgroups with different clinical appearance. It allows to detect occult MSI-H tumors with up to 10% and to confirm MSS tumors who seem to have a similar biological behaviour like sporadic CRC. Maybe that this genetic reclassification influence the decision of whether to offer patients chemotherapy or not, since it is known that patients with instable tumors do not benefit from chemotherapy as well as patients with microsatellite stable tumors.

Base Pair Mismatch↗
PubMed1992

Moderate head injury: an overview.

This review summarizes currently available epidemiologic, clinical, pathologic, and outcome data in patients with moderate head injury (MHI, GCS 9-12). This important subset comprises about 20% of head injuries in the United States. Affected patients usually are young, and most injuries are due to vehicular accidents. Current evidence (mortality rate and outcome) from various studies suggests an apparent dichotomy within the MHI category (9-10 vs 11-12). The former is more in keeping with the favorable subgroup of severe head injuries, and the latter is more appropriate to the mild head injury group. Should there be a reclassification based on this dichotomy? This is obviously important for clinical management and prognostication in these patients. The experimental evidence for a pathologic and biochemical substrate of MHI is reviewed. It is becoming increasing evident that biochemical mediators of secondary neuronal injury in MHI are at least as important as those attributed to severe head injury, but MHI may be more amenable to therapy. It may be prudent, therefore, to direct further effort to this subgroup of patients. Although additional study is required, the pattern of recovery in MHI as determined by extant neurobehavioral studies is analyzed.

Accidents, Traffic↗
PubMed2005

Mobile-bearing knee systems: ultra-high molecular weight polyethylene wear and design issues.

In June 2004, the U.S. Food and Drug Administration Orthopaedic Advisory Panel recommended the reclassification of mobile-bearing knee systems for general use. This reflects the increasing use of mobile-bearing knee systems internationally, which is currently limited in the United States by regulatory requirement. Mobile-bearing knee systems are distinguished from conventional, fixed-plateau systems in that they allow dual-surface articulation between an ultra-high molecular weight polyethylene insert and metallic femoral and tibial tray components. Their in vivo success is dependent on patient selection, design, and material choice, as well as surgical precision during implantation. Laboratory and clinical experience extending over 25 years with individual systems suggests that mobile-bearing knee systems represent a viable treatment option for patients with knee arthrosis.

Arthroplasty, Replacement, Knee↗
PubMed2005

A sarcoidosis genetic linkage consortium: the sarcoidosis genetic analysis (SAGA) study.

BACKGROUND: Sarcoidosis, a systemic granulomatous disease of unknown etiology, likely results from an environmental insult in a genetically susceptible host. In the United States of America, African Americans have a higher sarcoidosis incidence and suffer greater morbidity than Caucasians. METHODS: A sarcoidosis genetic linkage study consortium was established to recruit African-American affected sib pair (ASP) families to identify chromosomal regions that may harbor sarcoidosis susceptibility genes and to determine if environmental factors modify any genetic effects. RESULTS: We successfully met our goal of enrolling 359 ASPs using a multifaceted recruitment approach. In the total 559 sib pairs that were enrolled, genetic analyses revealed incorrectly specified relationships that required reclassification or removal from the analysis dataset of 10.4% of reported full and 1.4% of reported half sib pairs. The final study sample comprised 415 full and 104 half sib pairs with complete data. This included 338 ASPs. Within sib pairs, affection status was not associated with sex. Only 15 per cent of the 229 families had three or more affected sibs, but they contributed 42 per cent of the ASP total. CONCLUSIONS: The SAGA study experience should provide useful lessons and information to serve others in conducting genetic studies of complex diseases in African-American families.

Black or African American↗