Early diagnosis of pancreatic cancer: neutrophil gelatinase-associated lipocalin as a marker of pancreatic intraepithelial neoplasia

Pancreatic cancer is a highly lethal malignancy with a dismal 5-year survival of less than 5%. The scarcity of early biomarkers has considerably hindered our ability to launch preventive measures for this malignancy in a timely manner. Neutrophil gelatinase-associated lipocalin (NGAL), a 24-kDa glycoprotein, was reported to be upregulated nearly 27-fold in pancreatic cancer cells compared to normal ductal cells in a microarray analysis. Given the need for biomarkers in the early diagnosis of pancreatic cancer, we investigated the expression of NGAL in tissues with the objective of examining if NGAL immunostaining could be used to identify foci of pancreatic intraepithelial neoplasia, premalignant lesions preceding invasive cancer. To examine a possible correlation between NGAL expression and the degree of differentiation, we also analysed NGAL levels in pancreatic cancer cell lines with varying grades of differentiation. Although NGAL expression was strongly upregulated in pancreatic cancer, and moderately in pancreatitis, only a weak expression could be detected in the healthy pancreas. The average composite score for adenocarcinoma (4.26+/-2.44) was significantly higher than that for the normal pancreas (1.0) or pancreatitis (1.0) (P<0.0001). Further, although both well- and moderately differentiated pancreatic cancer were positive for NGAL, poorly differentiated adenocarcinoma was uniformly negative. Importantly, NGAL expression was detected as early as the PanIN-1 stage, suggesting that it could be a marker of the earliest premalignant changes in the pancreas. Further, we examined NGAL levels in serum samples. Serum NGAL levels were above the cutoff for healthy individuals in 94% of pancreatic cancer and 62.5% each of acute and chronic pancreatitis samples. However, the difference between NGAL levels in pancreatitis and pancreatic cancer was not significant. A ROC curve analysis revealed that ELISA for NGAL is fairly accurate in distinguishing pancreatic cancer from non-cancer cases (area under curve=0.75). In conclusion, NGAL is highly expressed in early dysplastic lesions in the pancreas, suggesting a possible role as an early diagnostic marker for pancreatic cancer. Further, serum NGAL measurement could be investigated as a possible biomarker in pancreatitis and pancreatic adenocarcinoma.

A Novel Measure of Uncertainty for Mobile Robot SLAM with Rao—Blackwellized Particle Filters

Rao—Blackwellized particle filters (RBPFs) are an implementation of sequential Bayesian filtering that has been successfully applied to mobile robot simultaneous localization and mapping (SLAM) and exploration. Measuring the uncertainty of the distribution estimated by a RBPF is required for tasks such as information gain-guided exploration or detecting loop closures in nested loop environments. In this paper we propose a new measure that takes the uncertainty in both the robot path and the map into account. Our approach relies on the entropy of the expected map (EM) of the RBPF, a new variable built by integrating the map hypotheses from all of the particles. Unlike previous works that use the joint entropy of the RBPF for active exploration, our proposal is better suited to detect opportunities to close loops, a key aspect to reduce the robot path uncertainty and consequently to improve the quality of the maps being built. We provide a theoretical discussion and experimental results with real data that support our claims.

Deficient lower-segment Cesarean section scars: prevalence and risk factors

OBJECTIVE

To examine the sonographic features of transverse lower-segment uterine Cesarean section scars in non-pregnant, premenopausal women and to identify factors associated with scar deficiency.

METHODS

Non-pregnant, premenopausal women with histories of previous transverse lower-segment Cesarean sections, who were referred for an ultrasound scan for a variety of gynecological indications, were included in this study. An attempt was made to identify the uterine scars on transvaginal ultrasound scan and to describe their locations and morphological features. Various demographic, clinical and ultrasound data were examined in order to identify factors associated with deficient scars. Deficient scars were defined as detectable myometrial thinning at the site of the Cesarean section scar.

RESULTS

Lower-segment uterine scars were detected in 321/324 (99.1%; 95% CI, 98.0-100) women with a history of previous Cesarean section. Sixty-three (19.4%; 95% CI, 15.1-23.8) women had evidence of deficient Cesarean scars. Using multivariate analysis, a history of multiple Cesarean sections, uterine retroflexion and the inability to visualize all Cesarean scars in women with previous multiple Cesarean sections were all shown to be significantly associated with deficient scars.

CONCLUSION

Deficient uterine scars are a frequent finding in women with a history of previous Cesarean section. The risk of scar deficiency is increased in women with a retroflexed uterus and in those who have undergone multiple Cesarean sections.

[Knowledge and attitude of primary health care doctors in the treatment of community-acquired infections]

The aim of this study was to evaluate the knowledge and attitude of the doctors who attend patients with community-acquired infections and who are responsible for most of the antibiotic prescriptions in primary health care. At the same time, the evolution experienced in the last ten years in relation to the main parameters analyzed was studied. The study was conducted by personal interviews, using a structured questionnaire, administered to 855 doctors of different specialties, who make up a statistically significant nationwide sample. The study showed that in spite of the improvements in the knowledge of the microbiology of infectious diseases and the choice of antimicrobial agents, there are still certain areas that need improvement. These are, above all, in regard to the bacterial resistance problem, underevaluation of the viral etiology of certain respiratory tract infections and the somewhat condescending attitude with "visits by third parties", indulgence prescriptions and therapeutic noncompliance. Efficacy defined not only as clinical remission but also, and essentially, as antibacterial coverage, are the main parameters considered when participating physicians choose an antibiotic.

Weight-based N-acetylcysteine dosing chart to minimise the risk of calculation errors in prescribing and preparing N-acetylcysteine infusions for adults presenting with paracetamol overdose in the emergency department

Management of paracetamol overdose (POD) is common in the emergency department (ED) and forms part of the clinical effectiveness audit programme of the British Association for Emergency Medicine. N-acetylcysteine (NAC) infusion regimens for the treatment of POD are complicated and prescribing and administration errors have been well documented. This study assessed the ability of doctors and nurses to calculate correct doses using manual calculation skills and a weight-based NAC dosing chart when prescribing and preparing NAC infusions. With manual calculations, errors were made by doctors and nurses in 26% of cases collectively. No errors were made using the dosing chart. The dosing chart ensured 100% accuracy in dose calculations, which may translate into improved patient safety.

The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage

OBJECTIVE

To identify ultrasound measurements that are the best predictors of the presence of retained products of conception (RPOC) within the uterine cavity in women with clinical diagnosis of incomplete miscarriage.

METHODS

This was a prospective observational study, set in a dedicated early pregnancy assessment unit in a London teaching hospital. Endometrial thickness and the volume of suspected retained products of conception were measured by transvaginal ultrasound scan preoperatively. Indications for surgical intervention were heavy vaginal bleeding or continuous bleeding lasting > 7 days. The main outcome measure was histological evidence of chorionic villi in surgical specimens.

RESULTS

Among the patients, 109 (85%) had evidence of chorionic villi on histology, whilst decidua was only found in the remaining 19 (15%). There was no identifiable cut-off for endometrial thickness or volume that could be used to differentiate between retained products of conception and decidua.

CONCLUSION

Measurements of endometrial thickness or volume on ultrasound scan are not good tests for diagnosing an incomplete miscarriage.

Olive oil mill wastewaters pollution abatement by physical treatments and biodegradation with Phanerochaetae chrysosporium

This paper discusses decolorization and chemical oxygen demand (COD) abatement in olive mill wastewaters (OMW) by Phanerochaetae chrysosporium grown in static, suspended and immobilised cultures. When P chrysosporium is used in cultures, no decolorization of crude OMW is observed. Decolorization occurs only after removal of polyphenols by adsorption on wood sawdust, which allows for removal of 39% of polyphenols. The use of High lignin peroxides (Lip) producing medium, yields the highest OMW decolorization and COD removal efficiencies. The use of P. chrysosporium immobilized on polyurethane foam leads to significant abatements of OMW polluting characteristics. In fact, chemical oxygen demand (COD), Biological oxygen demand (BOD5) and polyphenols contents are significantly reduced. In addition, a significant effluent decolorization is obvious.

Predicting the recovery of ventilatory activity in central respiratory paralysis

OBJECTIVE

To assess the value of the diaphragmatic response to transcranial magnetic stimulation (TMS) in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis.

METHODS

The authors studied 11 long-term ventilator-dependent patients with central respiratory paralysis (description group: spinal trauma 10, medullary ischemia 1) and 16 patients with central respiratory paralysis for less than 10 weeks (prognostic group, evaluated after a 1-year follow-up: spinal trauma 8, medullary ischemia 4, radiation myelitis 1, subdural hematoma 1, complication of neurosurgery 2).

RESULTS

In the description group, all the patients had a bilaterally abolished diaphragm response. In the prognostic group, six patients were fully ventilator dependent because of a complete absence of ventilatory activity at follow-up time. They lacked any diaphragm response. The 10 other patients had recovered ventilatory activity and full (n = 9) or partial (n = 1) ventilatory autonomy. In nine cases, diaphragm response was present at least on one side, with a normal latency (right: 15.6 +/- 1.5 milliseconds; left: 16.2 +/- 2.2 milliseconds). The test had 100% specificity (95% CI 52 to 100) and 90% sensitivity (95% CI 54 to 99) to predict the recovery of ventilatory activity.

CONCLUSION

Electrophysiologic studies of the diaphragm in response to transcranial magnetic stimulation may help predict the recovery of central respiratory paralysis within 1 year.

Production of recombinant protein Pap31 and its application for the diagnosis of Bartonella bacilliformis infection

Tropical bartonellosis is a highly fatal epidemic and endemic infectious disease that occurs throughout the communities of the Andes Mountains in South America. The disease is caused by the facultative intracellular bacteria, Bartonella bacilliformis. The emergence of bartonellosis in new geographic areas and an increase in the number of reported cases suggest the need for a rapid test for epidemiologic study and investigation of the disease burden. The objective of this research is to develop a rapid serologic diagnostic test using recombinant antigens to overcome the limitations of the current standard IFA technique for laboratory diagnosis. Western blot analysis with patient sera of whole cell lysate separated on a 2D gel identified Pap31 as a dominant antigen. PCR primers were designed according to the sequence of ATCC strain 35685 to amplify the gene coding for Pap31 from a local isolate (HOSP 800-09, Peru). The amplicon was subsequently cloned into pET24a, adding the T7 tag, and expressed in E. coli. Patient sera with different IFA titers confirmed the diagnostic band of 31 kDa on a Western blot of SDS-PAGE. The performance of affinity-purified recombinant Pap31 (rPap31) was also evaluated in an ELISA format with 137 patient sera of known IFA titers. The range of ELISA reading from positive sera did not overlap with the range of those from negative sera, suggesting the potential application of rPap31 in both ELISA for high throughput regional hospital settings and in the construction of handheld rapid tests for rural clinical sites.

Impact of a mass media campaign (MMC) on awareness of and willingness to participate in cancer clinical trials (CCT): Results from 2,269 survey respondents

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Background: Annually, only 3% of patients (pt) participate in CCT. Accrual barriers include lack of CCT awareness and uncertain third party coverage. In 1/02, a California law (SB37) required all third party payers to reimburse pt care costs related to CCT. We sought to increase awareness of CCT/SB37 through a MMC, and assessed willingness to participate. Methods: Following a pre-MMC survey of 1,188 cancer pt and/or their caregivers’ awareness and willingness levels (JCO 2005; 23:9282–89), a TV/radio/print/internet MMC was conducted in a 9-county catchment area for UC Davis Cancer Center from 4/05–6/05. The MMC emphasized CCT/SB37 availability and used an iconic “Big C” logo. The survey was repeated post-MMC in two pt/caregiver cohorts: from the UC Davis Cancer Center catchment area (C1), and a control group from the UC San Diego area (C2) who did not see the MMC. Changes in CCT/SB37 awareness and willingness to participate were probed pre- vs. post-MMC and C1 vs. C2 by Pearson χ2 & logistic regression. Results: Of 2,269 respondents, 1,081 were post-MMC: 957 from C1 and 124 from C2. Post-MMC respondents differed from pre-MMC by respondent type (pt > caregivers), age (older), race (more blacks), and income (more $75k+/yr). Pre- vs. post-MMC, C1 respondents had greater awareness of CCT (59% to 65%, p < 0.01) and SB37 (17% vs. 32%, p < 0.01); no significant change was seen in C2. Adjustment for demographic variables in C1 resulted in p > 0.05 for CCT/SB37 awareness. Willingness to participate in CCT did not change pre- vs. post-MMC in C1 or C2. Awareness level predicted willingness (OR = 2.3, p < 0.01), but this was not true for the lowest income/education groups. Blacks/Asians/lowest income (< $25K/yr) groups were least willing to participate (p < 0.01/0.04/0.02). Conclusions: Although CCT/SB37 awareness increased in C1 following the MMC, it is unclear whether this was wholly attributable to the MMC due to varying demographic variables. Awareness of CCT/SB37 did not universally translate into willingness to participate in all subgroups. Enhancing pt willingness (to increase CCT accrual) will require targeting other variables, such as physician or resource barriers, rather than just CCT/SB37 awareness. (R21 CA-03501).

No significant financial relationships to disclose.