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Yang Y, Zhou L, Luo J, Xue J, Liu J, Zhang J, Wang Z, Gong P, Chen T. Prediction analysis of TBI 24-h survival outcome based on machine learning. Heliyon 2024; 10:e30198. [PMID: 38707345 PMCID: PMC11066620 DOI: 10.1016/j.heliyon.2024.e30198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Background Traumatic brain injury (TBI) is the major reason for the death of young people and is well known for its high mortality and morbidity. This paper aim to predict the 24h survival of patients with TBI. Methods A total of 1224 samples were involved in this analysis, and the clinical indicators involved included age, gender, blood pressure, MGAP and other fields, among which the target variable was "outcome", which was a binary variable. The methods mainly involved in this paper include data visualization analysis, single factor analysis, feature engineering analysis, random forest model (RF), K-Nearst Neighbors (KNN) model, and so on. Logistic regression model (LR) and deep neural network model (DNN). We will oversample the training set using the SMOTE method because of the very unbalanced labeling of the sample itself. Results Although the accuracy of all models is very high, the recall rate is relatively low. The DNN model with the best performance only reaches 0.17, and the corresponding AUC is 0.80. After resampling, we find that the recall rate of positive samples of all models has increased a lot, but the AUC of some models has decreased. Finally, the optimal model is LR, whose positive sample recall rate is 0.67 and AUC is 0.82. Conclusion Through resampling, we obtained that the best model is the RF model, whose recall rate and AUC are the best, and the AUC level is about 0.87, indicating that the accuracy performance of the model is still good.
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Affiliation(s)
- Yang Yang
- Department of Trauma Center, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
- Department of Chemistry, School of Science, China Pharmaceutical University, Nanjing, 211198, China
| | - Liulei Zhou
- Department of Trauma Center, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Jinhua Luo
- Department of Anesthesia Surgery, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Jianhua Xue
- Department of Trauma Center, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Jiajia Liu
- Department of Trauma Center, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Jiajia Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Ziheng Wang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
- Clinical and Translational Research Center, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Macau, China
| | - Peipei Gong
- Department of Neurosurgery, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Tianxi Chen
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, No.20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
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Indraja G, Aashi A, Vema VK. Spatial and temporal classification and prediction of LULC in Brahmani and Baitarni basin using integrated cellular automata models. Environ Monit Assess 2024; 196:117. [PMID: 38183538 DOI: 10.1007/s10661-023-12289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
Monitoring the dynamics of land use and land cover (LULC) is imperative in the changing climate and evolving urbanization patterns worldwide. The shifts in land use have a significant impact on the hydrological response of watersheds across the globe. Several studies have applied machine learning (ML) algorithms using historical LULC maps along with elevation data and slope for predicting future LULC projections. However, the influence of other driving factors such as socio-economic and climatological factors has not been thoroughly explored. In the present study, a sensitivity analysis approach was adopted to understand the effect of both physical (elevation, slope, aspect, etc.) and socio-economic factors such as population density, distance to built-up, and distance to road and rail, as well as climatic factors (mean precipitation) on the accuracy of LULC prediction in the Brahmani and Baitarni (BB) basin of Eastern India. Additionally, in the absence of the recent LULC maps of the basin, three ML algorithms, i.e., random forest (RF), classified and regression trees (CART), and support vector machine (SVM) were utilized for LULC classification for the years 2007, 2014, and 2021 on Google earth engine (GEE) cloud computing platform. Among the three algorithms, RF performed best for classifying built-up areas along with all the other classes as compared to CART and SVM. The prediction results revealed that the proximity to built-up and population growth dominates in modeling LULC over physical factors such as elevation and slope. The analysis of historical data revealed an increase of 351% in built-up areas over the past years (2007-2021), with a corresponding decline in forest and water areas by 12% and 36% respectively. While the future predictions highlighted an increase in built-up class ranging from 11 to 38% during the years 2028-2070, the forested areas are anticipated to decline by 4 to 16%. The overall findings of the present study suggested that the BB basin, despite being primarily agricultural with a significant forest cover, is undergoing rapid expansion of built-up areas through the encroachment of agricultural and forested lands, which could have far-reaching implications for the region's ecosystem services and sustainability.
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Affiliation(s)
- Gorantla Indraja
- Department of Civil Engineering, National Institute of Technology Warangal, Warangal, 506004, Telangana, India
| | - Agarwal Aashi
- Department of Civil Engineering, National Institute of Technology Warangal, Warangal, 506004, Telangana, India
| | - Vamsi Krishna Vema
- Department of Civil Engineering, National Institute of Technology Warangal, Warangal, 506004, Telangana, India.
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Raj DK, Gopikrishnan T. Machine learning models for predicting vegetation conditions in Mahanadi River basin. Environ Monit Assess 2023; 195:1401. [PMID: 37917222 DOI: 10.1007/s10661-023-12006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
The vegetation of a river basin is affected by various climate factors, such as precipitation and land surface temperature (LST). This study explores the best machine learning model for the prediction of normalized difference vegetation index (NDVI) with LST and precipitation as input parameters. The study also determines the correlation between NDVI, LST, and precipitation of the Mahanadi basin from 2003 to 2021. Monthly precipitation data was extracted from the Center for Hydrometeorology and Remote Sensing (CHRS) portal. The Moderate Resolution Imaging Spectroradiometer (MODIS) products were used to derive the LST and NDVI using Google Earth Engine (GEE). Four different machine learning models were used to predict the NDVI of the Mahanadi basin: linear regression (LR), random forest (RF), support vector regression (SVR), and k-nearest neighbors (KNN). The coefficient of determination (R2), root mean square error (RMSE), mean square error (MSE), mean absolute error (MAE), and explained variance score (EVS) were calculated to evaluate the performance of the models. The results show that the RF model has the highest R2 value in both the training and testing sets among these models, indicating that it is the most optimal among these models for predicting NDVI. The SVR model has the lowest RMSE value in the training set, but the KNN model has the lowest RMSE value in the testing set. The results also show that there is a positive correlation between precipitation and NDVI, a negative correlation between precipitation and LST, and between NDVI and LST. This study provides insights into the relationship between NDVI, LST, and precipitation, and the best machine-learning model for predicting NDVI. The findings of this study can be used to improve the management of river basins and to predict the effects of climate change on vegetation.
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Affiliation(s)
- Deepak Kumar Raj
- Department of Civil Engineering, National Institute of Technology Patna, Patna, Bihar, India.
| | - T Gopikrishnan
- Department of Civil Engineering, National Institute of Technology Patna, Patna, Bihar, India
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Chellappan D, Rajaguru H. Enhancement of Classifier Performance Using Swarm Intelligence in Detection of Diabetes from Pancreatic Microarray Gene Data. Biomimetics (Basel) 2023; 8:503. [PMID: 37887634 PMCID: PMC10604158 DOI: 10.3390/biomimetics8060503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
In this study, we focused on using microarray gene data from pancreatic sources to detect diabetes mellitus. Dimensionality reduction (DR) techniques were used to reduce the dimensionally high microarray gene data. DR methods like the Bessel function, Discrete Cosine Transform (DCT), Least Squares Linear Regression (LSLR), and Artificial Algae Algorithm (AAA) are used. Subsequently, we applied meta-heuristic algorithms like the Dragonfly Optimization Algorithm (DOA) and Elephant Herding Optimization Algorithm (EHO) for feature selection. Classifiers such as Nonlinear Regression (NLR), Linear Regression (LR), Gaussian Mixture Model (GMM), Expectation Maximum (EM), Bayesian Linear Discriminant Classifier (BLDC), Logistic Regression (LoR), Softmax Discriminant Classifier (SDC), and Support Vector Machine (SVM) with three types of kernels, Linear, Polynomial, and Radial Basis Function (RBF), were utilized to detect diabetes. The classifier's performance was analyzed based on parameters like accuracy, F1 score, MCC, error rate, FM metric, and Kappa. Without feature selection, the SVM (RBF) classifier achieved a high accuracy of 90% using the AAA DR methods. The SVM (RBF) classifier using the AAA DR method for EHO feature selection outperformed the other classifiers with an accuracy of 95.714%. This improvement in the accuracy of the classifier's performance emphasizes the role of feature selection methods.
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Affiliation(s)
- Dinesh Chellappan
- Department of Electrical and Electronics Engineering, KPR Institute of Engineering and Technology, Coimbatore 641 407, Tamil Nadu, India;
| | - Harikumar Rajaguru
- Department of Electronics and Communication Engineering, Bannari Amman Institute of Technology, Sathyamangalam 638 401, Tamil Nadu, India
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Sachdeva RK, Bathla P, Rani P, Solanki V, Ahuja R. A systematic method for diagnosis of hepatitis disease using machine learning. Innov Syst Softw Eng 2023; 19:71-80. [PMID: 36628173 PMCID: PMC9818056 DOI: 10.1007/s11334-022-00509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Hepatitis is among the deadliest diseases on the planet. Machine learning approaches can contribute toward diagnosing hepatitis disease based on a few characteristics. On the UCI dataset, authors assessed distinct classifiers' performance in order to develop a systematic strategy for hepatitis disease diagnosis. The classifiers used are support vector machine, logistic regression (LR), K-nearest neighbor, and random forest. The classifiers were employed without class balancing and in conjunction with class balancing using SMOTE strategy. Both studies, classification without class balancing and with class balancing, were compared in terms of different performance parameters. After adopting class balancing, the efficiency of classifiers improved significantly. LR with SMOTE provided the highest level of accuracy (93.18%).
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Affiliation(s)
- Ravi Kumar Sachdeva
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab India
| | | | - Pooja Rani
- MMICTBM, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana India
| | - Vikas Solanki
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab India
| | - Rakesh Ahuja
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab India
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Rath A, Mishra D, Panda G. Imbalanced ECG signal-based heart disease classification using ensemble machine learning technique. Front Big Data 2022; 5:1021518. [PMID: 36299660 PMCID: PMC9589052 DOI: 10.3389/fdata.2022.1021518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023] Open
Abstract
The machine learning (ML)-based classification models are widely utilized for the automated detection of heart diseases (HDs) using various physiological signals such as electrocardiogram (ECG), magnetocardiography (MCG), heart sound (HS), and impedance cardiography (ICG) signals. However, ECG-based HD identification is the most common one used by clinicians. In the current investigation, the ECG records or subjects have been sampled and are used as inputs to the classification model to distinguish between normal and abnormal patients. The study has employed an imbalanced number of ECG samples for training the various classification models. Few ML methods such as support vector machine (SVM), logistic regression (LR), and adaptive boosting (AdaBoost) which have been rarely used for HD detection have been selected. The performance of the developed model has been evaluated in terms of accuracy, F1-score, and area under curve (AUC) values using ECG signals of subjects given in publicly available (PTB-ECG, MIT-BIH) datasets. Ranking of the models has been assigned based on these performance metrics and it is found that the AdaBoost and LR classifiers stand in first and second positions. These two models have been ensembled based on the majority voting principle and the performance measure of this ensemble model has also been determined. It is, in general, observed that the proposed ensemble model demonstrates the best HD detection performance of 0.946, 0.949, and 0.951 for the PTB-ECG dataset and 0.921, 0.926, and 0.950 for the MIT-BIH dataset in terms of accuracy, F1-score, and AUC, respectively. The proposed methodology can also be employed for the classification of HD using ICG, MCG, and HS signals as inputs. Further, the proposed methodology can also be applied to the detection of other diseases.
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Affiliation(s)
- Adyasha Rath
- Department of Computer Science and Engineering, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Debahuti Mishra
- Department of Computer Science and Engineering, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Ganapati Panda
- Department of Electronics and Tele Communication, C. V. Raman Global University, Bhubaneswar, Odisha, India,*Correspondence: Ganapati Panda
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Tao R, Xu Q, Wang S, Xia R, Yang Q, Chen A, Qu Y, Lv Y, Zhang S, Li C. Pairwise kinship analysis of 17 pedigrees using massively parallel sequencing. Forensic Sci Int Genet 2021; 57:102647. [PMID: 34902810 DOI: 10.1016/j.fsigen.2021.102647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 01/23/2023]
Abstract
With the tremendous development of massively parallel sequencing (MPS) in the last decade, it has been widely applied in basic science, clinical diagnostics, microbial genomics, as well as forensic genetics. MPS has lots of advantages that may facilitate the kinship analysis. In this study, 243 Chinese Han individuals from 17 families were involved and sequenced using the ForenSeq™ DNA Signature Prep Kit (Verogen, Inc., San Diego, USA), which provided the sequence information of 27 autosomal STRs (A-STRs), 7 X chromosomal STRs (X-STRs), 24 Y chromosomal STRs (Y-STRs) and 94 identity-informative SNPs (iSNPs). A total of 275 pairs of parent-child, 123 pairs of full siblings, 1 pair of twins, 1 pair of half siblings, 158 pairs of grandparent-grandchild, 222 pairs of uncle/aunt-nephew/niece and 121 pairs of first cousins, as well as 701 pairs of unrelated individuals were identified. Using both likelihood ratio (LR) and identical by state (IBS) methods, the kinship analysis was conducted among these relative and non-relative pairs based on the A-STRs and SNPs. As a result, the ForenSeq Signature Kit could solve the analysis of parent-child (t1 = -4, t2 = 4), full siblings (t1 = -2, t2 = 2) and most second-degree kinships (t1 = -1, t2 = 1) using the LR method. When the IBS method was applied, 123 full sibling pairs had a higher average IBS value than other kinship groups in this study. And the IBS method could play a role in the testing of parent-child and full siblings.
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Affiliation(s)
- Ruiyang Tao
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China
| | - Qiannan Xu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; Institute of Forensic Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, PR China
| | - Shouyu Wang
- Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Ruocheng Xia
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China
| | - Qi Yang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China
| | - Anqi Chen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Yiling Qu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; Department of Forensic Science, Medical School of Soochow University, Suzhou 215123, PR China
| | - Yehui Lv
- Shanghai University of Medicine & Health Sciences, Shanghai 200237, PR China
| | - Suhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
| | - Chengtao Li
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
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Gehrig C, Delémont S, Comte J, Hicks T, Basset P, Grosjean F, Dion D, Cossu C, Bottinelli M, Hecht M, Sulzer A, Voegeli P, Castella V. A Swiss collaborative exercise for Disaster Victim Identification (DVI): Covering situations with different levels of complexity. J Forensic Leg Med 2021; 83:102254. [PMID: 34592483 DOI: 10.1016/j.jflm.2021.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
The identification of victims of a disaster (DVI) requires the collaboration of different specialists. Within a DVI context, DNA analyses often play an important role. Consequently, forensic genetic laboratories should be prepared to cope with DVI situations, as this can involve large-scale DNA profile comparisons. Six forensic genetic laboratories from Switzerland participated in an exercise where supposedly a plane had crashed. The goal of the exercise was to monitor participants use of dedicated software with ground truth cases and to make them aware of the existence of particular situations that may occur in real cases. For assigning the value of the comparison of the DNA profiles, all participating laboratories used the DVI module of Familias v3.2.1 In addition, one of the 6 laboratories used the Pedigree Searcher from CODIS v7.0. The data (AmpFlSTR® NGM SElect™ profiles) were generated to challenge the participating laboratories: cases with first, second degree biological parents, mutation events, as well as non-paternity cases were included. This study shows that the majority of the participants used the software in an appropriate way. However, a few misleading conclusions were detected for the most challenging situations. These errors belonged to one of the following categories: false pedigree, false association using the higher LR, misleading contextual information (false paternity) and not clustering family members. Specific recommendations are provided in order to reduce misuse of the software and the risk of misinterpretations by using all the relevant information.
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Affiliation(s)
- Christian Gehrig
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland.
| | | | - Jennifer Comte
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland
| | - Tacha Hicks
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland; Fondation pour la Formation Continue Universitaire Lausannoise (UNIL-EPFL), Switzerland
| | - Patrick Basset
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland
| | | | - Daniel Dion
- Institut für Rechtsmedizin, Basel, Switzerland
| | | | | | - Mirco Hecht
- Institut für Rechtsmedizin, Bern, Switzerland
| | | | | | - Vincent Castella
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland
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Chen Z, Luo H, Xu L. Machine learning models of ischemia/hemorrhage in moyamoya disease and analysis of its risk factors. Clin Neurol Neurosurg 2021; 209:106919. [PMID: 34507124 DOI: 10.1016/j.clineuro.2021.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECT This study aimed to determine the risk factors of ischemic/hemorrhagic stroke in patients suffering moyamoya disease (MMD), as well as to compare the effects of six analysis methods. METHODS In the present retrospective study, the data originated from the database of Jiang Xi Province Medical Big Data Engineering & Technology Research Center. In addition, the information of patients with MMD that were admitted to the second affiliated hospital of Nanchang university from January 1st, 2012 to December 31st, 2019 was acquired. Six different machine learning methods were adopted to build the models, and XGboost, Logistic regression (LR) and Support vector machine (SVM) models were adopted to determine the risk factors of ischemic/hemorrhagic stroke in patients with MMD because of their excellent performance. Next, the effects of the built models were compared and validated in internal and independent external validation sets. The external validation set involving 204 cases from January 1st, 2018 to December 31st, 2019. RESULT On the whole, 790 patients with MMD were screened, i.e., 397 patients with cerebral infarction and 393 patients with cerebral hemorrhage. In the internal validation set, XGboost model exhibited significant discrimination (AUC>0.75), with its area under the curve (AUC) reaching 0.874 (95% CI: 0.859, 0.889). Compared with the LR and SVM models, the XGboost model in the internal validation set achieved the improved accuracy by 3.2% and 3.1%, respectively, whereas no significant difference was identified. CONCLUSION XGboost model could be more efficient in analyzing the risk factors of ischemic/hemorrhagic stroke in patients with MMD; the risk factors of hemorrhagic stroke in MMD might be closely related to Suzuki stages, presence of an aneurysm, rural residence, hospitalization times and age of onset.
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Morgan FC, Ruiz ES, Karia PS, Besaw RJ, Neel VA, Schmults CD. Factors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter. J Am Acad Dermatol 2019; 83:832-838. [PMID: 31600531 DOI: 10.1016/j.jaad.2019.09.075] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) recurrence and metastatic rates are known to be very low. The risk factors for these rare outcomes are subsequently not well studied. OBJECTIVE To identify risk factors independently associated with local recurrence (LR) and metastasis and/or death (M/D) in large (≥2 cm) BCC. METHODS BCCs histologically confirmed between 2000 and 2009 were retrospectively screened for tumor diameter at 2 academic centers. Medical records of all large BCCs and an equal number of randomly selected small BCCs were reviewed for LR and M/D. RESULTS Included were 248 large BCC and 248 small BCC tumors. Large BCCs had a significantly higher risk of LR and M/D than small BCCs (LR: 8.9% vs 0.8%, P < .001; M/D: 6.5% vs. 0%, P < .001). Because the risks were so low in small BCCs, they were excluded from further analysis. On multivariable logistic regression, head/neck location (odds ratio [OR], 9.7; 95% confidence interval [CI], 3.0-31.3) and depth beyond fat (OR, 3.1; 95% CI, 1.0-9.6) were associated with LR in large BCCs. Risk of LR was lower with Mohs micrographic surgery (OR, 0.14; 95% CI, 0.04-0.5). Head/neck location (OR, 5.3; 95% CI, 1.2-23.2), tumor diameter ≥4 cm (OR, 11.9; 95% CI, 2.4-59.4), and depth beyond fat (OR, 28.6; 95% CI, 6.7-121) were significant predictors of M/D in large BCCs. LIMITATIONS Retrospective cohort design. CONCLUSIONS Large BCCs, particularly those with additional risk factors, have a high enough risk of recurrence and metastasis to warrant further investigation to optimize management.
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Affiliation(s)
- Frederick C Morgan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Stamell Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pritesh S Karia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert J Besaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor A Neel
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Palmerini E, Torricelli E, Cascinu S, Pierini M, De Paolis M, Donati D, Cesari M, Longhi A, Abate M, Paioli A, Setola E, Ferrari S. Is there a role for chemotherapy after local relapse in high-grade osteosarcoma? Pediatr Blood Cancer 2019; 66:e27792. [PMID: 31058424 DOI: 10.1002/pbc.27792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-grade bone osteosarcoma has a high relapse rate. The best treatment of local recurrence (LR) is under discussion. The aim of this study is to analyze LR patterns and factors prognostic for survival. METHODS LR diagnostic modality (clinical or imaging), pattern of recurrence, and post-LR survival (PLRS) were assessed. RESULTS Sixty-two patients were identified, with median age 21 years (range, 9-75 years), including 11 (18%) ≤15 years, 30 (48%) from 16 to 29 years; 21 (34%) were older. Patterns of relapse were LR only 58%, LR + distant metastases (DM) 42%. Seventy-nine percent of patients relapsed within 24 months, and diagnosis was clinical in 88%. LR treatment was surgery 85%, chemotherapy 55%, chemotherapy + surgery 45%. Surgical complete remission after LR (CR2) was achieved in 60% (LR 86%; LR + DM 23%). With a median follow-up of 43 months (range, 5-235 months), the five-year PLRS was 37%, significantly better for patients with longer LR-free interval (LRFI; ≤24 months 31% vs > 24 months 61.5%, P = 0.03), absence of DM (no DM 56% vs DM 11.5%, P = 0.0001), and achievement of CR2 (no CR2 0% vs CR2 58.5%, P = 0.0001). No difference was found according to age and chemotherapy (LR only: five-year PLRS: 53% without chemotherapy vs 58% with chemotherapy, P = 0.9; LR + DM: five-year PLRS: 25% without chemotherapy vs 9% with chemotherapy, P = 0.7). CONCLUSIONS Early relapse is detected by symptoms in 90% of cases and associated with worse outcome. The achievement of CR2, not age, is crucial for survival. For patients with LR only, better survival was demonstrated, as compared with DM, and no improvement with chemotherapy after surgery was found.
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Affiliation(s)
| | - Elisa Torricelli
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Michela Pierini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Davide Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Abate
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Setola
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Oprea V, Grad O, Gheorghescu D, Moga D. Transinguinal Preperitoneal Mesh Plasty - An Alternative or a Dispensable Technique? A Prospective Analyze vs Lichtenstein Repair for Complex Unilateral Groin Hernias. Chirurgia (Bucur) 2019; 114:48-56. [PMID: 30830844 DOI: 10.21614/chirurgia.114.1.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
Abstract
Background: complex groin hernia is a well describe entity with a high risk of recurrence and postoperative complications. There is no standardized approach and no reports to confirm the efficcacy of a surgical procedure. Our goal was to compare Lichtenstein repair (LR) as "golden standard" for open anterior approach with the transinguinal preperitoneal plasty (TIPP) in the treatment of complex groin hernia repair. Material and methods: the study was a prospective one and includes all patients with complex hernias admitted in the Department of Surgery of the Military Hospital Cluj-Napoca between January 2010 and December 2014. All the patients were randomized in two groups: LR and TIPP. Baseline characteristics, intraoperative findings, pain and complications were recorded. Follow-up was at least 1 year. The main outcome after 1 year were recurrence, chronic pain and its intensity recorded on VAS scale. Results: 205 patients (101 in LR group and 104 in TIPP) were included in the study. There were no differences in baseline characteristics and operative findings. Postoperative pain was lower for TIPP group (p 0.05). Follw-up was 98% at 1 month, 74% after 6 months and 64% after 1 year. Recurrence rate was higher for LR (p=0.027). Pain was increased in LR group. Conclusion: TIPP is equal in terms of chronic pain and recurrence for complex groin inguinal hernias.
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Gittelson S, Berger CEH, Jackson G, Evett IW, Champod C, Robertson B, Curran JM, Taylor D, Weir BS, Coble MD, Buckleton JS. A response to "Likelihood ratio as weight of evidence: A closer look" by Lund and Iyer. Forensic Sci Int 2018; 288:e15-e19. [PMID: 29857959 PMCID: PMC7306225 DOI: 10.1016/j.forsciint.2018.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
Recently, Lund and Iyer (L&I) raised an argument regarding the use of likelihood ratios in court. In our view, their argument is based on a lack of understanding of the paradigm. L&I argue that the decision maker should not accept the expert's likelihood ratio without further consideration. This is agreed by all parties. In normal practice, there is often considerable and proper exploration in court of the basis for any probabilistic statement. We conclude that L&I argue against a practice that does not exist and which no one advocates. Further we conclude that the most informative summary of evidential weight is the likelihood ratio. We state that this is the summary that should be presented to a court in every scientific assessment of evidential weight with supporting information about how it was constructed and on what it was based.
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Affiliation(s)
- Simone Gittelson
- Centre for Forensic Science, University of Technology Sydney, P.O. Box 123, Broadway, NSW 2007, Australia.
| | - Charles E H Berger
- Leiden University, Institute for Criminal Law and Criminology, P.O. Box 9520, 2300 RA Leiden, The Netherlands
| | - Graham Jackson
- Advance Forensic Science, St. Andrews, Scotland, UK; School of Science, Engineering and Technology, Abertay University, Dundee, Scotland, UK
| | - Ian W Evett
- Principal Forensic Services Ltd., 34 Southborough Road, Bickley, Bromley, Kent BR1 2EB, UK
| | - Christophe Champod
- Ecole des Sciences Criminelles, Faculty of Law, Criminal Justice and Public Administration, Université de Lausanne, Batochime - Quartier Sorge, CH-1015 Lausanne-Dorigny, Switzerland
| | | | - James M Curran
- Department of Statistics, University of Auckland, PB 92019, Auckland, New Zealand
| | - Duncan Taylor
- Forensic Science South Australia, 21 Divett Place, Adelaide, SA 5000, Australia; School of Biological Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Bruce S Weir
- University of Washington, Department of Biostatistics, Seattle, WA 98195, United States
| | - Michael D Coble
- National Institute of Standards and Technology, Applied Genetics Group, 100 Bureau Drive, Gaithersburg, MD 20899, United States; Center for Human Identification, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States
| | - John S Buckleton
- University of Washington, Department of Biostatistics, Seattle, WA 98195, United States; Institute of Environmental Science and Research Limited, Private Bag 92021, Auckland 1142, New Zealand
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Sjåstad KE, Lucy D, Andersen T. Lead isotope ratios for bullets, forensic evaluation in a Bayesian paradigm. Talanta 2016; 146:62-70. [PMID: 26695235 DOI: 10.1016/j.talanta.2015.07.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/17/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
Forensic science is a discipline concerned with collection, examination and evaluation of physical evidence related to criminal cases. The results from the activities of the forensic scientist may ultimately be presented to the court in such a way that the triers of fact understand the implications of the data. Forensic science has been, and still is, driven by development of new technology, and in the last two decades evaluation of evidence based on logical reasoning and Bayesian statistic has reached some level of general acceptance within the forensic community. Tracing of lead fragments of unknown origin to a given source of ammunition is a task that might be of interest for the Court. Use of data from lead isotope ratios analysis interpreted within a Bayesian framework has shown to be suitable method to guide the Court to draw their conclusion for such task. In this work we have used isotopic composition of lead from small arms projectiles (cal. .22) and developed an approach based on Bayesian statistics and likelihood ratio calculation. The likelihood ratio is a single quantity that provides a measure of the value of evidence that can be used in the deliberation of the court.
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Affiliation(s)
- Knut-Endre Sjåstad
- University of Oslo, Department of Geosciences, Norway; National Criminal Investigation Service (KRIPOS), P.O. Box 8163, dep, 0034 Oslo, Norway.
| | - David Lucy
- Lancaster University, Department of Mathematics and Statistics, United Kingdom
| | - Tom Andersen
- University of Oslo, Department of Geosciences, Norway
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Venken K, Seeuws S, Zabeau L, Jacques P, Decruy T, Coudenys J, Verheugen E, Windels F, Catteeuw D, Drennan M, Van Calenbergh S, Lambrecht BN, Yoshimura A, Tavernier J, Elewaut D. A bidirectional crosstalk between iNKT cells and adipocytes mediated by leptin modulates susceptibility for T cell mediated hepatitis. J Hepatol 2014; 60:175-82. [PMID: 23973929 DOI: 10.1016/j.jhep.2013.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/26/2013] [Accepted: 08/05/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Immunometabolism is an emerging field of clinical investigation due to the obesity epidemic worldwide. A reciprocal involvement of immune mediators in the body energy metabolism has been recognized for years, but is only partially understood. We hypothesized that the adipokine leptin could provide an important modulator of iNKT cells. METHODS The expression of leptin receptor (LR) on resting and activated iNKT cells was measured by flow cytometry. FACS-sorted hepatic iNKT cells were stimulated with anti-CD3/CD28Ab coated beads in the absence or presence of a neutralizing anti-leptin Ab. Furthermore, we evaluated the outcome of LR blocking nanobody treatment in ConA induced hepatitis and towards metabolic parameters in WT and iNKT cell deficient mice. RESULTS The LR is expressed on iNKT cells and leptin suppresses iNKT cell proliferation and cytokine production in vitro. LR deficient iNKT cells are hyper-responsive further enforcing the role of leptin as an important inhibitor of iNKT cell function. Consistently, in vivo blockade of LR signaling exacerbated ConA hepatitis in wild-type but not in iNKT cell deficient mice, through both Janus kinase (JAK)2 and mitogen-activated protein kinase (MAPK) dependent mechanisms. Moreover, LR inhibition altered fat pad features and was accompanied by insulin resistance, only in wild-type mice. Curiously, this interaction was strictly dependent on MAPK mediated LR signaling in iNKT cells and uncoupled from the more central effects of leptin. CONCLUSIONS Our data support a new concept of immune regulation by which leptin protects towards T cell mediated hepatitis via modulation of iNKT cells.
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Affiliation(s)
- Koen Venken
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Sylvie Seeuws
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Lennart Zabeau
- Flanders Institute for Biotechnology, Department of Medical Protein Research, Faculty of Medicine and Health Sciences, Ghent University, A. Baertsoenkaai 3, 9000 Ghent, Belgium
| | - Peggy Jacques
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Tine Decruy
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Julie Coudenys
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Eveline Verheugen
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Fien Windels
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominiek Catteeuw
- Flanders Institute for Biotechnology, Department of Medical Protein Research, Faculty of Medicine and Health Sciences, Ghent University, A. Baertsoenkaai 3, 9000 Ghent, Belgium
| | - Michael Drennan
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Serge Van Calenbergh
- Laboratory for Medicinal Chemistry, Faculty of Pharmaceutical Sciences (FFW), Ghent University, Harelbekestraat 72, 9000 Ghent, Belgium
| | - Bart N Lambrecht
- Laboratory of Immunoregulation and Mucosal Immunology, Department of Molecular Biomedical Research, VIB and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo 160-8582, Japan; Japan Science and Technology Agency, CREST, Tokyo 102-0075, Japan
| | - Jan Tavernier
- Flanders Institute for Biotechnology, Department of Medical Protein Research, Faculty of Medicine and Health Sciences, Ghent University, A. Baertsoenkaai 3, 9000 Ghent, Belgium
| | - Dirk Elewaut
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
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16
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Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 2013; 133:291-307; quiz 308. [PMID: 24388012 DOI: 10.1016/j.jaci.2013.11.020] [Citation(s) in RCA: 836] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 01/04/2023]
Abstract
This review focuses on advances and updates in the epidemiology, pathogenesis, diagnosis, and treatment of food allergy over the past 3 years since our last comprehensive review. On the basis of numerous studies, food allergy likely affects nearly 5% of adults and 8% of children, with growing evidence of an increase in prevalence. Potentially rectifiable risk factors include vitamin D insufficiency, unhealthful dietary fat, obesity, increased hygiene, and the timing of exposure to foods, but genetics and other lifestyle issues play a role as well. Interesting clinical insights into pathogenesis include discoveries regarding gene-environment interactions and an increasing understanding of the role of nonoral sensitizing exposures causing food allergy, such as delayed allergic reactions to carbohydrate moieties in mammalian meats caused by sensitization from homologous substances transferred during tick bites. Component-resolved diagnosis is being rapidly incorporated into clinical use, and sophisticated diagnostic tests that indicate severity and prognosis are on the horizon. Current management relies heavily on avoidance and emergency preparedness, and recent studies, guidelines, and resources provide insight into improving the safety and well-being of patients and their families. Incorporation of extensively heated (heat-denatured) forms of milk and egg into the diets of children who tolerate these foods, rather than strict avoidance, represents a significant shift in clinical approach. Recommendations about the prevention of food allergy and atopic disease through diet have changed radically, with rescinding of many recommendations about extensive and prolonged allergen avoidance. Numerous therapies have reached clinical trials, with some showing promise to dramatically alter treatment. Ongoing studies will elucidate improved prevention, diagnosis, and treatment.
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Affiliation(s)
- Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Hugh A Sampson
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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Jiang G, Zeng J, He Y. Analysis of quantitative trait loci affecting chlorophyll content of rice leaves in a double haploid population and two backcross populations. Gene 2013; 536:287-95. [PMID: 24361205 DOI: 10.1016/j.gene.2013.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 12/07/2013] [Accepted: 12/09/2013] [Indexed: 02/04/2023]
Abstract
Chlorophyll content, one of the most important physiological parameters related to plant photosynthesis, is usually used to predict yield potential. To map the quantitative trait loci (QTLs) underlying the chlorophyll content of rice leaves, a double haploid (DH) population was developed from an indica/japonica (Zhenshan 97/Wuyujing 2) crossing and two backcross populations were established subsequently by backcrossing DH lines with each of their parents. The contents of chlorophyll a and chlorophyll b were determined by using a spectrophotometer to directly measure the leaf chlorophyll extracts. To determine the leaf chlorophyll retention along with maturation, all measurements were performed on the day of heading and were repeated 30 days later. A total of 60 QTLs were resolved for all the traits using these three populations. These QTLs were distributed on 10 rice chromosomes, except chromosomes 5 and 10; the closer the traits, the more clustering of the QTLs residing on common rice chromosomal regions. In general, the majority of QTLs that specify chlorophyll a content also play a role in determining chlorophyll b content. Strangely, chlorophyll content in this study was found mostly to be lacking or to have a negative correlation with yield. In both backcross F1 populations, overdominant (or underdominant) loci were more important than complete or partially dominant loci for main-effect QTLs and epistatic QTLs, thereby supporting previous findings that overdominant effects are the primary genetic basis for depression in inbreeding and heterosis in rice.
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Affiliation(s)
- Gonghao Jiang
- National Key Laboratory of Crop Genetic Improvement, National Center of Plant Gene Research and National Center of Crop Molecular Breeding, Huazhong Agricultural University, Wuhan 430070, PR China; College of Life Science, Heilongjiang University, Haerbin 150080, China
| | - Jing Zeng
- National Key Laboratory of Crop Genetic Improvement, National Center of Plant Gene Research and National Center of Crop Molecular Breeding, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Yuqing He
- National Key Laboratory of Crop Genetic Improvement, National Center of Plant Gene Research and National Center of Crop Molecular Breeding, Huazhong Agricultural University, Wuhan 430070, PR China.
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Herrera AS, Casanova JP, Gatica RI, Escobar F, Fuentealba JA. Clozapine pre-treatment has a protracted hypolocomotor effect on the induction and expression of amphetamine sensitization. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:1-6. [PMID: 23954739 DOI: 10.1016/j.pnpbp.2013.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/12/2013] [Accepted: 07/31/2013] [Indexed: 11/25/2022]
Abstract
Amphetamine locomotor sensitization is an animal model for the study of addiction and schizophrenia. The antipsychotic clozapine blocks the hyperlocomotion induced by an acute injection of amphetamine, but its effect on locomotor sensitization after repeated amphetamine administration remains unknown. In the present study we investigate the effect of repeated administration of clozapine on the induction and expression of amphetamine locomotor sensitization. We propose that repeated administration of clozapine blocks the induction and expression of amphetamine sensitization. Male Sprague-Dawley rats were classified according to their locomotor response to an acute saline injection in high responder saline (HRS) or low responder saline (LRS). Rats from both groups were injected once daily with amphetamine for 5 consecutive days. Horizontal locomotor activity was measured during 40 min. Four days after the last injection, an acute dose of amphetamine was administered to assess the expression of sensitization. Clozapine was injected once daily for 4 consecutive days before (pre-treatment) or after (treatment) induction of sensitization. Pre-treatment with clozapine significantly decreases both acute amphetamine-induced hyperlocomotion and the induction and expression of amphetamine sensitization only in LRS rats, showing a protracted hypolocomotor effect. On the other hand, clozapine treatment had no effect over locomotor response on the expression of amphetamine sensitization in either LRS or HRS rats. These data suggest that clozapine effect on amphetamine locomotor response depends on individual differences. Also, our results suggest that clozapine pre-treatment attenuates the neuroplasticity underlying amphetamine sensitization, but clozapine treatment is unable to reverse these changes once amphetamine sensitization has been induced.
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Affiliation(s)
- Andrea Susana Herrera
- Department of Pharmacy, Faculty of Chemistry, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Science Nucleus in Stress and Addiction, Pontificia Universidad Católica de Chile, Santiago, Chile
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Zhang H, Dong LY, Sun G, An W. Downregulation of hepatic stimulator substance during the early phase of liver regeneration inhibits E-cadherin expression in mice. Int J Biochem Cell Biol 2013; 47:38-46. [PMID: 24309469 DOI: 10.1016/j.biocel.2013.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 10/26/2022]
Abstract
Hepatic stimulatory substance (HSS), which encodes a sulfhydryl oxidase enzyme, promotes liver regeneration (LR) and maintains the viability of hepatocytes. Surprisingly, we found that the levels of the HSS mRNA and expressed protein were both strongly repressed at 12h after a 70% partial hepatectomy (PH) in mice. Understanding the mechanism and effect of this extraordinary suppression can provide a novel path for exploring the molecular function of HSS during LR. We observed that the EGF levels in the serum were negatively correlated with HSS expression in regenerating livers. Treating primary mouse hepatocytes or Hepa1-6 cells with EGF suppressed HSS mRNA expression. This suppression was transcriptional and was mediated by the effect of EGF on the phosphorylation of CCAAT/enhancer-binding protein β (C/EBPβ), which regulates HSS expression. We further showed that the enhanced phosphorylation of C/EBPβ after PH promoted its interaction with the HSS promoter and repressed HSS expression at early time-points after PH. Interestingly, the knockdown of HSS caused a dramatic decrease in E-cadherin expression in hepatocytes. E-cadherin expression was also significantly suppressed at 12h after PH. Moreover, the pre-injection of HSS-expressing adenovirus vectors prevented E-cadherin suppression after PH. Treatment with C/EBPβ siRNA reversed the EGF-mediated inhibition of HSS expression and led to enhanced E-cadherin expression and reduced cell migration. Our findings suggest that C/EBPβ directly inhibits the HSS promoter after PH and that this inhibition can downregulate E-cadherin expression. These data provide novel insight into the potential role of HSS in hepatic structural reconstruction during LR.
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Affiliation(s)
- Haifeng Zhang
- Department of Cell Biology and the Municipal Laboratory of Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Ling-Yue Dong
- Department of Cell Biology and the Municipal Laboratory of Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Guangyong Sun
- Department of Cell Biology and the Municipal Laboratory of Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Wei An
- Department of Cell Biology and the Municipal Laboratory of Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.
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Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology 2013; 145:1262-70.e1. [PMID: 23994201 DOI: 10.1053/j.gastro.2013.08.048] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/08/2013] [Accepted: 08/20/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care. METHODS We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria. RESULTS In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59). CONCLUSIONS Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required.
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Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
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Matyja-Bednarczyk A, Swadźba J, Iwaniec T, Sanak M, Dziedzina S, Ćmiel A, Musiał J. Risk factors for arterial thrombosis in antiphospholipid syndrome. Thromb Res 2013; 133:173-6. [PMID: 24321419 DOI: 10.1016/j.thromres.2013.11.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Antiphospholipid syndrome (APS) is associated with the risk of both arterial and venous thrombosis. However, it is not known which factors might determine the location of thrombosis. MATERIALS AND METHODS To retrospectively characterize factors associated with the risk of arterial thrombosis in a cohort of APS patients. Analysis included laboratory and clinical criteria of APS, together with classical cardiovascular risk factors and the possible role of platelet integrin α₂β₁ (807 C/T) and α(IIb)β₃ (PI A1/2) genetic polymorphisms. We enrolled 163 APS patients (123 women and 40 men aged 21-75; mean age 43 years); 78 suffered from arterial thrombosis. RESULTS There were no significant differences in the frequency or titers of different antiphospholipid antibodies with the exception of slightly increased frequency of IgG anticardiolipin antibodies (ACL) in the arterial thrombosis group. Livedo reticularis was observed significantly more often in the arterial thrombosis group, particularly in stroke patients. In univariate analysis arterial thrombosis was associated with male gender (OR-2,201; p=0,033), arterial hypertension (OR-2,81; p=0,002) and hypercholesterolemia (OR-3,69; p=0,001). On multivariate analysis arterial hypertension (OR=1,78; p=0,008) and hypercholesterolemia (OR=2,001; p=0,002) remained as independent risk factors for arterial thrombosis. Platelet glycoprotein polymorphisms studied did not show any significant associations with arterial thrombosis in APS patients. CONCLUSIONS Among APS patients those with ACL IgG antibodies, having livedo reticularis, and suffering from hypertension an hypercholesterolemia are at the increased risk of arterial thrombosis.
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Affiliation(s)
| | - Jakub Swadźba
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Iwaniec
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Sanak
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sylwia Dziedzina
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Ćmiel
- Faculty of Applied Mathematics, University of Science and Technology, Krakow, Poland
| | - Jacek Musiał
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, Sheppard B, Thurer R, Andaz S, Smith M, Mayfield W, Grannis F, Korst R, Pass H, Straznicka M, Flores R, Henschke CI. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg 2013; 147:754-62; Discussion 762-4. [PMID: 24280722 DOI: 10.1016/j.jtcvs.2013.09.065] [Citation(s) in RCA: 238] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/30/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection. METHODS We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles. RESULTS Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P = .45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P = .42 and P = .52, respectively). CONCLUSIONS Sublobar resection and lobectomy have equivalent survival for patients with clinical stage IA non-small cell lung cancer in the context of computed tomography screening for lung cancer.
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Affiliation(s)
- Nasser K Altorki
- NY Presbyterian Hospital/Weill Cornell Medical College, New York, NY
| | - Rowena Yip
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Ralph Aye
- Swedish Medical Center, Seattle, Wash
| | | | - Barry Sheppard
- Dorothy E. Schneider Cancer Center, Mills-Peninsula Health Services, San Mateo, Calif
| | - Richard Thurer
- Jackson Memorial Hospital, University of Miami, Miami, Fla
| | | | - Michael Smith
- Georgia Institute for Lung Cancer Research, Atlanta, Ga
| | | | - Fred Grannis
- City of Hope National Medical Center, Duarte, Calif
| | | | - Harvey Pass
- New York University Medical Center, New York, NY
| | | | - Raja Flores
- Icahn School of Medicine at Mount Sinai, New York, NY
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Sehnal B, Dusek L, Cibula D, Zima T, Halaska M, Driak D, Slama J. The relationship between the cervical and anal HPV infection in women with cervical intraepithelial neoplasia. J Clin Virol 2013; 59:18-23. [PMID: 24315797 DOI: 10.1016/j.jcv.2013.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/11/2013] [Accepted: 11/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND More than 90% of cases of anal cancers are caused by high-risk human papillomavirus (HR HPV) infection and a history of cervical intraepithelial neoplasia (CIN) is established as possible risk factor. OBJECTIVES To demonstrate relationship between anal and cervical HPV infection in women with different grades of CIN and microinvasive cervical cancer. STUDY DESIGN A total of 272 women were enrolled in the study. The study group included 172 women who underwent conization for high-grade CIN or microinvasive cervical cancer. The control group consisted of 100 women with non-neoplastic gynecologic diseases or biopsy-confirmed CIN 1. All participants completed a questionnaire detailing their medical history and sexual risk factors and were subjected to anal and cervical HPV genotyping using Cobas and Lynear array HPV test. RESULTS Cervical, anal, and concurrent cervical and anal HPV infections were detected in 82.6%, 48.3% and 42.4% of women in the study group, and in 28.0%, 26.0% and 8.0% of women in the control group, respectively. The prevalence of the HR HPV genotypes was higher in the study group and significantly increased with the severity of cervical lesion. Concurrent infections of the cervix and anus occurred 5.3-fold more often in the study group than in the control group. Any contact with the anus was the only significant risk factor for development of concurrent HPV infection. CONCLUSIONS Concurrent anal and cervical HR HPV infection was found in nearly half of women with CIN 2+. The dominant genotype found in both anatomical locations was HPV 16. Any frequency and any type of contact with the anus were shown as the most important risk factor for concurrent HPV infection.
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Affiliation(s)
- Borek Sehnal
- Hospital Na Bulovce and 1st School of Medicine, Charles University, Department of Gynaecology and Obstetrics, Budinova 2, Prague 8, 180 81, Czech Republic.
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Masaryk University, Kamenice 3, Brno, 625 00, Czech Republic
| | - David Cibula
- General University Hospital and 1st School of Medicine, Gynaecologic Oncology Centre, Charles University, Apolinarska 18, Prague 2, 128 51, Czech Republic
| | - Tomas Zima
- General University Hospital and 1st School of Medicine, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University, U Nemocnice 2, Prague 2, 128 08, Czech Republic
| | - Michael Halaska
- Hospital Na Bulovce and 1st School of Medicine, Charles University, Department of Gynaecology and Obstetrics, Budinova 2, Prague 8, 180 81, Czech Republic
| | - Daniel Driak
- Hospital Na Bulovce and 1st School of Medicine, Charles University, Department of Gynaecology and Obstetrics, Budinova 2, Prague 8, 180 81, Czech Republic
| | - Jiri Slama
- General University Hospital and 1st School of Medicine, Gynaecologic Oncology Centre, Charles University, Apolinarska 18, Prague 2, 128 51, Czech Republic
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Mesher D, Soldan K, Howell-Jones R, Panwar K, Manyenga P, Jit M, Beddows S, Gill ON. Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England. Vaccine 2013; 32:26-32. [PMID: 24211166 PMCID: PMC3898718 DOI: 10.1016/j.vaccine.2013.10.085] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
Abstract
We monitor HPV infection in sexually active young women in England. The prevalence of HPV 16/18 has reduced within 3 years of HPV immunisation. Reductions in HPV 16/18 were greatest at ages with highest immunisation coverage. The data suggest reductions in HPV 16/18 amongst unvaccinated young women and men.
Background Reduction in the prevalence of vaccine type HPV infection in young women is an early indication of the impact of the HPV immunisation programme and a necessary outcome if the subsequent impact on cervical cancer is to be realised. Methods Residual vulva-vaginal swab (VVS) specimens from young women aged 16–24 years undergoing chlamydia screening in community sexual health services (formerly known as family planning clinics), general practice (GP), and youth clinics in 2010–2012 were submitted from 10 laboratories in seven regions around England. These specimens were linked to demographic and sexual behaviour data reported with the chlamydia test, anonymised, and tested for type-specific HPV DNA using a multiplex PCR and Luminex-based genotyping test. Estimated immunisation coverage was calculated and findings were compared to a baseline survey conducted prior to the introduction of HPV immunisation in 2008. Results A total of 4664 eligible specimens were collected and 4178 had a valid test result. The post-immunisation prevalence of HPV 16/18 infection was lowest in this youngest age group (16–18 years) and increased with age. This increase with age was a reversal of the pattern seen prior to immunisation and was inversely associated with estimates of age-specific immunisation coverage (65% for 16–18 year olds). The prevalence of HPV 16/18 infection in the post-immunisation survey was 6.5% amongst 16–18 year olds, compared to 19.1% in the similar survey conducted prior to the introduction of HPV immunisation. Conclusions These findings are the first indication that the national HPV immunisation programme is successfully preventing HPV 16/18 infection in sexually active young women in England. The reductions seen suggest, for the estimated coverage, high vaccine effectiveness and some herd-protection benefits. Continued surveillance is needed to determine the effects of immunisation on non-vaccine HPV types.
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Affiliation(s)
- D Mesher
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - K Soldan
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - R Howell-Jones
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - K Panwar
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - P Manyenga
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - M Jit
- Public Health England, Statistics and Modelling Economics Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - S Beddows
- Public Health England, Virus Reference Department, 61 Colindale Avenue, London NW9 5EQ, UK
| | - O N Gill
- Public Health England, HIV & STI Department, 61 Colindale Avenue, London NW9 5EQ, UK
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25
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Schaap FG, Leclercq IA, Jansen PLM, Olde Damink SW. Prometheus' little helper, a novel role for fibroblast growth factor 15 in compensatory liver growth. J Hepatol 2013; 59:1121-3. [PMID: 23867316 DOI: 10.1016/j.jhep.2013.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/12/2013] [Accepted: 07/06/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Frank G Schaap
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands.
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26
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Sanai FM, Babatin MA, Bzeizi KI, Alsohaibani F, Al-Hamoudi W, Alsaad KO, Al Mana H, Handoo FA, Al-Ashgar H, Alghamdi H, Ibrahim A, Aljumah A, Alalwan A, Altraif IH, Al-Hussaini H, Myers RP, Abdo AA. Accuracy of international guidelines for identifying significant fibrosis in hepatitis B e antigen--negative patients with chronic hepatitis. Clin Gastroenterol Hepatol 2013; 11:1493-1499.e2. [PMID: 23811251 DOI: 10.1016/j.cgh.2013.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 04/22/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Differing threshold levels of hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) are recommended by international guidelines for commencement of antiviral therapy. These guidelines advocate therapy for patients with significant fibrosis (METAVIR score ≥F2); we assessed the accuracy of these guideline-defined thresholds in identifying patients with ≥F2 fibrosis. METHODS We applied the European (European Association for the Study of the Liver [EASL] 2012), Asian-Pacific (Asian-Pacific Association for the Study of the Liver [APASL] 2012), American (American Association for the Study of Liver Diseases [AASLD] 2009), and United States Panel Algorithm (USPA 2008) criteria to 366 consecutive hepatitis B e antigen-negative patients with liver biopsy samples: EASL, ALT >laboratory-defined upper limit of normal (ULN) and HBV DNA ≥2000 IU/mL (n = 171); APASL, ALT >2-fold laboratory-defined ULN and HBV DNA ≥2000 IU/mL (n = 87); AASLD, ALT >2-fold the updated ULN (0.5-fold ULN [corresponding to ≤19 U/L] for women and 0.75-fold the ULN [corresponding to ≤30 U/L] for men) and HBV DNA ≥20,000 IU/mL (n = 53); and USPA, ALT >updated ULN (>0.5-fold ULN for women and >0.75-fold ULN for men) and HBV DNA ≥2000 IU/mL (n = 173). RESULTS Overall, 113 patients (30.9%) had ≥F2 fibrosis, which was more frequent among patients who fulfilled any guideline criteria (45.7% vs 17.9% for those who did not fulfill any criteria, P < .0001). In applying the EASL, AASLD, APASL, and USPA criteria, sensitivity and specificity values for detection of ≥F2 fibrosis were 45.6%, 58.5%, 56.3%, and 45.7% (P = .145) and 82.1%, 73.8%, 77.1%, and 82.4% (P = .366), respectively. The EASL criteria (area under the receiver operating characteristic [AUROC] curve, 0.66; 95% confidence interval [CI], 0.61-0.71) and USPA criteria (AUROC, 0.66; 95% CI, 0.58-0.73) performed better than APASL (AUROC, 0.64; 95% CI, 0.59-0.69; P = .421) and significantly better than the AASLD criteria (AUROC, 0.59; 95% CI, 0.54-0.64; P = .013). CONCLUSIONS In hepatitis B e antigen-negative patients with chronic hepatitis, the EASL, AASLD, APASL, and USPA criteria identify patients with ≥F2 fibrosis with low levels of accuracy. However, the EASL and USPA criteria are the most accurate for identification of these patients.
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Affiliation(s)
- Faisal M Sanai
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Piloni NE, Fermandez V, Videla LA, Puntarulo S. Acute iron overload and oxidative stress in brain. Toxicology 2013; 314:174-82. [PMID: 24120471 DOI: 10.1016/j.tox.2013.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/09/2013] [Accepted: 09/30/2013] [Indexed: 12/11/2022]
Abstract
An in vivo model in rat was developed by intraperitoneally administration of Fe-dextran to study oxidative stress triggered by Fe-overload in rat brain. Total Fe levels, as well as the labile iron pool (LIP) concentration, in brain from rats subjected to Fe-overload were markedly increased over control values, 6h after Fe administration. In this in vivo Fe overload model, the ascorbyl (A)/ascorbate (AH(-)) ratio, taken as oxidative stress index, was assessed. The A/AH(-) ratio in brain was significantly higher in Fe-dextran group, in relation to values in control rats. Brain lipid peroxidation indexes, thiobarbituric acid reactive substances (TBARS) generation rate and lipid radical (LR) content detected by Electron Paramagnetic Resonance (EPR), in Fe-dextran supplemented rats were similar to control values. However, values of nuclear factor-kappaB deoxyribonucleic acid (NFκB DNA) binding activity were significantly increased (30%) after 8h of Fe administration, and catalase (CAT) activity was significantly enhanced (62%) 21h after Fe administration. Significant enhancements in Fe content in cortex (2.4 fold), hippocampus (1.6 fold) and striatum (2.9 fold), were found at 6h after Fe administration. CAT activity was significantly increased after 8h of Fe administration in cortex, hippocampus and striatum (1.4 fold, 86, and 47%, respectively). Fe response in the whole brain seems to lead to enhanced NF-κB DNA binding activity, which may contribute to limit oxygen reactive species-dependent damage by effects on the antioxidant enzyme CAT activity. Moreover, data shown here clearly indicate that even though Fe increased in several isolated brain areas, this parameter was more drastically enhanced in striatum than in cortex and hippocampus. However, comparison among the net increase in LR generation rate, in different brain areas, showed enhancements in cortex lipid peroxidation, without changes in striatum and hippocampus LR generation rate after 6h of Fe overload. This information has potential clinical relevance, as it could be the key to understand specific brain damage occurring in conditions of Fe overload.
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Affiliation(s)
- Natacha E Piloni
- Physical Chemistry-Institute of Biochemistry and Molecular Medicine (IBIMOL), School of Pharmacy and Biochemistry, University of Buenos Aires-CONICET, Buenos Aires, Argentina
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Zhang Y, Liu H, Yin H, Wang W, Zhao X, Du Y. Nitric oxide mediates alginate oligosaccharides-induced root development in wheat (Triticum aestivum L.). Plant Physiol Biochem 2013; 71:49-56. [PMID: 23872742 DOI: 10.1016/j.plaphy.2013.06.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/25/2013] [Indexed: 05/27/2023]
Abstract
Alginate oligosaccharides (AOS), which are marine oligosaccharides, are involved in regulating plant root growth, but the promotion mechanism for AOS remains unclear. Here, AOS (10-80 mg L(-1)) were found to induce the generation of nitric oxide (NO) in the root system of wheat (Triticum aestivum L.), which promoted the formation and elongation of wheat roots in a dose-dependent manner. NO inhibitors suggested that nitrate reductase (NR), rather than nitric oxide synthase (NOS), was essential for AOS-induced root development. Further studies confirmed that AOS-induced NO generation in wheat roots by up-regulating the gene expression and enzyme activity of NR at the post-transcriptional level. The anatomy and RT-PCR results showed that AOS accelerated the division and growth of stele cells, leading to an increase in the ratio of stele area to root transverse area. This could be inhibited by the NR inhibitor, sodium tungstate, which indicated that NO catalyzed by the NR was involved in AOS regulation of root development. Taken together, in the early stage of AOS-induced root development, NO generation was a novel mechanism by which AOS regulated plant growth. The results also showed that this marine resource could be widely used for crop development.
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Affiliation(s)
- Yunhong Zhang
- Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Liaoning Provincial Key Laboratory of Carbohydrates, 457 Zhongshan Road, Dalian 116023, Liaoning, PR China
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Rendo-Urteaga T, García-Calzón S, Martínez-Ansó E, Chueca M, Oyarzabal M, Azcona-Sanjulián MC, Bustos M, Moreno-Aliaga MJ, Martínez JA, Marti A. Decreased cardiotrophin-1 levels are associated with a lower risk of developing the metabolic syndrome in overweight/obese children after a weight loss program. Metabolism 2013; 62:1429-36. [PMID: 23856329 DOI: 10.1016/j.metabol.2013.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiotrophin-1 (CT-1) shares some similarities with other cytokines, and participates in the control of energy metabolism. Higher circulating levels are observed in obese humans, but little information is gathered in weight loss (WL) programs. Therefore, we aimed to investigate the association of serum CT-1 levels with metabolic variables and the risk of developing metabolic syndrome (MetS) after a WL program in overweight/obese children. SUBJECTS AND METHODS Forty-four overweight/obese children (mean age 11.5 y; 50% males) undergoing a 10-week WL program were enrolled. Subjects were dichotomized at the median of Body Mass Index-Standard Deviation Score (BMI-SDS) change, as high and low responders after intervention. RESULTS CT-1 levels were significantly reduced (-48 fmol/mL, p=0.043) in the high responder group after the WL program. They had significantly lower body weight (-3.7 kg, p<0.001), body fat mass (-8%, p<0.001), BMI-SDS (-0.78, p<0.001) and waist circumference (-5.4 cm, p<0.001), and a significant improvement in lipid and glucose profiles (p<0.05). Interestingly, decreased CT-1 levels significantly predicted changes in total cholesterol (41%) and LDL-cholesterol (28%). Moreover, in our participants the lower the CT-1 levels, the higher the reduction in MetS risk components, after the 10-week intervention, (p-ANCOVA=0.040, p-trend=0.024). CONCLUSION We showed, for the first time, a reduction in serum CT-1 levels after a WL program and this decrease in CT-1 was strongly associated with a reduction in cholesterol levels and in MetS risk factors in overweight/obese children. Our findings may suggest that CT-1 could be an indirect marker for the diagnosis of MetS in this population.
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Affiliation(s)
- Tara Rendo-Urteaga
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain
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Abstract
The scope of activity of the Blood Transfusion Service (BTS) makes it unique among the clinical laboratories. The combination of therapeutic and diagnostic roles necessitates a multi-faceted approach to utilization management in the BTS. We present our experience in utilization management in large academic medical center.
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Affiliation(s)
- Jeremy Ryan Andrew Peña
- Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Jackson 220, Boston, MA, USA 02114.
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von Knethen A, Sha LK, Kuchler L, Heeg AK, Fuhrmann D, Heide H, Wittig I, Maier TJ, Steinhilber D, Brüne B. 5-Lipoxygenase contributes to PPARγ activation in macrophages in response to apoptotic cells. Cell Signal 2013; 25:2762-8. [PMID: 24036216 DOI: 10.1016/j.cellsig.2013.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 12/21/2022]
Abstract
Macrophage polarization to an anti-inflammatory phenotype upon contact with apoptotic cells is a contributing hallmark to immune suppression during the late phase of sepsis. Although the peroxisome proliferator-activated receptor γ (PPARγ) supports this macrophage phenotype switch, it remains elusive how apoptotic cells activate PPARγ. Assuming that a molecule causing PPARγ activation in macrophages originates in the cell membrane of apoptotic cells we analyzed lipid rafts from apoptotic, necrotic, and living human Jurkat T cells which showed the presence of 5-lipoxygenase (5-LO) in lipid rafts of apoptotic cells only. Incubating macrophages with lipid rafts of apoptotic, but not necrotic or living cells, induced PPAR responsive element (PPRE)-driven mRuby reporter gene expression in RAW 264.7 macrophages stably transduced with a 4xPPRE containing vector. Experiments with lipid rafts of apoptotic murine EL4 T cells revealed similar results. To verify the involvement of 5-LO in activating PPARγ in macrophages, Jurkat T cells were incubated with the 5-LO inhibitor MK-866 prior to induction of apoptosis, which failed to induce mRuby expression. Similar results were obtained with lipid rafts of apoptotic EL4 T cells preexposed to the 5-LO inhibitors zileuton and CJ-13610. Interestingly, Jurkat T cells overexpressing 5-LO failed to activate PPARγ in macrophages, while their 5-LO overexpressing apoptotic counterparts did. Our results suggest that during apoptosis 5-LO gets associated with lipid rafts and synthesizes ligands that in turn stimulate PPARγ in macrophages.
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Affiliation(s)
- Andreas von Knethen
- Institute of Biochemistry I-Pathobiochemistry, Faculty of Medicine, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Andrade MC, Ferreira SBP, Gonçalves LC, De-Paula AMB, de Faria ES, Teixeira-Carvalho A, Martins-Filho OA. Cell surface markers for T and B lymphocytes activation and adhesion as putative prognostic biomarkers for head and neck squamous cell carcinoma. Hum Immunol 2013; 74:1563-74. [PMID: 23994583 DOI: 10.1016/j.humimm.2013.08.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/23/2013] [Accepted: 08/10/2013] [Indexed: 01/29/2023]
Abstract
The study population comprised HNSCC patients, risk-positive controls (tabagism and alcoholism habits), and risk-negative controls (without risk factors). Significant increases in the activation status of CD4(+)and CD8(+) T-cells, and higher migration potentials of lymphocytes were observed in HNSCC patients compared with control groups. Although decreased frequency of CD19(+)-B lymphocytes was observed in HSNCC patients, a higher percentage of HLA-DR(+)CD19(+)-B lymphocytes was detected in these individuals as compared with other evaluated groups. Metastasis and tumor grading were the major pathological parameters associated with significant alterations in the expression of activation molecules on circulating CD4(+) and CD8(+) T-cells. A reduced frequency of CD38-expressing CD8(+) T-cells was the most relevant biomarker associated with HNSCC aggressiveness. Performance analysis suggested a cut-off point for the CD8(+)CD38(+)/CD8(+) T-cell ratio of 7.0 for segregating patients according to tumor grading. In contrast, a higher proportion of CD8(+)CD54(+)/CD8(+) T-cells could represent a relevant biomarker associated with metastasis in HNSCC patients, and performance analysis suggested a cut-off point for the CD8(+)CD54(+)/CD8(+) T-cell ratio of 30 for segregating patients according to absence or presence of metastasis. The results obtained can increment immunological aspects of HNSCC and provide tools for the determination of cut-off scores of clinically relevant immunophenotypic prognostic biomarkers.
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Mangia A, Santoro R, Copetti M, Massari M, Piazzolla V, Spada E, Cappucci G, Missale G, Mottola L, Agostinacchio E, Mauro LD, Zuccaro O, Maio P, Pellegrini F, Folgori A, Ferrari C. Treatment optimization and prediction of HCV clearance in patients with acute HCV infection. J Hepatol 2013; 59:221-8. [PMID: 23587473 DOI: 10.1016/j.jhep.2013.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The lack of consensus on the optimal timing, regimen, and duration of treatment, in patients with acute HCV infection, stimulates the research on both favourable outcome predictors and individualized treatment regimens. This study aimed at investigating the impact of IL28B SNP rs12979860 alone or in combination with HLA class II alleles in both predicting spontaneous viral clearance and individualizing treatment strategies for patients with HCV persistence, after acute HCV exposure. METHODS 178 patients with AHC, consecutively treated with interferon alone or in combination with ribavirin, starting within or after 48 weeks from the diagnosis of AHC, were tested for IL28B SNPs and HLA class II alleles. RESULTS Spontaneous viral clearance was achieved in 28% of 169 patients available for genetic testing. Factors associated with HCV elimination were jaundice (OR 2.75, 95% CI 1.31-5.77) and IL28B CC (OR 3.87, CI 1.71-8.51), but not HLA alleles. In CT/TT patients without jaundice, NPV for virus persistence was 98%. In patients with IL28B CT/TT, starting treatment 48 weeks after the onset was significantly associated with lower rates of response (28% vs. 100%, p=0.027). By contrast, no significant differences in the rate of SVR were observed for CC carriers who started treatment later (65% vs. 85%, p=1.0). CONCLUSIONS In patients with acute HCV hepatitis, lack of viral clearance may be predicted by absence of jaundice and IL28B CT/TT genotype; in patients with these characteristics, treatment needs to be started immediately.
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Affiliation(s)
- Alessandra Mangia
- Liver Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
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D'Ambrosio R, Aghemo A, Fraquelli M, Rumi MG, Donato MF, Paradis V, Bedossa P, Colombo M. The diagnostic accuracy of Fibroscan for cirrhosis is influenced by liver morphometry in HCV patients with a sustained virological response. J Hepatol 2013; 59:251-6. [PMID: 23528378 DOI: 10.1016/j.jhep.2013.03.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Transient elastography (TE) is a validated non-invasive tool to evaluate hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Whether TE may sense changes of liver fibrosis following therapeutic HCV eradication has never been evaluated. METHODS 37 HCV cirrhotics with paired pre- and post-sustained virological response (SVR) liver biopsies (LB) underwent TE at the time of post-SVR LB. Liver fibrosis was staged with the METAVIR scoring system and the area of fibrosis (%) was assessed morphometrically. RESULTS Thirty-three patients had valid TE measurements after 61 (48-104) months from an SVR, and 20 (61%) of them had cirrhosis regression. On post-SVR LB, the median area of fibrosis was 2.3%, being significantly reduced from baseline (p<0.0001). Median TE value was 9.8 kPa being lower in regressed vs. not regressed patients (9.1 kPa vs. 12.9 kPa, p=0.01). TE was <12 kPa in 5 (38%) F4 patients and in 19 (95%) ≤F3 patients (p=0.0007). The diagnostic accuracy of TE for diagnosing F4 after treatment was 61% sensitivity, 95% specificity, 12.3 LR+, 0.4 LR-, and AUROC 0.77. A significant correlation was found between TE and both fibrosis stage (r=0.56; p=0.001) and morphometry (r=0.56, p=0.001) as well as between fibrosis stage and area of fibrosis (r=0.72, p=0001). CONCLUSIONS Following therapeutic eradication of HCV, the predictive power of the viremic cut-off of 12 kPa was low as a consequence of liver remodelling and fibrosis reabsorption. LB still remains the only reliable approach to stage liver fibrosis following an SVR.
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Affiliation(s)
- Roberta D'Ambrosio
- A.M. and A. Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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Culp SH, Dickstein RJ, Grossman HB, Pretzsch SM, Porten S, Daneshmand S, Cai J, Groshen S, Siefker-Radtke A, Millikan RE, Czerniak B, Navai N, Wszolek MF, Kamat AM, Dinney CP. Refining patient selection for neoadjuvant chemotherapy before radical cystectomy. J Urol 2014; 191:40-7. [PMID: 23911605 DOI: 10.1016/j.juro.2013.07.061] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy. MATERIALS AND METHODS We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings. RESULTS We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged. CONCLUSIONS The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity.
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Peters RL, Allen KJ, Dharmage SC, Tang MLK, Koplin JJ, Ponsonby AL, Lowe AJ, Hill D, Gurrin LC. Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. J Allergy Clin Immunol 2013; 132:874-80. [PMID: 23891354 DOI: 10.1016/j.jaci.2013.05.038] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/21/2013] [Accepted: 05/31/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited. OBJECTIVE We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion. METHODS HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow's milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing. RESULTS Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods. CONCLUSION These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors.
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Affiliation(s)
- Rachel L Peters
- Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Zhang R, Shi TY, Ren Y, Lu H, Wei ZH, Hou WJ, Zhang M, Xu C. Risk factors for human papillomavirus infection in Shanghai suburbs: a population-based study with 10,000 women. J Clin Virol 2013; 58:144-8. [PMID: 23849649 DOI: 10.1016/j.jcv.2013.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/28/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND High risk human papillomavirus (HPV) infection is the major cause of cervical cancer. Several epidemiological studies have performed HPV screening in Chinese women, but no report was for Shanghai suburb women. OBJECTIVES To understand the prevalence of HPV infection and risk factors in Shanghai suburbs. STUDY DESIGN Between March 2011 and May 2011, 10,000 female volunteers lived in Fengxian District of Shanghai were recruited for the detection of 21 HPV types using PCR and fast flow hybridization of gene chip array. For the 508 HPV-positive patients, we performed the liquid-based ThinPrep cytology test (TCT) and histological examination for the diagnosis of local cervical lesions. The questionnaire surveyed demographic and behavioral indicators for the evaluation of risk factors of HPV infection. RESULTS We found that the HPV-positive rate was 12.6%. The five top HPV types were as follows (in descending order): HPV52, 16, 58, 18 and 33. Moreover, HPV-positive rates were higher in women with older age, lower educational level, younger age of the first sexual intercourse, multiple sexual partners, no usage of condom for contraception, multiple deliveries, vaginal delivery, menopause, vaginal inflammation, cervical erosion and no regular cervical cytological examination. We also found that an HPV genotyping in combination with TCT and histological examination could improve early diagnosis for local cervical lesions. CONCLUSION HPV infection was associated with age, sexual behavior and chronic inflammation of the cervix and vagina. We recommend popularizing HPV genotyping in women with high risk factors for the early diagnosis and prevention of cervical cancer.
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Affiliation(s)
- Rong Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, PR China
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Kayalp D, Dogan K, Ceylan G, Senes M, Yucel D. Can routine automated urinalysis reduce culture requests? Clin Biochem 2013; 46:1285-9. [PMID: 23810583 DOI: 10.1016/j.clinbiochem.2013.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There are a substantial number of unnecessary urine culture requests. We aimed to investigate whether urine dipstick and microscopy results could accurately rule out urinary tract infection (UTI) without urine culture. DESIGN AND METHODS The study included a total of 32,998 patients (11,928 men and 21,070 women, mean age: 39 ± 32 years) with a preliminary diagnosis of UTI and both urinalysis and urinary culture were requested. All urine cultures were retrospectively reviewed; association of culture positivity with a positive urinalysis result for leukocyte esterase (LE) and nitrite in chemical analysis and pyuria (WBC) and bacteriuria in microscopy was determined. Diagnostic performance of urinalysis parameters for detection of UTI was evaluated. RESULTS In total, 758 (2.3%) patients were positive by urine culture. Out of these culture positive samples, ratios of positive dipstick results for LE and nitrite were 71.0% (n=538) and 17.7% (n=134), respectively. The positive microscopy results for WBC and bacteria were 68.2% (n=517) and 78.8% (n=597), respectively. Negative predictive values for LE, nitrite, bacteriuria and WBC were very close to 100%. CONCLUSIONS Most of the samples have no or insignificant bacterial growth. Urine dipstick and microscopy can accurately rule out UTI. Automated urinalysis is a practicable and faster screening test which may prevent unnecessary culture requests for majority of patients.
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Affiliation(s)
- Damla Kayalp
- Department of Medical Biochemistry, Ankara Training and Research Hospital, Ministry of Health, Cebeci, Ankara 06340, Turkey
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Talukdar R, Nechutova H, Clemens M, Vege SS. Could rising BUN predict the future development of infected pancreatic necrosis? Pancreatology 2013; 13:355-9. [PMID: 23890133 DOI: 10.1016/j.pan.2013.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infected (peri)pancreatic necrosis (IPN) in acute pancreatitis (AP) is associated with organ failure (OF) and high mortality. There are no established early markers of primary IPN. This study aimed to assess the association of simple parameters with primary IPN in AP. METHODS We retrospectively studied 281 patients with AP admitted to Mayo Clinic hospitals and identified those with microbiologically confirmed infections in (peri)pancreatic necrosis and collections. We defined primary IPN as infection of (peri)pancreatic necrotic tissue that developed before interventions. We recorded admission hematocrit, BMI, BUN, serum creatinine, SIRS score and development of persistent organ failure within 48 h of admission; and performed serial SIRS and BUN calculations for at least 48 h. We used univariate and multivariable analysis to assess associations and expressed results as odds ratio (OR)[95% CI]. RESULTS 27 (9.6%) patients developed IPN, of which 21 (77.7%) had primary IPN. 38.1% had Gram positive, 9.5% Gram negative and 52.3% mixed bacterial infections. Five (23.8%) of the patients with IPN had fungal infection. On univariate analysis, SIRS ≥ 2 at admission, rise in BUN by 5 mg/dL within 48 h of admission, persistence of SIRS for 48 h and development of persistent OF within 48 h of disease had significant association with development of primary IPN with OR (95% CI) of 4.12 (1.53-11.15), 10.25 (3.95-26.61), 1.19 (1.69-10.39) and 7.62 (2.58-21.25) [2-tailed p = 0.004, <0.0001, 0.002 and <0.0001] respectively. On multivariable analysis, only rise in BUN by 5 mg/dL within 48 h of admission was associated with primary IPN (p = 0.007). CONCLUSIONS Rising BUN within 48 h of admission can be used to predict development of primary IPN in AP.
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Affiliation(s)
- Rupjyoti Talukdar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Falch C, Stojadinovic A, Hann-von-Weyhern C, Protic M, Nissan A, Faries MB, Daumer M, Bilchik AJ, Itzhak A, Brücher BLDM. Anorectal malignant melanoma: extensive 45-year review and proposal for a novel staging classification. J Am Coll Surg 2013; 217:324-35. [PMID: 23697834 DOI: 10.1016/j.jamcollsurg.2013.02.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/22/2013] [Accepted: 02/22/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Claudius Falch
- Department of Surgery, University of Tübingen, Tübingen, Germany
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Tosoian JJ, JohnBull E, Trock BJ, Landis P, Epstein JI, Partin AW, Walsh PC, Carter HB. Pathological outcomes in men with low risk and very low risk prostate cancer: implications on the practice of active surveillance. J Urol 2013; 190:1218-22. [PMID: 23643603 DOI: 10.1016/j.juro.2013.04.071] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE We assessed oncologic outcomes at surgery in men with low risk and very low risk prostate cancer who were candidates for active surveillance. MATERIALS AND METHODS In a prospectively collected institutional database, we identified 7,486 subjects eligible for active surveillance who underwent radical retropubic prostatectomy. Candidates were designated as being at low risk (stage T1c/T2a, prostate specific antigen 10 ng/ml or less, and Gleason score 6 or less) or very low risk (stage T1c, prostate specific antigen density 0.15 or less, Gleason score 6 or less, 2 or fewer positive biopsy cores, 50% or less cancer involvement per core) based on preoperative data. Adverse findings were Gleason score upgrade (score 7 or greater) and nonorgan confined cancer on surgical pathology. The relative risk of adverse findings in men at low risk with very low risk disease was evaluated in a multivariate model using Poisson regression. RESULTS A total of 7,333 subjects met the criteria for low risk disease and 153 had very low risk disease. The proportion of subjects at low risk found to have Gleason score upgrade or nonorgan confined cancer on final pathology was 21.8% and 23.1%, respectively. Corresponding values in those at very low risk were 13.1% and 8.5%, respectively. After adjusting for age, race, year of surgery, body mass index, and prostate specific antigen at diagnosis, the relative risk of Gleason score upgrade in men with low risk vs very low risk disease was 1.89 (95% CI 1.21-2.95). The relative risk of nonorgan confined cancer was 2.06 (95% CI 1.19-3.57). CONCLUSIONS Men with very low risk prostate cancer were at significantly lower risk for adverse findings at surgery compared to those with low risk disease. These data support the stratification of low risk cancer when selecting and counseling men who may be appropriate for active surveillance.
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Affiliation(s)
- Jeffrey J Tosoian
- Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder. This review will focus on the basic science of hemostasis, the evaluation of HS, the skin manifestations associated with hypercoagulability, and the use of antiplatelet and anticoagulant therapy in dermatology.
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Affiliation(s)
- Laura A Thornsberry
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Pleijhuis RG, Kwast AB, Jansen L, de Vries J, Lanting R, Bart J, Wiggers T, van Dam GM, Siesling S. A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making. Breast 2013; 22:773-9. [PMID: 23462681 DOI: 10.1016/j.breast.2013.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/08/2013] [Accepted: 01/19/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Breast-conserving therapy, consisting of lumpectomy and adjuvant radiotherapy, is considered standard treatment for early-stage breast cancer. One of the most important risk factors of local recurrence is the presence of positive surgical margins following lumpectomy. We aimed to develop and validate a predictive model (nomogram) to predict for positive margins following the first attempt at lumpectomy as a preoperative tool for clinical decision-making. METHODS Patients with clinical T1-2N0-1Mx-0 histology-proven invasive breast carcinoma who underwent BCT throughout the North-East region of The Netherlands between June 2008 and July 2009 were selected from the Netherlands Cancer Registry (n = 1185). Results from multivariate logistic regression analyses served as the basis for development of the nomogram. Nomogram calibration and discrimination were assessed graphically and by calculation of a concordance index, respectively. Nomogram performance was validated on an external independent dataset (n = 331) from the University Medical Center Groningen. RESULTS The final multivariate regression model included clinical, radiological, and pathological variables. Concordance indices were calculated of 0.70 (95% CI: 0.66-0.74) and 0.69 (95% CI: 0.63-0.76) for the modeling and the validation group, respectively. Calibration of the model was considered adequate in both groups. A nomogram was developed as a graphical representation of the model. Moreover, a web-based application (http://www.breastconservation.com) was build to facilitate the use of our nomogram in a clinical setting. CONCLUSION We developed and validated a nomogram that enables estimation of the preoperative risk of positive margins in breast-conserving surgery. Our nomogram provides a valuable tool for identifying high-risk patients who might benefit from preoperative MRI and/or oncoplastic surgery.
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Dias CS, Silva JMP, Pereira AK, Marino VS, Silva LA, Coelho AM, Costa FP, Quirino IG, Simões E Silva AC, Oliveira EA. Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol 2013; 190:661-6. [PMID: 23416643 DOI: 10.1016/j.juro.2013.02.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE In this study we evaluate the diagnostic accuracy of renal pelvic dilatation for detecting infants with prenatal hydronephrosis who will need surgical intervention for ureteropelvic junction obstruction during followup. MATERIALS AND METHODS Between 1999 and 2010, 371 newborns diagnosed with isolated prenatal hydronephrosis were prospectively followed. The main event of interest was the need for pyeloplasty. Diagnostic odds ratio, sensitivity, specificity and diagnostic accuracy (assessed by AUC) of fetal renal pelvic dilatation and postnatal renal pelvic dilatation were evaluated. RESULTS A total of 312 patients were included in the analysis and 25 (7.5%) infants underwent pyeloplasty. The diagnostic performance for detecting the need for pyeloplasty was excellent for all ultrasonography measurements. The AUC was 0.96 (95% CI 0.92-0.98) for fetal renal pelvic dilatation, 0.97 (95% CI 0.95-0.98) for postnatal renal pelvic dilatation and 0.95 (95% CI 0.92-0.97) for the Society for Fetal Urology grading system. A cutoff of 18 mm for fetal renal pelvic dilatation and a cutoff of 16 mm for postnatal renal pelvic dilatation had the best diagnostic odds ratio to identify infants who needed pyeloplasty. Considering a diagnosis to be positive only if fetal renal pelvic dilatation was greater than 18 mm and postnatal dilatation was greater than 16 mm, sensitivity was 100% and specificity was 86% (95% CI 80.7-89.9). CONCLUSIONS Our findings suggest that the combination of fetal and postnatal renal pelvic dilatation is able to increase the diagnostic accuracy for detecting infants who need a more comprehensive postnatal investigation for upper urinary tract obstruction.
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Affiliation(s)
- Cristiane S Dias
- Pediatric Nephrourology Unit, Faculdade de Medicina, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. J Allergy Clin Immunol Pract 2012; 1:1-13; quiz 14. [PMID: 24229816 DOI: 10.1016/j.jaip.2012.10.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 12/14/2022]
Abstract
Peanut allergy is often severe, potentially fatal, usually persistent, and appears to have increased in prevalence. An accurate diagnosis is essential because there is a significant burden on quality of life. The tools available for diagnosis include the medical history, skin prick test (SPT), determination of serum peanut-specific IgE antibodies (PN-IgE), and medically supervised oral food challenges. Numerous studies, almost exclusively in children, have correlated clinical outcomes against SPTs and PN-IgE with informative results. The diagnostic utility of SPT and PN-IgE is maximized by considering the degree of positive result and consideration of the medical history (a priori estimation of risk). Emerging tests that evaluate IgE binding to specific proteins in peanut (component testing) add important additional diagnostic information in specific settings. Studies are increasingly focused on how the results of tests considered in combination (or performed serially) may increase diagnostic accuracy. Here, we review the utility of currently available tests and provide suggestions on how to best use them to accurately predict peanut allergy. Still, the physician-supervised oral food challenge remains the most definitive test available.
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Affiliation(s)
- Scott H Sicherer
- Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY.
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Abstract
Adolescence is a time of continued brain maturation, particularly in limbic and cortical regions, which undoubtedly plays a role in the physiological and emotional changes coincident with adolescence. An emerging line of research has indicated that stressors experienced during this crucial developmental stage may affect the trajectory of this neural maturation and contribute to the increase in psychological morbidities, such as anxiety and depression, often observed during adolescence. In this review, we discuss the short- and long-term effects of periadolescent stress exposure on the structure and function of the brain. More specifically, we examine how stress at prepubertal and early adolescent stages of development affects the morphological plasticity of limbic and cortical brain regions, as well as the enduring effects of adolescent stress exposure on these brain regions in adulthood. We suggest that, due to a number of converging factors during this period of maturation, the adolescent brain may be particularly sensitive to stress-induced neurobehavioral dysfunctions with important consequences on an individual's immediate and long-term health and well-being.
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Affiliation(s)
- L Eiland
- Laboratory of Neuroendocrinology, Rockefeller University, New York, NY 10065, United States
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