Borderline Sample Research Articles

A-324 Incorporating the Screening for Congenital Cytomegalovirus into a Newborn Genetic Testing Performed on Saliva Swab: An Intersection between Human Genetics and Infectious Diseases

Abstract Background Newborn genetic testing is a powerful tool for improving the future healthcare of infants because of its potential to screening for a wide range of disorders with a single test. The assay can be performed in non-invasive sample such as saliva swabs. Hundreds of genes associated to disorders with significant morbidity and mortality (if undiagnosed) are analyzed. Despite the knowledge that infectious disorders such as congenital cytomegalovirus virus (cCMV) infection also has potential to cause serious illness to newborns (10–15% of apparently asymptomatic infants with cCMV may develop hearing loss) most of the newborn genetic testing does not test the saliva for cCMV. This validation aims to compare two laboratory-developed PCR-based CMV tests in saliva samples to add the cCMV screening into our newborn genetic testing. Methods Saliva swabs (OCR-100, DNA Genotek) from infants of our NGS-based newborn genetic testing were enrolled (n = 171). Parent signed informed consent agreeing with the used of the left-over specimens. Infants age ranged from 0 to 10 years. Saliva DNA was extracted by using QIAsymphony and DSP DNA mini kit (Qiagen). CMV was tested by two independent qPCR assays performed on LightCycler 480II using LightCycler Multiplex DNA Master (Roche). Each assays target two separated regions of the CMV genome (UL55 + UL123 and UL34 + UL80.5). A third assay targeting human CPOX gene was used as process control. The assays limits of detection were calculated by applying probit regression to the qualitative results returned from a serial dilution (1:10) of a positive pool (2 310 000 UI/mL) into a negative pool of samples. The accuracies for CMV detection were estimated by the total, positive and negative agreement between the compared sets of assays. The assay with lower limit of detection were chosen and its precision was evaluated by testing a subset of 26 saliva swabs (6 positives and 20 negatives) during 3 distinct days. For accuracy and precision experiments, Cq values >35 (∼750 UI/mL) was considered as not detected. Results The limits of detections were 40.7 UI/mL (95% CI:19.2–62.27 UI/mL) for UL55 + UL123 and 184 UI/mL (95% CI:64–304 UI/mL) for UL34 + UL80.5. CMV was detected in 8 and not detected in 163 saliva swabs by either UL55 + UL123 and UL34 + UL80.5 resulting in total, positive and negative agreements of 100% (95% CI:97–100%), 100% (95% CI:67–100%) and 100% (95% CI:97–100%), respectively. The median (min-max) Cq values for UL55 + UL123 were 30.75 (21.39–34.42) and for UL34 + UL80.5 were 30.81 (20.53–34.1). In the assay precision evaluation, UL55 + UL123 returned the expected result in 26/26, 26/26 and 25/26 samples on day 1, 2 and 3, respectively. The exception was a borderline positive sample that reach the Cq cut-off value (>35) on day 3 evaluation. Conclusion The UL55 + UL123 assay had lower limit of detection for CMV compared UL34 + UL80.5 and was chosen to be used in our cCMV screening. Both assays showed complete agreement when applied to saliva swabs samples. UL55 + UL123 presented acceptable precisions for positive and negative results. The cCMV screening by qPCR is now performed in parallel to NGS in our newborn genetic testing. cCMV test is only performed for newborns with less than 21 days of life, as recommend by specific guidelines.

Emphasizing feature inter-class separability for improving highly imbalanced overlapped data classification

Class imbalance hinders the performance of some standard classifiers. However, class imbalance may not be solely responsible for the decrease in performance. Research efforts show that imbalanced datasets suffer from overlapping problems and borderline samples, which often deteriorate the classification performance. Conventional imbalanced learning methods mainly focus on balancing the distribution between classes but ignore difficulties caused by the above problems, thus underperforming drastically. This paper proposes a hybrid network called SemiPro-Empha to alleviate the aforementioned problems by learning a feature space with good inter-class separability and intra-class compactness. SemiPro-Empha comprises two modules: a feature learning loss called Semi-Prototype contrastive loss (Semi-Proto), guiding the feature extractor to learn a feature space where the projections of original overlapping classes can be separated, thereby improving classification performance. Additionally, this paper also presents a robust valuable borderline sample mining strategy called Emphasizing (Empha). Emphasizing identifies “valuable” borderline samples and eliminates noisy samples to create an auxiliary training dataset during each training epoch, providing up-to-date global classification boundary information for the training model while ensuring its robustness. Extensive experiments conducted on the breast cancer dataset and seven imbalanced datasets demonstrate the effectiveness of SemiPro-Empha.

Uncovering a novel role of focal adhesion and interferon-gamma in cellular rejection of kidney allografts at single cell resolution.

Kidney transplant recipients are currently treated with nonspecific immunosuppressants that cause severe systemic side effects. Current immunosuppressants were developed based on their effect on T-cell activation rather than the underlying mechanisms driving alloimmune responses. Thus, understanding the role of the intragraft microenvironment will help us identify more directed therapies with lower side effects. To understand the role of the alloimmune response and the intragraft microenvironment in cellular rejection progression, we conducted a Single nucleus RNA sequencing (snRNA-seq) on one human non-rejecting kidney allograft sample, one borderline sample, and T-cell mediated rejection (TCMR) sample (Banff IIa). We studied the differential gene expression and enriched pathways in different conditions, in addition to ligand-receptor (L-R) interactions. Pathway analysis of T-cells in borderline sample showed enrichment for allograft rejection pathway, suggesting that the borderline sample reflects an early rejection. Hence, this allows for studying the early stages of cellular rejection. Moreover, we showed that focal adhesion (FA), IFNg pathways, and endomucin (EMCN) were significantly upregulated in endothelial cell clusters (ECs) of borderline compared to ECs TCMR. Furthermore, we found that pericytes in TCMR seem to favor endothelial permeability compared to borderline. Similarly, T-cells interaction with ECs in borderline differs from TCMR by involving DAMPS-TLRs interactions. Our data revealed novel roles of T-cells, ECs, and pericytes in cellular rejection progression, providing new clues on the pathophysiology of allograft rejection.

Palatal shape covariation in extraction versus nonextraction borderline patients: A geometric morphometric study

This study aimed to evaluate changes in palatal shape after orthodontic treatment from a borderline sample of extraction and nonextraction patients with a Class I relationship. A borderline sample regarding premolar extractions was obtained through discriminant analysis and comprised 30 nonextraction and 23 extraction patients. The digital dental casts of these patients were digitized with 3 curves and 239 landmarks placed on the hard palate. Procrustes superimposition and principal component analysis were implemented to assess group shape variability patterns. The success of the discriminant analysis in identifying a borderline sample regarding the extraction modality was validated using geometric morphometrics. Concerning palatal shape, no sexual dimorphism was found (P= 0.78). The first 6 principal components that were statistically significant accounted for 79.2% of the total shape variance. Palatal changes were 61% more pronounced in the extraction group, which exhibited a decrease in palatal length (P= 0.02; 10,000 permutations). In contrast, the nonextraction group showed an increase in the palatal width (P<0.001; 10,000 permutations). Intergroup comparisons indicated that the nonextraction group exhibited longer palates, whereas the extraction group exhibited higher palates (P= 0.02; 10,000 permutations). Considerable changes in palatal shape were seen for the nonextraction and extraction treatment group, with the latter exhibiting more pronounced changes, mainly in terms of palatal length. Further investigations are needed to clarify the clinical significance of the palatal shape changes in borderline patients after extraction and nonextraction treatment.

A Psychosis Superspectrum in Borderline Personality Disorder?

Introduction The innermost relationship of the borderline concept and psychosis has been historically intertwined and can be traced back to the 20th century, but remarkably, to date, they have not been the focus of many empirical studies. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. Objectives In this study the framework of psychosis superspectrum were put closely in relation to both DSM-5 psychoticism/detachment domains, personality traits and psychopathological symptoms features in borderline personality disorder (PD). Methods A cross-sectional study of a borderline PD sample of 58 participants (Mage=39.76 years, SD=11.37; Mschooling=9 years), mainly male (58.5%). Self-reported assessment: PID-5; BSI; NEO-FFI. A multiple linear regression was computed. Results In borderline PD, the PID-5 disinhibition (β=.51), BSI psychoticism (β=.43), BSI depression (β=-.24) and NEO neuroticism (β=.29) predicted psychosis superspectrum, explaining 94% of the variance. Also, stands out as a complement that, the BSI psychoticism was predicted by PID-5 detachment and PID-5 psychoticism, explaining 82% of the variance. Conclusions Evidence appears to be emerging for the underlying psychosis superspectrum trough borderline PD. There is a closer dialogue between the state-of-art view of a dimensional pathological personality-symptoms and the borderline pathology. Disclosure of Interest None Declared

Analysis of external quality assessment samples revealed crucial performance differences between commercial RT-PCR assays for SARS-CoV-2 detection when taking extraction methods and real-time-PCR instruments into account

In limelight of the ongoing pandemic SARS-CoV-2 testing is critical for the diagnosis of infected patients, contact-tracing and mitigating the transmission. Diagnostic laboratories are expected to provide appropriate testing with maximum accuracy. Real-time reverse transcriptase PCR (RT-PCR) is the diagnostic standard. However, only a handful of studies have reviewed their performance in clinical settings. The aim of this study was to compare the performance of the overall analytical matrix including the extraction kit (BD MAX, Promega, Qiagen), the PCR instrument (Agilent Mx3005 P, BD MAX, Qiagen Rotor-Gene, Roche Cobas z 480) and the RT-PCR assay (Altona Diagnostics, CerTest Biotec, R-Biopharm AG) using predefined samples from proficiency testing organizers. The greatest difference of the cycle threshold values between the matrices was nine cycles. One borderline sample could not be detected by three out of twelve analytical matrices and yielded a false negative result. We therefore conclude that diagnostic laboratories should take the complete analytical matrix in addition to the performance values published by the manufacturer for a respective RT-PCR kit into account. With limited resources laboratories have to validate a wide range of kits to determine appropriate analytical matrices for detecting SARS-CoV-2 reliably. The interpretation of clinical results has to be adapted accordingly.

Breast Tumor Characterization Using [18F]FDG-PET/CT Imaging Combined with Data Preprocessing and Radiomics.

Simple SummaryBreast cancer is the second most common diagnosed malignancy in women worldwide. In this study, we examine the feasibility of breast tumor characterization based on [18F]FDG-PET/CT images using machine learning (ML) approaches in combination with data-preprocessing techniques. ML prediction models for breast cancer detection and the identification of breast cancer receptor status, proliferation rate, and molecular subtypes were established and evaluated. Furthermore, the importance of most repeatable features was investigated. Results displayed high performance of malignant/benign tumor differentiation and triple negative tumor subtype ML models. We observed high repeatability of radiomic features for both high performing predictive models.Background: This study investigated the performance of ensemble learning holomic models for the detection of breast cancer, receptor status, proliferation rate, and molecular subtypes from [18F]FDG-PET/CT images with and without incorporating data pre-processing algorithms. Additionally, machine learning (ML) models were compared with conventional data analysis using standard uptake value lesion classification. Methods: A cohort of 170 patients with 173 breast cancer tumors (132 malignant, 38 benign) was examined with [18F]FDG-PET/CT. Breast tumors were segmented and radiomic features were extracted following the imaging biomarker standardization initiative (IBSI) guidelines combined with optimized feature extraction. Ensemble learning including five supervised ML algorithms was utilized in a 100-fold Monte Carlo (MC) cross-validation scheme. Data pre-processing methods were incorporated prior to machine learning, including outlier and borderline noisy sample detection, feature selection, and class imbalance correction. Feature importance in each model was assessed by calculating feature occurrence by the R-squared method across MC folds. Results: Cross validation demonstrated high performance of the cancer detection model (80% sensitivity, 78% specificity, 80% accuracy, 0.81 area under the curve (AUC)), and of the triple negative tumor identification model (85% sensitivity, 78% specificity, 82% accuracy, 0.82 AUC). The individual receptor status and luminal A/B subtype models yielded low performance (0.46–0.68 AUC). SUVmax model yielded 0.76 AUC in cancer detection and 0.70 AUC in predicting triple negative subtype. Conclusions: Predictive models based on [18F]FDG-PET/CT images in combination with advanced data pre-processing steps aid in breast cancer diagnosis and in ML-based prediction of the aggressive triple negative breast cancer subtype.

CT SCAN FEATURES OF OVARIAN NEOPLASM AT VARIOUS CA125 LEVELS A RETROSPECTIVE STUDY IN Dr. SOETOMO GENERAL ACADEMIC HOSPITAL SURABAYA JANUARY 2017 - JUNE 2020

Background: Ovarian cancer is the third malignant tumor with the high mortality rate beside breast cancer and cervical cancer. CA 125 is one of the earliest tumor markers and often used by clinicians to diagnosed ovarian cancer. One of the criteria for malignant ovarian neoplasms diagnostic is the elevation of CA 125 levels, but CA 125 level milieu is not specifics indicated ovarian cancer. Contrast – enhanced CT scan of the abdomen and pelvis are the initial imaging modality that used to determined further diagnostic for developed treatment. In addition, preoperative discrimination between benign, borderline and malignant mass in the pelvis was needed. Objective: The objective of this study was to evaluate CT scan feature of ovarian neoplasm at various CA 125 levels. Methods: Retrospective descriptive study in Dr. Soetomo General Academic Hospital January 2017 until June 2020, 91 patients of ovarian neoplasm with pathological confirmed enrolled in the study. Patient did abdominal CT scan and CA 125 serum examination before surgery. CT scan feature was evaluated in raw data. Result: From this study, age range was 22-75 years old, 38.46 % sample was at 51– 60 years, CA 125 level range 7.1 – 8749.5 U/ml. Benign ovarian neoplasm samples were 24. 2 % with CA 125 range 13.1-32.5 U/ml, CT scan feature were cystic (100 %), septated (90.1%), with solid component (72.7%). Borderline ovarian neoplasm sample were 3.3 % with CA 125 range 33.8-454.6 U/ml, CT scan feature were cystic (100 %), septated (100%), with solid component (100%). Malignant ovarian neoplasm samples were 72.5 % with CA 125 range 7.1 – 8749.5 U/ml, CT Scan feature were cystic (100 %), septated (98,4%), with solid component (96.9%), contrast enhancement (96.9 %), irregular walls (84,8 %). Of all, 49 samples were found ascites (85,7% were malignant), 39 samples were found peritoneal carcinomatosis (92 % was malignant ovarian neoplasm). Conclusion: There were no difference finding of the CT scan characteristics in benign and borderline ovarian neoplasm group with normal CA 125 levels and elevated CA 125 levels. The difference between malignant ovarian group, in elevation of CA 125 level showed ascites and peritoneal cacinomatosis more.

A retrospective study of quality management system at national reference laboratory in Mumbai - Highlighting quality in HIV testing

Background: National reference laboratory (NRL) is a NABL certified center of HIV testing at National Institute of Immunohaematology. It has 2 union territories and 8 medical colleges as state reference laboratories (SRL’s) with integrated counseling and testing centers (ICTC’s) and blood banks (BB). It performs activities such as external quality assurance scheme, retesting of samples, and training programs. Objective: A retrospective study was carried out from 2012 to 2016 highlighting NRL’s unceasing efforts in maintaining stringency in the quality management system. Materials and Methods: Verification and calibration of pipettes, evaluation of hands-on expertise of technicians for Combaids assay and ELISA testing were assessed. Retesting of samples as part of the quality check was performed. Panel proficiency testing of all the centers was done twice annually. Results: In 2013 and 2016 (81% and 36% pipettes) passed calibration, respectively. Evaluation of Combaids assay was done on the scale of excellent, medium, and poor. In ELISA testing, 53% followed standard operating procedure, 42% followed good laboratory practice, and 5% showed reproducibility in results. Evaluation of BB technicians was done using the borderline reactive sample in January 13, September 13, and January 14 showed correct results by 5%, 0%, and 11%, respectively, while 78% ICTC technicians gave correct results in Combaids assay. Proficiency testing showed few discordant results every year with need for calibration and technical assessment of personnel while total retesting samples tested from year 2012 to 2016 were 419. Conclusion: NRL emphasizes on the preparation of borderline sample as in-house quality control sample, calibration of equipments, training regarding same for assuring reliability of test results.

Red Cell Exchange Transfusion in Sickle Cell Anaemia Patients at the University College Hospital, Ibadan, Nigeria

Level of HbA2 more than 4% is the reliable parameter to identify β- thalassemia carrier. However, in some cases the level is not typically increased hence leading to diagnostic dilemma. Thus the objectives of this study were to evaluate the existence of β- thalassemia among borderline HbA2 sample. Out of 11,790 samples received for thalassemia screening, 405 (3.4%) were found to have borderline HbA2 level. Out of this, 117(28.9%) samples were selected by simple random sampling for PCR. Multiplex ARMS-PCR was used to detect β-globin gene mutation and multiplex gap PCR for α-globin genes deletion. The result revealed 36 (30.8%) had β-globin gene mutations, 8 (6.8%) had α-globin gene deletions and 1 (0.9%) had coexistence of α and β-globin gene defects. The commonest gene mutation detected were CD 19 (A-G), detected from 17 (45.9%) samples, followed by 9 (24.3%) with IVS 1-1 (G-A) mutation, 5 (13.5%) with Poly A mutation and 1 (2.7%) showed CAP +1 (A-C) mutation. Two samples (5.4%) showed mutations of Poly A and CD19, 2 (5.4%) showed mutation of IVS 1-1 and CD 19 while 1 (2.7%) showed IVS 1-5 and CD 19 mutations. This study showed 10 (27.0%) positive molecular results even though the HbA2 level was at only 3.0%. There was significant number of people with HbA2 between 3.0% and 3.9% and confirmed as thalassemia carriers by PCR. This data may suggest the level of HbA2 need to be revised to ensure the success of thalassemia screening programme in our population.

Vertical skeletal changes after extraction and non-extraction treatment in matched class I patients identified by a discriminant analysis: cephalometric appraisal and Procrustes superimposition

BackgroundIn the long-lasting debate of extraction versus non-extraction treatment, the impact of extractions on the skeletal vertical dimension remains rather unclear. The aim of this retrospective research study was to obtain a bias-free sample of morphologically similar borderline patients treated with or without extraction of the four first premolars and to retrospectively evaluate the vertical changes that occurred.MethodsA borderline sample of 83 patients, 41 treated with four first premolar extractions and 42 treated without, was obtained by means of discriminant analysis applied to a previously investigated parent sample of 542 class I patients. The pretreatment and posttreatment cephalometric radiographs were analyzed digitally, and seven measurements were assessed for vertical skeletal changes. Also, average tracings between the two treatment groups were evaluated using the Procrustes superimposition method.ResultsThe variables of SN to Go-Gn and Y-axis showed adjusted intergroup differences of − 0.91° and − 1.11° (P = 0.04). Comparing the mean intra-group differences of all the variables simultaneously, a significant difference was found between the two treatment groups (overall P value = 0.04). In the extraction group, only the gonial angle showed a significant decrease (P = 0.01) while the overall P value evaluating the intra-group differences between pre- and posttreatment was significant (overall P value < 0.01). In the non-extraction group, the variable of N-ANS/N-Me showed a significant decrease (P = 0.02) and the overall P value evaluating the intra-group differences between pre- and posttreatment was also significant (overall P value < 0.01). Differences in treatment duration were assessed using a log-normal model and showed that extraction treatment lasted significantly longer than non-extraction treatment (P < 0.01).ConclusionsThe borderline group of patients identified by the discriminant analysis exhibited similar morphological characteristics at treatment’s onset; therefore, the posttreatment changes could safely be attributed to the choice of extraction or non-extraction treatment and not to pre-existing differences. Treatment choice had an impact on the patients’ vertical skeletal dimensions. Patients treated with four first premolar extractions showed a slight decrease in the vertical skeletal measurements, whereas non-extraction patient treatment showed a slight increase. The treatment time was also significantly higher in the extraction group.

Treatment outcomes after extraction and nonextraction treatment evaluated with the American Board of Orthodontics objective grading system

A controversy exists regarding better treatment outcomes when patients treated with extractions and without extractions are evaluated. The aims of this study were to use the American Board of Orthodontics objective grading system (ABO-OGS) to evaluate and compare treatment outcomes in extraction vs nonextraction Class I patients and to determine whether the treatment choice was a significant predictor of success according to the ABO examination. Discriminant analysis was applied to a sample of 542 patients, and a borderline sample of 55 patients was obtained. Of these patients, 25 were treated with extractions and 30 without extraction of the 4 first premolars. Treatment results were then assessed using the 8 variables of the ABO-OGS. The total scores ranged from 11 to 41 (mean, 27.04; SD, 6.3) for the extraction group and from 16 to 44 (mean, 29.07; SD, 7.1) for the nonextraction group. The variable of buccolingual inclination had the highest scores in both groups (8.44 [SD, 3.3] for the extraction group; 8.90 [SD, 3.8] for the nonextraction group; mean difference, 0.46; 95% CI, -1.44, 2.37; P=0.63). However, no statistically significant intergroup differences were found, either between the scores of the 8 ABO-OGS variables or between the total ABO-OGS scores. Regarding the success rates of the ABO examination, no significant difference was found between the 2 treatment groups (odds ratio, 2.55; 95% CI, 0.74, 0.85; P=0.14). For a patient with a borderline Class I malocclusion, extraction and nonextraction treatment can achieve the same quality of results as assessed by the ABO-OGS. Additionally, in these Class I patients, the treatment modality (extraction or nonextraction) is not a significant predictor of passing the ABO examination.

The Impact of Extraction vs Nonextraction Treatment on Soft Tissue Profile in Borderline Class I Malocclusion: A Cephalometric Study

Introduction: The continuous controversy concerning extraction of premolar teeth and its supposed effects on the facial profile led to the origin of this study, which compares the pretreatment and post-treatment facial profiles of patients who underwent premolar extraction with those of patients who did not undergo extraction. Objective: To analyze the soft tissue changes between the two different treatment groups, equally susceptible to both treatment options (extraction and nonextraction) and to compare the changes taking place in the soft tissue variables from one group to another using the cephalometric analysis. Materials and methods: The diagnostic extraction and treatment decisions were based on a total space analysis with differential extraction protocols. The pretreatment and posttreatment cephalograms of the borderline sample (100 female patients, 50 of the patients were treated with premolar extraction and 50 were treated without premolar extraction) were then subjected to a thorough soft tissue cephalometric analysis. Results: The results indicated that the three variables that played the most important role in the clinician’s treatment decision were indicators of lower crowding, soft tissue convexity and lower incisor protrusion. Significant differences (p < 0.05) regarding upper and lower lip protrusion, upper lip thickness (p < 0.05) and the nasolabial angle (p < 0.05) occurred after treatment. Conclusion: Extraction treatment of Class I borderline malocclusions led to significant soft tissue changes in relation to the upper and lower lip position and thickness as well as the nasio labial angle, whereas the nonextraction treatment resulted in significant upper lip retraction and lower lip protraction.

Hypoxia inducible factor 1α-mediated LOX expression correlates with migration and invasion in epithelial ovarian cancer

This study investigated the role of LOX in promoting invasion and metastasis of epithelial ovarian cancer in a hypoxic environment and its specific signal transduction pathway. Immunohistochemical detection of HIF-1α and LOX protein expression was performed on formalin-fixed paraffin sections of normal ovary, benign ovarian tumors, borderline and malignant epithelial ovarian tumor paraffin sample, using Mann-Whitney U test for independent comparisons and Wilcoxon signed-ranks test for paired comparisons. HIF-1α and LOX were knocked down in epithelial ovarian cancer cells (EOC), and HIF-1α/LOX regulation mechanism and LOX catalytic activity under hypoxia/reoxygenation microenvironment were explored. Cell migration and invasion ability in LOX inhibited HO8910 cells were investigated under hypoxia/reoxygenation conditions, using matrigel cell invasion and migration assays. We found that HIF-1α and LOX are highly expressed in epithelial ovarian cancer tissues, and the expression of both proteins is significantly correlated with the tumor grade, tumor diameter and lymph node metastasis. HIF-1α expression is positively correlated with the expression of LOX. Specifically, the expression of LOX and HIF-1α markedly increases under hypoxic conditions and decreases after reoxygenation. siRNA knockdown of LOX or β-aminoproprionitrile (βAPN), an inhibitor of LOX activity, that attenuates LOX activity, downregulates HIF-1α protein expression and inhibits HO8910 migratory and invasive abilities. LOX catalytic activity is significantly reduced under hypoxic conditions. Moreover, EOC cells display a marked increase in LOX-dependent FAK/AKT activation and cell migration following hypoxia/reoxygenation. Collectively, our study demonstrates that the hypoxia-HIF-1α, LOX-FAK/AKT pathway regulates the migration and invasion of epithelial ovarian cancer cells under hypoxia/reoxygenation conditions, thus, promoting metastasis of ovarian cancer.

The impact of extraction vs nonextraction treatment on soft tissue changes in Class I borderline malocclusions

To obtain through the use of discriminant analysis a relatively bias-free sample of extraction and nonextraction, Class I, equally susceptible to both treatments' malocclusions and to analyze retrospectively the soft tissue changes between the two different treatment groups. The cephalometric, model, and demographic data of 215 patients (females and males) fueled a stepwise discriminant analysis that provided the borderline homogenous subsample (30 extraction and 32 nonextraction cases). The pretreatment and postreatment cephalograms of the borderline sample were then subjected to a thorough soft tissue cephalometric analysis. The results indicated that the three variables that played the most important role in the clinician's treatment decision were indicators of lower crowding, soft tissue convexity, and lower incisor protrusion. Significant differences (P < .001) regarding upper and lower lip protrusion, upper lip thickness (P < .05), and the nasiolabial angle (P < .05) occurred. Extraction treatment of Class I borderline malocclusions led to significant soft tissue changes regarding the upper and lower lip position and thickness as well as the nasiolabial angle, whereas the nonextraction treatment resulted in significant upper lip retraction and lower lip protraction.

Body dysmorphic disorder in patients with borderline personality disorder: prevalence, clinical characteristics, and role of childhood trauma.

The prevalence of body dysmorphic disorder (BDD) in patients with borderline personality disorder (BPD) is unidentified. We hypothesised that BDD would be more common than realised in patients with BPD and comorbidity with BDD would result in a more severe clinical profile. Also, childhood trauma may play a predictive role in this association. The study included 70 BPD in-patients and 70 matched healthy controls. The subjects were evaluated with a comprehensive assessment battery using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) diagnostic tool for BDD, Global Assessment of Functioning, Traumatic Experiences Checklist and Hamilton Depression Rating Scale. The prevalence of BDD was 54.3% in the borderline sample. The BPD patients with BDD had significantly lower overall functioning and higher levels of BPD pathology, childhood traumatic experiences, suicide attempts, substance abuse and self-mutilation than those without BDD. Traumatic experiences were significant predictor of comorbid BDD diagnosis in BPD patients. Our results suggest a relatively high prevalence of BDD among patients with BPD, and co-occurrence of BDD and BPD remains to be clarified. The additional diagnosis of BDD in patients with BPD may cause a more severe global illness, and these two disorders may share, at least partly, a common psychopathologic mechanism.

Characterization of the Relation Between CT Technical Parameters and Accuracy of Quantification of Lung Attenuation on Quantitative Chest CT

The purpose of this study was to assess the compromise between CT technical parameters and the accuracy of CT quantification of lung attenuation. Materials that simulate water (0 H), healthy lung (-650 H), borderline emphysematous lung (-820 H), and severely emphysematous lung (-1,000 H) were placed at both the base and the apex of the lung of an anthropomorphic phantom and outside the phantom. Transaxial CT images through the samples were obtained while the effective tube current was varied from 440 to 10 mAs, kilovoltage from 140 to 80 kVp, and slice thickness from 0.625 to 10 mm. Mean +/- SD attenuation within the samples and the standard quantitative chest CT measurements, the percentage of pixels with attenuation less than -910 H and 15th percentile of attenuation, were computed. Outside the phantom, variations in CT parameters produced less than 2.0% error in all measurements. Within the anthropomorphic phantom at 30 mAs, error in measurements was much larger, ranging from zero to 200%. Below approximately 80 mAs, mean attenuation became increasingly biased. The effects were most pronounced at the apex of the lungs. Mean attenuation of the borderline emphysematous sample of apex decreased 55 H as the tube current was decreased from 300 to 30 mAs. Both the 15th percentile of attenuation and percentage of pixels with less than -910 H attenuation were more sensitive to variations in effective tube current than was mean attenuation. For example, the -820 H sample should have 0% of pixels less than -910 H, which was true at 400 mA. At 30 mA in the lung apex, however, the measurement was highly inaccurate, 51% of pixels being below this value. Decreased kilovoltage and slice thickness had analogous, but lesser, effects. The accuracy of quantitative chest CT is determined by the CT acquisition parameters. There can be significant decreases in accuracy at less than 80 mAs for thin slices in an anthropomorphic phantom, the most pronounced effects occurring in the lung apex.

External quality assessment of hemoglobin A2 measurement: data from an Italian pilot study with fresh whole blood samples and commercial HPLC systems

To evaluate the extent of interlaboratory variation and accuracy in hemoglobin A(2) (HbA(2)) assays, a pilot study of external quality assessment was organized among 48 Italian laboratories routinely measuring HbA(2). As part of the study, a survey was also performed by sending a questionnaire concerning some important analytical aspects related to the determination of HbA(2). The trial specimens consisted of three whole blood samples (A, B and C) with normal, pathological and borderline HbA(2) content, respectively. All laboratories used HPLC analyzers from the same manufacturer (Bio-Rad Laboratories). Normal and pathological samples were clearly differentiated by all laboratories, while data for the borderline sample partially overlapped those for the other samples. The overall interlaboratory coefficient of variation was 8.0%, 6.0% and 7.9% for samples with low, high and intermediate HbA(2) levels, respectively. To assign HbA(2) target values to the samples, the median of the laboratory group was used. The accuracy of HbA(2) results was evaluated on the basis of allowable total error. The proportion of laboratories reporting unacceptable results was 31.9% (15 out of 47) for sample A, 17.0% (8 out of 47) for sample B, and 31.9% (15 out of 47) for sample C. No abnormalities in the chromatographic separation pattern were reported by any of the laboratories. We conclude that quality in the measurement of HbA(2) should be improved.

Borderline Personality Disorder in Clinical Practice

Most studies of borderline personality disorder have drawn patients from among hospital inpatients or outpatients. The aims of this study were to examine the nature of borderline personality disorder patients in everyday clinical practice and to use data from a sample of borderline personality disorder patients seen in the community to refine the borderline construct. A random national sample of 117 experienced psychiatrists and psychologists from the membership registers of the American Psychiatric Association and American Psychological Association provided data on a randomly selected patient with borderline personality disorder (N=90) or dysthymic disorder (N=27) from their practice. The clinicians provided data on axis I comorbidity, axis II comorbidity, and adaptive functioning, as well as a personality description of the patient using the Shedler-Westen Assessment Procedure-200 (SWAP-200) Q-sort, an instrument designed for assessment and taxonomic purposes. Analyses compared borderline personality disorder and dysthymic disorder groups on variables of interest and aggregated SWAP-200 items across all borderline personality disorder patients to create a composite portrait of borderline personality disorder as seen in the community. The borderline personality disorder sample strongly resembled previously studied borderline personality disorder samples with regard to comorbidity and adaptive functioning. However, the SWAP-200 painted a portrait of borderline personality disorder patients as having more distress and emotion dysregulation, compared to the DSM-IV description. Borderline personality disorder patients in research samples are highly similar to those seen in a cross-section of clinical practice. However, several studies have now replicated a portrait of borderline personality disorder symptoms that places greater weight than the DSM-IV description on the intense psychological pain of these patients and suggests candidate diagnostic criteria for DSM-V.

Attachment Style, History, and Behavioral Contrasts for A Borderline and Normal Sample

Borderline pathology has been characterized by intense, unstable interpersonal relations, which has been associated with deficits in object relations as well as insecure styles of attachment. This study explores the degree and nature of differences in attachment behavioral manifestations, attachment style, and attachment history between two differing samples, inpatient borderline and college normal. The two groups were compared on five measures assessing behavioral and representational aspects of attachment related phenomena: the Bell Object Relations Reality Testing Inventory (BORRTI), Sperling's Attachment Style Inventory (ASI), West and Sheldon's Reciprocal Attachment Questionnaire (RAQ), Hazan and Shaver s Attachment Self-Report (HS), and a newly constructed Attachment History Adjective Sort (AHAS). Significant differences emerged on all measures, supporting the hypothesis that the maladaptive interpersonal relations associated with BPD can be usefully understood from an attachment perspective that offers some unique contributions over an object relations perspective, particularly in the area of attachment styles. Variations on subscales of the attachment measures were further investigated in order to more specifically identify those aspects of insecure attachment that are unique to BPD.