Borderline Zone Research Articles

A Generic Solution to the Sorites Paradox

AbstractThis paper offers a generic revenge-proof solution to the Sorites paradox that is compatible with several philosophical approaches to vagueness, including epistemicism, supervaluationism, psychological contextualism and intuitionism. The solution is traditional in that it rejects the Sorites conditional and proposes a modally expressed weakened conditional instead. The modalities are defined by the first-order logic QS4M+FIN. (This logic is a modal companion to the intermediate logic QH+KF, which places the solution between intuitionistic and classical logic.) Borderlineness is introduced modally as usual. The solution is innovative in that its modal system brings out the semi-determinability of vagueness. Whether something is borderline and whether a predicate is vague or precise is only semi-determinable: higher-order vagueness is columnar. Finally, the solution is based entirely on two assumptions. (1) It rejects the Sorites conditional. (2) It maintains that if one specifies borderlineness in terms of the ‒suitably interpreted‒ modal logic QS4M+FIN, then one can explain why the Sorites appears paradoxical. From (1)+(2) it results that one can tell neither where exactly in a Sorites series the borderline zone starts and ends nor what its extension is. Accordingly, the solution is also called agnostic.

Clinical validity of a borderline group in CSF biomarker classification in Alzheimer’s disease

AbstractBackgroundEfforts to translate the NIA‐AA AT(N) dichotomic research framework of Alzheimer’s disease (AD) into clinical practice should evaluate how to deal with borderline cases. We characterise a peri‐threshold group of individuals regarding Aß classification, using the Aß42/Aß40 ratio in cerebrospinal fluid (CSF).MethodWe conducted a retrospective study of consecutive patients referred to a university hospital memory clinic for diagnostic evaluation of cognitive impairment. We identified individuals (n = 31) with a Aß42/Aß40 ratio within a prior defined borderline zone. Two additional groups, matched for clinical severity, age and sex, were used for comparisons: a low Aß42 (normal Aß42/Aß40 ratio >0,5; pathological Aß42, n = 23), and a typical AD reference group (A+T+(N+)), n = 50). We compared demographic, clinical, neuropsychological and neuroimaging characteristics between the groups.ResultsIncluded patients had a median age of 72 years and presented either with mild cognitive impairment (CDR 0.5) or mild dementia (CDR 1). Groups did not differ in demographic and clinical characteristics (education, disease duration, prevalence of vascular risk factors). In comparison to the typical AD reference group, patients in the borderline group were overall similar, except for better mean performance on the MMSE (26 vs. 21, p<0.05), verbal delayed recall (mean z‐score ‐1.9±1.6 vs. ‐3.1±1.9, p<0.05) and verbal recognition (mean z‐score ‐1.65±1.1 vs. ‐2.5±1.8, p< 0.05). They also showed a less severe degree of parietal atrophy (Koedam rating score, p<0.05). Compared with the individuals in the low Aß42 group, the borderline group only had a better performance in semantic fluency (mean z‐score ‐1.3±1.9 vs. ‐2.3, p<0.05), verbal learning (mean z‐score ‐2.0±2.2 vs. ‐2.93±2.6, p<0.05) and less severe score in the medial temporal lobe atrophy rating scale (median score 1 vs. 2, p<0.001). The presence of abnormal phosho‐Tau levels did not mediate the observed differences.ConclusionThese findings suggest that patients in the borderline group are at least partly similar to the typical AD group, as well as the low Aß42 group. Further information from longitudinal data to assess risk progression and cross‐validation in other cohorts is needed to better translation of the AT(N) classification and assist clinical decision regarding borderline cases.

Preinterventional quantification of dense scar or borderline zone in patients undergoing ventricular tachycardia ablation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction This study sought to examine the prognostic role of quantifying areas of interest in preinterventional cardiac magnetic resonance (CMR) in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). Background The role of preinterventional CMR for the identification of scar areas, borderline zones and reentry channels in the ventricles has been well established. Whether the burden of dense scar or borderline tissue has a prognostic impact on the acute and the long-term ablation outcome in SHD patients is disputed. Methods and results We investigated 185 patients with SHD undergoing preinterventional CMR prior to VT-ablation. 38 patients were excluded because of poor imaging quality, leaving a cohort of 147 patients with positive late enhancement (LGE) imaging (mean age 62 years, 47% non-ischemic cardiomyopathy, mean left ventricle ejection fraction 38%, 96% with implanted ICD). The cohort was divided in ischemic (ICM) and non-ischemic (NICM) cardiomyopathy group and the results regarding burden of overall scar tissue, dense scar, borderline zone, as well as clinical and procedural characteristics, acute and long-term results of the two groups were compared. The ICM patients had more advanced NYHA stadium (p = 0.046), reduced left ventricular ejection fraction (LV-EF, p <0.001) and higher left ventricular enddiastolic volume (LVEDV, p <0.001). The NICM patients were more often under antiarrhythmic therapy (p = 0.005) and underwent more frequently epicardial ablation (p <0.001). Although the overall scar burden war higher in ICM patients (p <0.001), the groups showed no significant difference in borderline zone burden (p = 0.580). Furthermore, the two groups had similar results in number of inducible VTs (p = 0.054) and VT inducibility at the end of the procedure (p = 0.121). Nevertheless, the NICM group underwent overall more ablation procedures during the 19-month follow up (p = 0.023). Both groups showed similar results regarding assist device implantation, heart transplantation or death until the end of the follow up (p = 0.192). Conclusion While quantification of the scar tissue and the borderline zone is feasible in ICD patients with SHD, the scar or the borderline zone burden were not predictive of the VT ablation outcome.

Emotional and behavioral problems and coping strategies among adolescent orphans

<p><strong>Background and objective:</strong> Rising incidence of mental health problems is a serious issue all over the world. Adolescents living in orphanages are at a particular risk as they have numerous challenges in their life and coping with them requires adequate life skills. This study aims to assess the emotional and behavioral issues and the coping strategies adopted by adolescent orphans in Pakistan.<br /><strong>Methods: </strong>This cross-sectional study comprises 109 adolescent orphans living in different orphanages. The Strengths and Difficulties Questionnaire for evaluating the emotional and behavioral problems (EBPs) was used while KIDCOPE scale was adopted to assess the coping strategies.<br /><strong>Results: </strong>About 34.9% of orphans fell in an abnormal range of EBP and 22.9% were in the borderline zone. The most prevalent problem was conduct (25.7%) followed by peer problems (24.8%), emotional instability (18.3%), hyperactivity (17.4%), and prosocial behavior (11%). A significant and positive correlation was observed between peer problems and maladaptive strategies (r = 0.191, p = 0.047) and between prosocial behavior and adaptive strategies (r = 0.294, p = 0.002).<br /><strong>Conclusion: </strong>Orphans residing in orphanages suffer from behavioral and emotional problems and are using maladaptive coping strategies. It is highly suggestive to monitor and maintain an optimal psychological health of this vulnerable population in our country. </p>

Peripheral nerve sheath tumors – case series in tertiary health care center in the central India

Peripheral nerve sheath tumors (PNST) are one of the most common neoplasms, with classical morphology and histopathological features, but they can be diagnostically challenging at times. Albeit well defined subtypes of PNST have been described in literature, but controversies regarding reporting and typing of these tumors persists. Malignant PNSTs represent a diagnostically challenging group. Although the diagnosis and classification of most PNST are relatively straightforward, borderline grey zone neoplasms continue to be a diagnostic difficulty. In our case series, we attempt in providing some useful information for the oncopathologist to help navigate these persistent and challenging problems. In the present study, we found 26 cases of PNST, out of which the most common was schwannoma (n=18), followed by neurofibroma (n=7) and one case of malignant type, that is, malignant PNST. The cases involving all age from 12 to 65 years, showing slight male preponderance.

Nonalcoholic fatty liver disease risk and histologic severity are associated with genetic polymorphisms in children.

NAFLD is the most common chronic liver disease in children. Large pediatric studies identifying single nucleotide polymorphisms (SNPs) associated with risk and histologic severity of NAFLD are limited. Study aims included investigating SNPs associated with risk for NAFLD using family trios and association of candidate alleles with histologic severity. Children with biopsy-confirmed NAFLD were enrolled from the NASH Clinical Research Network. The Expert Pathology Committee reviewed liver histology. Genotyping was conducted with allele-specific primers for 60 candidate SNPs. Parents were enrolled for trio analysis. To assess risk for NAFLD, the transmission disequilibrium test was conducted in trios. Among cases, regression analysis assessed associations with histologic severity. A total of 822 children with NAFLD had mean age 13.2 years (SD 2.7) and mean ALT 101 U/L (SD 90). PNPLA3 (rs738409) demonstrated the strongest risk ( p = 2.24 × 10 -14 ) for NAFLD. Among children with NAFLD, stratifying by PNPLA3 s738409 genotype, the variant genotype associated with steatosis ( p = 0.005), lobular ( p = 0.03) and portal inflammation ( p = 0.002). Steatosis grade associated with TM6SF2 ( p = 0.0009), GCKR ( p = 0.0032), PNPLA3 rs738409 ( p = 0.0053), and MTTP ( p = 0.0051). Fibrosis stage associated with PARVB rs6006473 ( p = 0.0001), NR1I2 ( p = 0.0021), ADIPOR2 ( p = 0.0038), and OXTR ( p = 0.0065). PNPLA3 rs738409 ( p = 0.0002) associated with borderline zone 1 NASH. This study demonstrated disease-associated SNPs in children with NAFLD. In particular, rs6006473 was highly associated with severity of fibrosis. These hypothesis-generating results support future mechanistic studies of development of adverse outcomes such as fibrosis and generation of therapeutic targets for NAFLD in children.

Insights into Clinical, Genetic, and Pathological Aspects of Hereditary Spastic Paraplegias: A Comprehensive Overview.

Hereditary spastic paraplegias (HSP) are a heterogeneous group of motor neurodegenerative disorders that have the core clinical presentation of pyramidal syndrome which starts typically in the lower limbs. They can present as pure or complex forms with all classical modes of monogenic inheritance reported. To date, there are more than 100 loci/88 spastic paraplegia genes (SPG) involved in the pathogenesis of HSP. New patterns of inheritance are being increasingly identified in this era of huge advances in genetic and functional studies. A wide range of clinical symptoms and signs are now reported to complicate HSP with increasing overall complexity of the clinical presentations considered as HSP. This is especially true with the emergence of multiple HSP phenotypes that are situated in the borderline zone with other neurogenetic disorders. The genetic diagnostic approaches and the utilized techniques leave a diagnostic gap of 25% in the best studies. In this review, we summarize the known types of HSP with special focus on those in which spasticity is the principal clinical phenotype (“SPGn” designation). We discuss their modes of inheritance, clinical phenotypes, underlying genetics, and molecular pathways, providing some observations about therapeutic opportunities gained from animal models and functional studies. This review may pave the way for more analytic approaches that take into consideration the overall picture of HSP. It will shed light on subtle associations that can explain the occurrence of the disease and allow a better understanding of its observed variations. This should help in the identification of future biomarkers, predictors of disease onset and progression, and treatments for both better functional outcomes and quality of life.

Function Heterogeneity of Different Segments of Left Ventricle in Pediatric Dilated Cardiomyopathy: A Tissue Doppler Study

Function Heterogeneity of Different Segments of Left Ventricle in Pediatric Dilated Cardiomyopathy: A Tissue Doppler Study Background: Dilated cardiomyopathy (DCM) is characterized by impaired systolic function of one or both ventricles. The aim of this study is to assess left ventricular (LV) regional systolic as well as global systolic and diastolic functions in children with DCM using tissue Doppler imaging. Subjects and methods: the study comprised 30 patients with DCM (4.4+3.3 years) and 10 healthy children as a control group. ECG-gated echocardiography was done using m-mode and conventional Doppler as well as Tissue Doppler imaging to obtain modified Tei index, mitral annular wave velocities (S', E' and A') as well as offline analysis of color tissue velocity imaging to obtain the peak systolic velocities of 12 LV points in 4 chamber apical, 2chamber and long axis views. Results: The peak systolic velocities of Mitral anuulus as well as the different LV segments of patients were significantly lower than that of the control group. The E/E' ratio of patients was (11.39+2.4). S' and E' wave of lateral and septal aspects of mitral annulus were correlated. The Tei index of LV of patients (0.568+0.1136) was significantly higher than that of the control group. The averaged mid LV segments showed significantly lower peak systolic velocity (3.018+0.777cm/sec). There was significant difference between different LV segments as regards the peak systolic velocities (P<0.05). Conclusion: In pediatric DCM the diastolic dysfunction lies in the borderline zone, systolic and diastolic dysfunctions are correlated. There is regional heterogeneity of left ventricular systolic velocities being in general lower in mid segments.

Influence of lesion and disease subsets on the diagnostic performance of the quantitative flow ratio in real-world patients

The quantitative flow ratio (QFR) is a novel angiography-based computational method assessing functional ischemia caused by coronary stenosis. This study aimed to evaluate the diagnostic performance of quantitative flow ratio (QFR) in patients with angina and acute myocardial infarction (AMI) and to identify the conditions with low diagnostic performance. We assessed the QFR for 1077 vessels under fractional flow ratio (FFR) evaluation in 915 patients with angina and AMI. The diagnostic accuracies of the QFR for identifying an FFR ≤ 0.8 were 95.98% (95% confidence interval [CI] 94.52 to 97.14%) for the angina group and 92.42% (95% CI 86.51 to 96.31%) for the AMI group. The diagnostic accuracy of the QFR in the borderline FFR zones (> 0.75, ≤ 0.85) (91.23% [95% CI 88.25 to 93.66%]) was significantly lower than that in others (difference: 4.32; p = 0.001). The condition accompanying both AMI and the borderline FFR zone showed the lowest QFR diagnostic accuracy in our data (83.93% [95% CI 71.67 to 92.38]). The diagnostic accuracy was reduced for tandem lesions (p = 0.04, not correcting for multiple testing). Our study found that the QFR method yielded a high overall diagnostic performance in real-world patients. However, low diagnostic accuracy has been observed in borderline FFR zones with AMI, and the hybrid FFR approach needs to be considered.

O almoxarifado de afetos

The main goal of this research is an investigation of the fondness for pop-mass culture by some Brazilian contemporary poets. This will be unfolded in two main scenarios: first, through the proposition of a temporal constitution of the weaving of different (and anachronistic) communities of reception, gathered together in a great pop-massive archive of the common time. Thereafter, this paper will canvass what Marcelo Montenegro suggests as a “warehouse of fondness”, as a specific borderline zone between the concept of archive and the one of writing of self. Finally, it will try to situate this scenario as a privileged one for reframing one important image for the theory of the contemporary.

Pilot study of cerebral and somatic autoregulation using NIRS in preterm neonates.

As neonates transition from a relatively hypoxic environment to extra-uterine life, arterial oxygen saturation dramatically increases. This transition occurs while most organs have not fully matured. The ability for immature tissue to adequately extract and utilize oxygen remains largely unknown. With the development of near-infrared spectroscopy (NIRS), measuring specific tissue oxygen saturation (StO2) noninvasively, clinicians can measure StO2 and determine if adequate tissue oxygenation is maintained. The objective of this study is to determine the relationships of NIRS brain and somatic autoregulation function to patients' severity of illness. In this prospective cohort pilot study, after parental consent, neonates less than 34 weeks with arterial access, were enrolled. The FORE-SIGHT NIRS probe was placed on the forehead and abdominal wall for 24 hours. Continuous arterial blood pressure, SpO2 and cerebral and somatic NIRS were used to derive autoregulation function. Data was obtained from 17 neonates (0.540 to 2.37 kg, gestation 23.0 to 33.2 weeks). The autoregulation function categorizes pressure passive index (PPI) values as good, borderline, or poor. For normal autoregulation function, PPI values tend to be low and fairly constant for a range of MAP. The PPI borderline zone is a hypothetical range of PPI values where autoregulation function transitions from good to poor. Our results show most premature neonates, as long as they maintained normal BP and systemic circulation can autoregulate cerebral perfusion. When BP are above or below the normal MAP for age, the neonate is at risk for losing brain and somatic autoregulation.

Alanine Aminotransferase and Gamma-Glutamyl Transpeptidase Predict Histologic Improvement in Pediatric Nonalcoholic Steatohepatitis.

Predictive, noninvasive tools are needed to monitor key features of nonalcoholic fatty liver disease (NAFLD) in children that relate to improvement in liver histology. The purpose of this study was to evaluate the relationship between liver chemistries and liver histology using data from the CyNCh (Cysteamine Bitartrate Delayed-Release for the Treatment of NAFLD in Children) clinical trial. This study included 146 children. Improvement in liver histology, defined as decrease in nonalcoholic fatty liver disease (NAFLD) Activity Score ≥2 points without worsening of fibrosis, occurred in 43 participants (30%). There were 46 participants with borderline zone 1 nonalcoholic steatohepatitis (NASH) at baseline, with resolution in 28% (12 of 46). Multivariate models were constructed using baseline and change in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) at 52weeks, for improvement in (1) liver histology primary outcome, (2) borderline zone 1 NASH, and (3) fibrosis. For improvement in histology, the model (P<0.0001) retained baseline and change in GGT (area under the receiver operating characteristic [AUROC], 0.79; 95% confidence interval [CI], 0.71-0.87). For borderline zone 1 NASH, the model (P=0.0004) retained baseline and change in ALT (AUROC, 0.80; 95% CI, 0.67-0.93). For fibrosis, the model (P<0.001) retained baseline and change in ALT (AUROC, 0.80; 95% CI, 0.67-0.93). Additional clinical parameters were added to the models using Akaike's information criterion selection, and significantly boosted performance: improvement in histology with AUROC of 0.89 (95% CI, 0.82-0.95), borderline zone 1 NASH with AUROC of 0.91 (95% CI, 0.83-0.99), and fibrosis with AUROC of 0.89 (95% CI, 0.82-0.94). Models were validated using data from the TONIC (Treatment of Nonalcoholic Fatty Liver Disease in Children) trial. In children with NAFLD, dynamic changes in serum ALT and GGT are associated with change in liver histology and appear to be powerful indicators of histological response.

Tuberculosis Infection Screening in 5468 Italian Healthcare Students: Investigation of a Borderline Zone Value for the QFT-Test.

Healthcare workers are at an increased risk of contracting Mycobacterium tuberculosis infection. Tuberculin skin test (TST) and interferon gamma release assay (IGRA) represent the available tests most used for the diagnosis of latent tuberculosis infection (LTBI). Different borderline zones have been proposed for defining conversions and reversions to improve the interpretation of the IGRA test results as part of serial testing. From 2012 to 2017, 5468 health students of an Italian University Hospital were screened for tuberculosis infection through the execution of the TST and, in case of positivity, of the QuantiFERON-TB® Gold In-Tube assay (QFT–GIT). The QFT–GIT is considered “borderline” with values from 0.35 to 0.99 IU/mL. Among the students who performed the QFT–GIT assay, 27 subjects presented a range of values defined as borderline. The QFT–GIT was repeated after 90 days on 19 subjects with borderline values and showed a negativization of the values in 14 students and a positive conversion in three cases, while for two students, a borderline value was also found for the second test, with a 74% regression of the borderline cases. The introduction of QuantiFERON borderline values is a useful assessment tool to bring out LTBI case candidates for chemoprophylaxis.

Progression of Fatty Liver Disease in Children Receiving Standard of Care Lifestyle Advice

Nonalcoholic fatty liver disease (NAFLD) is the most common pediatric chronic liver disease. Little is known about outcomes in recognized youth. We compared paired liver biopsies from 122 of 139 children with NAFLD (74% male; 64% white; 71% Hispanic; mean age, 13 ± 3 years; age range, 8-17 years) who received placebo and standard of care lifestyle advice in 2 double-blind, randomized clinical trials within the nonalcoholic steatohepatitis (NASH) clinical research network from 2005 through 2015. We analyzed histologic changes with respect to baseline and longitudinal change in clinical variables using regression analysis. At enrollment, 31% of the children had definite NASH, 34% had borderline zone 1 NASH, 13% had borderline zone 3 NASH, and 21% had fatty liver but not NASH. Over a mean period of 1.6 ± 0.4 years, borderline or definite NASH resolved in 29% of the children, whereas 18% of the children with fatty liver or borderline NASH developed definite NASH. Fibrosis improved in 34% of the children but worsened in 23%. Any progression to definite NASH and/or in fibrosis was associated with adolescent age, and higher waist circumference, levels of alanine or aspartate aminotransferase, total and low-density lipoprotein cholesterol at baseline (<0.05), and over follow-up time, with increasing level of alanine aminotransferase, hemoglobin A1C (P<.05), gamma-glutamyl transferase and development of type 2 diabetes (P<.01). Increasing level of gamma-glutamyl transferase was also associated with reduced odds of any improvement (P= .003). One-third of children with NAFLD enrolled in placebo groups of clinical trials had histologic features of progression within 2 years, in association with increasing obesity and serum levels of aminotransferases and loss of glucose homeostasis.

The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers.

ObjectiveAn interferon-gamma release assay (IGRA) is used to screen for latent tuberculosis infection (LTBI). Among IGRAs, the QuantiFERON-TB Gold In-Tube (QFT-GIT) results are highly variable, so the borderline zone has been proposed to reduce unnecessary LTBI treatment. The aim of this study was to examine the proportion of the borderline zone of QFT-GIT in healthcare workers’ (HCWs) serial IGRA and to retrospectively identify the utility of predicting tuberculosis (TB) in a moderate TB incidence setting.MethodsThe participants were HCWs who had undergone serial LTBI screening between June 2013 and June 2018. IGRA-positive HCWs underwent examinations that included low-dose computed tomography (LDCT) and TB culture, if necessary. Applying the borderline zone (0.2-<0.7 IU/mL), the results were classified as definite negative, borderline negative, borderline positive and definite positive.ResultsThrough the follow-up of 477 HCWs, 441 (92.5%) invariant, 30 (6.3%) conversion, 2 (0.4%) reversion and 5 (1.0%) indeterminate results were observed with the manufacturer’s cutoff. Applying the borderline zone, 419 (87.8%) invariant, 22 (4.6%) conversion, 1 (0.2%) reversion and 36 (7.5%) decision pending, including 5 (1.0%) indeterminate results, were observed. At the time of screening, five TB cases were identified. Chest X-ray (CXR) identified one TB case, and LDCT identified four additional TB cases. After one year, two TB cases were diagnosed, and their screening QFT-GIT results were definite positive and borderline negative. In the Cochran-Armitage trend test, the greater the maximum difference in the QFT-GIT grade with the borderline zone was, the higher the probability of developing TB (P-value <0.001).ConclusionThe application of the borderline zone lowered the conversion rate but increased the decision pending rate. Introducing the borderline zone requires a careful approach, and a thorough examination needs to be performed to rule out TB in converters. HCWs with borderline QFT-GIT results also need close observation.

Perkembangan Pemeriksaan &lt;i&gt;Interferon-Gamma Release Assay&lt;/i&gt; (IGRA) dengan Metode T-SPOT.TB serta Aspek Klinis Pelaporan Hasil

Latent tuberculosis infection (LTBI) screening and its treatment play important role in controlling tuberculosis (TB). Healthcare workers are known to be at high risk of latent TB infection. CDC suggests that every healthcare service should have TB controlling program. CDC recommends IGRA test for people who have history of contact with atypical mycobacteria patiens, screening in pregnancy, healthcare worker screening, and serial evaluation for Mycobacterium tuberculosis (MTB) infection. IGRA test kits that are commercially available are QFT and T-SPOT.TB. Term “indeterminate” is used as a borderline value in QFT, but in T-SPOT.TB, it means the result is invalid. Term "borderline zone" is used in T-SPOT.TB, but not in QFT. T-SPOT.TB uses borderline zone which is designed to reduce uncertainty result in narrow range around single cut-off point. There are still no recommendations to use IGRA test for therapeutic monitoring.

Performance of QuantiFERON-TB Gold Plus for detection of latent tuberculosis infection in pregnant women living in a tuberculosis- and HIV-endemic setting.

We evaluated the performance of QuantiFERON-TB Gold Plus (QFT-Plus), which includes two Mycobacterium tuberculosis antigen formulations (TB1 and TB2), for detection of latent tuberculosis infection during pregnancy. Eight-hundred-twenty-nine Ethiopian pregnant women (5.9% HIV-positive) were tested with QFT-Plus, with bacteriological sputum analysis performed for women with clinically suspected tuberculosis and HIV-positive women irrespective of clinical presentation. QFT-Plus read-out was categorized according to the conventional cut-off (0.35 IU/ml) for both antigen formulations. In addition, we analysed the distribution of QFT-Plus results within a borderline zone (0.20–0.70 IU/ml), and interferon-γ response in relation to HIV infection and gestational age. Two-hundred-seventy-seven women (33%) were QFT-Plus-positive (HIV-positive 16/49 [33%]; HIV-negative 261/780 [33%]). There was a strong agreement between the two antigen formulations (κ = 0.92), with discordant results in 29 cases (3.5%). Whereas discordant QFT-Plus results were rare in pregnancy, several results with both TB1 and TB2 within the borderline range were observed (11/49 [22%] vs. 43/780 [5.5%] in HIV-positive and HIV-negative women, respectively; p<0.0001). HIV-positive women had lower absolute interferon-γ levels (TB1: 0.47 vs. 2.16 IU/ml; p<0.001, TB2: 0.49 vs. 2.24 IU/ml, p<0.001, considering results ≥0.20 IU/ml) compared to HIV-negative women. QFT-Plus-positive women who submitted samples at later stages of pregnancy had lower mitogen- (p<0.001) but higher TB-antigen-specific (p = 0.031 for TB1, p = 0.061 for TB2) interferon-γ response. Considering their lower capacity to produce TB-specific interferon-γ, a lower cut-off level for defining QFT-Plus-positivity may be considered in HIV-positive pregnant women.

Current endovascular management of complex pararenal aneurysms.

Endovascular approach to abdominal aortic aneurysm has increased in frequency over the last decade and is preferred by many practitioners and patients alike. However, its role in "complex" aneurysms with challenging anatomy, short neck length, or borderline landing zone for grafts is less well understood. Additionally, the endovascular role in complex urgent or emergent repairs has not been adequately studied. Several techniques have been developed in order to address these concerns and further the endovascular approach. This article seeks to describe incidents in which an endovascular approach may be challenging, describe the most popular techniques now available for approaching these cases, and present the best literature available for considering these techniques. Medline searches were performed with the key words "complex endovascular aneurysm repair," "fenestrated endovascular aneurysm repair," "chimney grafts" and "snorkel grafts" to gain access to available data. Articles were reviewed for results and technical considerations. By employing increasingly complex endovascular techniques, complex pararenal aneurysms can be successfully treated in an endovascular fashion.

Evolution of the mandibular defects reconstruction with free fibula flapx

One of the most important steps in achieving aesthetical and functional result in mandible reconstruction with fibula free flap is positioning of the bony part relative to the basis of the native mandible. Positioning fibular bony part continuing inferior mandible border may produce a high discrepancy between the residual mandible and fibula bone that results in difficulty in denture rehabilitation. Positioning fibular bony part continuing alveolar mandible border creates asymmetric jowls and changed shape of jawline in border-line zone. The double-barrel technique solves this problem, but needs a meticulous preoperative planning and precision free fibula flap modelling.

Micronucleus Study on Breast Cytology Aspirate Smears and its Diagnostic Utility.

Background:Micronucleus is a small fragment of nucleus present in the cells which have undergone chromosomal damage. It is used as a biomarker of genomic damage.Aims:We aim to study the presence of micronucleus on breast cytology smears and the use of scoring the micronucleus as an additional criteria for the classification of breast lesions with emphasis on borderline gray zone categories.Settings and Design:This is a cross-sectional retrospective descriptive study.Materials and Methods:Retrospective analysis of breast cytology smears received over a period of 2 years formed the basis of the study. Micronucleus scoring was done by counting the number of micronuclei in 1000 epithelial cells under oil immersion and compared in the benign, adenosis, usual/atypical ductal hyperplasia, and the three grades of infiltrating ductal carcinomas.Statistical Analysis:Descriptive analyses and one-way analysis of variance was used for statistical analysis.Results:Of the 243 cases, the average statistically significant (P < 0.05) micronuclei scores of the benign (190), adenosis (7), usual (11)/atypical (5) hyperplasia, grade 1, 2, and 3 carcinomas (30) were 0.5, 2, 2.9, 6.6, 13.2, 20.6, and 27.5, respectively (the corresponding median scores were 0.5, 2, 3, 6, and 20, respectively). Micronucleus score of ≤1 had a high sensitivity (100%) and specificity (99%) in confirmation of benign cases. Micronucleus score of ≥5 and <10 had a moderate sensitivity (60%) but a high specificity of 99% in detecting atypical ductal hyperplasia. Micronucleus score of ≥10 had a high sensitivity (96%) and specificity (99%) of detecting carcinomas.Conclusion:Micronucleus scores showed a gradual increase across the categories proving the gradual occurrence of genomic damage. Micronucleus scoring serves as an additional criterion for the diagnosis of breast lesions.