Discrepant Cases Research Articles

Unreported Insider Trades: Indicators of Future Earnings and Analyst Forecast Error

We provide evidence of unreported trading by corporate insiders in their own firm’s shares and link this activity to future firm earnings and analyst forecast error. Unreported trading are cases of discrepancies between insider shareholdings from trades reported to the Exchange and their shareholdings disclosed in the firm’s annual report. Over the five year period from 2007 to 2011, the rate of unreported trading is 7.73%, being at its lowest in 2008 of 4.86% and peaking at 9.59% in 2011. Such activity is influenced by the firm’s growth opportunities and individual insider factors such as equity based compensation and also insider ownership in the firm. We separate unreported purchases from unreported sales due to the different motivations for buying and selling. Unreported purchases do not lead earnings increases though they indicate with analyst forecast error. On the other hand, unreported sales predict future decreases in up to two years’ earnings and are also related to forecast error. These findings suggest that insiders are aware of decreases in earnings and conceal their sales to profit from such information. Insiders also trade opportunistically on analyst forecast error.

Long-Term Results of Ewing’s Sarcoma—In a Single Institution

Purpose: This study analyzed oncological and functional outcomes of treatment for Ewing’s sarcoma, as well as its significant risk factors through long-term follow up. Objective and Method: Between September 1990 and April 2009, 20 cases that were diagnosed and treated as Ewing’s sarcoma in Kosin University Gospel Hospital were entered onto the study. Mean follow-up period was 45.4 (12 - 108) months. There were 7 cases of male and 13 cases of female, and mean age was 19.9 (5 - 48) years old. Retrospective review was done about treatment outcomes, complications, and significant risk factors. Results: In terms of oncologic results, there were 9 cases of CDF (continuous disease free), 1 case of NED (no evidence of disease), 4 cases of AWD (alive with disease), 5 cases of DOD (dead of disease), and 1 case of DWOD (dead with other disease). Five-year overall survival rate of all the patients was 70.0% and event-free survival rate was 50.0%. The mean MSTS (Musculoskeletal Tumor Society) score was 15.9 (53%) points at last follow-up. Among prognostic factors of age at diagnosis, Enneking stage, size of tumor, site of primary lesion, and distant metastasis, 5-year survival rate of groups without metastasis were 90.9%, nevertheless 44.4% in other group with the metastasis showing statistical significance (p = 0.020). Postoperative complications were 3 cases of infection, each 2 cases of ankylosis and metal failure, and each 1 case of leg length discrepancy, periprosthetic fracture, and local recurrence. Conclusion: Five-year survival rate of this study was similar to that of multicenter studies in America and Europe. Among the prognostic factors, distant metastasis was proven to be most significant. Enneking stage, size of tumor and site of primary lesion are also important and could be statistically significant if with more cases.

Fetoplacental Discrepancy with Normal Karyotype in Amniotic Fluid and Two Different Cell Lines in Placenta

We present a case of fetoplacental discrepancy in a second-trimester fetus with normal karyotype in amniotic fluid and two different Robertsonian translocations in placenta. A 41-year-old woman of Middle-Eastern origin, gravida 2, para 1, underwent amniocentesis at 16-week gestation because of advanced maternal age. Amniotic fluid karyotype showed a normal 46,XX karyotype with a homozygous inv(9). Parental chromosome analysis showed both parents to be carriers of inv(9) and the parents are not consanguineous. Fetal ultrasound was normal. The mother presented to the clinic 4 weeks later with intrauterine fetal demise. Chromosome analysis from the placenta showed two different cell lines: a balanced (15;21) Roberstonian translocation in 11 cells and an unbalanced (21;21) Robertsonian translocation in 9 cells. The karyotype was interpreted as mos 45,XX,inv(9)(p11q13)x2,der(15;21)(q10;q10)[11]/46,XX,inv(9)(p11q13)x2,+21,der(21;21)(q10;q10). Mother was a carrier for the Cystic Fibrosis (delta F508), Factor V Leiden mutations, HbD-Los Angeles and HbQ-India variants. She also had a sibling with term stillbirth. Her husband's history was unremarkable. Our case appears to be another example of confined placental mosaicism (CPM) with normal fetal karyotype. However, we could not confirm the possibility that CPM contributed to the IUFD in our case given the complex medical history of the mother.

The Collum Femoris Preserving Stem: Early Results

Femoral neck preserving stems have been developed to take advantage of the biomechanical properties of the femoral neck, and to optimise femoral anchorage and load distribution. The aim of this study was to report the clinical and radiological results in a group of 126 patients (150 hips), operated on for a total hip arthroplasty with the CFP stem. Clinical evaluation considered Harris Hip Score (HHS), thigh pain, Charnley classification, peri- and post-operative complications. Radiographic variables were stem sizing and alignment, femoral and acetabular osteolysis, the quality of cementation and restoration of the offset. The HHS at mean follow-up of 66 months was 83 points. We did not observe femoral or acetabular osteolysis, secondary malalignment or radiographic reactions, but only bone remodelling under the collar. The CFP stem must be used appropriately based on pre-operative planning (correct morphology and torsion of the femur). The surgical technique is straightforward if carried out step by step. We did not see any cases of significant limb length discrepancy.

Discrepancy Between Preoperative Imaging and Surgical Findings in Patients With Advanced Ovarian Cancer

The objective of this study was to determine the patterns of erroneous interpretation of preoperative computed tomography (CT) for detection of peritoneal lesions in advanced ovarian cancer. Between 2007 and 2011, 148 patients with International Federation of Gynecology and Obstetrics stage IIIC-IV ovarian cancer, who underwent multi-detector-row CT before primary cytoreduction, were enrolled. We reviewed the preoperative CT and compared the findings with the surgical findings. For the discrepant cases, false-negative cases were reevaluated after revealing of surgical findings and were categorized as either absence or presence of lesion (missed case). We performed region-based comparisons according to predefined peritoneal lesion locations. Sixty-eight false-negative cases were identified, of which 43 were revealed to be initially missed cases. The most common locations were found to be the small-bowel mesentery (21%), subdiaphragmatic space (19%), and porta hepatis (16%). The missed peritoneal implants commonly resided in the same sites of preoperative imaging criteria that could predict suboptimal primary cytoreduction.

Is Automated Electronic Surveillance for Healthcare-Associated Infections Accurate in the Burn Unit?

As monitoring requirements for healthcare-acquired infection increase, an efficient and accurate method for surveillance has been sought. The authors evaluated the accuracy of electronic surveillance in multiple intensive care unit settings. Data from 500 intensive care unit patients were reviewed to determine the presence of central line-associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). An electronic surveillance report was obtained to determine whether patients had a blood-line nosocomial infection marker or a urine nosocomial infection marker. Manual review was based on Centers for Disease Control and Prevention criteria. An infection preventionist then reviewed all discrepant cases and made a final determination, which was used as the gold standard. Sensitivity, specificity, false-positive rate, and false-negative rate were then calculated for electronic surveillance. In the burn population the sensitivity of electronic surveillance for CAUTI was 66.66%, specificity 96.5%, false-positive rate 3.44%, false-negative rate 33%; and for CLABSI the sensitivity was 100%, specificity 95%, false-positive rate 4.96%, false-negative rate 0%. In the nonburn population the sensitivity for CAUTI was 50%, specificity 97.9%, false-positive rate 2%, and false-negative rate 30%; and for CLABSI sensitivity was 60%, specificity 98.8%, false-positive rate 1%, and false-negative rate 60%. Burn centers may experience a higher false-positive rate for electronic surveillance of CLABSI and CAUTI than other critical care units.

The allele burden ofJAK2V617F can aid in differential diagnosis of Philadelphia Chromosome-Negative Myeloproliferative Neoplasm

BackgroundWe aimed to evaluate the feasibility of using the allele burden of Janus kinase 2 (JAK2) V617F as a criterion for discriminating 3 subtypes of Philadelphia chromosome-negative myeloproliferative neoplasm (Ph-MPN): polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF).MethodsWe collected 70 peripheral blood (PB) and 81 bone marrow (BM) samples from patients diagnosed with Ph-MPN. Real-time quantitative PCR (RQ-PCR) and Amplification Refractory Mutation System (ARMS) assays were performed for each sample. We compared the allele burden of JAK2 V617F for each subtype of Ph-MPN and determined the concordance rates of the results between the 2 tests.ResultsThe JAK2 V617F allele burden differed significantly among the 3 disease categories in both PB (P=0.045) and BM (P=0.011) samples. Subsequent subgroup analysis revealed that the median allele burden of JAK2 V617F for ET (21.71% for PB and 24.95% for BM) was significantly lower than that for PV (56.88% for PB, P=0.047; 72.66% for BM, P=0.003) and PMF (56.16% for PB, P=0.050; 59.04% for BM, P=0.049). Concordance rate between the RQ-PCR and ARMS data was 90.7%. Of the 14 discrepant cases, 12 were RQ-PCR(+)/ARMS(-) and 2 were RQ-PCR(-)/ARMS(+).ConclusionThe allele burden of JAK2 V617F was significantly lower for ET than that for PV or PMF in both PB and BM samples. The JAK2 V617F allele burden is a diagnostic tool for differentiating PV or PMF from ET.

Why is microcalcification missed on mammography?

Ductal carcinoma in situ (DCIS) is often only mammographically evident as microcalcification. Although the overall percentage of screening cases with histologically proven DCIS microcalcification is small, the clinical relevance of missing this finding is significant. The current guidelines in Australia for breast screening departments are for double reading of mammograms to reduce both perceptive and interpretative error. This retrospective study identified patients from a state screening program with histologically proven DCIS whose mammograms showed microcalcification. The initial double reader results were documented according to the 5-point grading scale of BreastScreen Tasmania, and discrepancies between readers were noted. Mammographic factors such as breast density, lesion location, morphology, distribution, size and presence on previous imaging were assessed for significant influence on inter-reader discrepancy. Histological evidence of invasion and grade of malignancy were also analysed. Of 65 identified cases, 29 (45%) showed that one of the two readers had not flagged the microcalcification on the report. Analyses revealed no significant difference in reader discrepancy with any of the analysed factors including breast density, size of microcalcification or presence on previous imaging. Twenty-five of 29 (86%) cases of discrepancy were perceptive. Breast screening reading for microcalcification is poorly correlated to mammographic or histological features. The majority of errors were perceptive rather than interpretative. Double reading is advocated as standard practice to reduce perceptive error.

Abstract P1-07-12: Using Natural Language Processing to Identify and Extract HER2 Value from a large EMR system

Abstract Background: HER2 status is important in breast cancer prognosis but has not been well collected in NCI-SEER affiliated cancer registries until recent years. For example, in a cohort of 2,846 women who were diagnosed with breast cancer from 1997 to 2011 in a large health plan, only 49% of these patients had known HER2 status. However, many of these with missing HER2 status were documented in clinical notes. This study used Natural Language Processing (NLP) technology to identify and extract HER2 status. NLP results were validated by comparison with cancer registry data and any discrepancies were manually reviewed. Method: We assembled a cohort of 2,846 breast cancer patients from the membership of a health plan based in southern California, Kaiser Permanente. All free text notes including pathology reports, progress notes, and discharge summaries were extracted from our electronic medical record (EMR) system. A window of 9 months before and after the diagnosis date was applied to restrict the number of notes needed to be processed. Overall, 513,903 clinical notes were processed and indexed, which averages to 180 notes per patient. Separate ontologies were created for the HER2 terminology and HER2 status. HER2 status values included positive, negative, borderline, test performed and test not performed. The NLP system employed additional components such as spelling correction, acronym recognition and negation identification. The output from the NLP system was further processed in three steps: Identification of the HER2 concept, followed by extraction of the most likely HER2 value, and lastly, a decision module to select the most likely HER2 value if there were conflicting values. Results: Use the cancer registry data as the gold standard, for positive and negative HER2 values, the sensitivity and specificity of the NLP algorithm were 94.7% and 93.3%, respectively, including the cases where NLP did not select either positive or negative values. A manual chart review was performed on the discrepant cases. We found that the NLP were correct for many of these cases. For example, out of the 39 NLP positive but registry negative cases, 4 were false positives and 35 were true positives. Compared to the cancer registry data, NLP increased capture of positive and negative HER2 cases from 49% to 73% of the cohort population. Discussion: NLP provides the opportunity to process clinical notes which are added to the EMR after the cancer registry has completed documenting the patients' initial course of cancer treatment. On the other hand, NLP was not able to access some of the HER2 related clinical notes. For example, according to our chart review, some notes were stored as scanned images and not retrievable. In addition, clinical notes with incorrect filing dates so patients without any diagnosis date were not processed. We also identified key challenges in determining HER2 results using NLP in this study. First, non-standard terminology for the HER2 receptor in the clinical notes hampered the NLP effectiveness. Second, clinicians described HER2 results in many different ways. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-07-12.

Interrater Agreement in the Evaluation of Discrepant Imaging Findings With the Radpeer System

The Radpeer system is central to the quality assurance process in many radiology practices. Previous studies have shown poor agreement between physicians in the evaluation of their peers. The purpose of this study was to assess the reliability of the Radpeer scoring system. A sample of 25 discrepant cases was extracted from our quality assurance database. Images were made anonymous; associated reports and identities of interpreting radiologists were removed. Indications for the studies and descriptions of the discrepancies were provided. Twenty-one subspecialist attending radiologists rated the cases using the Radpeer scoring system. Multirater kappa statistics were used to assess interrater agreement, both with the standard scoring system and with dichotomized scores to reflect the practice of further review for cases rated 3 and 4. Subgroup analyses were conducted to assess subspecialist evaluation of cases. Interrater agreement was slight to fair compared with that expected by chance. For the group of 21 raters, the kappa values were 0.11 (95% CI, 0.06-0.16) with the standard scoring system and 0.20 (95% CI, 0.13-0.27) with dichotomized scores. There was disagreement about whether a discrepancy had occurred in 20 cases. Subgroup analyses did not reveal significant differences in the degree of interrater agreement. The identification of discrepant interpretations is valuable for the education of individual radiologists and for larger-scale quality assurance and quality improvement efforts. Our results show that a ratings-based peer review system is unreliable and subjective for the evaluation of discrepant interpretations. Resources should be devoted to developing more robust and objective assessment procedures, particularly those with clear quality improvement goals.

Whole slide images for primary diagnostics of paediatric pathology specimens: a feasibility study

IntroductionWhole slide images (WSI) have been used in many pathology applications such as teleconsultation, teaching and research, but not in primary diagnostics. The aim of this study was to test...

How accurate is intraoperative frozen section in the diagnosis of ovarian tumors?

The aim of this study was to evaluate the accuracy of intraoperative frozen section of ovarian tumors and to analyze the factors that influence the accuracy. We compared the frozen section diagnosis of 218 ovarian tumors with their final diagnosis in paraffin sections, over a period of 10 years from 1999 to 2008. Results were analyzed on two parameters: (i) status of malignancy and (ii) histological type. The overall accuracy was 95%. The sensitivity for benign, borderline and malignant tumors was 99.3%, 86.66% and 96.3%, respectively. The corresponding specificities were 92.6%, 97% and 100%. Most of the discrepant cases were of borderline category. The overall accuracy for histological diagnosis was 80.7%. The number of sections examined at frozen and paraffin had a statistically significant association with the accuracy of frozen section. Frozen section diagnosis is of high quality at our center with a few exceptions in borderline category. The numbers of sections examined have a statistically significant influence on the accuracy of frozen section of ovarian masses.

Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast

To evaluate the utility of ThinPrep® as an optional specimen processing method for the detection of axillary lymph node metastasis of invasive breast carcinoma. A computer SNOMED search from the file at our institution between January 2003 and August 2011 retrieved a total of 209 fine needle aspiration (FNA) specimens of axillary lymph nodes prepared by ThinPrep and followed by axillary lymph node biopsy and/or dissection. Original cytological diagnoses and corresponding histological diagnoses were documented. Using the histological diagnoses as the gold standard, the diagnostic parameters including sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were calculated. Both cytology and histology slides from cyto-histologically discrepant cases were reviewed. Out of a total of 209 specimens, 193 (92%) had adequate diagnostic material while the remaining 16 specimens (8%) were inadequate for cytological assessment. The diagnostic specimens included 168 invasive ductal carcinomas (IDC), 15 invasive lobular carcinomas (ILC) and 10 mixed carcinomas (IDC and ILC). Excluding 19 cases with malignant cells on FNA in which no residual tumour was found in fibrotic lymph nodes after neoadjuvant therapy (cytology and histology confirmed on review) ThinPrep detected nodal metastasis with an overall sensitivity of 77.5%, specificity of 100%, PPV of 100% and NPV of 53.7%. Diagnostic accuracy was 82.2%. There was no difference in Bloom-Richardson grade or the number or size of metastases between tumours with true-positive and false-negative cytology. Sampling error was the sole factor contributing to cyto-histological discrepancy. ThinPrep is a good alternative to the conventional smear for cytological assessment of axillary lymph node status in patients with invasive breast carcinoma, particularly when specimens are collected at remote sites or when cytologists are not available for assistance during FNA.

Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain

The role of CT imaging in the diagnosis and management of acute abdominal pain is well established, but its utility is limited in a minority of cases. The aim of this study was to quantify the degree to which radiological and clinical findings differ. Interobserver variability in CT reporting was also assessed. Clinical data and CT reports were analysed retrospectively for any discrepancies by comparing CT diagnosis, clinical diagnosis as stated on the discharge summary and final diagnosis (based on consensus review of all information). Blinded review of all CT imaging was performed to determine interobserver variability. 120 consecutive scans fulfilled the inclusion criteria (114 patients; 79 women; mean age 55 years). The correct clinical diagnosis was made in 87.5% of cases based on CT findings. The lack of intravenous contrast limited diagnostic interpretation in 6 of the 15 discrepant cases. CT was unable to define early inflammatory changes in three patients and early caecal carcinoma in one. A right paraduodenal internal hernia was difficult to detect in another patient. Interobserver agreement was 93%, but with a low kappa value of 0.27. A paradox exists due to an imbalance in the positive and negative agreement of 96% and 31%, respectively. The utility of CT imaging in the diagnosis and management of patients presenting with acute abdominal pain is confirmed, but is limited in a minority of cases where poor negative interobserver agreement exists. Good communication to the reporting radiologist of the relevant patient history and clinical question becomes important.

Fine‐needle aspiration of gray zone lesions of the breast: Fibroadenoma versus ductal carcinoma

While breast lesions have characteristic cytological features, some lesions, particularly adenocarcinoma and fibroadenoma, may present with overlapping features causing erroneous diagnoses. The current study aimed to define significant cytomorphologic features predictive of fibroadenoma and adenocarcinoma, respectively. Further, we intended to evaluate the predictive characteristics for differentiation between gray zone lesions and to identify root causes contributing to misdiagnoses. First, direct smears prepared from 14 histology-confirmed fibroadenomas and 14 adenocarcinomas were reviewed and characteristics of commonly encountered morphologic features were assessed. We then retrospectively and blindly reviewed nine cytohistologic discrepant cases using the significant characteristic as a guideline, in order to assess whether these discrepant cases could be correctly categorized. Morphologic characteristics predictive of fibroadenoma included moderate cellularity, large, folded cellular sheets/aggregates, staghorn projections, smooth and round borders, monolayers, honeycomb arrangement, smaller nuclear size, and background bipolar cells. Predictive characteristics of adenocarcinoma included high cellularity, loose cohesive sheets/aggregates, pointed projections, irregular borders, larger nuclear size, irregular nuclear membrane, prominent nucleoli, and single atypical epithelial cells. Retrospective, blind review correctly re-classified seven out of nine cytohistologic discrepant cases, including five false negative cases and two false positive cases. Root causes contributing to the misdiagnoses were large branching sheets of carcinoma mimicking folded sheets of fibroadenoma; fibroblasts mimicking myoepithelial cells; apocrine cells mimicking carcinoma cells; and not recognizing the loose myxoid matrix presenting as soap bubbles in fibroadenoma. In conclusion, this study identified significant characteristics that can assist in achieving accurate diagnosis in a subpopulation of breast aspirates that present with overlapping features.

Digital slide images for primary diagnostics in breast pathology: a feasibility study

Digital slide images have been used in many areas of pathology such as teaching, research, digital archiving, teleconsultation, and quality assurance testing. However, they have not much been used as yet for upfront diagnostics. The aim of this study was therefore to test the feasibility of digital slide image-based diagnosis of breast specimens. Sections of 100 breast specimens previously diagnosed conventionally were scanned and rediagnosed on digital slide images by the same pathologists who performed the initial light microscopy-based diagnosis. The digital slide image diagnoses were compared with the light microscopy diagnoses and classified as concordant, slightly discrepant (without clinical or prognostic consequences), or discrepant. The original light microscopy- and digital slide image-based diagnoses were concordant in 93% and slightly discrepant in 6% of cases. There was only 1 discrepant case with clinical or prognostic implication to the patient. However, for this case, no final agreement could be achieved. For 4 of the 6 slightly discrepant cases, digital slide image diagnosis was considered the better one, whereas the original diagnosis was preferred in only 1 case. In addition, for 1 case categorized as slightly discrepant, both the digital slide image and conventional diagnosis were imperfect according to 2 reviewing breast pathologists. This study demonstrates that upfront histopathologic diagnosis of breast biopsies and resections can reliably be done on digital slide image.

A simple diagnostic strategy for RhD typing in discrepant cases in the Indian population.

The D antigen is the most immunogenic antigen in the Rh system. D variants must be considered if there is a significant discrepancy in the strength of reaction obtained with different anti-D reagents, a discrepancy between current and historical test results and if anti-D is detected in an individual serologically typed as RhD positive. A panel of monoclonal anti-D reagents can be used to identify partial D and weak D variants. The aim of this study was to develop a strategy for RhD typing in discrepant cases. Sixty RhD discrepant samples referred to our Institute for confirmation of RhD status were tested with a panel of 12 monoclonal anti-D reagents (ALBAclone advanced partial RhD typing kit) and Rh phenotype was determined using C, c, D, E, and e antisera. Ninety-three percent of the RhD discrepant cases were classified into weak and partial D using this kit. Among the D variants characterised, 37% belonged to DFR, 23% to DOL, 12% to weak D, and the remaining 21% to DAR, DV, DMH, DCS and DVI categories. Ninety-seven percent of the D variants were "C" antigen positive. Out of the panel of 12 monoclonal anti-D used, cell line LHM-70/45 gave negative reactions with all RhD discrepant cases and cell lines LHM-76/59, LHM-76/55 and ESD-1 gave positive reactions with all 60 RhD discrepant cases studied. The Advanced partial D kit was very useful in characterising and identifying D variants in the Indian population. A preliminary strategy for the detection and identification of D variants in discrepant cases could be to test for the presence of "C" antigen with anti-C, and for "D" antigen with anti-D of cell line LHM 70/45. A more comprehensive, but simple way to identify D variants in routine RhD typing is to use two anti-D reagents i.e LHM 70/45 and one out of LHM-76/59, LHM-76/55 and ESD-1. D variants can be further characterised by using the partial D typing kit and molecular genotyping in specialised laboratories.

The role of role: learning in longitudinal integrated and traditional block clerkships

Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinal integrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design. This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data. Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care. Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care.

P1.03 SNPS Detection in the Braf Gene

Personalized medicine focused at individual patient's treatment by matching between the genetic information hidden at the DNA and medication. Single nucleotide mutations (SNPs) play a major role in genetic variability and the ability to react to medications.BRAF gene is involved in solid tumors like malignant melanoma and thyroid. BRAF is a serine/threonine protein kinase, activates the MAPK/ERK signaling pathway.The development of specific BRAF inhibitors that work only on the SNP V600E1 (T > A at position 1799) such as vemurafenib (Zelboraf) gave push to personalized medicine as 50% of metastatic melanoma patients carry this mutation. Those who carry the mutation demonstrate better response to vemurafenib than others. By comparison between 2 methods to detect SNPs in the BRAF gene, we show here that INFINITI™ Analyzer is the most accurate and reliable method. MethodsBRAF mutation analysis by Length Analysis. We used allele-specific DNA with two specific forward primers for the mutant and the wild-type alleles and one common reverse primer. Mutated allele gives fragment of 160 bp and the wild type allele gives fragment of 157 bp. PCR was carried out and products were separated on sequencer and analyzed using peak scanner. BRAF mutation detected by AutoGenomics INFINITI-BRAF Assay. Following PCR amplification a removal of the non-incorporated dNTPs was performed.The products were loaded on BioFilmChip microarrays together with analyte specific primer extension fluorescently label. Results and DiscussionWe tested 101 samples and compare the results from the AutoGenomics INFINITI Assay with those of the DNA Fragment Analysis. The result reveals that the INFINITI BRAF Assay is sensitive and most easy to work with. That assay is almost fully automated and need shorter time for processing and lower concentration of DNA. The last issue is more important in cases of thyroid cancer were samples are taken by fine needle aspiration. We achieved 97% of concordance between both methods. All 3 discrepant cases were of V600E1 mutation detection that were found only by the INFINITI-BRAF. The ability of the INFINITI to detect mutation is 1 mutant cell I population of 100 cells. Both methods are suitable for SNP detection.

CT Findings and Long-Term Mortality After Pulmonary Embolism

The utility of CT findings in predicting long-term mortality in patients with acute pulmonary embolism (PE) is unknown. The purpose of this study is to retrospectively determine whether three CT findings--increased embolic burden, interventricular septal bowing toward the left ventricle, and right ventricle-to-left ventricle (RV/LV) diameter ratio greater than 1--are independent predictors of long-term all-cause mortality after acute PE. A total of 1105 patients (47% female; mean age, 63 ± 16 years) with CT scans positive for PE from January 1, 1997, to December 31, 2002, were included. Scans were independently interpreted by two observers, with a third independent observer reviewing discrepant cases. CT findings and clinical information were compared with all-cause mortality using univariate and multivariate logistic regression analyses. The median duration of survival was 6.2 years following acute PE, with estimated 10-year survival of 37.4%. CT-derived embolic burden was associated with a very small decrease in long-term all-cause mortality in both univariate (hazard ratio [HR], 0.97; p < 0.001) and multivariate (HR, 0.97; p < 0.001) analyses. Interventricular septal bowing and RV/LV diameter ratio were not significantly associated with long-term all-cause mortality. CT findings are not predictive of decreased long-term survival after acute PE.