Common Clinical Tool Research Articles

Investigating the Effectiveness of Formative OSCE Combined with Visual Feedback in Improving Clinical Competence among Iranian Nurse Anesthesia Students: A Quasi-experimental study.

Lack of clinical competence can endanger the patient's safety and reduce the quality of providing health care services. The aim of this study was to examine the impact of formative Objective Structured Clinical Examinations (OSCEs) with immediate verbal and visual feedback on the clinical competence of fourth-year nurse anesthesia students. This was a single blind quasi-experimental study with a pre-test/post-test design in compliance with the CONSORT (Consolidated Standards of Reporting Trials) statement. Forty-eight students were allocated to intervention (n=24) and control (n=24) groups. During the academic semester, the students of the intervention group attended 3 sessions of formative OSCE (5 stations) with immediate verbal and visual feedback. In the control group, however, the students received in-person feedback according to curricular routine. The data collection tool included two sections. The first section included a questionnaire to collect demographic information such as age, sex, grade point average and marital status. In the second section, clinical competence of students was measured by Common Clinical Assessment Tool (CCAT). The collected data were analyzed by Analysis of Covariance, paired T-test, Chi-square, and Fischer's exact test in SPSS, version 16. Comparing post-test scores by ANCOVA showed a significant difference between groups (p=0.001) because there was a significant positive change in the overall clinical competence score in the intervention group after receiving formative OSCE. This study showed that regular implementation of formative OSCEs in nurse anesthesia education fosters learning and has a positive effect on improving students' educational behaviors and helps them learn more efficiently. However, it is recommended to conduct more studies with a larger number of participants to confirm this conclusion.

Deep Learning-Enhanced Hand Grip and Release Test for Degenerative Cervical Myelopathy: Shortening Assessment Duration to 6 Seconds.

Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.

Value of Central Venous Pressure Monitoring in the Patients with Sepsis-Associated Acute Kidney Injury.

Although the measurement of central venous pressure (CVP) is a common clinical tool, the role of CVP monitoring in the outcome of sepsis is controversial because threshold values of CVP are uncertain, and there are only limited data on short-term survival of patients with septic acute kidney injury (AKI). This retrospective cohort study was based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (source of the training dataset). Multivariate regression analysis was performed to clarify the relation between CVP measurement and clinical outcomes, and a univariate regression model after propensity score matching was utilized to validate our findings. A mortality prediction model for septic AKI and a risk stratification scoring approach were developed, and the emergency intensive care unit (eICU) database was used for external validation. Of the 9170 patients in the training set, 2446 (26.7%) underwent CVP measurement. No significant association was found between CVP monitoring and 28-day mortality among patients with septic AKI (odds ratio = 0.479; 95% confidence interval 0.213-1.076, P = 0.075), even after adjustments (propensity score matching; P = 0.178). Length of ICU stay and hospital stay was markedly reduced in patients undergoing CVP measurement within 3 hours (median 6.2 and 10.9 days, respectively, P < 0.001). The addition of the mean perfusion pressure initial, CVP, and the magnitude of the CVP change within 48 hours to the model significantly increased model discrimination (area under the receiver operating characteristic curve: 0.867 and 0.780, respectively, P < 0.001). These findings suggest that CVP measurement alone has little effect on the outcome of septic AKI. Nonetheless, initial CVP levels and the dynamic changes in CVP within the first 48 hours after ICU admission and the mean perfusion pressure initial can improve the accuracy of outcome prediction models.

Cot-side imaging of functional connectivity in the developing brain during sleep using wearable high-density diffuse optical tomography

Studies of cortical function in newborn infants in clinical settings are extremely challenging to undertake with traditional neuroimaging approaches. Partly in response to this challenge, functional near-infrared spectroscopy (fNIRS) has become an increasingly common clinical research tool but has significant limitations including a low spatial resolution and poor depth specificity. Moreover, the bulky optical fibres required in traditional fNIRS approaches present significant mechanical challenges, particularly for the study of vulnerable newborn infants. A new generation of wearable, modular, high-density diffuse optical tomography (HD-DOT) technologies has recently emerged that overcomes many of the limitations of traditional, fibre-based and low-density fNIRS measurements. Driven by the development of this new technology, we have undertaken the first cot-side study of newborn infants using wearable HD-DOT in a clinical setting. We use this technology to study functional brain connectivity (FC) in newborn infants during sleep and assess the effect of neonatal sleep states, active sleep (AS) and quiet sleep (QS), on resting state FC. Our results demonstrate that it is now possible to obtain high-quality functional images of the neonatal brain in the clinical setting with few constraints. Our results also suggest that sleep states differentially affect FC in the neonatal brain, consistent with prior reports.

Research progress and hotspot of the artificial intelligence application in the ultrasound during 2011-2021: A bibliometric analysis.

Ultrasound, as a common clinical examination tool, inevitably has human errors due to the limitations of manual operation. Artificial intelligence is an advanced computer program that can solve this problem. Therefore, the relevant literature on the application of artificial intelligence in the ultrasonic field from 2011 to 2021 was screened by authors from the Web of Science Core Collection, which aims to summarize the trend of artificial intelligence application in the field of ultrasound, meanwhile, visualize and predict research hotspots. A total of 908 publications were included in the study. Overall, the number of global publications is on the rise, and studies on the application of artificial intelligence in the field of ultrasound continue to increase. China has made the largest contribution in this field. In terms of institutions, Fudan University has the most number of publications. Recently, IEEE Access is the most published journal. Suri J. S. published most of the articles and had the highest number of citations in this field (29 articles). It's worth noting that, convolutional neural networks (CNN), as a kind of deep learning algorithm, was considered to bring better image analysis and processing ability in recent most-cited articles. According to the analysis of keywords, the latest keyword is “COVID-19” (2020.8). The co-occurrence analysis of keywords by VOSviewer visually presented four clusters which consisted of “deep learning,” “machine learning,” “application in the field of visceral organs,” and “application in the field of cardiovascular”. The latest hot words of these clusters were “COVID-19; neural-network; hepatocellular carcinoma; atherosclerotic plaques”. This study reveals the importance of multi-institutional and multi-field collaboration in promoting research progress.

Body Surface Potential Mapping: Contemporary Applications and Future Perspectives

Body surface potential mapping (BSPM) is a noninvasive modality to assess cardiac bioelectric activity with a rich history of practical applications for both research and clinical investigation. BSPM provides comprehensive acquisition of bioelectric signals across the entire thorax, allowing for more complex and extensive analysis than the standard electrocardiogram (ECG). Despite its advantages, BSPM is not a common clinical tool. BSPM does, however, serve as a valuable research tool and as an input for other modes of analysis such as electrocardiographic imaging and, more recently, machine learning and artificial intelligence. In this report, we examine contemporary uses of BSPM, and provide an assessment of its future prospects in both clinical and research environments. We assess the state of the art of BSPM implementations and explore modern applications of advanced modeling and statistical analysis of BSPM data. We predict that BSPM will continue to be a valuable research tool, and will find clinical utility at the intersection of computational modeling approaches and artificial intelligence.

Simulation-Based Estimation of the Number of Cameras Required for 3D Reconstruction in a Narrow-Baseline Multi-Camera Setup.

Graphical visualization systems are a common clinical tool for displaying digital images and three-dimensional volumetric data. These systems provide a broad spectrum of information to support physicians in their clinical routine. For example, the field of radiology enjoys unrestricted options for interaction with the data, since information is pre-recorded and available entirely in digital form. However, some fields, such as microsurgery, do not benefit from this yet. Microscopes, endoscopes, and laparoscopes show the surgical site as it is. To allow free data manipulation and information fusion, 3D digitization of surgical sites is required. We aimed to find the number of cameras needed to add this functionality to surgical microscopes. For this, we performed in silico simulations of the 3D reconstruction of representative models of microsurgical sites with different numbers of cameras in narrow-baseline setups. Our results show that eight independent camera views are preferable, while at least four are necessary for a digital surgical site. In most cases, eight cameras allow the reconstruction of over 99% of the visible part. With four cameras, still over 95% can be achieved. This answers one of the key questions for the development of a prototype microscope. In future, such a system can provide functionality which is unattainable today.

Mortality Risk Assessment Using CHA(2)DS(2)-VASc Scores in Patients Hospitalized With Coronavirus Disease 2019 Infection

Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.

Tracheal intubation using the Airtraq video laryngoscope vs. Macintosh laryngoscope in patients with anticipated difficult intubation

BackgroundVarious types of laryngoscopes have been invented to ameliorate the laryngoscopic view of the glottis, in normal and difficult airway, which helps anaesthesiologists to secure the airway during anaesthesia. In this prospective study, we aimed to compare the efficacy of the Airtraq video laryngoscope (AVL) and the Macintosh curved-blade laryngoscope (MBL), by using a common clinical assessment tool in patients with modified Mallampati class III and IV. MethodsA total of 60 patients [group A (AVL) and group M (MBL)] with modified Mallampati class III and IV listed for general anaesthesia were included. Each patient was intubated with either of the laryngoscope based on the group allotted. Time taken for tracheal intubation, grade of visualisation of glottis and need for manoeuvres to optimise the glottic view were compared. ResultsThe degree of the glottic view during successful intubation attempt was easily appreciated in group A (p < 0.0001). Difference in the requirement of manoeuvres for optimising the laryngeal view/assisting in intubation as assessed by manoeuvre score was easily appreciated in group A (p < 0.010). Rise in heart rate and mean arterial pressure 1 and 2 min after intubation was more in group M than in group A (p < 0.0001). No event of any airway trauma, as evidenced by visible trauma to lips or oral mucosa or blood on laryngoscope, was observed with either of the laryngoscope. ConclusionThe novel AVL provides better intubation conditions with greater ease of intubation, better glottic view and lesser haemodynamic alterations during laryngoscopy than MBL.

Short-Term Heart Rate Variability and Blood Biomarkers of Gastric Cancer Prognosis

Inflammation, nutrition, and coagulation play significant roles in cancer prognosis. Autonomic function is also actively involved in tumorigenesis. Previous studies have shown that an elevated C-reactive protein (CRP) level, a serum marker for inflammation, is associated with low heart rate variability (HRV), a common clinical tool for the assessment of autonomic function. It is yet to be investigated whether HRV links to these prognostic factors in cancer patients. Sixty-one patients who were first diagnosed with gastric cancer (GC) were enrolled in this study. Fasting blood samples were collected in the morning seven days before surgery. Blood CRP, prealbumin (PA), and fibrinogen (FIB) were used to assess the inflammation level, nutritional status, and coagulation function respectively. Five-minute resting electrocardiogram (ECG) signals were collected one day before surgical treatment. Short-term HRV time-series were extracted from ECG recordings and were analyzed using commonly-used time- and frequency-domain parameters including standard deviation of normal-to-normal intervals (SDNN), root mean square of successive heartbeat interval differences (RMSSD), very-low-frequency power (VLF), low-frequency power (LF), high-frequency power (HF), total power (TP), LF power in normalized units (LF n.u.), HF power in normalized units (HF n.u.), and ratio of LF to HF (LF/HF). After adjusted for sex, age, body mass index, alcohol consumption, history of diabetes, left ventricular ejection fraction, and hemoglobin levels, our results demonstrated negative associations of HRV with levels of CRP and FIB, while positive associations between HRV and PA level, with effect sizes of as high as 35%-52% standard deviations (SD) changes in CRP, FIB, or PA per 1-SD change in HRV parameters. Therefore, decreased HRV in patients with GC predicts increased burdens of inflammation and coagulation and perturbed nutrition, suggesting that short-term HRV measurement can potentially be a noninvasive biomarker for GC prognosis.

The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults

ABSTRACTBackground/Objectives: Post-concussion syndrome refers to the adverse group of symptoms following a mild traumatic brain injury (mTBI). The Rivermead post-concussion syndrome questionnaire (RPQ) is a common clinical tool for assessing baseline post-concussion syndrome symptomology; however, it is unknown if scores on this questionnaire are associated with future disability. Therefore, the goal of this study was to determine the association between baseline RPQ scores and future disability in older adults with mTBI.Methods and Findings: This study used a prospective cohort design, using the RPQ to measure baseline post-concussion syndrome symptomatology. Disability at 6 months was measured using the Glasgow Outcome Scale-Extended (GOSE; disability), short-form 12 (SF-12; physical and mental quality of life), and self-reported recovery. Linear and logistic models adjusted for confounding factors were estimated using 200 bootstrapped samples. Individuals with higher levels of baseline symptomatology were more likely to have poor GOSE scores (RR = 2.13, 95% CI [1.51, 2.31]) and self-reported recovery (RR = 2.64, 95% CI [1.31, 8.98]) 6 months later.Conclusions: High levels of baseline symptomatology may be associated with overall disability and individual perceptions of recovery 6 months post-MTBI. While the RPQ is valid in assessing a patient’s post-concussive symptoms following mTBI, it may not predict long-term physical or mental health in older adults.

S1-4. PET imaging of epilepsy

If we can visualize the epileptogenic lesion, the intractable epilepsy might be cured by the resective surgery. PET is a common clinical imaging tool, and it can evaluate and visualize brain function quantitatively and multidimensionally with various radio ligands. (18) FDG-PET and (11) C-flumazenil-PET are mainly used in the clinical settings, and they showed the decrease of glucose metabolism and binding in the epilepsy focus. In this decade, many PET radio-ligands are developed for positive imaging of epileptogenic lesion. The first target is neuroinflammation, such as 18 kDa-translocator protein (TSPO). (11) PK-11195-PET showed increase of TSPO binding in the focus in animal model, however, this alteration is unclear in human clinical study. Glutamate receptors are believed to be a novel biomarkers of epileptogenesis in future, and our experimental study showed the possibility that it could be a positive marker. Furthermore, other PET studies for neurotransmitters reported the role of opioids, cannabinoids, acetylcholine, and dopamine in modulating neuronal hyperexcitability. PET has the possibility not only to visualize the epileptic foci, but also elucidate of the mechanism of epileptogenesis.

Longitudinal micro-CT as an outcome measure of interstitial lung disease in TNF-transgenic mice.

IntroductionRheumatoid arthritis associated interstitial lung disease (RA-ILD) is a debilitating condition with poor survival prognosis. High resolution computed tomography (CT) is a common clinical tool to diagnose RA-ILD, and is increasingly being adopted in pre-clinical studies. However, murine models recapitulating RA-ILD are lacking, and CT outcomes for inflammatory lung disease have yet to be formally validated. To address this, we validate μCT outcomes for ILD in the tumor necrosis factor transgenic (TNF-Tg) mouse model of RA.MethodsCross sectional μCT was performed on cohorts of male TNF-Tg mice and their WT littermates at 3, 4, 5.5 and 12 months of age (n = 4–6). Lung μCT outcomes measures were determined by segmentation of the μCT datasets to generate Aerated and Tissue volumes. After each scan, lungs were obtained for histopathology and 3 sections stained with hematoxylin and eosin. Automated histomorphometry was performed to quantify the tissue area (nuclei, cytoplasm, and extracellular matrix) and aerated area (white space) within the tissue sections. Spearman’s correlation coefficients were used to evaluate the extent of association between μCT imaging and histopathology endpoints.ResultsTNF-Tg mice had significantly greater tissue volume, total lung volume and mean intensity at all timepoints compared to age matched WT littermates. Histomorphometry also demonstrated a significant increase in tissue area at 3, 4, and 5.5 months of age in TNF-Tg mice. Lung tissue volume was correlated with lung tissue area (ρ = 0.81, p<0.0001), and normalize lung aerated volume was correlated with normalized lung air area (ρ = 0.73, p<0.0001).ConclusionsWe have validated in vivo μCT as a quantitative biomarker of ILD in mice. Further, development of longitudinal measures is critical for dissecting pathologic progression of ILD, and μCT is a useful non-invasive method to study lung inflammation in the TNF-Tg mouse model.

Laser Biophotomodulation in Patients with Neurosensory Disturbance of the Inferior Alveolar Nerve After Sagittal Split Ramus Osteotomy: A 2-Year Follow-Up Study

To evaluate the effect of the application of photobiomodulation in a 2-year follow-up period in patients who have been intervened with a sagittal ramus split osteotomy and present neurosensory disturbance of the inferior alveolar nerve. Photobiomodulation is a common clinical tool in dentistry, for its beneficial effects have been shown in surgical and periodontal wound healing, reducing of swelling and pain, neurosensory recovery, and treatment of temporomandibular joint disorders. This is a 2-year follow-up study with an experimental (Laser) group (n = 33) that received photobiomodulation, and a control (Sham) group (n = 9), placebo. All patients from the Laser group received laser applications (continuous wave of 0.353 W/cm2, 27 J in 270 sec per session) on days 1, 2, 3, 5, 10, 14, 21, and 28 after surgery. Neurosensory disturbance was evaluated with five tests: Visual Analog Scale (VAS) for pain and sensitivity, sensitivity threshold test, two-point discrimination, and thermal discrimination. All tests were performed before (24 h before surgery) and after surgery (24 h, 28 days, 60 days, 6 months, 1 year, 2 years, more than 2 years). Participants and evaluator were blinded to intervention. Variables were described with absolute frequencies, percentages, and medians. Ordinal and dichotomous variables were compared with Mann-Whitney's and Fisher's tests, respectively. Clinical improvement was observed during the follow-up period for the Laser group; general VAS for sensitivity was normal in 11 participants from the Laser group at 2 years postsurgery (40.74%), while no participants from the Sham group achieved this (p = 0.0341). Twenty-three participants recovered initial values for two-point discrimination (69.7%) after 2 years of follow-up (p = 0.0025) as well as sensitivity threshold test. General VAS for pain was normal in 31 patients from the Laser group after 2 years of follow-up (93.94%, p = 0.0254). Photobiomodulation was effective for neurosensory recovery on sample studied.

Reliability of four models for clinical gait analysis

Three-dimensional gait analysis (3DGA) has become a common clinical tool for treatment planning in children with cerebral palsy (CP). Many clinical gait laboratories use the conventional gait analysis model (e.g. Plug-in-Gait model), which uses Direct Kinematics (DK) for joint kinematic calculations, whereas, musculoskeletal models, mainly used for research, use Inverse Kinematics (IK). Musculoskeletal IK models have the advantage of enabling additional analyses which might improve the clinical decision-making in children with CP. Before any new model can be used in a clinical setting, its reliability has to be evaluated and compared to a commonly used clinical gait model (e.g. Plug-in-Gait model) which was the purpose of this study. Two testers performed 3DGA in eleven CP and seven typically developing participants on two occasions. Intra- and inter-tester standard deviations (SD) and standard error of measurement (SEM) were used to compare the reliability of two DK models (Plug-in-Gait and a six degrees-of-freedom model solved using Vicon software) and two IK models (two modifications of ‘gait2392’ solved using OpenSim). All models showed good reliability (mean SEM of 3.0° over all analysed models and joint angles). Variations in joint kinetics were less in typically developed than in CP participants. The modified ‘gait2392’ model which included all the joint rotations commonly reported in clinical 3DGA, showed reasonable reliable joint kinematic and kinetic estimates, and allows additional musculoskeletal analysis on surgically adjustable parameters, e.g. muscle-tendon lengths, and, therefore, is a suitable model for clinical gait analysis.

Biomarkers for the Detection of Prenatal Alcohol Exposure: A Review.

Alcohol exposure during pregnancy can cause adverse effects to the fetus, because it interferes with fetal development, leading to later physical and mental impairment. The most common clinical tool to determine fetal alcohol exposure is maternal self-reporting. However, a more objective and useful method is based on the use of biomarkers in biological specimens alone or in combination with maternal self-reporting. This review reports on clinically relevant biomarkers for detection of prenatal alcohol exposure (PAE). A systematic search was performed to ensure a proper overview in existing literature. Studies were selected to give an overview on clinically relevant neonatal and maternal biomarkers. The direct biomarkers fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulfate, and phosphatidylethanol (PEth) were found to be the most appropriate biomarkers in relation to detection of PAE. To review each biomarker in a clinical context, we have compared the advantages and disadvantages of each biomarker, in relation to its window of detectability, ease of collection, and the ease and cost of analysis of each biomarker. The biomarkers PEth, FAEEs, and EtG were found to be applicable for detection of even low levels of alcohol exposure. Meconium is an accessible matrix for determination of FAEEs and EtG, and blood an accessible matrix for determination of PEth.

Association between abnormal serum free light chains ratio and known prognostic factors in lymphoma; a nephrology viewpoint.

Introduction: The serum immunoglobulin free light chain (FLC) assay quantities of free kappa (κ) and lambda (λ) light chains. This assay has prognostic value in plasma cell proliferative disorders. There are limited data on serum FLC in B-cell malignancies. Objectives: The aim of this study was to compare the known prognostic factors in non-Hodgkin’s lymphoma of the type B-cell and Hodgkin disease with an abnormal secretion amount of light chains in these lymphomas. Patients and Methods: The association of pretreatment FLC and FLC ratio (κ:λ) with previously known prognostic factors for lymphoma such as the international prognostic index (IPI) and B symptoms were evaluated in 50 patients with Hodgkin’s and non-Hodgkin’s lymphoma. IPI is a prognostic score given based on the clinical variables including age, disease stage, serum LDH and extra-nodal involvement. Elevated FLC and an abnormal κ:λ ratio was defined based on the previous publications. Results: The prevalence of abnormal FLC ratio was 38% in all patients and 40.9% in patients with diffuse large B-cell lymphoma. Abnormal FLC ratio was significantly associated with IPI (P=0.04) and B symptoms (P=0.02) in both groups of the patients with Hodgkin’s and non-Hodgkin’s lymphoma. The stage of the disease in Hodgkin’s lymphoma patients showed a significant relationship with the abnormal FLC ratio (P=0.04). Presence of the B symptoms in patients with Hodgkin’s lymphoma had a modest but not statistically significant association with the abnormal FLC ratio (P=0.07). Conclusion: Abnormal FLC ratio as a new potent prognostic biomarker has a significant association with IPI which is the most common clinical tool used to predict outcome in lymphoma patients. Since there is a need for developing a reliable and quantitative prognostic biomarker for lymphoma, evaluation of the independent effect of the abnormal serum FLC ratio is suggested to be considered in future prospective studies. The result of these studies will also be useful for nephrologists, while serum immunoglobulin FLC is capable to damage kidney.

Cardiovascular risk assessment using LOX-index and Self-Rating Depression Scale

ObjectiveLOX-Index is a novel biomarker for cardiovascular disease (CVD) and is calculated by multiplying LOX-1 ligands containing apolipoprotein B (LAB) and soluble LOX-1 (sLOX-1). The Framingham risk score (FRS) is a common clinical tool for risk assessment of coronary artery disease. Mental stress can also be an important risk factor for CVD. The purpose of this study was to examine the relationship between LOX-Index and FRS or mental stress. MethodsLOX-Index was measured in 453 subjects including 150 consecutive outpatients with lifestyle-related diseases such as diabetes, hyperlipidemia, and hypertension and 303 healthy volunteers. Mental stress was evaluated by the Self-Rating Depression Scale (SDS). ResultsLOX-Index was significantly related with the 10-years risk of FRS. Multiple regression analysis demonstrated that LAB was closely associated with the smoking status, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). There were no significant associations between LOX-Index and the SDS scores; however, by simultaneously using LOX-Index and SDS, the subjects could be classified in terms of oxidative stress and mental stress. ConclusionsLOX-Index appears to be a comprehensive marker that could evaluate the status of multiple CVD risk factors. The classification with LOX-Index and SDS could contribute to the risk assessment for CVD.

Abstract A69: The PAX8 cistrome in benign and malignant Mullerian epithelia.

Abstract Background: PAX8 is a highly evolutionarily conserved transcription factor with essential roles in both Mullerian development as well as high grade serous ovarian cancer. While PAX8 has emerged as a common clinical tool to identify Mullerian primary tumors, the transcriptional network directed by PAX8 in Mullerian epithelia is unknown. In this study, we sought to understand how PAX8 interacts with chromatin in the context of both benign fallopian tube secretory epithelial cells as well as in high grade serous carcinomas. Methods: This study examined PAX8 using six cell lines: three immortalized fallopian tube secretory cell lines (FT33TAg, FT194, FT246) generated by our laboratory and three high grade serous ovarian cancer cell lines (KURAMOCHI, OVSAHO, and JHOS4) with high genomic fidelity to human tumors according to The Cancer Genome Atlas. First, we used chromatin immunoprecipitation combined with DNA sequencing (ChIP-Seq) to map PAX8 binding sites along the genome. Overlapping peaks among the cell lines were aligned to define a minimum consensus binding motif for PAX8. Unsupervised hierarchical clustering then segregated the peaks into groups. The nearest gene within 50000 base pairs to each peak was identified. Next, we used a series of RNAi experiments to knockdown PAX8 in all six cell lines using three independent siRNA sequences plus a pool and examined the effect on the transcriptome in each cell line using RNA-seq. Finally, we used pathway analysis software and gene ontology tools to map the signaling networks directed by PAX8. Results: Among the six cell lines, there were 11,361 unique PAX8 peaks by ChIP-seq. Approximately half of all PAX8 binding sites were located in intergenic sequences and about a 40% were in intronic sequences. The consensus DNA binding motif was almost identical between benign and malignant cell lines and was consistent with a predicted PAX homology motif. Unsupervised clustering identified 3 sets of peaks: 1) a highly conserved set of peaks among all six cell lines comprised of 558 peaks; 2) a common set of peaks common to benign cell lines but absent in cancer cell lines comprised of 3013 peaks; and 3) a very heterogeneous pattern of DNA binding unique to each cancer cell line ranging from few PAX8 peaks (JHOS4) to more than 3000 PAX8 peaks (both KURAMOCHI and OVSAHO). By gene ontology analysis, the common set of peaks for all six cell lines clustered around apoptosis and programmed cell death. Using the combination of RNAi with RNA-seq, few genes (ranging from 1 – 32 genes) were affected by loss of PAX8 in the fallopian tube cell lines or JHOS4, while more than 200 genes were altered in KURAMOCHI and OVSAHO. While in KURAMOCHI these genes were more likely to involve metabolic processes, in OVSAHO these genes were more likely to involve cell cycle regulation. Conclusions: PAX8 expression is shared among benign fallopian tube secretory cells and high grade serous carcinoma, but PAX8 function appears to be context dependent. While there is a shared set of PAX8 binding sites in benign and malignant Mullerian epithelia, PAX8 appears to be essential for the expression of very few targets in benign cells compared to cancer. In addition, PAX8 appears to have greater access to chromatin in the setting of cancer as evidenced by an increase in the number of PAX8 binding sites, while at the same time losing affinity for a set of binding sites seen only in benign fallopian tube cells. Together, these data suggest a dynamic reorganization of chromatin in the process of malignant transformation. Citation Format: Kevin M. Elias, Megan Emori, Myles Brown, Ronny Drapkin. The PAX8 cistrome in benign and malignant Mullerian epithelia. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr A69.

Perceptual evaluation of tracheoesophageal speech: Is it a reliable tool?

Perceptual voice evaluation is a common clinical tool for rating the severity of vocal quality impairment. It has been used in research as a gold standard for comparison with acoustic and aerodynamics measurements. Nevertheless, it has disadvantages in the form of being time-consuming, a group of raters is needed and last but not the least it is a subjective manner of evaluation. Intraobserver and interobserver reliability is an important issue in perceptual evaluations. Different perceptual scales have been developed to describe the quality of a patient's voice but none is internationally accepted. Although not entirely comprehensive, perceptual evaluations will be used as a standard against which other measures will be evaluated. Data were collected by conducting a computer-aided search of the MED-LINE and PUBMED databases, supplemented by hand searches of key journals. More than 50 articles in the last three decades on the topic have been reviewed out of which approximately 31 were found to be relevant to this article.