Considerable Clinical Usefulness Research Articles

Multiparametric MRI-based radiomics nomogram for the preoperative prediction of lymph node metastasis in rectal cancer: A two-center study

PurposeTo develop a radiomic nomogram based on multiparametric magnetic resonance imaging for the preoperative prediction of lymph node metastasis (LNM) in rectal cancer. MethodsThis retrospective study included 318 patients with pathologically proven rectal adenocarcinoma from two hospitals. Radiomic features were extracted from T2-weighted imaging, diffusion-weighted imaging, and contrast-enhanced T1-weighted imaging scans of the training cohort, and the radsore model was then constructed. The combined model was obtained by integrating the Radscore and clinical models. The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic effectiveness of each model, and the best-performing model was used to develop the nomogram. ResultsThe Radscore and clinical models exhibited similar diagnostic efficacy (DeLong’s test, P > 0.05). The AUC of the combined model was significantly higher than those of the clinical and Radscore models in the training cohort (AUC: 0.837 vs. 0.763 and 0.787, P: 0.02120 and 0.02309) and the external validation cohort (AUC: 0.880 vs. 0.797 and 0.779, P: 0.02310 and 0.02471). However, the diagnostic performance of the three models was comparable in the internal validation cohort (P > 0.05). Thus, among the three models, the combined model exhibited the highest diagnostic efficiency. The calibration curve exhibited satisfactory consistency between the nomogram predictions and the actual results. DCA confirmed the considerable clinical usefulness of the nomogram. ConclusionThe radiomics nomogram can accurately and noninvasively predict LNM in rectal cancer before surgery, serving as a convenient visualization tool for informing treatment decisions, including the choice of surgical approach and the need for neoadjuvant therapy.

Construction and Validation of a Robust Cancer Stem Cell-Associated Gene Set-Based Signature to Predict Early Biochemical Recurrence in Prostate Cancer.

Background Postoperative early biochemical recurrence (BCR) was an essential indicator for recurrence and distant metastasis of prostate cancer (PCa). The aim of this study was to construct a cancer stem cell- (CSC-) associated gene set-based signature to identify a subgroup of PCa patients who are at high risk of early BCR. Methods The PCa dataset from The Cancer Genome Atlas (TCGA) was randomly separated into discovery and validation set. Patients in discovery set were divided into early BCR group and long-term survival group. Propensity score matching analysis and differentially expressed gene selection were used to identify candidate CSC-associated genes. The LASSO Cox regression model was finally performed to filter the most useful prognostic CSC-associated genes for predicting early BCR. Results By applying the LASSO Cox regression model, we built a thirteen-CSC-associated gene-based early BCR-predicting signature. In the discovery set, patients in high-risk group showed significantly poorer BCR free survival than that patients in low-risk group (HR: 4.91, 95% CI: 2.75–8.76, P < 0.001). The results were further validated in the internal validation set (HR: 2.99, 95% CI: 1.34–6.70, P = 0.005). Time-dependent ROC at 1 year suggested that the CSC gene signature (AUC = 0.800) possessed better predictive value than any other clinicopathological features in the entire TCGA cohort. Additionally, survival decision curve analysis revealed a considerable clinical usefulness of the CSC gene signature. Conclusions We successfully developed a CSC-associated gene set-based signature that can accurately predict early BCR in PCa cancer.

A convenient clinical nomogram for predicting the cancer-specific survival of individual patients with small-intestine adenocarcinoma

BackgroundThe objective of this study was to develop a practical nomogram for predicting the cancer-specific survival (CSS) of patients with small-intestine adenocarcinoma.MethodsPatients diagnosed with small-intestine adenocarcinoma between 2010 and 2015 were selected for inclusion in this study from the Surveillance, Epidemiology, and End Results (SEER) database. The selected patients were randomly divided into the training and validation cohorts at a ratio of 7:3. The predictors of CSS were identified by applying both forward and backward stepwise selection methods in a Cox regression model. The performance of the nomogram was measured by the concordance index (C-index), the area under receiver operating characteristic curve (AUC), calibration plots, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), and decision-curve analysis (DCA).ResultsMultivariate Cox regression indicated that factors including age at diagnosis, sex, marital status, insurance status, histology grade, SEER stage, surgery status, T stage, and N stage were independent covariates associated with CSS. These factors were used to construct a predictive model, which was built and virtualized by a nomogram. The C-index of the constructed nomogram was 0.850. The AUC values indicated that the established nomogram displayed better discrimination performance than did the seventh edition of the American Joint Committee on Cancer TNM staging system in predicting CSS. The IDI and NRI also showed that the nomogram exhibited superior performance in both the training and validation cohorts. Furthermore, the calibrated nomogram predicted survival rates that closely corresponded to actual survival rates, while the DCA demonstrated the considerable clinical usefulness of the nomogram.ConclusionWe have constructed a nomogram for predicting the CSS of small-intestine adenocarcinoma patients. This prognostic model may improve the ability of clinicians to predict survival in individual patients and provide them with treatment recommendations.

Transmucosal Core Needle Biopsy: A Novel Diagnostic Approach to Oral and Oropharyngeal Lesions

Oral and oropharyngeal tumors have often been characterized by a deep submucosal growth pattern under an intact mucous membrane. This will be particularly true for lesions of the tongue and could be associated with relevant difficulties regarding diagnosis and treatment planning. We hypothesized that the transoral transmucosal application of a core needle biopsy (CNB) for lesions of the tongue, the base of the tongue, and the floor of the mouth could be of considerable clinical usefulness for many patients. It has only previously been described in single cases and has not yet been separately discussed. We report on the novel transoral use of CNB during rigid endoscopy with the patient under general anesthesia, with an emphasis on lesions of the tongue. A series of cases and illustrative patients are presented. Transmucosal CNB was accurate and of considerable clinical usefulness in all cases. The relevant advantages of this technique compared with conventional biopsy using biopsy forceps and transmucosal fine needle aspiration are presented. The transoral transmucosal approach to the submucosal space of the oral cavity and the oropharynx has further extended the field of application of CNB. In selected patients, this CNB approach offers essential diagnostic benefits, in particular, for tumors of the tongue.

Quantification of Myocardial Perfusion: SPECT

Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) is important for the management of patients with suspected or known coronary artery disease. Stress myocardial perfusion images may be interpreted by visual inspection or by quantitative analysis. The use of visual inspection alone may introduce considerable observer variability and clinical usefulness of myocardial perfusion imaging may not be consistently reproduced in many laboratories using visual analysis. Relative myocardial distribution of imaging agents on SPECT images can be quantified and compared with normal data files by computer processing. Quantification of myocardial perfusion images provides a reproducible measure of the extent of perfusion abnormalities and defect reversibility. The quantification of myocardial perfusion images improves not only the overall diagnostic yield but also enhances reliability, accuracy, confidence, and reproducibility of interpretation. This review illustrates the current status and the future perspectives of myocardial perfusion quantification by SPECT imaging.

OP-1 Clinical Studies

Osteopontin-1 (OP-1) has demonstrated considerable clinical usefulness, along with a strong record of safety, in a wide variety of musculoskeletal disorders in more than 500 patients worldwide during the past decade. Specifically, the outcomes of patients with tibial nonunions enrolled in a randomized, prospective clinical trial in the United States and treated with OP-1 and intramedullary fixation were comparable with those of patients treated with bone autograft and a rod. These, and the other carefully observed cases, build on substantial preclinical evaluation and begin the very important and practical process of clarifying the unique role these molecules will play in the clinical arena. As with many new directions in medicine, the earliest research raises meaningful questions about study goals and design, including the specific questions to be addressed, the appropriateness and limitations of available methods of assessment, and the interpretation of data. The scope and the funding of clinical trials, as well as management of the partnership between academia and industry, are frequent issues encountered and addressed in the conduct of novel and cutting-edge …

Detection of fragile X non-penetrant males by DNA marker analysis.

Segregation analysis of the fragile-X [fra(X)] syndrome uncovered an unexpected 20% excess of normal males among sibships by Sherman et al. (Sherman SL, Morton NE, Jacobs PA, Turner G [1984]. Ann Hum Genet 48:21-37; Sherman SL, Jacobs PA, Morton NE, Froster-Iskenius U, Howard-Peebles PN, Neilsen KB, Partington MW, Sutherland GR, Turner G, Watson M [1985]: Hum Genet 63:289-299). This result predicts that about 17% (1/6) of normal sons of carrier fra(X) females will be non-penetrant. A way to test this prediction is by DNA markers. We analyzed DNA samples from 100 families with a set of flanking DNA markers linked to the fra(X) locus. Ten of 51 (19.6%) normal brothers, doubly informative and non-recombinant for flanking DNA markers, were found to be non-penetrant males. This result closely confirms the predictions of the segregation analysis indicating that about 1/6 of normal brothers are non-penetrant carrier males. The use of DNA markers to identify non-penetrant brothers and grandfathers can help to clarify the inheritance of the fra(X) mutation and be of considerable clinical usefulness. Using DNA markers, it was possible to study grandparental transmission in 71 of the families. In 39 families, DNA analysis confirmed the apparent pattern of inheritance. In 18 families, the grandparents had a single daughter with affected children. Of these, a new mutation at the time of their daughters' conception was possible in 15 and quite likely in 3. In 14 families with 2 or more daughters with affected fra(X) offspring, the grandparents had no affected sons or other relatives known to be positive for fra(X).(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic solid-phase enzyme immunoassay for the detection of anti-glomerular basement membrane antibodies

A new enzyme immunoassay has been developed for the demonstration of antiglomerular basement membrane antibodies. Magnetically responsive polyacrylamide-agorose beads (Magnogel) activated with glutaraldehyde were used to bind sonicated insoluble rat glomerular basement membranes. Both the collagenous and the non-collagenous moieties were demonstrated to be fixed on the beads. Sera from brown Norway rats with anti-glomerular basement membrane antibodies induced by HgCl 2 injections were incubated with the beads. After washing, the fixed rat IgG were revealed using alkaline phosphatase labelled Fab fragments from anti-rat IgG sheep, IgG s. Comparison with a radioimmunoassay showed that results were reliable. This enzyme immunoassay has several advantages which may render this assay of considerable clinical usefulness.

PRECORDIAL VIBRATIONS; CLINICAL CLUES FROM PALPATION.

The low-frequency precordial vibrations originating at the point of the apex beat, and especially those in the subaudible range, seem to offer considerable clinical usefulness. In this paper I have briefly outlined some of the physiologic, pathologic, and pharmacologic evidence to support this impression. The instrumentation we have used is crude and undoubtedly we have been misled on occasion by artifacts. However, there is sufficient validity in the technic, reproducibility of result, and correlation with intracardiac events to warrant intensive study.

Value of oral potassium salts in differentiation of functional and organic T wave changes

Ten grams of oral potassium salts were administered to 60 patients with functionally inverted (anxiety induced) left ventricular T waves, to 119 patients with organically inverted T waves and 4 patients with inverted T waves of indeterminate etiology. All functionally inverted T waves were reverted to normal 90 minutes after ingestion of K +. The T wave inversion resulting from 10 to 15 seconds of brisk hyperventilation likewise was abolished. Organic T waves of myocardial infarction were generally unaltered following ingestion of K +. Several of the inverted T waves due to infarction showed increased negativity. On the other hand, inverted T waves over the “fringe areas” of lateral wall ischemia in either anterior or posterior wall infarction occasionally showed a tendency to normalization. In a single instance of an acute posterior wall infarction, K + ingestion improved the T wave contour in lead II only. Of the 40 instances of acute myocardial ischemia, 32 showed no change; 2 showed slightly increasing T wave negativity; 4 showed improvement although not normalization of the ischemie zone; and 2 showed normalization. In 1 of these last 2 patients the control tracing had shown almost complete resolution of the ischemie episode. Ten instances of left bundle branch block, 10 of digitalis effect and 2 of subacute pericarditis showed no alteration of T wave polarity following K + ingestion. As previously noted in the literature, electrocardiograms of left ventricular preponderance showed the greatest variability of T wave configuration following K + ingestion. Eight tracings showed no change; 1 showed slight improvement and 3, moderate improvement. None, however, showed complete normalization. The K + salt was generally well tolerated when administered 1 1 2 hours following the noon meal. It must be regarded as a potentially dangerous drug, particularly in patients with acute ischemie episodes. Adequate renal function is a prerequisite for the test. This procedure appears to be of considerable clinical usefulness in evaluating T wave abnormalities of obscure etiology. It should not, however, usurp clinical judgment since the results to date are purely empirical and lack a sound pathophysiologic basis.

Brief objective measures for the determination of mental status in the aged.

1. Data are presented on a random sample of 1,077 persons residing in homes for the aged, nursing homes and state hospitals in New York City, who were 65 years of age or over at the time of first admission. Each person was examined by a psychiatrist using a standard interview technique, and by a psychologist who administered two brief tests: the face-hand test, and a 10-item questionnaire testing orientation and recall of personal and general information. 2. The results of both tests were highly related to psychiatrists' clinical evaluations of the presence and degree of chronic brain syndrome, the presence or absence of psychosis associated with chronic brain syndrome, opinion as to certifiability, and degree of management problem. 3. It is concluded that the face-hand test and the mental status questionnaire are valid measures for the determination of mental status in the aged, particularly for disorders associated with cerebral damage. 4. These tests are considered to have a considerable potential clinical usefulness for rapid screening purposes. They provide an objective basis for uniformity of observation and evaluation by different observers. The brevity and objectivity of these tests make them desirable procedures for research purposes.