Mean Number Of Samples Research Articles

The Role of CT-guided Core Needle Biopsy in Pancreatic Tumors: An Initial Evaluation in Modern Oncology.

Neoadjuvant chemotherapy has recently become the standard of care for borderline resectable pancreatic ductal adenocarcinoma (PDAC), and there have even been numerous reports evaluating its potential benefits in resectable PDAC. However, neoadjuvant therapy first requires a histological or cytological diagnosis. This study aimed to analyze the safety and diagnostic yield of CT-guided core needle biopsy (CNB). A retrospective analysis of patients with pancreatic tumor requiring a CNB during the period 2015 to 2023 were included. Biopsies were performed with an 18-20 G Tru-Core needle using a coaxial system and automatic biopsy gun. Demographics, procedural variables, postoperative outcomes, and histological results were analyzed. A total of 43 pancreatic biopsies were performed in 42 patients. The mean age was 60 years (35 to 81y), and 24 (56%) were males. Tumors were more frequently localized in the head (42%) and body (42%) of the pancreas. The mean size of the pancreatic lesions was 53.77 mm (17 to 181 mm) and the mean number of samples per biopsy was 4 (1 to 12). Most procedures were performed via direct access (81%). No major complications were observed. Histological diagnosis was obtained in 40 (93%) patients, with a sensitivity of 93%, specificity of 100% and an overall accuracy rate of 93%. The probability of performing a molecular diagnostic test increased with the year of biopsy (OR 3.34, 95% CI 1.33-8.40, P=0.01). CNB is an efficient and safe method for obtaining high-quality material. This approach could be essential as molecular profiling continues to improve the diagnosis, prognosis, and treatment of PDAC.

Lower blood levels of isavuconazole in critically ill patients compared with other populations: possible need for therapeutic drug monitoring.

Isavuconazole is first-line treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) is deemed not necessary, since most patients reached therapeutic levels (>1 mg/L) in large studies. Low levels were reported in some critically ill patients admitted to the ICU. The aim was to compare isavuconazole levels between critically ill and non-critically ill patients. Retrospective analysis of data from all patients treated with standard-dose isavuconazole between 1 January 2019 and 26 October 2022 was performed. The following data were collected: TDM results from the first 30 days of therapy; ward of admission; demographic and clinical characteristics; continuous renal replacement therapy; extracorporeal membrane oxygenation; and co-administered drugs. Seventy-two patients (median age 65 years) and 188 TDM measurements (mean number of samples per patient 2.6 ± 1.7) were included; 33 (45.8%) were ICU patients (3 also had haematological disorders); 39 (54.2%) were non-ICU patients, of whom 31 had haematological disorders. In all patients, the mean isavuconazole blood level was 3.33 ± 2.26 mg/L. Significantly lower levels were observed in the ICU versus the non-ICU population: mean 2.02 ± 1.22 versus 4.15 ± 2.31 mg/L (P < 0.001). Significantly higher rates of subtherapeutic levels were observed in ICU patients compared with the non-ICU population: all determinations <2 mg/L in 33.3% versus 7.7%, and all determinations <1 mg/L in 12.1% versus 0%, respectively. Predictors of lower isavuconazole levels were admission to the ICU, BMI > 25 kg/m2, bilirubin > 1.2 mg/dL and the absence of haematological disorder. ICU patients had significantly lower isavuconazole blood levels compared to non-ICU population. The TDM of isavuconazole for efficacy should be performed in ICU.

Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?

There are no consensus guidelines regarding the use of percutaneous needle biopsy for the diagnosis of soft tissue and bone tumors. The aim of this study was to understand the efficacy of image-guided percutaneous biopsy for pediatric patients with soft tissue and bony masses, the role of intraoperative image guidance, and diagnostic accuracy. A retrospective institutional chart review was performed on patients who underwent percutaneous biopsy of soft tissue or bone tumors between 2007 and 2017. Data collected included preoperative imaging, type of biopsy, demographics, insurance status, number of samples taken, and pathologic results. One hundred forty-one children and young adults underwent 169 biopsies. Female patients received 48.2% of biopsies. The mean age was 14.3 ± 7.0 years. Core needle biopsies made up 89.4% of procedures, while 10.6% were fine needle aspirate. The mean number of samples per patient was 3.6 ± 2.5. All patients had imaging guidance, with computed tomography used in 44.7% of patients, 9.9% using fluoroscopy, 7.1% using ultrasound for guidance, and 53 (37.6%) patients had more than one modality. Diagnostic specimens were obtained in 97.9% of biopsies. The most common overall pathology was osteoid osteoma. The most common malignant tumors were osteosarcoma and Ewing's sarcoma. Image-guided percutaneous biopsy is a safe and effective method of obtaining accurate tissue samples in children and young adults with soft tissue or bone masses. Level 4-Study of diagnostic test.

Sodium fluorescein application in brain tumor biopsy.

Needle biopsy is a routinely, relatively safe, and effective tool for patients with brain tumors not suitable for surgical resection. Despite technical advancements, missed diagnosis is still reported in up to 24% of cases. The aim of this study is to investigate the role of sodium fluorescein (NaFL), a cheap and safe fluorophore, in the biopsy setting mainly with the perspective of an enhancement of the sampling accuracy. Between January 2018 and March 2020, we prospectively enrolled 48 consecutive patients with suspicion of high-grade glioma to receive NaFL-guided brain tumor biopsy. We compared results between NaFL-group and our historical cohort of patients that underwent biopsy without any dye administration (N.=58). In the NaFL-guided biopsy group, there was a statistically significant increase in diagnostic accuracy compared to the historical cohort (100% vs. 86.2%, P<0.05). The mean number of samples was significantly reduced, (3.3 instead of 4.4 of the control group, P<0.05). Differences in terms of complications related to the procedure, hospital stay, and surgical time were not significant (P=0.49). To the authors' knowledge, this is the largest published series supporting the usefulness of NaFL during biopsy procedure, with improved diagnostic accuracy. This also allows a reduction in the number of samples needed for diagnosis, and subsequent risks of procedure-related complications, without adding risks related to the drug itself.

Type 1 diabetes outcomes of children born in Israel of Eritrean asylum seekers.

Disparities in health outcomes in pediatric type 1 diabetes (T1D) based on race/ethnicity and socioeconomic position (SEP) have been reported. We compared T1D characteristics between Eritrean status-less children living in Israel and native-born Israeli children. This observational study compared 7 Eritrean and 28 Israeli children (< 8years old at T1D diagnosis) who were diagnosed in a single diabetes center during 2015-2019. Sociodemographic and diabetes-related data from diagnosis until the last clinic visit were retrieved from their medical files. At diagnosis, the mean age was 4.8 ± 2.2years, 17 (48.6%) had diabetic ketoacidosis with a mean HbA1c level of 10.5 ± 2.1% (91.3mmol/mol) and 29 (82.9%) had ≥ 2 pancreatic autoantibodies. The mean T1D duration of follow-up was 2.7 ± 1.4years. Overall glycemic control during follow-up (> 6months from diagnosis, mean number of samples 10.6 ± 5.2) was good, with mean, best, and peak HbA1c levels of 7.4 ± 0.8% (57.4mmol/mol), 6.7 ± 0.7% (49.7mmol/mol), and 8.1 ± 1.1% (65mmol/mol), respectively. Thirty-two children (91.4%) used continuous glucose monitoring devices (CGMs), and the mean time from diagnosis to CGM initiation was 10.8 ± 14.1months. CGM metrics: time CGM active: 95.4 ± 3.8%, mean glucose level: 170.0 ± 27.0mg/dl (9.4mmol/L), time-in-range: 56.4 ± 14.7%, time-below-range: 5.5 ± 5.7%, and time-above-range: 38.6 ± 16.1%. Diabetes-related parameters at diagnosis and during follow-up were similar between groups. Eritrean children had significantly lower SEPs (P < 0.001) and parental education levels (P < 0.001). Correlations between SEP and diabetes parameters and SEP and growth parameters were not significant. Eritrean status-less children in Israel achieved glycemic targets similar to those of Israeli children, perhaps reflecting uniformity in the standard of care and CGM usage.

Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy

Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved its diagnostic value in various diffuse parenchymal lung diseases (DPLD). However, there is substantial variability among interventional pulmonologists in procedural technique, diagnostic yield, and complication rate. Radial endobronchial ultrasound (R-EBUS) is useful for identification of ground-glass opacity lesions and can help identify target lung parenchyma. We aim to evaluate R-EBUS in TBLC histopathologic diagnosis for patients with DPLD. This was a prospective observational study of patients with clinical and radiologic features suggestive of DPLD who underwent TBLC. The R-EBUS probe was initially advanced to the desired lobe under fluoroscopic guidance until reaching 1 cm from the pleura. R-EBUS images were identified looking for either blizzard or mixed blizzard signs. TBLC samples were sent to pathology and microbiology laboratories for diagnostic analysis. Procedural complications were recorded. In total, 40 patients (16 women/24 men) with a mean age of 63 years were included. The mean area of the samples was 36.2 mm (9 to 189 mm) with mean number of samples per procedure of 3.45 (1 to 6). Definitive diagnosis was obtained in 37 patients (92.5%). The most frequent histopathologic patterns were: usual interstitial pneumonia (37.5%), nonspecific interstitial pneumonia (17.5%), and pulmonary infection (7.5%). There were 2 pneumothoraces (5%) and 5 cases of moderate bleeding (12.5%). The use of R-EBUS to locate and select target lung biopsy site before TBLC might increase diagnostic yield. Randomized studies comparing TBLC histopathologic diagnosis with and without R-EBUS are needed to ascertain its clinical value.

Input of a Multi-Disciplinary Meeting in the Treatment of Osteoarticular Infections in French War Casualties.

Extremity war-wounds present an elevated risk of infection and compromise reconstructive procedures. In a French military hospital, a multi-disciplinary meeting (MDM) was created to standardize the care given to soldiers with osteoarticular infection. The aim of this study was to evaluate the usefulness of MDM decisions. An observational case study was performed including the French wounded at war treated for an osteoarticular infection between 2004 and 2016. They were separated into two groups according to their time of management: before (group A) or after (group B) the MDM creation in September 2010. Various operative and bacteriological parameters were analyzed retrospectively. A questionnaire was created to evaluate healthcare professionals' satisfaction toward the usefulness of the MDM on their practice. During the study period, 38 patients were included: 19 in group A and 19 in group B. Initial tests found an infection with one pathogen in 15 patients, an infection with 2 pathogens in 11 patients, and an infection with 3 or more pathogens in 12 patients. Enterobacter cloacae was the most common pathogen. Pseudomonas aeruginosa and Escherichia coli were also frequent. The mean number of samples taken to conduct the bacteriological tests per operating session was significantly higher for group B than for group A. Twelve of the 14 questioned healthcare professionals believed the MDM was very useful in their patient management. The MDM seems to have had a beneficial impact on orthopedic surgeon practices. A significant increase of the number of samples taken was the most obvious sign that the French recommended practices for osteoarticular infections were followed since the creation of MDM.

Reinfection of urogenital schistosomiasis in pre-school children in a highly endemic district in Northern Zimbabwe: a 12 months compliance study

BackgroundIn light of the shift to aiming for schistosomiasis elimination, the following are needed: data on reinfection patterns, participation, and sample submission adherence of all high-risk age groups to intervention strategies. This study was conducted to assess prevalence, reinfections along with consecutive participation, sample submission adherence, and effect of treatment on schistosomiasis prevalence in children aged five years and below in an endemic district in Zimbabwe, over one year.MethodsThe study was conducted from February 2016–February 2017 in Madziwa area, Shamva district. Following community mobilisation, mothers brought their children aged 5 years and below for recruitment at baseline and also urine sample collection at baseline, 3, 6, 9 and 12 months follow up surveys. At each time point, urine was tested for urogenital schistosomiasis by urine filtration and children found positive received treatment. Schistosoma haematobium prevalence, reinfections as well as children participation, and urine sample submission at each visit were assessed at each time point for one year.ResultsOf the 535 children recruited from the five communities, 169 (31.6%) participated consecutively at all survey points. The highest mean number of samples submitted was 2.9 among communities and survey points. S. haematobium prevalence significantly reduced from 13.3% at baseline to 2.8% at 12 months for all participants and from 24.9% at baseline to 1.8% at 12 months (P < 0.001) for participants coming at all- time points. Among the communities, the highest baseline prevalence was found in Chihuri for both the participants coming consecutively (38.5%, 10/26) and all participants (20.4%, 21/103). Reinfections were significantly high at 9 months follow up survey (P = 0.021) and in Mupfure (P = 0.003). New infections significantly decreased over time (P < 0.001). Logistic regression analysis showed that the risk of acquiring schistosomiasis was high in some communities (P < 0.05).ConclusionsS. haematobium infections and reinfections are seasonal and depend on micro-geographical settings. The risk of being infected with schistosomes in pre-school aged children increases with increasing age. Sustained treatment of infected individuals in a community reduces prevalence overtime. Participation compliance at consecutive visits and sample submission adherence are important for effective operational control interventions.

SENSITIVITY ANALYSIS OF SHUHART CONTROL CHARTS

The article is devoted to the analysis of the Shewhart control charts sensitivity for quantitative data depended on the number of sample values, on the basis of which the current values and are calculated, and depends on the probability of choosing the control limits.The sensitivity of the Shewhart control charts is their ability to detect possible changes in the technological process, i.e. the appearance of the process biasing or its values scattering increasing.Sensitivity analysis for mean values control charts was carried out. Sensitivity is estimated based on the mean length of the series – the mean number of samples. The samples are taken and analyzed through the same time intervals. It is supposed that the sample mean values are not correlated. As shown by the analysis, the sensitivity depends on the number of elements in the samples for mean value charts. In relation to corrective actions, the chart sensitivity of average values for the number of values in the sample is 20% is less than at . This can significantly increase the allowable losses due to the reduction of product quality produced in small batches. The dependence at is additionally presented to reflect the effect of the sample volume.S-charts sensitivity analysis is carried out. It indicates that assertion regarding the numerical values in the samples in the normative documents ( and in some cases 3) is fair.When using - and -charts together, the process is considered to be statistically manageable in the case when both charts confirm this. Practically the simultaneous shift of the normalized value of the technological process and scattering increase is almost not observed. Therefore, this case is more theoretical.The knowledge of the control charts sensitivity (the number of steps of sampling control) allows us to determine the intervals between samples and introduce additional warning boundary values, when it is necessary, provided that the technological process is short-lived (typical for low-power production).This is especially true for low-power enterprises, where the assortment of products varies relatively often and the correct construction of the control process is a guarantee of the products quality.

Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound-preliminary experience.

To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound. Patients were selected during the procedure based on the real-time clinical scenario of unsatisfactory B-mode ultrasound lesion visualization and all patients would have otherwise undergone CT guided liver lesion biopsy. A total of 26 patients underwent CEUS guided biopsy and were included in this retrospective analysis. The review of the patients' files included demographic information, lesion characteristics on imaging, procedural details and pathology outcome. Technical success was defined as concordance between the radiological findings, pathology report and clinical follow-up-demonstrating lack of need for re-biopsy or re-biopsy with identical pathological results. Patients with less than 2 months follow-up were excluded from the study. CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7±12.3 minutes and the average lesion size was 2.2±1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (±1.7). CEUS guidance biopsies of focal liver lesions (FLL) that were difficult to visualize on B-mode ultrasound demonstrated high success rate and may be an evolving image guidance modality in selected patients to avoid CT guided procedures.

(635) - Impact of Operator and Anesthesia Choice on Bronchoscopic Biopsy Yield and Complications

Flexible bronchoscopy with bronchoalveolar lavage and transbronchial biopsy is the gold standard for the diagnosis of infection, acute rejection, and airway complications in lung transplant recipients. In the hands of an experienced operator, bronchoscopy carries minimal risk. The outcome of all bronchoscopies performed in the first year following lung transplantation at the Hospital of the University of Pennsylvania was recorded retrospectively. Records were included if lung transplantation was performed from January 2011 to December 2013. A total of 549 bronchoscopies were performed on 132 patients. Three hundred bronchoscopies were done on bilateral lung transplants and 249 on single lung transplants. Intravenous conscious sedation managed by the pulmonologist was used in 459 cases and 90 were done under general anesthesia. The bronchoscopy was performed during a rotation with a novice fellow in 168 of the 549 cases. The mean number of samples sent for analysis was 9.09±3.5 pieces, with a mean number of samples with alveolated tissue of 7.08±3.2. With novice fellows, the mean number sent was 8.82 with 6.97 pieces of alveolated tissue. These numbers were 9.10 and 7.12 versus 9.17 and 6.67 under conscious sedation and general anesthesia, respectively. There were complications in 82 (14.9%) of the bronchoscopies. We purposely had a sensitive definition of to be able to capture all unexpected events that were described in the report. These included: Bleeding controlled with suctioning, bleeding requiring the use of iced saline or epinephrine, bleeding requiring an endotracheal tube or bronchial blocker, pneumothorax without need for tube thoracostomy, pneumothorax requiring tube thoracostomy, hypoxemia requiring intervention during the procedure, hypoxemia requiring admission, sepsis linked to the procedure, and death. There was no significant difference in complications based on trainee level. There were more complications when procedures were performed under intravenous conscious sedation, with complications noted in 77 cases (16.8%) versus in 5 cases (5.6%) performed under general anesthesia. Bronchoscopy can be performed safely with no change in procedural yield or complications when novice trainees participate. While it does not affect yield, complications can potentially be reduced by the use of general anesthesia.

Significance of routine cerebrospinal fluid analysis in subarachnoid hemorrhage.

The aim of this paper was to determine the diagnostic value of cerebrospinal fluid (CSF) analysis in the setting of aneurysmal subarachnoid hemorrhage (aSAH), hypothesizing that CSF analysis is only critical in confirming suspected infection and may be useful in predicting and/or detecting delayed cerebral ischemia (DCI). Retrospective review of consecutive adult patients diagnosed with aSAH from 1/2000 to 12/2013 at Mayo Clinic, Rochester, MN, USA with cerebral aneurysm(s) identified by vascular imaging, and CSF drawn within 14 days of the date of hemorrhage. We identified 741 patients during the study period, 167 met inclusion criteria and 356 samples were collected. First Median CSF samples were taken 5 (4-8) days postbleed. Multiple samples were taken in 94 (54.5%) patients and the mean number of samples per patient was 2.1. Ventriculitis, confirmed by growth of organism from CSF culture was present in 2 (1.2%) patients and one patient (0.6%) developed meningitis. CSF WBC count remained elevated throughout the 14 days, even when corrected for red blood cell count (RBC). Peak CSF RBCs occurred 2-4 days post bleed, and then gradually normalized. Maximum CSF RBCs did not correlate with modified Fisher grades (P=0.422). Delayed cerebral ischemia (DCI) was present in 86 (51.5%) patients and there was no difference in the CSF profile of patients with DCI compared with those without. Routine CSF sampling for cell count and chemistry in the setting of temporary diversion following aSAH appears to have little clinical benefit beyond the evaluation for infection.

A New Imbalanced Learning and Dictions Tree Method for Breast Cancer Diagnosis

In the most of standard learning algorithms it is presumed or at least expected that the distribution of data points in different classes of at-hand dataset are balanced; it means that there are almost the identical number of data points in each class. It is also implicitly presumed that the misclassification cost of each data point is a fixed value regardless of its class. The standard algorithms will fail to learn if the at-hand dataset is imbalanced. An imbalance dataset is the one that the distribution of data points among their classes is not identical; it means that the numbers of data points in different classes are considerably different. A well-known domain in that it is highly likely for each exemplary dataset to be imbalanced is patient detection. In such systems there are many clients while a few of them are patient and the all others are healthy. So it is very common and likely to face an imbalanced dataset in such a system that is to detect a patient from various clients. In a breast cancer detection that is a special case of the mentioned systems, it is tried to discriminate the patient clients from healthy clients. It should be noted that the imbalanced shape of a dataset can be either relative or non-relative. The imbalanced shape of a dataset is relative where the mean number of samples is high in the minority class, but it is very less rather than the number of samples in the majority class. The imbalanced shape of a dataset is non-relative where the mean number of samples is low in the minority class. This paper presents an algorithm which is well-suited for and applicable to the field of non-relative imbalanced datasets. It is efficient in terms of both of the speed and the efficacy of learning. The experimental results show that the performance of the proposed algorithm outperforms some of the best methods in the literature.

Characteristics of ciprofloxacin and cephalosporin resistant Escherichia coli isolated from turkeys in Great Britain

1. A field study was performed to investigate the presence and characteristics of ciprofloxacin-resistant, extended spectrum β-lactamase (ESBL) and AmpC Escherichia coli from turkeys in Great Britain. E. coli were isolated from ∼9000 boot swab samples from 27 different farms owned by four different companies. Between 1 and 14 visits were made to each farm (mean 3) at between 0 and 15 m intervals (mean ∼ 5 m). 2. CHROMagar ECC with and without ciprofloxacin or cephalosporin antibiotics was used as selective isolation media. Representative isolates with different phenotypes were tested for mutations in gyrA and for: qnrA, B, S, qepA and aac(6′)-Ib genes, for ESBL phenotype, the presence of bla CTX-M genes and plasmid type, and for ampC genes. Representative ciprofloxacin-resistant and CTX-M isolates were further tested for serotype and PFGE type. On ciprofloxacin selective media 55% of samples yielded ciprofloxacin resistant E. coli and of those further analysed, most had ciprofloxacin MICs >4 mg/l and mutations in gyrA. 3. For the different companies, the mean number of samples per farm with cefoxitin- or cefotaxime-resistant isolates ranged from 1·0% to 61·9% and 4·7% to 31·7% respectively. Cefotaxime-resistance was most commonly associated with an ESBL phenotype, a CTX-M-1 or CTX-M-14 sequence type and an I1-γ or K plasmid inc type. The mechanism of cefoxitin resistance was not determined for most isolates, but where determined it was bla CMY-2. 4. PFGE and serotyping showed clonally-related isolates persisting over multiple visits suggesting both more prudent use of antibiotics and improved farm hygiene are needed to address the issue of antimicrobial resistance in isolates from turkeys.

An affordable, quality-assured community-based system for high-resolution entomological surveillance of vector mosquitoes that reflects human malaria infection risk patterns.

BackgroundMore sensitive and scalable entomological surveillance tools are required to monitor low levels of transmission that are increasingly common across the tropics, particularly where vector control has been successful. A large-scale larviciding programme in urban Dar es Salaam, Tanzania is supported by a community-based (CB) system for trapping adult mosquito densities to monitor programme performance.MethodologyAn intensive and extensive CB system for routine, longitudinal, programmatic surveillance of malaria vectors and other mosquitoes using the Ifakara Tent Trap (ITT-C) was developed in Urban Dar es Salaam, Tanzania, and validated by comparison with quality assurance (QA) surveys using either ITT-C or human landing catches (HLC), as well as a cross-sectional survey of malaria parasite prevalence in the same housing compounds.ResultsCommunity-based ITT-C had much lower sensitivity per person-night of sampling than HLC (Relative Rate (RR) [95% Confidence Interval (CI)] = 0.079 [0.051, 0.121], P < 0.001 for Anopheles gambiae s.l. and 0.153 [0.137, 0.171], P < 0.001 for Culicines) but only moderately differed from QA surveys with the same trap (0.536 [0.406,0.617], P = 0.001 and 0.747 [0.677,0.824], P < 0.001, for An. gambiae or Culex respectively). Despite the poor sensitivity of the ITT per night of sampling, when CB-ITT was compared with QA-HLC, it proved at least comparably sensitive in absolute terms (171 versus 169 primary vectors caught) and cost-effective (153US$ versus 187US$ per An. gambiae caught) because it allowed more spatially extensive and temporally intensive sampling (4284 versus 335 trap nights distributed over 615 versus 240 locations with a mean number of samples per year of 143 versus 141). Despite the very low vectors densities (Annual estimate of about 170 An gambiae s.l bites per person per year), CB-ITT was the only entomological predictor of parasite infection risk (Odds Ratio [95% CI] = 4.43[3.027,7. 454] per An. gambiae or Anopheles funestus caught per night, P =0.0373).Discussion and conclusionCB trapping approaches could be improved with more sensitive traps, but already offer a practical, safe and affordable system for routine programmatic mosquito surveillance and clusters could be distributed across entire countries by adapting the sample submission and quality assurance procedures accordingly.

Pulmonary Masses: Initial Results of Cone-beam CT Guidance with Needle Planning Software for Percutaneous Lung Biopsy

To evaluate the outcome of percutaneous lung biopsy (PLB) findings using cone-beam computed tomographic (CT) guidance (CBCT guidance) and compared to conventional biopsy guidance techniques. CBCT guidance is a stereotactic technique for needle interventions, combining 3D soft-tissue cone-beam CT, needle planning software, and real-time fluoroscopy. Between March 2007 and August 2010, we performed 84 Tru-Cut PLBs, where bronchoscopy did not provide histopathologic diagnosis. Mean patient age was 64.6 (range 24-85) years; 57 patients were men, and 25 were women. Records were prospectively collected for calculating sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. We also registered fluoroscopy time, room time, interventional time, dose-area product (DAP), and complications. Procedures were divided into subgroups (e.g., location, size, operator). Mean lesion diameter was 32.5 (range 3.0-93.0)mm, and the mean number of samples per biopsy procedure was 3.2 (range 1-7). Mean fluoroscopy time was 161 (range 104-551)s, room time was 34 (range 15-79)min, mean DAP value was 25.9 (range 3.9-80.5)Gy·cm(-2), and interventional time was 18 (range 5-65)min. Of 84 lesions, 70 were malignant (83.3%) and 14 were benign (16.7%). Seven (8.3%) of the biopsy samples were nondiagnostic. All nondiagnostic biopsied lesions proved to be malignant during surgical resection. The outcome for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 90% (95% confidence interval [CI] 86-96), 100% (95% CI 82-100), 100% (95% CI 96-100), 66.7% (95% CI 55-83), and 91.7% (95% CI 86-96), respectively. Sixteen patients (19%) had minor and 2 (2.4%) had major complications. CBCT guidance is an effective method for PLB, with results comparable to CT/CT fluoroscopy guidance.

The reproducibility of serum anti-Müllerian hormone in subfertile women: within and between patient variability

Serum anti-Müllerian hormone concentrations vary significantly over time and this should be taken into account when tailoring treatment protocols for patients undergoing controlled ovarian hyperstimulation (COH). Compared with FSH, serum anti-Müllerian hormone may have greater discriminatory power because of its modest intrapatient variation and the larger interpatient variation.

Sequential decision plan for controlling Mamestra configurata in spring canola

AbstractA sequential decision plan was developed for controlling larvae of the bertha armyworm, Mamestra configurata Walker (Lepidoptera: Noctuidae), in canola (Brassica napus L. and B. rapa L., Brassicaceae), using 0.25 and 0.5 m2 sampling units. Fields in Manitoba were sampled from 1980 to 1994 to determine minimum sample sizes and upper and lower cumulative larval counts at three economic thresholds. Taylor’s power law described most of the variation between mean larval density and variance for 0.25 m2 (r2 = 0.926) and 0.5 m2 (r2 = 0.924) samples. Larvae were found to have a moderately clumped distribution in canola (b = 1.42). Levels of precision (D0) varying from 0.15 to 0.25 caused minimum sample sizes to vary between 6 and 21 for the 0.5 m2 samples to between 9 and 31 for the 0.25 m2 samples, for an economic threshold of 16–24 larvae/m2 (P = 0.20). Mean sampling times ranged from 40–108 for the 0.25 m2 samples to 49–126 min for the 0.5 m2 samples. The sampling plan for the 0.25 m2 samples was verified in 18 fields in 2006 and 2007. A correct decision was made in 87% (D0 = 0.25), 91% (D0 = 0.20), and 94% (D0 = 0.15) of the fields when the recommendation was to spray if a decision could not be reached after a second sampling. The mean number of samples needed for making a decision was 14 (D0 = 0.25), 19 (D0 = 0.20), and 32 (D0 = 0.15). We recommend that growers use a precision level of 0.20 to minimize error rates and sampling effort. In most years, the minimum number of 0.25 m2 samples per field that growers would need to take is 14–17.

False-Positive Results of Aspergillus Galactomannan Antigenemia in Liver Transplant Recipients

Aspergillus galactomannan (GM) antigenemia is an early marker of invasive aspergillosis (IA), but may yield false-positive results. A prospective study, testing GM periodically in serum samples of liver transplant recipients, was performed. An index more than or equal to 0.5 were considered positive. Positive GM in samples from patients without any other criteria of proven or probable IA was considered as false-positive. The test was performed weekly during the first month after transplantation. Three patients developed IA. In total, 414 serum samples from 85 liver transplant recipients were analyzed. Mean number of samples per patient (out of those who could be assessed) was 4.8. The number of false-positive GM samples was 40 (9.6%), corresponding to 28 patients. The frequency of false-positive results in samples obtained during the first week posttransplantation was 36% (27 of 75), significantly higher than the number of false-positive samples obtained after the first week (3.8%; 13 of 339; P<0.001). Multivariate analysis showed that antibacterial prophylaxis with ampicillin was the only independent factor associated with a false-positive result. Different vials of beta-lactam antibiotics were tested for GM. We obtained a positive GM value (>0.5) in four of the six vials of ampicillin, in three of the six vials of piperacillin-tazobactam, in none of the six vials of cefotaxime, and in none of the six controls. The present study suggests that the administration of ampicillin as antibacterial prophylaxis during the first days after transplantation could be a possible cause of false-positive GM results.

Monitoring of Minimal Residual Disease in NPM1 Mutated Acute Myeloid Leukemia (AML): Results of the AML Study Group (AMLSG)

Background: Mutations in the nucleophosmin 1 (NPM1) gene represent the most frequent gene mutations in acute myeloid leukemia (AML), with highest frequency (50–60%) in cytogenetic normal (CN)-AML and these mutations can be used as molecular markers for monitoring of minimal residual disease (MRD).Aims: To examine the applicability and sensitivity of DNA- and RNA-based real-time quantitative polymerase chain reaction (RQ-PCR) assays and to evaluate whether MRD levels are of prognostic relevance in younger (16 to 60 years) patients (pts) with AML harboring NPM1 mutations (NPM1mut ) type A, B or D.Methods: All pts were treated within the AMLSG 07-04 treatment trial including double induction therapy with ICE (idarubicin, cytarabine, etoposide) followed by three courses of high-dose cytarabine or allogeneic stem cell transplantation from matched related donors as consolidation therapy. Levels of NPM1mut expression ratios, defined as NPM1mut copies/ 104abl copies, were determined by RQ-PCR using TaqMan technology. DNA- and RNA-based RQ-PCR assays were used in parallel.Results: A total of 537 samples [bone marrow (BM) n=463, peripheral blood (PB) n=74] from 88 pts have been analyzed (mean number of samples per patient, n=6;, range, 1–16) at diagnosis (BM, n=75; PB, n=12), after induction therapy (BM, n=190; PB, n=28), during consolidation (BM, n=115; PB, n=16) and during follow-up (BM, n=83; PB n=18). Sensitivity was 10−6 for the RNA- and 10−4 for the DNA-based assays. Both assays were highly specific as no wildtype (wt) NPM1 could be detected. The lower sensitivity of the DNA-based assay was demonstrated by the finding that the DNA-based RQ-PCR became negative in 102 samples while RNA-based RQ-PCR still showed NPM1mut expression in 68 of these samples (range 2.1–11018.1). In addition, comparison of 63 paired (BM and PB) samples revealed a median 6.8 times higher NPM1mut expression in BM with 13 of 15 samples being negative in PB but positive in BM. Based on these results we subsequently performed RNA-based RQ-PCR analysis in BM samples.NPM1mut expression ratios at diagnosis varied between 1.1 × 104 and 6.4 × 106 with a median of 5.6 × 105. Pretreatment transcript levels were not associated with clinical characteristics (e.g., age, WBC counts, BM blasts) and did not impact on relapse-free (RFS) and overall survival (OS). The median decrease of the MRD level ratio after first and second induction therapy normalized to pretreatment levels was 2.24 log10 (−8.57–1.88 log10) and 3.9 log10 (−8.58–0.67 log10), respectively. There was no difference in FLT3-ITD positive and negative pts (p=0.72 and p=0.20, respectively). During consolidation therapy NPM1mut expression levels in the FLT3-ITD negative pts further decreased after each cycle and were significantly lower compared to FLT3-ITD positive patients (p=0.00008, p=0.05, p=0.003). Of note, FLT3-ITD positive pts had rebounding MRD levels during consolidation therapy in comparison to levels achieved after induction therapy. Achievement of RQ-PCR-negativity in at least 1 BM sample (n=20) during consolidation therapy was associated with superior RFS (p=0.004) of 76.8% (95% CI 13%–61%) after 2 years compared to 29.0% (95% CI 59%–100%) for pts with persistent RQ-PCR positivity (n=37). For this analysis pts with allogeneic transplantation were excluded.Different courses of MRD were identified in 31 relapsed pts. In 19 patients increasing (range 1.0–322.3) or constantly high MRD levels 28 to 518 days (median 66) before occurrence of clinical relapse were detected. For the remaining pts, molecular relapse was not detectable due to loss of the NPM1mut clone in relapse material (n=3), a decrease in MRD levels 71 to 90 days before relapse (n=3) or the lack of samples within 3 months before relapse (n=6).Conclusions:NPM1 mutations are a sensitive marker for MRD monitoring in AML, in particular when RNA-based RQ-PCR assays on BM samples are used. Achievement of MRD negativity appears to predict favorable clinical outcome.