Useful Tool For Early Identification Research Articles

Construction and validation of machine learning models for sepsis prediction in patients with acute pancreatitis

BackgroundThis study aimed to construct predictive models for the risk of sepsis in patients with Acute pancreatitis (AP) using machine learning methods and compared optimal one with the logistic regression (LR) model and scoring systems.MethodsIn this retrospective cohort study, data were collected from the Medical Information Mart for Intensive Care III (MIMIC III) database between 2001 and 2012 and the MIMIC IV database between 2008 and 2019. Patients were randomly divided into training and test sets (8:2). The least absolute shrinkage and selection operator (LASSO) regression plus 5-fold cross-validation were used to screen and confirm the predictive factors. Based on the selected predictive factors, 6 machine learning models were constructed, including support vector machine (SVM), K-nearest neighbour (KNN), multi-layer perceptron (MLP), LR, gradient boosting decision tree (GBDT) and adaptive enhancement algorithm (AdaBoost). The models and scoring systems were evaluated and compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the curve (AUC).ResultsA total of 1, 672 patients were eligible for participation. In the training set, 261 AP patients (19.51%) were diagnosed with sepsis. The predictive factors for the risk of sepsis in AP patients included age, insurance, vasopressors, mechanical ventilation, Glasgow Coma Scale (GCS), heart rate, respiratory rate, temperature, SpO2, platelet, red blood cell distribution width (RDW), International Normalized Ratio (INR), and blood urea nitrogen (BUN). The AUC of the GBDT model for sepsis prediction in the AP patients in the testing set was 0.985. The GBDT model showed better performance in sepsis prediction than the LR, systemic inflammatory response syndrome (SIRS) score, bedside index for severity in acute pancreatitis (BISAP) score, sequential organ failure assessment (SOFA) score, quick-SOFA (qSOFA), and simplified acute physiology score II (SAPS II).ConclusionThe present findings suggest that compared to the classical LR model and SOFA, qSOFA, SAPS II, SIRS, and BISAP scores, the machine learning model-GBDT model had a better performance in predicting sepsis in the AP patients, which is a useful tool for early identification of high-risk patients and timely clinical interventions.

Evaluation of a novel scoring system based on thrombosis and inflammation for predicting stroke-associated pneumonia: A retrospective cohort study.

Inflammation and thrombosis are involved in the development of stroke-associated pneumonia (SAP). Our aim was to evaluate the predictive value of a novel, simplified, thrombo-inflammatory prognostic score (TIPS) that combines both inflammatory and thrombus biomarkers in the early phase of ischemic stroke (IS). The study population consisted of 897 patients with a first diagnosis of IS admitted to the emergency department of five tertiary hospitals in China. Of these, the data from 70% of patients was randomly selected to derive the model and the other 30% for model validation. A TIPS of "2" was indicative of high inflammation and thrombosis biomarkers and "1" of one biomarker, with "0" indicative of absence of biomarkers. Multivariate logistic regression analyses were used to identify the association between TIPS and SAP. The TIPS was an independent predictor of SAP and 90-day mortality, with the incidence of SAP being significantly higher for patients with a high TIPS. The TIPS provided superior predictive value for SAP than clinical scores (A2DS2) and biomarkers currently used in practice, for both the derivation and validation sets. Mediation analysis revealed that TIPS provided a predictive value than either thrombotic (NLR) and inflammatory (D-dimer) biomarkers alone. The TIPS score may be a useful tool for early identification of patients at high-risk for SAP after IS.

Predicting High-Flow Nasal Cannula Therapy Outcomes Using the ROX-HR Index in the Pediatric ICU.

High-flow nasal cannula (HFNC) use is increasing in pediatric patients. Objective measures that predict HFNC outcomes are lacking. The respiratory rate-oxygenation (ROX) and ROX heart rate (ROX-HR) indices are validated to predict HFNC therapy failure in adults. This study examined the performance of both indices in predicting HFNC therapy failure in children admitted to the pediatric ICU (PICU). This retrospective, longitudinal, observational cohort study was completed in a 24-bed PICU in a quaternary care children's hospital. All subjects ≤ 24 months of age initiated on HFNC in the PICU from January 1, 2018-August 31, 2020, were included. The ROX and ROX-HR indices were collected at standardized time points during HFNC therapy. Performance in predicting HFNC failure was evaluated using area under the receiver operating characteristic curve (AUROC) and Kaplan-Meier survival analysis. Failure was defined as escalation of respiratory support to either noninvasive ventilation or endotracheal intubation. Among 446 subject encounters, 111 (24.9%) failed HFNC therapy. HFNC failure was associated with lower ROX and ROX-HR indices at termination compared to HFNC liberation (P < .001). A ROX-HR index < 3 was significantly associated with a higher risk of HFNC failure at 1 (AUROC 0.76, P = .01) and 6 (AUROC 0.81, P = .02) h. ROX-HR may be a useful tool for early identification of patients ≤ 24 months at risk for HFNC failure and allow for earlier intervention. Larger prospective studies are necessary to validate the utility of the ROX-HR index in pediatric patients.

Using a Diabetes Risk Score to Identify Patients Without Diabetes at Risk for New Hyperglycemia in the Hospital

ObjectiveTo assess the value of a validated diabetes risk test, the Cambridge Risk Score (CRS), to identify patients admitted to hospital without diabetes at risk for new hyperglycemia (NH). MethodsThis retrospective cross-sectional study included adults admitted to a hospital over a 4-year period. Patients with no diabetes diagnosis and not on antidiabetics were included. The CRS was calculated for each patient, and those with available glycated hemoglobin (HbA1C) results were investigated in a second analysis. Multivariate regression analyses were performed to assess the association among CRS, HbA1C, and the risk for NH. ResultsA total of 19,830 subjects comprised the sample, of which 38% were found to have developed NH, defined as a blood glucose level ≥140 mg/dL. After accounting for covariates, the CRS was significantly associated with NH (odds ratio [OR], 1.19 [1.16, 1.22]; P < .001). Only 17% of patients had their HbA1C values checked within 6 months of admission. Compared with patients without diabetes, patients with prediabetes based on their HbA1C level (OR, 1.59 [1.37, 1.86]; P < .001) and patients with undiagnosed diabetes (OR, 5.95 [3.50, 10.65]; P < .001) were also significantly more likely to have NH. ConclusionResults of this study show that the CRS and HbA1C levels were significantly associated with the risk of developing NH in inpatient adults without diabetes. Given that an HbA1C level was missing in most medical records of hospitalized patients without diabetes, the CRS could be a useful tool for early identification and management of NH, possibly leading to better outcomes.

Development of risk prediction models for lung cancer based on tumor markers and radiological signs.

BackgroundAccurate prediction of malignancy risk for pulmonary lesions with pleural effusion improves early diagnosis of lung cancer. This study aimed to develop and validate a model to predict lung cancer.MethodsClinical data of 536 patients with pulmonary diseases were collected. The risk factors were identified by regression analysis. Three prediction models were developed. The predictive performances of the models were measured by the area under the curves (AUCs) and calibrated with 1000 bootstrap samples to minimize the over‐fitting bias. The net benefits of the models were evaluated by decision curve analysis. Finally, a separate cohort of 134 patients was used to validate the models externally.ResultsSeven independent risk factors were identified from 18 clinical variables, which included the pleural fluid carcinoembryonic antigen (CEA), serum cytokeratin‐19 fragment (CYFRA 21‐1), the ratio of CEA in the pleural fluid to serum, extrathoracic cancer history (>5 years), tumor size, vessel convergence, and lobulation. The AUCs of the three models were 0.976, 0.927, and 0.944 in the training set and 0.930, 0.845, and 0.944 in the external set, respectively. The accuracies of the three models were 89.6%, 81.4%, and 88.8%. Model 1 showed the best iteration fit (R 2 = 0.84, 0.68, and 0.73) and a higher net benefit on decision curve analysis when compared to the other two models.ConclusionThe advantageous model could assess the risk of lung cancer in patients with pleural effusion and act as a useful tool for early identification of lung cancer.

Early Prediction of Post-hepatectomy Liver Failure in Patients Undergoing Major Hepatectomy Using a PHLF Prognostic Nomogram.

Liver resection (LR) is the main modality of treatment for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). Post-hepatectomy liver failure (PHLF) remains the most dreaded complication. We aim to create a prognostic score for early risk stratification of patients undergoing LR. Clinical and operative data of 472 patients between 2000 and 2016 with HCC or CRLM undergoing major hepatectomy were extracted and analysed from a prospectively maintained database. PHLF was defined using the 50-50 criteria. Liver cirrhosis and fatty liver were histologically confirmed in 35.6% and 53% of patients. 4.7% (n = 22) of patients had PHLF. A 90-day mortality was 5.1% (n = 24). Pre-operative albumin-bilirubin score (p = 0.0385), prothrombin time (p < 0.0001) and the natural logarithm of the ratio of post-operative day 1 to pre-operative serum bilirubin (SB) (ln(POD1Bil/pre-opBil); p < 0.0001) were significantly independent predictors of PHLF. The PHLF prognostic nomogram was developed using these factors with receiver operating curve showing area under curve of 0.88. Excellent sensitivity (94.7%) and specificity (95.7%) for the prediction of PHLF (50-50 criteria) were achieved at cut-offs of 9 and 11 points on this model. This score was also predictive of PHLF according to PeakBil > 7 and International Study Group for Liver Surgery criteria, intensive care unit admissions, length of stay, all complications, major complications, re-admissions and mortality (p < 0.05). The PHLF nomogram ( https://tinyurl.com/SGH-PHLF-Risk-Calculator ) can serve as a useful tool for early identification of patients at high risk of PHLF before the 'point of no return'. This allows enforcement of closer monitoring, timely intervention and mitigation of adverse outcomes.

In-Vivo Retention of 5-Fluorouracil Using 19F Magnetic Resonance Chemical Shift Imaging in Colorectal Cancer in a Murine Model

Colorectal cancer is the third leading cause of cancer death worldwide. 5-Fluorouracil (5-FU) is one of the most commonly used chemotherapies for treatment of solid tumours, including colorectal cancer. The efficacy of treatment is dependent on tumour type and can only be determined six weeks after beginning chemotherapy, with only 40–50% of patients responding positively to the 5-FU therapy. In this paper, we demonstrate the potential of using Magnetic Resonance (MR) Chemical Shift Imaging (CSI) for in-vivo monitoring of 5-FU tumor-retention in two different colorectal tumour types (HT-29 & H-508). Time curves for 5-FU signals from the liver and bladder were also acquired. We observed significant differences (p < 0.01) in 5-FU signal time dependencies for the HT-29 and H-508 tumours. Retention of 5-FU occurred in the H-508 tumour, whereas the HT-29 tumour is not expected to retain 5FU due to the observation of the negative b time constant indicating a decline in 5FU within the tumour. This study successfully demonstrates that CSI may be a useful tool for early identification of 5-FU responsive tumours based on observed tumour retention of the 5-FU.

Allergy screening in a schoolchildren-based population.

Schoolchildren screening for allergic diseases may improve early identification and management of atopic children. The aim of this study was to perform a schoolchildren screening program for identification of children with allergic diseases. All parents of children attending to 13 primary schools in the city of Rome were requested to fill in a demographic data form and the ChAt questionnaire. Allergological evaluation was performed in the children with suspect of allergy (ChAt score>2). Ocular examination was performed to identify signs of allergic conjunctivitis. The presence of allergic symptoms was related to demographic and environmental variables. A total of 2667 children (mean age: 7.1±1years) were included, and 2489 (93.3%) parents completed the ChAt questionnaire. Results of ChAt questionnaire showed a previous diagnosis of allergic disease in 637 (25.6%) children and the potential presence of an allergic disease (ChAt score>2) in 35.1%. Multivariate analysis showed that older age, male gender, and having less than two siblings were associated with higher risk of allergic disease. Visual screening showed the presence of clinical signs of allergic conjunctivitis in 2% of children. Allergologic evaluation in 334 children confirmed the diagnosis of allergic disease in 324 (97%) cases. Among them, 97 (29.9%) did not refer to a previous formal diagnosis of allergic condition. This study confirmed that schoolchildren screening using ChAt questionnaire could represent a useful tool for early identification of yet undiagnosed atopic children.

Serodiagnosis of elephant tuberculosis: a useful tool for early identification of infected elephants at the captive-wild interface

Tuberculosis (TB) is an emerging disease in elephants primarily caused by Mycobacterium tuberculosis (M. tb) and in some occassion by M. bovis. We performed culture and three serological tests—the Elephant TB STAT-PAK,® DPP VetTB® Assay, and MAPIA (multi-antigen print immunoassay)—prospectively on samples from eight elephants in Nepal that died of suspected or confirmed tuberculosis (TB) between 2007 and 2013. Among them, all elephants were reactive to DPP VetTB® Assay, five to Elephant TB STAT-PAK,® and two were reactive to MAPIA. Similarly, six elephants were positive on culture on samples collected antemortem or postmortem. We observed antibody responses months to years before culture confirmation of TB which shows that serological tests can be highly useful for the early diagnosis of TB in elephants. Validated point-of-care serological tests are easily performed in the field and hold promise for improved TB surveillance in other non-domestic species.

Potential of phosphatases for express assessment of self-purification at different types of pollution in running waters

Abstract The potential of an express enzymological indicator – phosphatase activity index (PAI) – for assessment of different types of pollution and self-purification potential in running waters was evaluated for three river subcatchments, representative for different ecological situations and impacts. According to the values of correlation coefficients, a significant positive correlation existed among PAI and total microbial count, organic loading and phosphate concentrations. The enzyme activity is useful tool for early identification of risks from point discharge of different wastewaters (treated or non-treated). The role of PAI as an indicator is significant at case of disinfection after treatment of wastewaters in treatment plant – the aquatic microbial community at the discharge point is suppressed but not at a functional level. The results allow classical microbiological and chemical parameters (state variables) to be related directly to the dynamics of the transformation processes by functional variable – PAI.

Outcomes of Newborn Hearing Screening Program: A Hospital Based Study.

Hearing loss is hidden disability and second most common congenital pathology. Prevention, early identification and early intervention of hearing loss can prevent further disability in development of speech, language, cognition and other developmental domains. The prevalence of congenital hearing loss has been estimated to be 1.2-5.7 per thousand in neonates. In these contexts, the aim of study was to determine outcomes of neonates hearing screening program in Hospital. It is a clinical cross-sectional study which was conducted in tertiary care centre from 8th July, 2015 to 31th May, 2016. Total no of 2254 cases were screened. Details case history including high risk register, Pediatric Audiometry, Otoacoustic Emission tests were performed followed brainstem evoked response audiometry. The Prevalence of hearing loss among high risk babies confirmation by BERA was 8.8% per 1000 babies and 16 cases were recommended for Cochlear Implant. The screening protocol with objective test i.e. Distortion Product Otoacoustic Emission and confirmation by Brainstem Evoked Response Audiometry is very useful tool in early identification of congenital hearing loss in neonates. Hence, the results of this study will be used to initiate universal newborn hearing screening in other hospitals. Moreover, this study highlights the relevance of neonatal hearing screening in other states of India and country where this screening is not performed routinely in all hospitals and creating awareness to identify neonatal risk factors associated with hearing loss and understand the importance of early identification and early intervention and among health care professionals.

Immune signatures of Alzheimer’s disease: profiles of neutrophils. (HUM1P.301)

Abstract Alzheimer's disease (AD) is the most common form of dementia. Amyloïd plaques accumulation and microbial infections have been proposed as an important components of AD aetiology. Defects in amyloïd-β clearance by monocyte/macrophage/microglia, imply that the immune system may participate in development and progression of AD. Phenotype and functional analysis of polymorphonuclear neutrophils (PMN) in peripheral blood were performed by flow cytometry. Our cohort of patients comprised amnestic Mild Cognitive Impairment (aMCI) (n = 10), mild stage AD (mAD) (n = 10) and healthy elderly controls (n = 10). aMCI patients had memory impairment but no functional disorders. However, these patients have a 50% chance of developing AD within 3 years following the diagnostic. PMN number was unchanged between the three groups. In contrast, the CD177+ population was significantly increased in mAD patients (p &amp;lt; 0.05). Phagocytosis of opsonized bacteria was less in aMCI and AD patients than controls. This observation was associated in aMCI with a decrease in CD33 (siglec 3) and complement receptor for C5A expression. Decreased expression of CD14 (a pattern recognition receptor), CD15 (carbohydrate adhesion molecule) and CD16 (FcγRIII) expression was found in mAD patients. Our results describe for the first time alterations of neutrophils in aMCI patients. PMN analysis may provide a useful tool in early identification of AD patients.

Relationship Between Neurological Assessments of Preterm Infants in the First 2 Years and Cognitive Outcome at School Age

BackgroundThe risk of cognitive disability in preterm infants is higher than in general population. The Amiel-Tison neurological assessment could be a useful tool for early identification of preterm children at risk of cognitive disability in school age. This study investigated the value of categorization of neurological signs assessed by the Amiel-Tison neurological assessment in the first 2 years of life in relation to cognitive performance at school age in a group of preterm children. MethodsPreterm children with gestational age from 23 to 36 weeks were included in the prospective study. From the initial group of 45 children, in whom the Amiel-Tison neurological assessment was performed at term age, at 3 months corrected age, and at 2 years, the Wechsler Intelligence Scale for Children–third edition was performed in 39 children after school entry. ResultsFull scale IQ, Verbal IQ, and Performance IQ of the whole group of preterm children were not significantly different from the normative data; most of the children had IQ scores in the normal range (≥85). The mean cognitive results of children decreased as the number of neurological signs increased. There was a significant correlation between the categories of neurological signs at 2 years and later cognitive results. ConclusionsThe grade of severity of neurological signs at 2 years was associated with the cognitive results at school age. The categorization of neurological signs according to the Amiel-Tison neurological assessment in preterm children might have prognostic value for cognitive outcome at school age.

Autoantibodies in Autoimmune Diseases

The occurrence of autoantibodies is a common feature of autoimmune diseases. This review is intended to give an overview of the most important autoantibodies and their role in diagnosis, disease activity and prognosis in rheumatoid arthritis (RA), systemic lupus erythematodes (SLE) and multiple sclerosis (MS). Whereas in RA and SLE these antibodies are meaningful for diagnosis and partially for the prognosis of the disease, the situation is quite different in the case of MS. Up to date, no specific antibody is known to be exclusively present in the serum or cerebrospinal fluid (CSF) of MS-patients compared to the respective fluids of healthy individuals. Nevertheless, there are some antigens that are reported to be bound significantly more often by MS-patients' serum or CSF than by comparable samples of healthy volunteers. In addition to the importance of several autoantibodies for diagnosis of the respective disease, the serum concentration of certain antibodies in RA and SLE is associated with therapy response. Since therapy with biologicals (e. g. TNF-alpha blockade, B-cell depletion) is expensive, monitoring these autoantibodies seems to be an additional useful tool for early identification of therapy responders or non-responders.

Biochemical markers as a useful tool for the early identification of Fusarium oxysporum f.sp. cubense, race 1 resistance banana clones

Panama disease of banana (Musa spp) caused by the fungus Fusarium oxysporum f. sp. Cubense (FOC), is a serious constraint both to the commercial production of banana and cultivation for subsistence agriculture. Chemical control is not economically effective and is also hazardous to the environment and human health. Breeding for disease resistance is an alternative strategy, which leads to the development of resistance clones. Field evaluation is the most reliable method of screening for disease resistance, but it is demanding in terms of cost, manpower and space requirements. Another approach of screening hybrids at the sucker's stage (planting material) through biochemical markers has been found to be effective in early identification of resistant hybrids. The resistance mechanisms involving the role of phenol, PAL, oxidative enzymes like peroxidase (PO), polyphenol oxidase (PPO), superoxide dismutase (SOD), catalase and PR-proteins like chitinase, β-1-3 glucanase were studied and they showed relatively higher activity in resistant hybrids than susceptible hybrids. Isozyme analysis of peroxidase (PO) and polyphenol oxidase (PPO) was also carried out in cultivars and hybrids, which revealed the induction of specific isoforms in the resistant hybrids upon challenge inoculation. This could be a useful tool for early identification of F. oxysporum f. sp. cubense resistance banana clones.

Nursing Neurologic Assessments After Cardiac Operations

Although the neurologic status of patients undergoing cardiac operations has been well studied at other times, there are few studies of neurologic status in the immediate postoperative state. This study used standardized nursing neurologic evaluations to describe the sequence of neurologic changes during the first few hours after cardiac operations and the factors that influence them. In this prospective study, patients arriving in the intensive care unit after cardiac operations were serially assessed using the using the Neurologic Intensive Care Evaluation (NICE) for up to 24 hours postoperatively. The study evaluated the effects on outcome of various preoperative and intraoperative variables, as well as the NICE scores. Recovery of brainstem reflexes occurred at 1.4 +/- 1.4 hours, and the fully alert state occurred at a mean of 5.1 +/- 3.8 hours after admission to the intensive care unit in patients without a new neurologic deficit. Patients with new neurologic deficits or patients discharged to supervised care settings took longer to reach each neurologic milestone. Older patients, patients with more complex surgical procedures, and patients with higher cardiovascular risk factors took longer to become fully alert. The time to reach the highest NICE score was a strong predictor of the duration of intubation but only weakly predicted other outcome variables in a multivariable analysis. Standardized, serial nursing neurologic assessments of postoperative cardiac patients provide insight into the immediate postoperative period and may be a useful tool for early identification of patients at risk for adverse outcomes.

The usefulness of positron emission tomography (PET) scanning to identify early recurrent melanoma in high risk resected stage III and IV patients: A retrospective review

8566 Background: The incidence of malignant melanoma has risen dramatically over the past decades. Prognosis for patients with metastatic melanoma is poor and treatment options are limited. Complete surgical resection is frequently front line therapy for patients with resectable metastases. However this is only an option if relapse is diagnosed early. PET imaging using 2-flourine-18, 2-fluro-2-deoxy-D-glucose (FDG) has been used successfully for staging of metastatic melanoma. However it's usefulness in surveillance for patients at high-risk of relapse (resected stage III and IV disease) has not been well studied. We conducted a retrospective review of our institutional experience using PET scanning as part of regular follow up in patients with resected stage III or IV melanoma for the purpose of detection of early recurrence. Methods: Retrospective review of the medical records of 667 consecutive patients seen at Mayo Clinic from 12/13/1999–1/1/2007, with the diagnosis of malignant melanoma for whom PET imaging was performed or reviewed at our institution. Eligibility criteria included: resected stage III or IV melanoma with at least 2 PET scans (&lt;1 year apart) as part of regular clinical follow-up (surveillance). Frequency of PET scanning was variable and at physician discretion. Results: Of the 667 patients, 110 patients were deemed eligible for review. There were 98 recurrences among 65 patients. Of these 37 recurrences (38%) were found by PET scanning alone (asymptomatic); 61 recurrences (62%) were found by other methods (physical exam, CT, MRI, etc). Of the 37 recurrences found by routine PET scanning 17 (46%) were completely resected; of the other 61 recurrences found by other methods 33 (54%) were completely resected. Conclusions: PET scanning as regular surveillance for patients with high risk melanoma, may be a useful tool in early identification of asymptomatic melanoma relapse amenable to complete surgical resection (additional 1/3 of cases). Considering the potential clinical benefit of completely resected melanoma relapse, and the retrospective nature of this review, these data are hypothesis-generating and warrant further investigation. No significant financial relationships to disclose.

Colorectal cancer screening: Results of a 5-year program in asymptomatic subjects at increased risk

Background and aims The province of Ferrara has one of the highest incidences of colorectal cancer (CRC) in Italy. In January 2000, we set up a colonoscopy screening program focussing on first-degree relatives of CRC patients. We now report the results 5 years after the beginning of the project. Screenees and methods In October 1999, we started a campaign stressing the usefulness of colonoscopy for the first-degree relatives of CRC patients. Subjects included in the screening program were aged between 45 and 75 years with at least one first-degree relative affected by CRC. They were invited to an interview where a physician suggested colonoscopy as a screening option. Results In 5 years, 776 subjects were interviewed and 733 (94.4%) agreed to an endoscopic examination (M/F:375/401; mean age 55 years): 562 colonoscopies were performed. Adenomas and cancers were found in 122 (21.7%) and 12 (2.1%) subjects, respectively. Histological examination in 181 persons with lesions (32.8%) showed (most serious lesion quoted) 47 hyperplastic polyps (26% of all lesions), 2 serrated adenomas (1.1%), 68 tubular adenomas (48%), 24 tubulovillous adenomas (13.3%), 9 adenomas with high grade dysplasia (5%) and 12 adenocarcinomas (6.6%). The majority of the cancers were at an early stage (8 Dukes A and 3 Dukes B). Sedation was used in only 42 colonoscopies (7.5%). Conclusions A colonoscopy-based screening in this selected high-risk population is feasible. Even without sedation subjects readily agreed to the endoscopic procedure. We identified a significant number of advanced neoplasms and cancers at an early stage suggesting that this could be a useful tool in early identification of CRC.

The Caregiver Role Identity Scale

Objective: This article reports the validation of the Caregiver Role Identity Scale, designed to measure the prominence of helping professionals’identity as personal and professional caregivers. The authors developed the measure to test its application to burnout, depression, and professional impairment among social workers. Method: Data from a probability sample of 751 practicing social workers were collected in an anonymous survey about social workers’ health and work issues. The authors split the sample to conduct exploratory and confirmatory factor analyses. Results: The exploratory analysis demonstrated good internal consistency reliability, good content validity, and preliminary discriminant validity. The confirmatory analysis demonstrated excellent factorial validity for a revised scale, retaining reliability and demonstrating convergent validity. Caregiver role identity was related to burnout, depression, professional impairment, and not seeking help for personal problems. Conclusions: This scale may be a useful tool for early identification, prevention, and intervention strategies for impairment among social workers.

Deregulated expression of the PCPH proto-oncogene in human breast cancers

We performed a study on the expression of the PCPH protein in samples corresponding to normal, pre-malignant and malignant stages of the human mammary gland by using protocols of immunohistochemistry and Western blot analysis with anti-PCPH specific antibodies. Results obtained from the immunohistochemical study showed that PCPH was undetectable in samples of normal breast and of benign diseases, with the exception of glands presenting apocrine metaplasia, in which an intense PCPH stain was observed both in the basal cytoplasm of the secretory cells and in the apocrine secretion. On the contrary, an intense labeling was observed in the cytoplasm of neoplastic cells in samples of both ductal and lobular carcinoma in situ, with this immunostaining increasing even further in samples of infiltrating carcinoma, both ductal and lobular. Western blot analyses of the same set of samples detected a 47 kDa form as the main PCPH polypeptide present in all cases studied. However, whereas this 47 kDa polypeptide was the only PCPH form detected in normal and pre-malignant samples, multiple forms could be detected in carcinoma samples, indicating the presence of altered PCPH polypeptides at these disease stages. These results were in agreement with those from the immunohistochemical study and together indicated that PCPH protein expression represents a good molecular marker to follow the process of human breast carcinogenesis. Furthermore, these results suggested that characterization of the pattern and level of PCPH expression may be a useful tool for early identification of breast cancers.