Growth rate of hepatocellular carcinoma: evaluation with serial computed tomography or magnetic resonance imaging

OBJECTIVE: To evaluate the growth rate of untreated hepatocellular carcinoma (HCC) by calculating tumor volume doubling time (TVDT) on serial computed tomography (CT) or magnetic resonance imaging (MRI) and to predict TVDT based on initial tumor size. METHODS: Sixteen untreated HCCs in 11 patients with cirrhosis who underwent serial CT or MRI at our institution were retrospectively identified. Two independent readers recorded bidimensional measurements for all tumors, which were used to determine tumor volume (TV). Growth rate was expressed as TVDT. A mathematic model was used to predict TVDT based on baseline tumor size. RESULTS: Mean baseline and follow-up TVs were 10.5 cm3 (range: 0.7-243.6 cm3) and 22.0 cm3 (range: 2.5-870.8 cm3), respectively. Mean duration of follow-up was 176 days (range: 76-472 days). Mean TVDT was 127 days (95% confidence interval: 80, 203; range: 17.5-541.4 days). Expected TVDT could be expressed as TVDT = 114 x (baseline volume)0.14 (P < 0.002). CONCLUSION: The results of this study suggest a preferred interval follow-up of approximately 4.5 months (127 days) for HCC screening. Small HCCs show a tendency toward faster growth and may require shorter follow-up to demonstrate progression.     

Intraductal papillary mucinous tumors of the pancreas: features with multimodality imaging

The radiologic diagnosis of intraductal papillary mucinous tumor (IPMT) of the pancreas is important to establish because of its malignant potential and in order to determine the site of tumor origin and its extent. These pancreatic tumors are recognized more often now than previously because of the increasing use of imaging modalities such as computed tomography and magnetic resonance cholangiopancreatography. The main features of IPMT are given in this pictorial essay, with illustrations provided from a series of 50 patients with a surgically proven diagnosis of IPMT.     

Phenogenomic heterogeneity of post-transplant plasmablastic lymphomas

Plasmablastic lymphoma (PBL) is a rare and clinically aggressive neoplasm that typically occurs in immunocompromised individuals, including those infected with human immunodeficiency virus (HIV) and solid organ allograft recipients. Most prior studies have focused on delineating the clinico-pathological features and genetic attributes of HIVrelated PBL, in which MYC deregulation, Epstein-Barr virus (EBV) infection and, more recently, mutations in JAK/STAT, MAP kinase, and NOTCH pathway genes have been implicated in disease pathogenesis. The phenotypic spectrum of post-transplant (PT)-PBL is not well characterized and data on underlying genetic alterations are limited. This led us to perform comprehensive histopathological and immunophenotypic evaluation and targeted sequencing of 18 samples from 11 patients (8 males, 3 females; age range, 12-76 years) with PT-PBL; eight de novo and three preceded by other types of post-transplant lymphoproliferative disorders. Post-transplant PBL displayed morphological and immunophenotypic heterogeneity and some features overlapped those of plasmablastic myeloma. Six (55%) cases were EBV positive and five (45%) showed MYC rearrangement by fluorescence in situ hybridization. Recurrent mutations in epigenetic regulators (KMT2/MLL family, TET2) and DNA damage repair and response (TP53, mismatch repair genes, FANCA, ATRX), MAP kinase (KRAS, NRAS, HRAS, BRAF), JAK/STAT (STAT3, STAT6, SOCS1), NOTCH (NOTCH1, NOTCH3, SPEN), and immune surveillance (FAS, CD58) pathway genes were observed, with the mutational profiles of EBV⁺ and EBV^– cases exhibiting both similarities and differences. Clinical outcomes also varied, with survival ranging from 0-15.9 years after diagnosis. Besides uncovering the biological heterogeneity of PT-PBL, our study highlights similarities and distinctions between PT-PBL and PBL occurring in other settings and reveals potentially targetable oncogenic pathways in subsets of the disease.     

Genetic and hematological studies in a group of 114 adult patients with SC sickle cell disease

The clinical and biological heterogeneity of sickle cell hemoglobin (Hb) C disease (SC disease) is similar to sickle cell anemia, but has a much milder course. The effect of genetic factors such as α thalassemia or β-globin gene haplotype has been analyzed in a limited number of cases. In this work, we report about 114 adult SC patients, aged 15 to 65 years (M/F = 0.93). The frequency of deletional α thalassemia (α^-3.7) was found to be about 35. The coinheritance of an α-thalassemia trait with SC disease had no effect on the hemoglobin level but hemolysis was significantly reduced. In these patients, as described for homozygous Hb S individuals, the Hb F level was higher in females than in males and in individuals carrying the β^s-Senegal haplotype. This haplotype involves the presence of an XmnI site 5′ to Gγ, which is considered responsible for an increased GγAγ ratio. Our survey showed that some genetic factors may modulate hematological parameters in SC disease. Am. J. Hematol. 59:15–21, 1998. © 1998 Wiley-Liss, Inc.     

Synthesis of [14C]‐, [13C4]‐, and [13C4, 15N2]‐ 5‐amino‐4‐iodopyrimidine

5‐Amino‐4‐iodopyrimidine labeled with either carbon‐14 or with the stable isotopes carbon‐13 and nitrogen‐15 was prepared starting from commercially available labeled diethylmalonate and formamide. This compound is a useful intermediate for carbon–nitrogen and carbon–carbon bond formations. Copyright © 2008 John Wiley & Sons, Ltd     

Synthesis of tritium‐ and deuterium‐labeled budesonide

Tritium‐labeled budesonide was prepared by the selective reduction of a double bond in the butenylenedioxy side chain using carrier‐free tritium and palladium on carbon as a catalyst in absolute ethanol. Although the reduction gave a mixture of the desired product and the expected byproducts resulting from over reduction of the other double bonds in ring A, the desired tritium‐labeled budesonide was easily isolated by reverse phase HPLC and with specific activity of 54 Ci/mmol. [D₈]‐budesonide was prepared from 16α‐hydroxyprednisolone and D₈‐butyraldehyde in 1,4‐dioxane in the presence of perchloric acid. The isotopic enrichment was found to be more than 99 atom% D. Copyright © 2008 John Wiley & Sons, Ltd.     

Digital fractional order differentiation-based algorithm for P and T-waves detection and delineation

The paper presents a new algorithm based on digital fractional order differentiation for P and T-waves detection and delineation. It is simple to implement and performs in one step high frequency noise filtering and differentiation. The characteristics of the resulting filter depend only on two parameters: the fractional negative order (fractional integration) and the filter order. Tests of the algorithm on ECG signals taken from the Massachusetts Institute Of Technology/Beth Israel Hospital (MIT/BIH) database prove its capability to detect and delineate P-waves and T-waves in noisy ECG as well as low amplitude P-wave and inverted T-wave.

Résumé

Dans cet article, nous présentons un nouvel algorithme fondé sur la dérivation d'ordre fractionnaire pour la détection et la segmentation des ondes P et T. C'est une méthode simple à appliquer utilisant un filtrage du bruit haute fréquence et une dérivation du signal. Les caractéristiques du filtre résultant dépendent seulement de deux paramètres : l'ordre négatif fractionnaire (l'intégration fractionnaire) et l'ordre du filtre. La méthode originale testée sur des signaux de la base de donnée MIT/BIH a montré sa capacité à détecter et segmenter les ondes P et T dans le cas des signaux ECG bruités, de faible amplitude P et présentant des ondes inversées.     

Mapping the health and environmental situation in informal zones in Aleppo, Syria: report from the Aleppo household survey

Objectives: Despite large communities living in informal zones around major cities in Syria, there is currently no information on the health and environmental situations in these areas. From May to August 2004, the Syrian Center for Tobacco Studies (SCTS) conducted the first household survey aiming to provide a baseline map of main health problems and exposures affecting these communities in Aleppo, the second largest city in Syria (2,500,000 inhabitants). Methods: Information on 1,021 participants randomly selected using stratified cluster sampling were available (46% males, mean age 34±11.7, age range 18–65 years, response rate 86%), including self-reported health/disability, exposures, and saliva cotinine measurement. Results Some positive findings include better than expected access to electricity, piped water, city sewage, and the use of propane for cooking. Particular areas of concern include high fertility rates, overcrowded housing conditions, and gender inequality in education and work. Household features likely to reflect negatively on residents health include the use of diesel chimneys for heating and lack of smoking restrictions. Overall, residents of informal zones suffer from substantial physical and mental health problems and are exposed to high levels of indoor air pollution. All seem to affect women and the elderly disproportionately, while men are more affected by smoking, occupational respiratory exposures, and injuries. Both infectious and non-infectious respiratory outcomes were very common among study participants. Chronic and degenerative disease, including CVD and joint problems, were a source of substantial morbidity among the studied communities. Conclusions: This study highlights major health and environmental specificities of marginalized populations living in Aleppo, where women seem to bear a disproportionate burden of poor health and disability. Smoking and exposure to tobacco smoke seem among the major exposures facing these populations.