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1.
Dena M Bravata Kathryn M McDonald Herbert Szeto Wendy M Smith Chara Rydzak Douglas K Owens 《Medical decision making》2004,24(2):192-206
OBJECTIVES: The authors sought to develop a conceptual framework for evaluating whether existing information technologies and decision support systems (IT/DSSs) would assist the key decisions faced by clinicians and public health officials preparing for and responding to bioterrorism. METHODS: They reviewed reports of natural and bioterrorism related infectious outbreaks, bioterrorism preparedness exercises, and advice from experts to identify the key decisions, tasks, and information needs of clinicians and public health officials during a bioterrorism response. The authors used task decomposition to identify the subtasks and data requirements of IT/DSSs designed to facilitate a bioterrorism response. They used the results of the task decomposition to develop evaluation criteria for IT/DSSs for bioterrorism preparedness. They then applied these evaluation criteria to 341 reports of 217 existing IT/DSSs that could be used to support a bioterrorism response. Main Results: In response to bioterrorism, clinicians must make decisions in 4 critical domains (diagnosis, management, prevention, and reporting to public health), and public health officials must make decisions in 4 other domains (interpretation of bioterrorism surveillance data, outbreak investigation, outbreak control, and communication). The time horizons and utility functions for these decisions differ. From the task decomposition, the authors identified critical subtasks for each of the 8 decisions. For example, interpretation of diagnostic tests is an important subtask of diagnostic decision making that requires an understanding of the tests' sensitivity and specificity. Therefore, an evaluation criterion applied to reports of diagnostic IT/DSSs for bioterrorism asked whether the reports described the systems' sensitivity and specificity. Of the 217 existing IT/DSSs that could be used to respond to bioterrorism, 79 studies evaluated 58 systems for at least 1 performance metric. CONCLUSIONS: The authors identified 8 key decisions that clinicians and public health officials must make in response to bioterrorism. When applying the evaluation system to 217 currently available IT/DSSs that could potentially support the decisions of clinicians and public health officials, the authors found that the literature provides little information about the accuracy of these systems. 相似文献
2.
Maria Kostaki Argyro D. Manona Irene Stavraka Penelope Korkolopoulou Georgia Levidou Eleni‐Andriana Trigka Eleftheria Christofidou Grigorios Champsas Alexandros J. Stratigos Andreas Katsambas Othon Papadopoulos Christina Piperi Athanasios G. Papavassiliou 《Experimental dermatology》2014,23(5):332-338
Epigenetic mechanisms participate in melanoma development and progression. The effect of histone modifications and their catalysing enzymes over euchromatic promoter DNA methylation in melanoma remains unclear. This study investigated the potential association of p16INK4A promoter methylation with histone methyltransferase SETDB1 expression in Greek patients with sporadic melanoma and their correlation with clinicopathological characteristics. Promoter methylation was detected by methylation‐specific PCR in 100 peripheral blood samples and 58 melanoma tissues from the same patients. Cell proliferation (Ki‐67 index), p16INK4A and SETDB1 expression were evaluated by immunohistochemistry. High‐frequency promoter methylation (25.86%) was observed in tissue samples and correlated with increased cell proliferation (P = 0.0514). p16INK4A promoter methylation was higher in vertical growth‐phase (60%) melanomas than in radial (40%, P = 0.063) and those displaying epidermal involvement (P = 0.046). Importantly, p16INK4A methylation correlated with increased melanoma thickness according to Breslow index (P = 0.0495) and marginally with increased Clark level (I/II vs III/IV/V, P = 0.070). Low (1–30%) p16INK4A expression was detected at the majority (19 of 54) of melanoma cases (35.19%), being marginally correlated with tumor lymphocytic infiltration (P = 0.078). SETDB1 nuclear immunoreactivity was observed in 47 of 57 (82.46%) cases, whereas 27 of 57 (47.37%) showed cytoplasmic immunoexpression. Cytoplasmic SETDB1 expression correlated with higher frequency of p16INK4A methylation and p16INK4A expression (P = 0.033, P = 0.011, respectively). Increased nuclear SETDB1 levels were associated with higher mitotic count (0–5/mm2 vs >5/mm2, P = 0.0869), advanced Clark level (III‐V, P = 0.0380), epidermal involvement (P = 0.0331) and the non‐chronic sun exposure‐associated melanoma type (P = 0.0664). Our data demonstrate for the first time the association of histone methyltransferase SETDB1 with frequent methylation of the euchromatic p16INK4A promoter and several prognostic parameters in melanomas. 相似文献
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4.
Remodeling of myocyte gap junctions in arrhythmogenic right ventricular cardiomyopathy due to a deletion in plakoglobin (Naxos disease). 总被引:8,自引:0,他引:8
Starr R Kaplan Joseph J Gard Nikos Protonotarios Adalena Tsatsopoulou Chara Spiliopoulou Aris Anastasakis Catherine Prost Squarcioni William J McKenna Gaetano Thiene Cristina Basso Nicole Brousse Guy Fontaine Jeffrey E Saffitz 《Heart rhythm》2004,1(1):3-11
OBJECTIVES: We tested the hypothesis that defective interactions between adhesion junctions and the cytoskeleton caused by the plakoglobin mutation in Naxos disease lead to remodeling of gap junctions and altered expression of the major gap junction protein, connexin43. BACKGROUND: Naxos disease, a recessive form of arrhythmogenic right ventricular cardiomyopathy, is associated with a high incidence of arrhythmias and sudden cardiac death. Naxos disease is caused by a mutation in plakoglobin, a protein that links cell-cell adhesion molecules to the cytoskeleton. METHODS: Myocardial expression of connexin43 and other intercellular junction proteins was characterized in 4 patients with Naxos disease. Immunohistochemistry was performed in all 4 patients, and immunoblotting and electron microscopy were performed in 1 patient who died in childhood before overt arrhythmogenic right ventricular cardiomyopathy had developed. RESULTS: Connexin43 expression at intercellular junctions was reduced significantly in both right and left ventricles in all patients with Naxos disease. Electron microscopy revealed smaller and fewer gap junctions interconnecting ventricular myocytes. Mutant plakoglobin was expressed but failed to localize normally at intercellular junctions. Localization of N-cadherin, alpha- and beta-catenins, plakophilin-2, desmoplakin-1, and desmocollin-2 at intercalated disks appeared normal. CONCLUSIONS: Remodeling of gap junctions occurs early in Naxos disease, presumably because of abnormal linkage between mechanical junctions and the cytoskeleton. Gap junction remodeling may produce a coupling defect which, combined with the subsequent development of pathologic changes in myocardium, could contribute to a highly arrhythmogenic substrate and enhance the risk of sudden death in Naxos disease. 相似文献
5.
6.
Maria Katselou Ioannis Papoutsis Panagiota Nikolaou Chara Spiliopoulou Sotiris Athanaselis 《Forensic Toxicology》2016,34(2):201-212
Acetylfentanyl is a potent synthetic opioid analgesic that has been increasingly available in America, Europe, Japan, China, and Australia during the last years. It has no approved medical or veterinary use, but it is used illicitly around the world as a substitute of its controlled precursor, fentanyl, as well as of heroin or other related substances in opioid dependent individuals. It is available in retail or “head shops” or over the Internet by companies based mainly in China. Acetylfentanyl is available in the form of powder, tablets, and blotters, while liquid and injectable formulations have been also reported. Acetylfentanyl seizures have dramatically increased during the last 4 years, and its abuse has already caused a number of deaths in the United States, the United Kingdom, Sweden, and Japan, thus leading to its scheduling under the 1961 Single Convention on Narcotic Drugs in the United States, and some European Countries, China, and Japan since 2015. The aim of this review is to summarize the current knowledge about this drug concerning its chemistry, synthesis, prevalence, metabolism, pharmacology, and toxicology, as well as its legal status. Analytical methodologies developed for the determination of acetylfentanyl in biological specimens, as well as published or reported acetylfentanyl related cases, fatal or not, and self reports from drug users are presented. 相似文献
7.
Aberrant p16 promoter methylation among Greek lung cancer patients and smokers: correlation with smoking. 总被引:3,自引:0,他引:3
Elisavet Georgiou Rozalia Valeri Georgios Tzimagiorgis Jacob Anzel Dimitrios Krikelis Christos Tsilikas Georgios Sarikos Chara Destouni Afroditi Dimitriadou Sofia Kouidou 《European journal of cancer prevention》2007,16(5):396-402
Genetic and environmental factors (dietary and smoking) influence lung cancer epidemiology and induce epigenetic modifications that should be assessed in individual populations. We analyzed p16 methylation among Greek non-small cell lung carcinoma patients and smokers using two-stage methylation-specific polymerase chain reaction. One hundred and fifty specimens from cancerous and adjacent non-cancerous tissue, bronchial washings and sputum from patients and 48 specimens, mostly sputum, from disease-free smokers were included. p16 methylation was very frequent in biopsies (82.85%) and bronchial washings (non-small cell lung carcinoma, 80.35%; small cell lung carcinoma, 16.66%) from patients, but also in adjacent non-cancerous tissue (45.71%). Concordance of p16 methylation and positivity by cytological examination was 51.78%. Methylation was also observed in sputum from asymptomatic cytology-negative smokers (22.5%) and chronic obstructive pulmonary disease patients (three of eight). Among disease-free individuals, methylation correlated only with heavy smoking (>50 pack-years, P<0.001) and differed among male and female disease-free smokers. In summary, p16 methylation is very frequent among non-small cell lung carcinoma patients, and correlates with heavy cigarette consumption only in disease-free smokers. 相似文献
8.
9.
Panagiotis Georgoulias Chara Tzavara Nikolaos Demakopoulos Stavroula Giannakou Varvara Valotassiou Ioannis Tsougos Petros Xaplanteris Ioannis Fezoulidis 《Annals of nuclear medicine》2008,22(10):899-909
Objective Percutaneous transluminal coronary angioplasty is a well-established therapeutic method in selected patients with coronary
artery disease. The aim of this study was to assess the incremental prognostic value of technetium-99m (99mTc)-tetrofosmin myocardial gated-single- photon emission computed tomography (SPECT) in asymptomatic patients after coronary
artery stenting.
Methods A total of 246 consecutive patients (aged 55.5 ± 8.2 years, 182 men) participated in the study with a median follow-up of
9.5 years (interquartile ra 5.8–10.5 years). All patients underwent exercise gated-SPECT myocardial imaging within 5–7 months.
Myocardial scintigrams were performed using 99mTctetrofosmin, and were evaluated calculating the summed stress score (SSS),
summed rest score (SRS), and summed difference score (SDS) indexes. Cardiovascular death and non-fatal myocardial infarction
were considered as hard cardiac events, and late revascularization (>3 months after myocardial SPECT) procedures as soft events.
Receiver-operating characteristic (ROC) analysis was used to test the prognostic ability of SSS and SDS for cardiac events.
Cox proportional hazards models were used to evaluate the incremental value of SPECT variables.
Results Cardiac death occurred in 12 (4.9%) patients and non-fatal myocardial infarction in 20 (8.1%) patients. In addition, 60 (24.4%)
patients underwent a late revascularization procedure. Using ROC analysis the optimal cut-offs of SSS (AUC = 0.94; 95% CI
0.92–0.97) and SDS (AUC = 0. 76; 95% CI 0.70–0.82) for the prediction of cardiac events were 10 and 1.7, respectively. Multiple
Cox regression analyses revealed that SSS > 10 (HR = 24.2; 95% CI 7.44–78.79) and SDS > 1.7 (HR = 2.72; 95% CI 1.23–6.00)
provided incremental prognostic value over clinical and exercise test data for the composite end points of any cardiac event.
Conclusions
99mTc-tetrofosmin myocardial gated- SPECT, performed 6 months post-percutaneous coronary intervention (PCI), provides incremental
prognostic information for the prediction of cardiac events in asymptomatic patients after PCI. 相似文献