Objective We sought to assess the ability of human epididymis protein 4 (HE4) and CA-125 to distinguish among benign, borderline, and malignant pelvic masses in premenopausal women. Study Design We ...conducted a subset analysis of data from a prospective clinical trial that enrolled women undergoing surgery for an adnexal mass. Diagnostic performance of CA-125 and HE4 for epithelial ovarian cancer (EOC) detection in premenopausal women was determined. Results Of 229 premenopausal patients, 195 (85%) had benign masses, 18 (8%) had EOC, and 16 (7%) had borderline ovarian tumor. The sensitivity of CA-125 and HE4 for EOC detection was 83.3% and 88.9%, respectively. The specificity of CA-125 and HE4 was 59.5% and 91.8%, respectively. A normal HE4 level ruled out invasive cancer in 98% of women with an elevated CA-125. Conclusion HE4 offers superior specificity compared to CA-125 for the differentiation of benign and malignant adnexal masses in premenopausal women.
Complementary DNAs encoding immunoglobulin light chains were isolated from two monotreme species, Ornithorhynchus anatinus (duckbill platypus) and Tachyglossus aculeatus (echidna). The sequences of ...both the variable and constant regions of these clones had greater similarity to IGK than to other light chain classes and phylogenetic analyses place them squarely within the mammalian IGK group, establishing them as monotreme IGK homologues. The constant region sequences of all clones were essentially identical within each species and, along with Southern blot results, the data are consistent with a single IGKC in each species. The expressed IGKV repertoires from both platypus and echidna were randomly sampled and there appear to be at least four platypus and at least nine echidna IGKV subgroups. The IGKV subgroups are highly divergent within species, in some cases sharing as little as 57% nucleotide identity. Two of the IGKV subgroups are present in both species, so there is some degree of overlap in the germline repertoires of these two monotremes. Overall the complexity seen in platypus and echidna IGK light chains is comparable with that of other mammals considered to have high levels of germline diversity and is in contrast to what has been found so far for monotreme IGL.
The Clouds and the Earth's Radiant Energy System (CERES) is part of NASA's Earth Observing System (EOS), CERES objectives include the following. (1) For climate change analysis, provide a ...continuation of the Earth Radiation Budget Experiment (ERBE) record of radiative fluxes at the top-of-the-atmosphere (TOA), analyzed using the same techniques as the existing ERBE data. (2) Double the accuracy of estimates of radiative fluxes at TOA and the Earth's surface. (3) Provide the first long-term global estimates of the radiative fluxes within the Earth's atmosphere. (4) Provide cloud property estimates collocated in space and time that are consistent with the radiative fluxes from surface to TOA. In order to accomplish these goals, CERES uses data from a combination of spaceborne instruments: CERES scanners, which are an improved version of the ERBE broadband radiometers, and collocated cloud spectral imager data on the same spacecraft. The CERES cloud and radiative flux data products should prove extremely useful in advancing the understanding of cloud-radiation interactions, particularly cloud feedback effects on the Earth's radiation balance. For this reason, the CERES data should be fundamental to the ability to understand, detect, and predict global climate change. CERES results should also be very useful for studying regional climate changes associated with deforestation, desertification, anthropogenic aerosols, and ENSO events. This overview summarizes the Release 3 version of the planned CERES data products and data analysis algorithms. These algorithms are a prototype for the system that will produce the scientific data required for studying the role of clouds and radiation in the Earth's climate system.
Noncoding genetic variants at 11q13 have been associated at genome-wide significance in studies of allergic sensitization, asthma, allergic rhinitis, atopic dermatitis, and EoE suggesting that these ...loci contains variants that participate in the allelic regulation of a molecular pathway that is central to the etiology of allergic disease.
Abstract Background Laparoscopic reoperative antireflux surgery remains challenging and the advantages compared to an open approach remain unclear. Methods Retrospective chart review and follow-up ...questionnaire via phone. Results 50 reoperative hiatal hernia repairs were performed in 47 patients. Values: median and interquartile range (IQR). There were 10 males, 37 females, 55 (49–66) years. Reoperative procedures: 38 laparoscopic vs. 12 open transabdominal. Length of operation: 185 (147–254) vs. 325 (276–394) minutes (p < 0.0008). Length of stay: 3 (2–4) vs.10 (8–13) days (p < 0.0001). None required Collis gastroplasty. There was no 30-day mortality. Follow-up questionnaire was obtained in 36/45 (80%) at 21 (11–40) months (2 cancer related deaths). In all, 24/36 (67%) were free of preoperative symptoms and 33/36 (92%) were satisfied with the operation. There was no difference between the laparoscopic and open group. Conclusions Laparoscopic reoperative antireflux surgery is a safe approach with high patient satisfaction and low morbidity. Tension-free esophageal length can be achieved laparoscopically without Collis gastroplasty. The duration of the operation and length of stay are less in the laparoscopic vs. open group. Symptomatic relief and patient satisfaction are similar in both approaches.
The initial experience with left atrial esophageal fistula (LAEF) secondary to atrial fibrillation (AF) ablation procedures revealed a near-universal mortality. A comprehensive description of the ...principles of LAEF repair in the modern era and its resulting impact on morbidity and mortality are lacking in the literature.
To describe the presentation, surgical management, and outcomes of patients with LAEF.
A retrospective cohort analysis of 29 patients was performed, including previously unpublished cases of surgically repaired LAEF from 4 institutions (n = 6), and all published cases of surgically repaired (n = 16) or stented (n = 7) LAEF.
The mean age was 55 ± 13 years, and 75% were men who were undergoing radiofrequency energy catheter ablation (n = 26), cryoablation (n = 1), high-intensity focused ultrasound ablation (n = 1), and surgical mini-MAZE procedure (n = 1) and presented 30 ± 12 days postablation procedure. Overall, 55% of the patients receiving an intervention for LAEF died (41% surgical repair; 100% stent). Patients who did not receive primary esophageal repair were more likely to experience postoperative complications, including mediastinitis, need for percutaneous endoscopic gastrostomy (PEG) feeds, esophageal stent, or death (P = .05). In addition, interposing tissue between the repaired esophagus and the left atrium resulted in fewer postoperative complications (P = .02).
While improved relative to initial reports, mortality associated with LAEF remains high after corrective intervention. Primary esophageal repair with the placement of tissue between the repaired esophagus and the left atrium may result in lower morbidity and mortality.
Vaccination against viruses has rarely been associated with Guillain-Barré syndrome (GBS), and an association with the COVID-19 vaccine is unknown. We performed a population-based study of National ...Health Service data in England and a multicentre surveillance study from UK hospitals to investigate the relationship between COVID-19 vaccination and GBS. Firstly, case dates of GBS identified retrospectively in the National Immunoglobulin Database from 8 December 2021 to 8 July 2021 were linked to receipt dates of COVID-19 vaccines using data from the National Immunisation Management System in England. For the linked dataset, GBS cases temporally associated with vaccination within a 6-week risk window of any COVID-19 vaccine were identified. Secondly, we prospectively collected incident UK-wide (four nations) GBS cases from 1 January 2021 to 7 November 2021 in a separate UK multicentre surveillance database. For this multicentre UK-wide surveillance dataset, we explored phenotypes of reported GBS cases to identify features of COVID-19 vaccine-associated GBS. Nine hundred and ninety-six GBS cases were recorded in the National Immunoglobulin Database from January to October 2021. A spike of GBS cases above the 2016-2020 average occurred in March-April 2021. One hundred and ninety-eight GBS cases occurred within 6 weeks of the first-dose COVID-19 vaccination in England 0.618 cases per 100,000 vaccinations; 176 ChAdOx1 nCoV-19 (AstraZeneca), 21 tozinameran (Pfizer) and one mRNA-1273 (Moderna). The 6-week excess of GBS (compared to the baseline rate of GBS cases 6-12 weeks after vaccination) occurred with a peak at 24 days post-vaccination; first-doses of ChAdOx1 nCoV-19 accounted for the excess. No excess was seen for second-dose vaccination. The absolute number of excess GBS cases from January-July 2021 was between 98-140 cases for first-dose ChAdOx1 nCoV-19 vaccination. First-dose tozinameran and second-dose of any vaccination showed no excess GBS risk. Detailed clinical data from 121 GBS patients were reported in the separate multicentre surveillance dataset during this timeframe. No phenotypic or demographic differences identified between vaccine-associated and non-vaccinated GBS cases occurring in the same timeframe. Analysis of the linked NID/NIMS dataset suggested that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95% confidence interval 0.481-0.691) cases per 100 000 doses. However, examination of a multicentre surveillance dataset suggested that no specific clinical features, including facial weakness, are associated with vaccination-related GBS compared to non-vaccinated cases. The pathogenic cause of the ChAdOx1 nCoV-19 specific first dose link warrants further study.
The intermolecular self‐crosslinking of functionalized macromolecules under ultra‐dilute conditions (see Figure) provides a versatile approach to the preparation of nanoparticles with very small ...sizes. The size and the chemical nature of the particles are easily controlled and the use of particles produced in this way in the generation of nanoporous thin films where the particles act as sacrificial porogens has been demonstrated.
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