280 research outputs found
Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department
Chest pain is a common reason for presentation to the emergency department (ED). Absolute criteria for Acute Coronary Syndrome without ST elevation (NSTE-ACS) are lacking. An acute coronary syndrome (ACS) needs to be distinguished from a variety of other cardiac and non-cardiac diseases that may cause chest pain
Dutch iliac stent trial:Long-term results in patients randomized for primary or selective stent placement
Advances in the genetic classification of amyotrophic lateral sclerosis
Purpose of review
Amyotrophic lateral sclerosis (ALS) is an archetypal complex disease wherein disease risk and severity are, for the majority of patients, the product of interaction between multiple genetic and environmental factors. We are in a period of unprecedented discovery with new large-scale genome-wide association study (GWAS) and accelerating discovery of risk genes. However, much of the observed heritability of ALS is undiscovered and we are not yet approaching elucidation of the total genetic architecture, which will be necessary for comprehensive disease subclassification.
Recent findings
We summarize recent developments and discuss the future. New machine learning models will help to address nonlinear genetic interactions. Statistical power for genetic discovery may be boosted by reducing the search-space using cell-specific epigenetic profiles and expanding our scope to include genetically correlated phenotypes. Structural variation, somatic heterogeneity and consideration of environmental modifiers represent significant challenges which will require integration of multiple technologies and a multidisciplinary approach, including clinicians, geneticists and pathologists.
Summary
The move away from fully penetrant Mendelian risk genes necessitates new experimental designs and new standards for validation. The challenges are significant, but the potential reward for successful disease subclassification is large-scale and effective personalized medicine
Clinical consequences of diagnostic variability in the histopathological evaluation of early rectal cancer
Introduction: In early rectal cancer, organ sparing treatment strategies such as local excision have gained popularity. The necessity of radical surgery is based on the histopathological evaluation of the local excision specimen. This study aimed to describe diagnostic variability between pathologists, and its impact on treatment allocation in patients with locally excised early rectal cancer. Materials and methods: Patients with locally excised pT1-2 rectal cancer were included in this prospective cohort study. Both quantitative measures and histopathological risk factors (i.e. poor differentiation, deep submucosal invasion, and lymphatic- or venous invasion) were evaluated. Interobserver variability was reported by both percentages and Fleiss’ Kappa- (ĸ) or intra-class correlation coefficients. Results: A total of 126 patients were included. Ninety-four percent of the original histopathological reports contained all required parameters. In 73 of the 126 (57.9%) patients, at least one discordant parameter was observed, which regarded histopathological risk factors for lymph node metastases in 36 patients (28.6%). Interobserver agreement among different variables varied between 74% and 95% or ĸ 0.530–0.962. The assessment of lymphovascular invasion showed discordances in 26% (ĸ = 0.530, 95% CI 0.375–0.684) of the cases. In fourteen (11%) patients, discordances led to a change in treatment strategy. Conclusion: This study demonstrated that there is substantial interobserver variability between pathologists, especially in the assessment of lymphovascular invasion. Pathologists play a key role in treatment allocation after local excision of early rectal cancer, therefore interobserver variability needs to be reduced to decrease the number of patients that are over- or undertreated.</p
Clinical consequences of diagnostic variability in the histopathological evaluation of early rectal cancer
Introduction: In early rectal cancer, organ sparing treatment strategies such as local excision have gained popularity. The necessity of radical surgery is based on the histopathological evaluation of the local excision specimen. This study aimed to describe diagnostic variability between pathologists, and its impact on treatment allocation in patients with locally excised early rectal cancer. Materials and methods: Patients with locally excised pT1-2 rectal cancer were included in this prospective cohort study. Both quantitative measures and histopathological risk factors (i.e. poor differentiation, deep submucosal invasion, and lymphatic- or venous invasion) were evaluated. Interobserver variability was reported by both percentages and Fleiss’ Kappa- (ĸ) or intra-class correlation coefficients. Results: A total of 126 patients were included. Ninety-four percent of the original histopathological reports contained all required parameters. In 73 of the 126 (57.9%) patients, at least one discordant parameter was observed, which regarded histopathological risk factors for lymph node metastases in 36 patients (28.6%). Interobserver agreement among different variables varied between 74% and 95% or ĸ 0.530–0.962. The assessment of lymphovascular invasion showed discordances in 26% (ĸ = 0.530, 95% CI 0.375–0.684) of the cases. In fourteen (11%) patients, discordances led to a change in treatment strategy. Conclusion: This study demonstrated that there is substantial interobserver variability between pathologists, especially in the assessment of lymphovascular invasion. Pathologists play a key role in treatment allocation after local excision of early rectal cancer, therefore interobserver variability needs to be reduced to decrease the number of patients that are over- or undertreated.</p
Metal enrichment processes
There are many processes that can transport gas from the galaxies to their
environment and enrich the environment in this way with metals. These metal
enrichment processes have a large influence on the evolution of both the
galaxies and their environment. Various processes can contribute to the gas
transfer: ram-pressure stripping, galactic winds, AGN outflows, galaxy-galaxy
interactions and others. We review their observational evidence, corresponding
simulations, their efficiencies, and their time scales as far as they are known
to date. It seems that all processes can contribute to the enrichment. There is
not a single process that always dominates the enrichment, because the
efficiencies of the processes vary strongly with galaxy and environmental
properties.Comment: 18 pages, 8 figures, accepted for publication in Space Science
Reviews, special issue "Clusters of galaxies: beyond the thermal view",
Editor J.S. Kaastra, Chapter 17; work done by an international team at the
International Space Science Institute (ISSI), Bern, organised by J.S.
Kaastra, A.M. Bykov, S. Schindler & J.A.M. Bleeke
Developmental pathways to autism: a review of prospective studies of infants at risk
Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders characterized by impairments in social interaction and communication, and the presence of restrictive and repetitive behaviors. Symptoms of ASD likely emerge from a complex interaction between pre-existing neurodevelopmental vulnerabilities and the child's environment, modified by compensatory skills and protective factors. Prospective studies of infants at high familial risk for ASD (who have an older sibling with a diagnosis) are beginning to characterize these developmental pathways to the emergence of clinical symptoms. Here, we review the range of behavioral and neurocognitive markers for later ASD that have been identified in high-risk infants in the first years of life. We discuss theoretical implications of emerging patterns, and identify key directions for future work, including potential resolutions to several methodological challenges for the field. Mapping how ASD unfolds from birth is critical to our understanding of the developmental mechanisms underlying this disorder. A more nuanced understanding of developmental pathways to ASD will help us not only to identify children who need early intervention, but also to improve the range of interventions available to them
Influence of GaAs Substrate Orientation on InAs Quantum Dots: Surface Morphology, Critical Thickness, and Optical Properties
InAs/GaAs heterostructures have been simultaneously grown by molecular beam epitaxy on GaAs (100), GaAs (100) with a 2° misorientation angle towards [01−1], and GaAs (n11)B (n = 9, 7, 5) substrates. While the substrate misorientation angle increased from 0° to 15.8°, a clear evolution from quantum dots to quantum well was evident by the surface morphology, the photoluminescence, and the time-resolved photoluminescence, respectively. This evolution revealed an increased critical thickness and a delayed formation of InAs quantum dots as the surface orientation departed from GaAs (100), which was explained by the thermal-equilibrium model due to the less efficient of strain relaxation on misoriented substrate surfaces
Multiwavelength studies of MHD waves in the solar chromosphere: An overview of recent results
The chromosphere is a thin layer of the solar atmosphere that bridges the
relatively cool photosphere and the intensely heated transition region and
corona. Compressible and incompressible waves propagating through the
chromosphere can supply significant amounts of energy to the interface region
and corona. In recent years an abundance of high-resolution observations from
state-of-the-art facilities have provided new and exciting ways of
disentangling the characteristics of oscillatory phenomena propagating through
the dynamic chromosphere. Coupled with rapid advancements in
magnetohydrodynamic wave theory, we are now in an ideal position to thoroughly
investigate the role waves play in supplying energy to sustain chromospheric
and coronal heating. Here, we review the recent progress made in
characterising, categorising and interpreting oscillations manifesting in the
solar chromosphere, with an impetus placed on their intrinsic energetics.Comment: 48 pages, 25 figures, accepted into Space Science Review
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