Analysis of a marker for cancer of the thyroid with a limit of detection

Limit of detection (LoD) is a common problem in the analysis of data generated by instruments that cannot detect very small concentra- tions or other quantities, resulting in left-censored measurements. Methods intended for data that are not subject to this problem are often difficult to modify for censoring. We adapt the simulation- extrapolation method, devised originally for fitting models with measurement error, to dealing with LoD in conjunction with a mix- ture analysis. The application relates the levels of thyroglobulin in individuals with cancer of the thyroid before and after treatment with radioactive iodine I–131. We conclude that the fitted mixture components correspond to levels of effectiveness of the treatment

Indexes to Measure Dependence between Clinical Diagnostic Tests: A Comparative Study

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)In many practical situations, clinical diagnostic procedures include two or more biological traits whose outcomes are expressed on a continuous scale and are then dichotomized using a cut point. As measurements are performed on the same individual there is a. likely correlation between the continuous underlying traits that; can go unnoticed when the parameter estimation is done with the resulting binary variables. In this paper, we compare the performance of two different indexes developed to evaluate the dependence between diagnostic clinical tests that assume binary structure in the results with the performance of the binary covariance and two copula dependence parameters.343433450Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Ecohydrology and ecosystem services of a natural and an artificial bofedal wetland in the central Andes

High-altitude wetlands of the Central Andes, locally known as bofedales, provide important ecosystem services, particularly carbon storage, forage provisioning, and water regulation. Local communities have artificially expanded bofedales by irrigating surrounding grasslands to maximise areas for alpaca grazing. Despite their importance, biophysical processes of both natural and artificial bofedales are still poorly studied, which hinders the development of adequate management and conservation strategies. We analyse and compare the vegetation composition, hydrological variables, groundwater chemistry, and soil characteristics of a natural and an artificial bofedal of at least 10 years old in southern Peru, to understand their interrelations and the consequences for ecosystem service provisioning. We do not find statistically significant differences in the soil, water, and vegetation characteristics. Soil organic carbon (SOC) content, which we use as a proxy for carbon storage, is negatively correlated to dissolved oxygen, pH, and soil water temperature. In addition, Non-Metric Multidimensional Scaling analysis shows a positive relation between plant community composition, SOC content, and water electric conductivity. Our results suggest a three-way interaction between hydrological, soil, and vegetation characteristics in the natural bofedal, which also holds for the artificial bofedal. Vegetation cover of two of the most highly nutritious species for alpaca, Lachemilla diplophylla and Lilaeopsis macloviana with 19-22% of crude protein, are weakly or not correlated to environmental variables, suggesting grazing might be obscuring these potential relationships. Given the high economic importance of alpaca breeding for local communities, expanding bofedales artificially appears an effective strategy to enhance their ecosystem services with minimal impact on the ecohydrological properties of bofedales

Crystal Field and Dzyaloshinsky-Moriya Interaction in orbitally ordered La_{0.95}Sr_{0.05}MnO_3: An ESR Study

We present a comprehensive analysis of Dzyaloshinsky-Moriya interaction and crystal-field parameters using the angular dependence of the paramagnetic resonance shift and linewidth in single crystals of La_{0.95}Sr_{0.05}MnO_3 within the orthorhombic Jahn-Teller distorted phase. The Dzyaloshinsky-Moriya interaction (~ 1K) results from the tilting of the MnO_6 octahedra against each other. The crystal-field parameters D and E are found to be of comparable magnitude (~ 1K) with D ~= -E. This indicates a strong mixing of the |3z^2-r^2> and |x^2-y^2> states for the real orbital configuration.Comment: 12 pages, 6 figure

Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine

During the recent years improved operation techniques and administrative procedures have been developed for early rehabilitation. At the same time preoperative lifestyle intervention (prehabilitation) has revealed a large potential for additional risk reduction

Dermatofibrosarcoma presenting as a nodule in the breast of a 75-year-old woman: a case report

ABSTRACT: INTRODUCTION: Dermatofibrosarcoma protuberans is a rare neoplasm of soft tissues and its location in the breast is extremely uncommon. Confusion is possible with other primary breast lesions. CASE PRESENTATION: A 75-year-old Caucasian woman presented with a mass in her left breast 21 years after being diagnosed with invasive ductal carcinoma of the right breast, treated by a right mastectomy and axillary dissection followed by radiotherapy and breast reconstruction. Mammography revealed a dish-shaped skin nodule formation in the upper outer quadrant of her left breast. Echography confirmed the presence of a lesion measuring 1.4 x 0.8 cm. Based on imaging, the diagnosis was a probable angiosarcoma. Due to the presence of a pacemaker for cardiac arrhythmia and full anticoagulation therapy for a pulmonary embolism, magnetic resonance imaging and a biopsy were not done. We proceeded directly to a quadrantectomy and the final diagnosis revealed a dermatofibrosarcoma protuberans, 1. 8 cm in its greatest microscopic dimension, located 0.1 cm from the upper surgical margin. To ensure the wide resection margins required for this type of neoplasm, a re-excision was performed. CONCLUSION: A dermatofibrosarcoma protuberans of the breast is an uncommon discovery. The aim of this case report is to highlight the importance of the surgical procedure in cases of the discovery of dermatofibrosarcoma protuberans. Re-excision may be necessary to ensure adequate resection margins

Adults with corrected oesophageal atresia: is oesophageal function associated with complaints and/or quality of life?

The aim of this study was to evaluate oesophageal function after correction of oesophageal atresia in adults, and to investigate the association between complaints, oesophageal function and quality of life (QoL). Twenty-five adults were included who participated in previous follow-up studies, during which complaints of dysphagia and gastro-oesophageal reflux (GOR), results of upper gastrointestinal endoscopy, oesophageal biopsies and QoL had been collected. Manometry was performed in 20 patients, 24 h pH-measurements were performed in 21 patients. pH-values (sample time 5 s) were calculated using criteria of Johnson and DeMeester. Associations were tested with ANOVA and χ2-tests. Ten patients (48%) reported complaints of dysphagia, seven (33%) of GOR. The amplitude of oesophageal contractions was low (<15 mmHg) in four patients (20%). pH-measurements showed pathological reflux in three patients (14%). Patients reporting dysphagia more often had disturbed motility (P = 0.011), and lower scores on the domains “general health perceptions” (SF-36) (P = 0.026), “standardised physical component” (SF-36) (P = 0.013), and “physical well-being” (GIQLI) (0.047). No other associations were found. This study shows a high percentage of oesophageal motility disturbances and a moderate percentage of GOR after correction of oesophageal atresia. Patients reporting dysphagia, whom more often had disturbed motility, seemed to be affected by these symptoms in their QoL

Challenges in the diagnosis and management of acromegaly : a focus on comorbidities

Q2Q1Introduction: Acromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life. Methods: We conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment. Findings and conclusions: Successful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.https://orcid.org/0000-0002-8433-5435N/