Rare KIT (CD117) expression in multiple myeloma abrogates the usefulness of imatinib mesylate treatment

Background: Imatinib mesylate blocks the tyrosine kinase activity of KIT (CD117) and is an effective treatment for gastrointestinal stromal tumors. In multiple myeloma, KIT expression has been detected by flow cytometry in about 33% of specimens, but no previous immunohistochemical assessment has yet been made of the expression pattern of KIT. Materials and methods: We performed immunohistochemical analyses of 100 patients, including 72 with multiple myeloma (MM), 8 with lymphoplasmacytic lymphoma (LPL), 10 with monoclonal gammopathy of undetermined significance (MGUS) and 10 with reactive plasmocytosis. One KIT-positive MM was sequenced using polymerase chain reaction analysis. Results: In MM, only 2 cases (2.8%) were KIT positive. The great majority of the cases (97, 2%) did not express the KIT receptor tyrosine kinase. No mutation of the c-kit gene was detected. Conclusions: KIT expression is a rare event in MM and not detectable in MGUS and LPL. Therefore, treatment with imatinib is unlikely to be effective in these patient

Discrepancy of target sites between clinician and cytopathological reports in head neck fine needle aspiration: Did I miss the target or did the clinician mistake the organ site?

The diagnostic accuracy of fine needle aspiration cytology (FNAC) of head and neck lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features according to labeled site by physician. These errors may have an impact on pathology search engines, healthcare costs or even adverse outcomes. The cytology archive database of multiple institutions in southern Iran and Australia covering the period 2001–2011, were searched using keywords: salivary gland, head, neck, FNAC, and cytology. All the extracted reports were reviewed. The reports which showed discordance between the clinician’s impression of the organ involved and subsequent fine needle biopsy request, and the eventual cytological diagnosis were selected. The cytological diagnosis was confirmed by histology or cell block, with assistance from imaging, clinical outcome, physical examination, molecular studies, or microbiological culture. The total number of 10,200 head and neck superficial FNAC were included in the study, from which 48 cases showed discordance between the clinicians request and the actual site of pathology. Apart from the histopathology, the imaging, clinical history, physical examination, immunohistochemical study, microbiologic culture and molecular testing helped to finalize the target organ of pathology in 23, 6, 7, 8, 2, and 1 cases respectively. The commonest discrepancies were for FNAC of “salivary gland” [total: 20 with actual final pathology in: bone (7), soft tissue (5), lymph node (3), odontogenic (3) and skin (2)], “lymph node” [total: 12 with final pathology in: soft tissue (3), skin (3), bone (1) and brain (1)], “soft tissue” [total: 11 with final pathology in: bone (5), skin (2), salivary gland (1), and ocular region (1)] and “skin” [total: 5 with final pathology in: lymph node (2), bone (1), soft tissue (1) and salivary gland (1)]. The primary physician requesting FNAC of head and neck lesions are incorrect in their clinical impression of the actual site in nearly 0.5 percent of cases, due to the overlapping clinical and imaging findings or possibly due to inadequate history taking or physical examination

Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

<p>Abstract</p> <p>Background</p> <p>To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps</p> <p>Methods</p> <p>From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve.</p> <p>Results</p> <p>Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days.</p> <p>Conclusion</p> <p>Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.</p

Effects of a social tutor on participation, sense of community and learning in online university courses

Recently, Computer Supported Collaborative Learning researchers have become interested in the notion of scripting and assigning roles to students enrolled in online courses, in order to increase their engagement in collaborative activities. This study aimed to investigate whether assigning a role called social tutor to a student enrolled in an online university course can promote 1) peers’ participation in online discussions, 2) the development of a Sense of Community (SC), consisting of three factors: membership, fulfilment of needs and goal achievement and mutual influence of the individual/group, and 3) effective learning. The participants were 53 undergraduate students who enrolled in an online course, and were divided into two groups: 1) a group of 29 students with a social tutor and 2) a group of 24 students with no social tutor. The results indicate that students’ participation as well as the membership factor of SC improved only in the group that the social tutor was present. In contrast, the scores on the other two SC factors improved regardless of the presence of a social tutor. Moreover, the results show no difference between these two groups in terms of students’ grades in the final examination. The importance of a social tutor in the design of effective online university courses is discussed

What Teachers Need for Orchestrating Robotic Classrooms

Educational Robots are gaining popularity in classrooms but can increase the load on teachers compared to the use of more traditional technologies. Providing support to teachers can make teachers confident in including robots in their teaching routines. In order to support teachers in managing robotic activities in the classroom, it is important to first understand the challenges they face when engaging with these activities. To investigate these challenges, we observed three teachers managing robotic activities across fifteen standard school sessions, followed by retrospective interviews. In these sessions, students performed group activities on assembling and programming different robotic platforms. The results highlight a) how managing the additional technical complexity of the robotic activity is challenging for teachers b) teachers interventions focus on supporting students make connections between their programs and their robot behaviour in the real-world. Building on our results, we discuss how orchestration tools may be designed to help alleviate teachers challenges and support teachers interventions in robotic classrooms

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Marjan Mokhtare,&nbsp;Vida Bozorgi, Shahram Agah,&nbsp;Mehdi Nikkhah,&nbsp;Amirhossein Faghihi,&nbsp;Amirhossein Boghratian,&nbsp;Neda Shalbaf,&nbsp;Abbas Khanlari,&nbsp;Hamidreza Seifmanesh Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran Background: Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB. Patients and methods: Two hundred patients (age &gt;18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A&nbsp;receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point. Results: Eighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P&lt;0.001). Conclusion: We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes. Keywords: full Rockall score, Glasgow-Blatchford score, gastrointestinal bleeding, mortality, prognosi