We developed and validated a clinical prediction rule based on a set of electrocardiographic criteria for the diagnosis of acute myocardial infarction in patients with chest pain and left bundle-branch block. The use of these criteria, which are based on simple ST-segment changes, may help identify patients with acute myocardial infarction, who can then receive appropriate treatment.

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Myocardial infarction with normal coronary arteries was identified in 74 patients with a mean age of 43 years (range 19 to 66). A mean follow-up period of 10.5 years after documented myocardial infarction and 8.6 years after cardiac catheterization was obtained. The survival rate was 85% (n = 63). There were no statistical differences in age or clinical risk factor prevalence between survivors and nonsurvivors. Moderate (55%) to severe (27%) left ventricular impairment was more common in nonsurvivors. Nine of 11 deaths were cardiovascular, 6 were sudden and 8 occurred in patients with moderate to severe global left ventricular impairment. Seventy-six percent of survivors were asymptomatic and 86% were fully active at follow-up. Two survivors and three nonsurvivors experienced a second myocardial infarction. The clinical risk factors of the study group (Group I) were compared by age, sex and year of catheterization with risk factors in two matched groups. Group II consisted of 74 patients with coronary occlusive disease and myocardial infarction and Group III consisted of 148 patients with normal arteriograms. Group I differed from Group II in having fewer clinical risk factors (p = 0.01 to less than 0.0001). Cigarette smoking did not differ significantly between Group I (72%) and Group II (69%) but was less common in Group III (45%) (p less than 0.001). Hormone therapy or the peripartum state was more common in women in Group I (34%) than in women in Group III (14%) (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

The goal of this study was to compare how accumulation of chromosomal aberrations in human papillomavirus (HPV)-infected cells correlates with the severity of cervical dysplastic lesions. We assessed the frequency of genomic alterations for 35 different loci in a pilot biopsy study and selected two loci (3q26 and 8q24) with the highest frequency of copy number gains found in high-grade dysplasia and cancer. These probes were labeled with gold and red fluorophores and combined with HPV biotin-labeled probes for subsequent detection using a tyramide signal amplification system with a green fluorophore. Cells that were both HPV positive and chromosomally abnormal were designated as "double-positive cells." Cervical cytology specimens from 235 patients were used for this blinded study. In the last decade, the etiological role of human papillomavirus (HPV) infection in the development of cervical dysplasia and cancer has been well established.1-4 The frequency of HPV infection in women with a diagnosis of atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL) is approximately 50, 80, and 95%, respectively. 5-7Still, only a fraction of HPV-infected women will develop high-grade lesions and cervical cancer. 8HPV infections compromise normal cellular proliferation through degradation of the tumor suppressor proteins p53 and pRB by viral proteins E6 and E7, respectively. In addition, HPV infection has been shown to induce abnormal centrosome duplication early in the infection process.9 -12 HPV infection of replicating immature cells prevents epithelial maturation and differentiation, leading to continued replication and accumulation of genetic abnormalities. 2,13,14 Chromosomal instability at a numerical or structural level is a hallmark of malignant tumors.9 Deletion, duplication, and amplification of various genomic regions have been demonstrated in cervical cancer by comparative genomic hybridization and fluorescence in situ hybridization (FISH) methods. [15][16][17][18] In an internal study, we assessed biopsy specimens showing high-grade dysplasia and cancer with FISH probes to 35 unique loci and identified 2 loci, the 3q26 region (comprising H-TERC gene) and the 8q24 region (comprising c-MYC gene), which showed highest frequency of copy number gains in high-grade dysplasia and cancer. Because these loci are frequently altered in cervical cancer tumorigenesis, 16,17,19,20 we hypothesized that they might be useful markers for the detection of cervical dysplasia and carcinoma.To explore this further, we created a fluorescence in situ hybridization assay that allows for the simultaneous Supported by a grant from Abbott Molecular (to K.C.H.).

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