Biliary brushings obtained during ERCP can have one of three cellular interpretations: benign, malignant, or "atypical." Atypical interpretations usually result in further testing, and may cause controversy over management and increases in cost. We evaluated a large cohort of patients with atypical biliary brushings for analysis and risk stratification. All biliary brushing specimens collected between January 1, 2001 and December 31, 2010 that had an atypical result were included. Hospital electronic records were reviewed for these patients to include: demographics, indication for ERCP, endoscopist/pathologist impressions, serologic testing, stricture site, and information relating to the final clinical diagnosis. Eighty-six patients were included. Totally, 60/86 patients (70%) had malignancies while 26/86 (30%) had no evidence of malignancy during long term follow up. Univariate analysis showed that the risk of malignant outcomes was significantly associated with older age, suspicious/malignant endoscopic impression, pancreatic mass, indications including jaundice and/or dilated bile ducts, stricture location within the common bile duct, PSC, and CA 19-9 levels >300 U/mL. We created a novel scoring system for prediction of malignancy based on clinical and endoscopic factors. We identified parameters that are typically available to the clinician to categorize patients with an "atypical" bile duct brushing results into "high risk" and "lower risk" classifications. Our proposed scoring system would allow such risk stratification to take place.

No abstract

This paper presents a study to determine the role of commercialization on purchase intention in auto industry. The study designs a questionnaire in Likert scale and distributes it among some randomly selected people who lived in city of Tehran, Iran. The study investigates the effects of four factors including competitive condition, product development strategy, competitive advantage and economic growth on customers' intention to purchase. Using structural equation modeling the study has determined a positive and meaningful relationship between each four components and purchase intention. In our study, the highest impact belongs to competitive condition followed by product development strategy.

No abstract

Recent advances in targeted anticancer therapies have substantially improved the prognosis of several cancers. Such targeted therapies are not, however, free of side effects, but these side effects are clearly distinct from those induced by classical cytotoxic chemotherapies. This is likely so because targeted therapies are designed to interfere with specific oncogenic signaling pathways rather than to inhibit cell proliferation in general. In fact, interference with specific signaling pathways may lead to effects that mimic those associated with genetic disorders due to alterations in the corresponding signaling pathways. Here, based on clinical pictures of patients and a review of the litterature, we compare the clinical effects of treatment with BRAF-inhibitors with those of genetic RASopathies. We find a striking overlap between the inhibitor-induced, iatrogenic dermatoses with the genodermatoses seen in patients with corresponding congenital RASopathies, including keratosis pilaris, palmo-plantar hyperkeratosis of areas of pressure, verrucous papillomas, nevi efflorescence, wavy hair, sparse eyelashes/eyebrows, poor hair growth, and increased cancer risk. Interestingly, several cutaneous side effects induced by BRAF-inhibitors that are not typically found in RASopathies, such as acneiform dermatitis and vemurafenib-specific phototoxicity, persist/increase under co-treatment with a MEK inhibitor. This may account for an off-target effect, independent from the well described paradoxical activation of the MAPK pathway by BRAF-inhibitors in BRAFwt cells. We hope that such comparisons lead to a better understanding of the side effects of targeted therapies and perhaps a reassessment of their validity in our current therapeutic arsenal.