Several models for predicting the risk of non-sentinel lymph node (NSLN) metastasis in breast cancer patients with positive sentinel lymph nodes (SLNs) have been developed. The purpose of this study was to validate and compare these models in Chinese patients. A total of 159 breast cancer patients with positive SLNs treated at our institution were included. Among them, 81 (50.9%) patients had at least one NSLN involvement. The Cambridge, Mou, Mayo, Tenon, MDA, Memorial Sloan-Kettering Cancer Center (MSKCC), Ljubljana, SNUH, Turkish, Louisville, Stanford, and Saidi models were evaluated and compared using receiver operating characteristic (ROC) curves, calibration plots, and false negative (FN) rates. The Cambridge and Mou models outperformed the others, both with area under the ROC curves (AUCs) of 0.73. The Mayo, Tenon, MDA, MSKCC, Turkish, Ljubljana, SNUH, and Louisville models had AUCs of 0. 68, 0.66, 0.66, 0.64, 0.63, 0.62, 0.61, and 0.60, respectively. The Stanford and Saidi models did not present any discriminative capabilities, with AUCs of 0.54 and 0.50, respectively. The Cambridge, MSKCC, and Mayo models were well calibrated. With adjusted thresholds, the Mayo model outperformed the others by classifying the highest proportion of patients (20%) into the low-risk group. Our study revealed that the Cambridge and Mou models performed well in Chinese patients. The ROC curves, calibration plots, and FN rates should be used together for the accurate evaluation of prediction models. Selection of these models should be based on the clinicopathological features of the targeted population. The models specifically designed for patients with micrometastases or macrometastases of SLNs are needed in the future. (Cancer Sci 2012; 103: 274-281) S entinel lymph node biopsy can be used to accurately determine the axillary stage in breast cancer patients and significantly reduce morbidity.(1) Patients with negative SLNs can avoid ALND, as confirmed by the NSABP B-32 clinical trial.(2)For patients with positive SLNs, ALND remains the standard of care.(3) However, the NSLNs are shown to be clear of tumor cells during ALND in approximately 40-60% of patients with positive SLNs.(4-11) These patients undergo unnecessary ALND, with more post-surgical complications and no therapeutic benefits.Several models for predicting the risk of NSLN involvement in SLN-positive patients have been published. Before being incorporated into clinical use, these models should be validated in different populations. It has been unclear how these models would perform in Asian women. In this study, we validated and compared the efficacy of the following models in 159 Chinese breast cancer patients: (i) MethodsStudy population. This study was approved by the Institutional Review Board of Sun Yat-sen Memorial Hospital (Guangzhou, China). Breast cancer patients with clinically negative axilla who had undergone SLNB followed by ALND between 2003 and 2010 in Sun Yat-sen Memorial Hospital were identified. Patients were excluded if they met any of th...
IntroductionVisceral larva migrans is a syndrome caused by an infection with larval helminths, which may result in partial or general pathological changes in host tissues. Due to the difficulty in finding the causative parasites, the diagnosis of visceral larva migrans is generally based on compatible clinical signs, epidemic history, marked eosinophilia and pathological examination, especially positive serological test results and the disappearance of symptoms after specific treatment.Case presentationWe report here the case of a 21-year-old Chinese man who, having ingested living earthworms and geckos at a witch’s suggestion, presented with fatigue and wordlessness lasting for one year along with elevated transaminase levels for one month. Clinical examination showed eosinophilia, elevated transaminase levels, nodular lesions in his liver and typical pathological characteristics of hepatic visceral larva migrans. After four courses of anthelmintic therapy, our patient presented with sustaining improvement of clinical manifestations and normalization of laboratory data.ConclusionsBecause of the difficulty in making a definite diagnosis, anthelmintic therapy should be performed in patients with a suspected diagnosis of visceral larva migrans based on their epidemic history and presence of typical manifestations, especially when the serological test results are negative. Furthermore, patients with severe parasite infection may require multiple anthelmintic therapies in order to eliminate the parasites.
BackgroundPurifying stem cells is an inevitable process for further investigation and cell-therapy. Sorting side population (SP) cells is generally regarded as an effective method to enrich for progenitor cells. This study was to explore whether sorting SP could enrich for the Musashi1 (Msi1) positive cells from Msi1 high expression cells (Msi1high cells) derived from mouse embryonic stem cells (ESCs) in vitro.ResultsIn this study, Msi1high cell population derived from ESCs were stained by Hoechst 33342, and then the SP and non-SP (NSP) fractions were analyzed and sorted by fluorescence activated cell sorter. Subsequently, the expressions of Msi1 and other markers for neural and intestinal stem cells in SP and NSP were respectively detected. SP and NSP cells were hypodermically engrafted into the backs of NOD/SCID mice to form grafts. The developments of neural and intestinal epithelial cells in these grafts were investigated. SP fraction was identified and isolated from Msi1high cell population. The expression of Msi1 in SP fraction was significantly higher than that in NSP fraction and unsorted Msi1high cells (P< 0.05). Furthermore, the markers for neural cells and intestinal epithelial cells were more highly expressed in the grafts from SP fraction than those from NSP fraction (P< 0.05).ConclusionsSP fraction, isolated from Msi1high cells, contains almost all the Msi1-positive cells and has the potential to differentiate into neural and intestinal epithelial cells in vivo. Sorting SP fraction could be a convenient and practical method to enrich for Msi1-positive cells from the differentiated cell population derived from ESCs.
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