We investigated the utility of the erythrocyte sedimentation rate in planning the diagnostic and surgical strategy for patients who were found by conventional radiography to have a solitary skeletal lesion. A series of 101 patients was separated into two groups according to their ultimate diagnoses. Group I included patients with skeletal metastases of unknown origin, unusual bone infections, and marrow cell tumors. Group II included benign and malignant primary bone tumors. Using the Westergren method to determine the erythrocyte sedimentation rate prior to biopsy, we found that only one of 65 Group II patients had a rate above 30 mm/h whereas 22 of 36 Group I patients had rates greater than 60 mm/h. By using Receiver Operating Characteristic analysis, we estimated the trade-offs between sensitivity and specificity that can be achieved with various threshold sedimentation rates. In particular, we found that a critical erythrocyte sedimentation rate of 30 mm/h allows separation of Group II patients from Group I patients with 96.9% sensitivity and 82.6% specificity. Our results indicate that the erythrocyte sedimentation rate can be used effectively in conjunction with conventional radiography in the planning of an appropriate further diagnostic strategy.

A retrospective study of patients with osteosarcoma was undertaken to determine whether there was a relationship between biopsy and survival. Fifty-seven patients treated at the Karolinska Hospital, Stockholm, between 1938 and 1959 were included in this study, all ofwhom were less than thirty years old, had a metaphysial osteosarcoma in a long bone but had no pulmonary metastases at the time of diagnosis; all were treated by amputation. No clinical variants of osteosarcoma were included. Twenty-four of the fifty-seven patients had an amputation without a prior biopsy; the others had biopsies before amputation. These two groups were fairly closely matched in age, sex, site and size of tumour, and in the level of

Total and pneumococcal-specific IgA levels did not change after initiation of HAART. No change was detected in the levels of pneumococcal-specific IgA when expressed as a percentage of total IgA. No significant correlation was found between BAL IL-6 and IgA concentration or BAL percentage lymphocytes and IgA concentrations. Conclusion: HAART is not associated with significant changes in total or pneumococcal-specific IgA concentrations in the distal respiratory tract. We speculate that this reflects the more dominant role of IgG in protection of the alveolar space against bacterial pathogens.

RationaleThe unilateral (one lung injured and the contralateral lung intact) model of ventilator-associated lung injury (VALI) allows us to utilize uninjured lung as the systemic VALI effects indicator. We speculated that regulation of genes in uninjured lung will be attributed to blood or lymph carrying effectors produced by an injured lung and the analysis of upstream bioprocesses governed by affected genes will lead to the effectors' discovery.MethodsDogs (n = 4) were intubated, left lung lavaged, and then both lungs were either independently ventilated (total Vt = 15 mL/kg) for 6 hours (injured and uninjured) or immediately harvested (control). Lung mRNA (n = 16 for all three groups) was hybridized to HG_U133A and analyzed by SAM using interspecies probe adjustment. Genes with the lowest false discovery rate (q = 0.124%) that imposed fold change (FC) range from -3.52 to -1.26 and 1.22 to 6.96 with corresponding FC averages -1.59 and 2.01 were considered affected by VALI. Gene ontology filtering for receptor activity term was conducted by MAPPFinder.ResultsOur analyses revealed 22 receptor-related genes, of which 7 were growth factor receptors including EGFR (FC = -1.54), FGFR1 (FC = -1.59), FGFR2 (FC = -1.56), and PDGFR (FC = -1.30). The overall down-regulation of these receptors was concordant with decreased expression of their corresponding ligands in injured lung including EGF (FC = -1.39), FGF2 (FC = -1.39), PDGFA (FC = -1.41), and PDGFB (FC = -2.00). Fibroblast (Z = 6.17) and epidermal (Z = 4.49) growth factor receptor activity were the first and the third significantly (Z > 1.96) affected pathways.ConclusionsOur approaches effectively identify a class of potential biomarkers in VALI. Further investigation of this study may elucidate systemic VALI effects and facilitate the development of new diagnostic tools.Funded by SCCOR U01 HL-073994.