The clinicopathological and prognostic significance of CD24, CD44, CD133, ALDH1 expressions in invasive ductal carcinoma of the breast: CD44/CD24 expression in breast cancer.

BACKGROUND: Recently, there are several studies about cancer stem cells (CSC), indicating that they are the cells that initiate the tumor, provide progression, metastasis and responsible for the aggressive tumor behavior. MATERIALS AND METHODS: The purpose of this study is to investigate the expressions of CD24, CD44, their different combinations, ALDH1 and CD133 in invasive ductal carcinoma. Their relationships with clinicopathologic parameters, such as tumor grade, lymphovascular invasion, tumor size, axillary lymph node involvement, stage, hormone receptors, HER2 expression, basal like tumors, triple negative status and prognosis were also investigated. Tissue microarray method was used to investigate immunohistochemical CD24, CD44, ALDH1 and CD133 expressions in 105 invasive ductal carcinoma cases. RESULTS: CD133 expression was significantly associated with tumor size (p=0.023) and stage (p=0.009). CD133 expression was decreased in tumors with larger tumor size, higher stage and lymphovascular invasion. CD133 expression was positively correlated with CD44 (r=0.212, p=0.032) and CD44(+)/CD24(+) (r=0.202, p=0.040) expressions. CD44, CD24 and ALDH1 expressions showed no significant relationship and correlation with clinicopathologic features. There was a significant relationship (p=0.048) between CD44(+)/CD24(-/low) phenotype and basal like tumors. EGFR expression was positively correlated with CD44(+)/CD24(-/low) phenotype (r=0.211, p=0.036). CONCLUSIONS: Basal like tumors are enriched for CSCs with CD44(+)/CD24(-/low) phenotype. CD133 can detect a different population of CSC in breast carcinoma.

Body mass index, cholecystitis, cholelithiasis, pancreatitis and imaging of common bile duct stones.

PURPOSE: Studies to date have not investigated whether body mass index (BMI) affects the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP). The purpose of this study was to investigate the effect of BMI and also concomitant pancreatitis, cholecystitis and cholelithiasis on the sensitivity and specificity of MRCP. MATERIALS AND METHODS: Between January 2004 and December 2011, 185 patients were included in the study and divided into 3 groups according to BMI as normal, overweight or obese. Both MRCP and endoscopic retrograde cholangiopancreatography (ERCP) were performed in all patients. ERCP was accepted as the "gold standard." The accuracy, sensitivity and specificity values of the 3 groups were calculated to determine any effects on the results of the MRCP. RESULTS: Before separating into groups according to BMI, the statistical results for MRCP in the detection of stone disease were as follows: specificity 74.3%, sensitivity 81.7% and accuracy 79%. After dividing the patients into 3 groups according to BMI, the specificity of stone detection with MRCP in the normal-weight group was 93.8% but decreased to 65.5% in the overweight group and to 72% in the obese group. The sensitivity of stone detection with MRCP in the normal-weight group was 85.2% but decreased to 75% in the overweight group and increased to 88.9% in the obese group. The accuracy was 88.3% in the normal-weight group but decreased to 71.6% in the overweight group and to 81.9% in the obese group. CONCLUSION: Our study showed that MRCP performance was decreased in the overweight and obese groups.

A clinical comparison of cordless and conventional displacement systems regarding clinical performance and impression quality.

STATEMENT OF PROBLEM: It is not clear whether newly introduced cordless displacement systems are better able to manage gingiva than conventional systems. PURPOSE: The purpose of this in vivo study was to evaluate the gingival management ability of 4 different displacement methods with a standardized subgingival preparation finish line. MATERIAL AND METHODS: The effects of 4 displacement techniques on gingival management and impression quality were evaluated by means of 6 evaluation criteria. A subgingival preparation finish line of between 1 and 2 mm was ensured, and the buccal aspects of 252 (n=63) teeth were clinically assessed for ease of application, time spent, bleeding, remnants, and dilatation. The complete reproduction of the preparation finish line and the bubble and void formations on polyether impressions were also evaluated. The data were statistically analyzed with the χ(2) test (α=.05). The Bonferroni correction was used to control Type I error for the pairwise comparison groups (α=.008). RESULTS: Statistically significant differences were found for all criteria among the groups (P<.05). The nonimpregnated displacement cord group was the least effective group in terms of bleeding and impression quality (P<.008). The aluminum chloride impregnated cord group and the displacement paste with cap group were found to be comparable in terms of remnants, dilatation, and impression quality (P>.008). The retraction cap with paste group showed better results for ease of application, time spent, and bleeding than the aluminum chloride impregnated cord group (P<.008). Although the group with aluminum chloride impregnated cord, displacement paste, and cap showed better results for dilatation, it was time consuming and difficult (P<.008). CONCLUSIONS: Except for the nonimpregnated cord group, all of the groups were comparable and clinically useful, with perfect or acceptable impression qualities.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE: The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain. METHODS: This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS: Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION: The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.

Role of cytological characteristics of benign thyroid nodules on effectiveness of their treatment with levothyroxine.

INTRODUCTION: Levothyroxine (LT4) therapy has been used for the treatment of euthyroid nodular goiter, but there are controversial results about its usefulness. We aimed to evaluate the possible role of benign nodules' cytological characteristics in response to LT4 therapy. MATERIAL AND METHODS: In total, 93 patients with 128 nodules were included in the study; 74 of the nodules were treated with LT4 (group 1), and 54 of them had no medication (group 2). The subgroups consisted of adenomatous nodules, colloid nodules and cystic nodules. RESULTS: In group 1, mean thyroid volume and mean nodule volume were reduced significantly (p = 0.002 and p = 0.022, respectively) with low-normal level thyrotropin (TSH) suppression (between 0.3 mIU/ml and 1.0 mIU/ml), while there were no significant changes in group 2. When we evaluated changes of the initial and last nodule volumes in cytological subgroups, only colloid nodules in group 1 had significant reduction (p = 0.040) and the others had no significant changes. By omitting the colloid nodules, when the other nodules were revaluated, there were no significant changes in either group. CONCLUSIONS: On the basis of these results, obtained from a large sample of Anatolian patients, it is possible that LT4 therapy leads to significant reductions of both thyroid volume and nodule size in colloid nodules, but not in other kinds of benign nodules.

Diagnostic accuracy of fine-needle aspiration cytology of palpable breast masses: an SROC curve with fixed and random effects linear meta-regression models.

We used various meta-analytic methods to compare 25 studies describing fine-needle aspiration (FNA) cytologic analyses performed from 1984 to 2007 on palpable breast masses. We found that in the 25 studies examined, the sensitivity ranged from 78% to 100%, the specificity ranged from 76% to 100%, and the diagnostic odds ratio (DOR) ranged from 15.83 to 33 198. The overall diagnostic accuracy was found to be as follows: 0.93 (95% CI: 0.92-0.94) for sensitivity, 0.98 (95% CI: 0.97-0.98) for specificity, and 505.209 (95% CI: 273.08-934.95) for the DOR. The overall diagnostic accuracy according to the results of summary receiving operating characteristic (SROC) curve analysis was 0.95 +/- 0.0032, and the overall weighted area under the (receiving operating characteristic [ROC]) curve (AUC) was 0.99 +/- 0.0014. The DOR values did not show a large variation in the various positivity threshold values. However, the results of those studies had some heterogeneity. The four covariates that were added to the standard SROC model to evaluate variations in the results of the studies were the year of publication, the number of aspirations, the percentage of insufficient material, and the study design. The relative diagnostic accuracy of studies performed after 1990 was 3.98 times higher than that of studies performed before 1990. The relative DOR (RDOR) value was also found to be statistically significant (95% CI: 1.22-13.02). That result may be attributed to the technologic improvements in diagnostic tools over the years. Although it was not statistically significant, an increase in the number of aspirations caused an increase in the RDOR of the FNA cytology (95% CI: 0.52-8.11). In contrast, increasing the percent of insufficient material caused a statistically insignificant but clinically significant decrease in the RDOR of FNA (RDOR = 0.79, 95% CI: 0.21-2.98). In conclusion, our meta-analysis has shown that FNA cytologic analysis of palpable breast masses is highly accurate in the diagnostic differentiation of benign from malignant tumors.