ABSTRACT
Genetics of cancer is a hot topic, an excellent example of translational medicine. Risk stratification, selection of cases for surgery in Bethesda categories 3 &4 FNAB are examples of the high impact of genetic evaluation in thyroid neoplasia.
ABSTRACT
Medullary thyroid carcinoma is a neuroendocrine tumour of the parafollicular C cells of the thyroid gland. It is an aggressive tumor that can be cured only by complete resection of the thyroid tumour and any local and regional metastases. Thus, the discovery of novel diagnostic and prognostic markers is very important for early diagnosis and correct management, in order for the survival rates to rise. New research has emphasized the potential role of various genes, serum and immunohistochemical markers, as well as potential targets for therapeutic agents. The calcium stimulated calcitonin test has been recently reintroduced in clinical practice, and current medullary thyroid carcinoma guidelines encourage laboratories to set their own criteria defining reference ranges for elevated serum basal and stimulated calcitonin levels.
ABSTRACT
The paper discusses the methods to apply OLAP techniques for multidimensional databases that leverage the existing, performance-enhancing technique, known as practical pre-aggregation, by making this technique relevant to a much wider range of medical applications, as a logistic support to the data warehousing techniques. The transformations have practically low computational complexity and they may be implemented using standard relational database technology. The paper also describes how to integrate the transformed hierarchies in current OLAP systems, transparently to the user and proposes a flexible, "multimodel" federated system for extending OLAP querying to external object databases.
Subject(s)
Biomedical Research/methods , Databases as Topic , Electronic Health Records/trends , Information Storage and Retrieval/methods , Medical Informatics/methods , Online Systems , Confidentiality/standards , Medical Informatics/trendsABSTRACT
BACKGROUND: Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources. OBJECTIVE: To assess the added value of IGRA compared to TST alone in the Netherlands. METHODS: Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated. RESULTS: In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made. CONCLUSION: With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.
Subject(s)
Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Mycobacterium tuberculosis/pathogenicity , Tuberculin Test , Adolescent , Adult , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Cost-Benefit Analysis , False Negative Reactions , False Positive Reactions , Female , Health Care Costs , Humans , Interferon-gamma Release Tests/economics , Latent Tuberculosis/drug therapy , Latent Tuberculosis/economics , Latent Tuberculosis/immunology , Latent Tuberculosis/microbiology , Male , Middle Aged , Mycobacterium tuberculosis/immunology , Netherlands , Predictive Value of Tests , Reproducibility of Results , Tuberculin Test/economics , Unnecessary Procedures , Young AdultABSTRACT
The paper discusses the connection between emergence, pattern formation and nonlinear dynamics, focusing on the similarity between discrete patterns and fractal structures, and then describes different solutions to model reaction-diffusion systems as representative processes in morphogenesis. A specific example is the diffusion limited aggregation growth process, illustrated by the simulation of the evolution of a bacterial colony that shows the roles of instability and sensitivity in non-equilibrium pattern formation. Based on this particular case, it is shown how self-organization could be achieved from non-organized agglomeration of separate entities, in a region of space. We conclude with some brief remarks about universality, predictability and long-term prospects for this field of research.
Subject(s)
Models, Biological , Morphogenesis , Algorithms , Bacteria/growth & development , Diffusion , Fractals , Nonlinear DynamicsABSTRACT
Last years studies made by researchers from over the world show that fractal geometry is a viable alternative for image analysis. Fractal features of natural forms give to fractal analysis new valences in various fields, medical imaging being a very important one. This paper intend to prove that fractal dimension, as a way to characterize the complexity of a form, can be used for diagnosis of mammographic lesions classified BI-RADS 4, further investigations being not necessary. The experiments made on 30 cases classified BI-RADS 4 confirmed that 89% of benign lesions have an average fractal dimension under the threshold 1.4, meanwhile malign lesions are characterized, in a similar percentage, by an average fractal dimension over that threshold.
