Identification and assessment of classification criteria attributes for systemic lupus erythematosus in a regional medical record data network.

OBJECTIVE: To assess the application and utility of algorithms designed to detect features of SLE in electronic health record (EHR) data in a multisite, urban data network. METHODS: Using the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN), a Clinical Data Research Network (CDRN) containing data from multiple healthcare sites, we identified patients with at least one positively identified criterion from three SLE classification criteria sets developed by the American College of Rheumatology (ACR) in 1997, the Systemic Lupus International Collaborating Clinics (SLICC) in 2012, and the European Alliance of Associations for Rheumatology and the ACR in 2019 using EHR-based algorithms. To measure the algorithms' performance in this data setting, we first evaluated whether the number of clinical encounters for SLE was associated with a greater quantity of positively identified criteria domains using Poisson regression. We next quantified the amount of SLE criteria identified at a single healthcare institution versus all sites to assess the amount of SLE-related information gained from implementing the algorithms in a CDRN. RESULTS: Patients with three or more SLE encounters were estimated to have documented 2.77 (2.73 to 2.80) times the number of positive SLE attributes from the 2012 SLICC criteria set than patients without an SLE encounter via Poisson regression. Patients with three or more SLE-related encounters and with documented care from multiple institutions were identified with more SLICC criteria domains when data were included from all CAPriCORN sites compared with a single site (p<0.05). CONCLUSIONS: The positive association observed between amount of SLE-related clinical encounters and the number of criteria domains detected suggests that the algorithms used in this study can be used to help describe SLE features in this data environment. This work also demonstrates the benefit of aggregating data across healthcare institutions for patients with fragmented care.

Survival of retinoblastoma in less-developed countries impact of socioeconomic and health-related indicators.

BACKGROUND: The survival of retinoblastoma in less-developed countries (LDCs) and the impact of socioeconomic variables on survival are not widely available in the literature. METHODS: A systematic review of publications from LDCs was performed. Articles were from multiple databases and written in seven languages. Results were correlated with socioeconomic indicators. Lower-income countries (LICs) and middle-income countries (MICs) were included in our analyses. RESULTS: An analysis of 164 publications including 14,800 patients from 48 LDCs was performed. Twenty-six per cent of the papers were written in languages other than English. Estimated survival in LICs was 40% (range, 23-70%); in lower MICs, 77% (range, 60-92%) and in upper MICs, 79% (range, 54-93%; p = 0.001).Significant differences were also found in the occurrence of metastasis: in LICs, 32% (range, 12-45); in lower MICs, 12% (range, 3-31) and in upper MICs, 9.5% (range, 3-24; p = 0.04). On multivariate analysis, physician density and human development index were significantly associated with survival and metastasis. Maternal mortality rate and per capita health expenditure were significantly associated with treatment refusal. CONCLUSIONS: Important information from LDCs is not always available in English or in major databases. Indicators of socioeconomic development and maternal and infant health were related with outcome.

Electron correlated ab initio study of amino group flexibility for improvement of molecular mechanics simulations on nucleic acid conformations and interactions.

High level ab initio studies demonstrate substantial conformational flexibility of amino groups of nucleic acid bases. This flexibility is important for biological functions of DNA. Existing force field models of molecular mechanics do not describe this phenomenon due to a lack of quantitative experimental data necessary for an adjustment of empirical parameters. We have performed extensive calculations of nucleic acid bases at the MP2/6-31G(d,p) level of ab initio theory for broad set of amino group configurations. Two-dimensional maps of energy and geometrical characteristics as functions of two amino hydrogen torsions have been constructed. We approximate the maps by polynomial expressions, which can be used in molecular mechanics calculations. Detailed considerations of these maps enable us to propose a method for determination of numerical coefficients in the developed formulae using restricted sets of points obtained via higher-level calculations.

Thyroid cancer in Belarus post-Chernobyl: improved detection or increased incidence?

There is debate on whether the reported increase in the number of cases of childhood thyroid cancer in Belarus is real and attributable to radiation released following the Chernobyl nuclear accident, or rather an artefact due to incorrect histological diagnosis, more complete case reporting and mass screening of children after the accident. We have scrutinised the histological slides of 120 (75%) of the 160 cases reported among children aged up to 15 years to the Belarus tumour registry from 1986 to 1992 and examined time trends and geographical patterns in incidence and tumour characteristics. Incidence based on reported cases increased from 0.041 per 100,000 in 1986 to 2.548 in 1992. Carcinoma was confirmed in 94% of reviewed tumours. Except for one medullary carcinoma all histologies were of the papillary type. Most of the tumours had spread beyond the organ capsule and measured over 10 mm in diameter. There was a weak and statistically non-significant trend (p = 0.19) towards smaller tumours in the later years. The proportion of cases with lymphnode or distant metastasis remained unchanged. Incidence based on histologically confirmed cases was highest adjacent and to the west and north of Chernobyl, matching best estimates of iodine-131 contamination. Our data thus strongly suggest that the observed increase is real but more data are needed in order to assess the impact of mass screening and to clarify the possible association with radiation released at Chernobyl in 1986.

Occult thyroid carcinomas in the region of Minsk, Belarus. An autopsy study of 215 patients.

Thyroid glands from 215 patients, aged 19 to 88 years, without known thyroid disease, were serially sectioned at 2-3 mm intervals and microscopically examined for occult disease. Glands were normal in 32.5%, while nodules were observed in 60% and adenomas in 13%. Carcinomas were found in 20 cases (9.3%): occult papillary carcinomas in 19 (8.8%) and one medullary carcinoma. No carcinomas were found in the thyroids of 15 patients less than 40 years of age. There were no significant differences in frequency of occult carcinomas between female and male patients and, for patients over 40 years, with increasing age. Of the 19 papillary tumours more than one focus was found in six cases (a total of 28 foci). The diameter of 27 of these tumours was less than or equal to 5 mm (96.4%), with one exception (diameter 6.3 mm). These findings were compared with those obtained in 86 thyroid glands of children surgically resected for carcinomas between 1986 and 1991. Only 10 of these tumours (11.6%) were less than or equal to 1 cm. These tumours, however, were significantly larger than the occult papillary carcinomas and their morphological features were quite different. Our results are discussed with regard to the possible role of factors other than irradiation due to the nuclear accident at Chernobyl, and the observed sharp numerical increase of thyroid carcinomas in children of the Republic of Belarus after this event.

[Thyroid pathomorphology in children of the Republic of Byelarus subjected to radiation exposure as a result of the accident at the Chernobyl Atomic Electric Power Station]. / Patomorfologiia shchitovidnoi zhelezy detei Respubliki Belarus', podvergshikhsia radiatsionnomu vozdeistviiu v rezul'tate avarii na Chernobyl'skoi AES.

Early and late effects of short-living iodine isotopes on the thyroid of children in Byelarus are described. Early effects manifested with an increase in the thyroid functional activity in children up to one year of age during 1986. Follicular cell hypertrophy is considered as a marker of the radiation effect at a dose level from 0.1 to 1 krad. Late effects are thyroid carcinomas the incidence of which in the country rose ten-fold within the last 5 years.

Sensitivity of different rat tumour strains to photodynamic treatment with chlorin e6.

Transplantable rat tumours (sarcoma M-1, sarcoma 45, alveolar liver cancer PC-1 and Pliss' lymphosarcoma) were used to study chlorin e6 accumulation in tumours and its photodynamic effect. Tumours were irradiated by krypton ion laser light (647 and 676 nm; 90 J cm-2) 15 min and 24 h after chlorin e6 injection at doses of 5 and 10 mg kg-1. The relationship between some morphological peculiarities of these tumour strains, photosensitizer accumulation in tumours and their response to the photodynamic treatment is discussed.

Pathomorphological findings in thyroid cancers of children from the Republic of Belarus: a study of 86 cases occurring between 1986 ('post-Chernobyl') and 1991.

Recently, an impressive increase in malignant thyroid tumours has been observed among children less than 15 years of age living in the Republic of Belarus at the time of the nuclear accident of Chernobyl in 1986. More than half of these patients lived in the region of Gomel, nearest to Chernobyl. Because of the very short time interval between the accident and the tumour occurrence an independent review of the available histopathological material was done. Out of 101 cases diagnosed as thyroid cancers, we reviewed slides of 93 cases and agreed the diagnosis of malignancy in 92.5%. Of these tumours 96.5% were papillary carcinomas, 61.5% were moderately or poorly differentiated. Extrathyroidal extension was observed in 60.5%, regional lymph node metastases in 74% and distant metastases in 7%. One of the patients died from lung metastases. Our results confirm that the neoplasms increasingly diagnosed between 1986 and 1991 among children of this region are thyroid carcinomas. In addition, we correlate several histopathological findings with sex and age of the patients and other parameters, and compare the results with data from other studies.

[Latent cancerous pathology of the thyroid]. / Skrytaia onkologicheskaia patologiia shchitovidnoi zhelezy.

Postmortem morphologic examination of the thyroid was performed in 122 residents of the Minsk Region, Byelorussian Republic. Various pathology underdiagnosed during life was found in 68%. Fourteen papillary carcinomas were detected in 11 (9.9%) of cases whereas 27 (22.1%) subjects revealed 46 follicular adenomas. Nodular goiter was established in 52.5%, thyroiditis--6.5% and cancer metastases--in 5.7% of cases. The male/female ratio for microcarcinoma was 8:3. All tumor-bearing subjects were over 41 years of age. Occurrence of the occult thyroid pathology in different regions of the country can be used to compare potential radiation and other hazards.

Photodynamic therapy with chlorin e6. A morphologic study of tumor damage efficiency in experiment.

Morphological changes in rat sarcoma M-1 after photodynamic treatment with chlorin e6 were studied. The frequency of necrosis appearance and the depth of its spreading in tumor tissue were evaluated after intraperitoneal injection of chlorin e6 in doses of 1-10 mg kg-1 and subsequent irradiation by a krypton laser with light energy density 22.5-135 J cm-2, using the method of vital staining with Evans blue. It was found that the antitumoral effect of photodynamic treatment was strengthened by increasing the dose of the agent and light and reduced by increasing the time interval between chlorin e6 injection and light irradiation. The treatment being given in the parameters mentioned produced a depth of tumor necrosis which varied from 4.0 mm to 16.6 mm. The mechanisms of tumor tissue damage after photodynamic treatment in vivo are discussed.

[Quantitative assessment of morphologic changes in tumors during combined use of irradiation, induced hyperglycemia and local hyperthermia]. / Kolichestvennaia otsenka morfologicheskikh izmenenii v opukholiakh pri sochetannom primenenii oblucheniia, iskusstvennoi giperglikemii i lokal'noi gipertermii.

The paper is concerned with morphometric evaluation of changes in Ehrlich mouse solid carcinoma after a separate, dual and combined use of x-ray irradiation, induced hyperglycemia (IH) and local hyperthermia (HT), using two-staged quantitative analysis of tumor tissue injuries. A portion of viable tissue was determined at the first stage, and the density of location of undestroyed tumor cells was evaluated at the second stage. The general result was characterized by the product of these indices. Disorders in the tumor tissue structure were noted in 24 h, the main damage being done by IH and HT in the center of a tumor. In 48 h the total effect was on the increase only in groups with irradiation as a result of cell death in the peripheral zone. In the double use of the agents their combined effect was less than the additive one, and the combined use of all three methods resulted in obvious synergism, and the number of viable tumor cells (by morphological criteria) was decreased by more than two orders.

[Complex treatment of locally advanced soft tissue sarcoma of the limbs]. / Kompleksnoe lechenie mestno-rasprostranennykh sarkom miagkikh tkanei konechnostei.

The experience of treatment of 40 patients with locally-advanced soft tissue sarcoma of the limbs. Treatment included preoperative chemoradiotherapy in combination with electromagnetic hyperthermia. As a result, 38 (95%) patients showed marked response which allowed radical limb-saving surgery whereas in 2 (5%) amputation was performed. Adjuvant chemotherapy was used for anaplastic tumors. Five-year survival rate was 64.7 +/- 6.7%.

[The immediate results of the use of isometronidazole in the combination therapy of patients with lung cancer]. / Neposredstvennye rezul'taty primeneniia izometronidazola pri kombinirovannom lechenii bol'nykh rakom legkogo.

The paper is devoted to assessment of isometronidazole tolerance, used as a radiosensitizer for preoperative irradiation of lung cancer patients, and to characterization of morphological postradiation changes in tissues of carcinomas removed at operation. Isometronidazole was shown to cause no severe side-effects in patients, improving considerably radiation injury of the tumor parenchyma.

[Diagnosis and treatment of mesenchymal chondrosarcoma]. / Diagnostika i lechenie mezenkhimal'noi khondrosarkomy.

Eight cases of mesenchymal chondrosarcoma (3 males and 5 females aged 15-65) are described. Morphological examination revealed in all cases biphasal tumor consisting of the chondroid tissue of varying maturity and undifferentiated tissue. Combination and complex treatment was given to 6 patients. In 4 cases, radiotherapy was carried out in combination with chemotherapy and local electromagnetic hyperthermia. Out of 8 patients, seven are still alive and are examined at 4 month - 11 year intervals (average of 39.7 months). One female patient died 12 months after the beginning of treatment. Combined and complex procedures should be recommended for treatment of such patients.

[Effect of artificial hyperglycemia and resection of the primary site on metastases of RL-67 carcinoma]. / Vliianie iskusstvennoi giperglikemii i issecheniia pervichnogo ochaga na metastazirovanie kartsinomy RL-67.

In the experiments on the C57Bl mice the authors studied the effect of artificial hyperglycemia (AH), amputation of the extremities with tumors as well as combinations of these effects on the intensity of metastatic spreading of carcinoma RL-67 to the lungs. AH did not prove to intensify the process of metastasizing if it was conducted on the 1, 3, 5, 7, 9 and 11th days. The average number of metastases did not differ from that in the control group. AH which was conducted one day before amputation of the extremity with the tumor caused a more significant inhibition of metastasizing than a surgical intervention.