Immunohistochemical prognostic markers in intracranial ependymomas: systematic review and meta-analysis.

Distinction between grade II ependymomas and anaplastic ependymomas based on histopathological examination solely is problematic and, therefore, the management of intracranial ependymomas remains controversial. The aim of this study was to conduct a systematic review (SR) and meta-analysis (MA) of data published on immunohistochemical prognostic markers (IPM) in intracranial ependymomas (IE), and to establish an evidence-based perspective on their clinical value. Following the extensive search based on a strictly defined group of key words, 30 studies reporting results on IPM in IE were identified. Due to a pronounced inter-study heterogeneity, only 14 publications fulfilled the criteria for inclusion into SR. From the total of 67 immunohistochemical markers, 18 were found to correlate with prognosis. However, owing to inadequate data publishing, MA could be performed only with data on proliferation marker MIB-1 (Ki-67) from 5 publications, including 337 patients: The pooled hazard ratio for overall survival was 3.16 (95% confidence interval = 1.96-5.09; p < 0.001) implicating that patients suffering from tumors with higher immunohistochemical expression of MIB-1 had a significantly worse outcome. Marked inter-study heterogeneity and incomplete data publishing in primary studies significantly limited extent of the SR, and the possibility of performing MA. Although the prognostic impact of MIB-1 immunoexpression in IE could be confirmed, there remains lack of further reliable IPM that could be used in routine diagnosis. We encourage to search for new, useful markers, as well as to standardize lab-techniques and data interpretation algorithms across laboratories in order to increase data compatibility.

[Free sources for medical informatics teaching]. / Volne dostupné zdroje pro výuku lékarské informatiky.

Important worldwide websites offering medical informatics have been searched through to find freely available web-based sources for teaching of medical informatics at faculties of medicine. The conclusion suggests that a complex system for teaching of the whole field of study does not exist. However, a sufficient offer of specialized articles, model programmes and presentations is available, which can be used for teaching. The author lists a brief characterization of the found sources and the programmes he uses. This computer-aided research is only rough. A more precisely defined searching strategy can help find other sources of specialized subjects useful for medical informatics.

Is there anticipation in the age at onset of cancer in families with Li-Fraumeni syndrome?

Anticipation in the age at onset of cancer in successive generations was described in several familial cancer syndromes. Based on multiple statistical analyses of a database of families with germline TP53 mutations, and using several different approaches and measures to eliminate possible biases, we show that anticipation may be a feature of the Li-Fraumeni syndrome. Definitive proof of anticipation in pedigrees with germline TP53 mutations will require more family data and further analysis, as well as research on the role of the p53 protein in processes like genome stability, which may represent the biological basis of anticipation in these families. This should have important practical implications for genetic testing, counselling, and preventative care for individuals at risk.