HE4 as a serum biomarker for the diagnosis of pelvic masses: a prospective, multicenter study in 965 patients.

BACKGROUND: To evaluate the diagnostic value of adding human epididymis protein 4 (HE4), cancer antigen 125 (CA125) and risk of malignancy algorithm (ROMA) to ultrasound for detecting ovarian cancer in patients with a pelvic mass. METHODS: This was a prospective, observational, multicenter study. Patients aged > 18 years who were scheduled to undergo surgery for a suspicious pelvic mass had CA125 and HE4 levels measured prior to surgery, in addition to a routine transvaginal ultrasound scan. The diagnostic performance of CA125, HE4 and ROMA for distinguishing between benign and malignant adnexal masses was assessed using receiver operating characteristic (ROC) analysis and the corresponding area under the curve (AUC). RESULTS: Of 965 evaluable patients, 804 were diagnosed with benign tumors and 161 were diagnosed with ovarian cancer. In late-stage ovarian cancer, CA125, HE4 and ROMA all had an excellent diagnostic performance (AUC > 0.92), whereas in stage I and II, diagnostic performance of all three biomarkers was less adequate (AUC < 0.77). In the differential diagnosis of ovarian cancer and endometriosis, ROMA and HE4 performed better than CA125 with 99 and 98.1% versus 75.0% sensitivity, respectively, at 75.4% specificity. CONCLUSIONS: ROMA and HE4 could be valuable biomarkers to help with the diagnosis of ovarian cancer in premenopausal patients in order to differentiate from endometriosis, whereas CA125 may be more adequate for postmenopausal patients.

Patients' subjective assessment as a decisive predictor of malignancy in pelvic masses: results of a multicentric, prospective pelvic mass study.

OBJECTIVE: The prognosis for ovarian cancer patients remains poor. A key to maximizing survival rates is early detection and treatment. This requires an accurate prediction of malignancy. Our study seeks to improve the accuracy of prediction by focusing on early subjective assessment of malignancy. We therefore investigated the assessment of patients themselves in comparison to the assessment of physicians. METHODS: One thousand three hundred and thirty patients participated in a prospective and multicenter study in six hospitals in Berlin. Using univariate analysis and multivariate logistic regression models, we measured the accuracy of the early subjective assessment in comparison to the final histological outcome. Moreover, we investigated factors related to the assessment of patients and physicians. RESULTS: The patients' assessment of malignancy is remarkably accurate. With a positive predictive value of 58%, the majority of patients correctly assessed a pelvic mass as malignant. With more information available, physicians achieved only a slightly more accurate prediction of 63%. CONCLUSIONS: For the first time, our study considered subjective factors in the diagnostic process of pelvic masses. This paper demonstrates that the patients' personal assessment should be taken seriously as it can provide a significant contribution to earlier diagnosis and thus improved therapy and overall prognosis.

[Rating and standardisation of pictures from the International Affective Picture System appropriated for children. Examination of children in a field sample aged six to twelve years]. / Validierung und Normierung von kindgerechten, standardisierten Bildmotiven aus dem International Affective Picture System. Untersuchung an einer deutschen Feldstichprobe von Kindern im Alter zwischen sechs und zwölf Jahren.

OBJECTIVE: The aim of this study was to validate and standardise a number of pictures from the International Affective Picture System from Lang (CSEA-NIMH, 1999; Lang et al., 1999) relative to arousal and valence in 57 boys and 63 girls aged between six and twelve years. METHOD: 18 pictures with six positive, six negative and six neutral stimuli were presented to children aged between six and twelve years. The children had to rate the pictures with regard to the dimensions valence and arousal using the Self-Assessment-Manikin (SAM; Lang et at., 1980; Bradley et al., 1994), a visual rating scale. RESULTS: Children aged between six and twelve years were able to discriminate pictures and to rate them according to the two basic dimensions of emotion valence and arousal. CONCLUSIONS: Our selection of pictures from Lang's International Affective Picture System provides a number of standardised stimuli, which are suitable for affect induction for example in psychophysiological and neuroimaging studies in the age group of children between six and twelve years.

Alcohol and Aldehyde Adducts of Zinc Thiolates: Structural Modeling of Alcoholdehydrogenase.

Bis(pentafluorothiophenolato)zinc (1) and bis(2,4,6-triisopropylthiophenolato)zinc (2) can be combined with nitrogen-containing derivatives of benzyl alcohol and benzaldehyde to form (N,O-chelate) zinc thiolates. 2-Pyridylmethanol as well as 2-quinolylmethanol (HetMeOH) yield [(HetMeO)Zn(SR)](4) (3, 4) having a cyclo-Zn(4)(&mgr;-O)(4) backbone and only terminal SR. Likewise, thiolate 1 and 2-(dimethylamino)benzyl alcohol form zwitterionic [(dimethylammoniobenzylato)Zn(SR)(2)](2) (5) with bridging alkoxide and terminal thiolate. In contrast, 6-picolylmethanol (PicMeOH) and thiolate 1 result in [(PicMeOH)Zn(SC(6)F(5))(2)] (6) containing zinc in a tetrahedral ZnNS(2)O, environment. Simple aromatic aldehydes form polymeric complexes [(RCHO)Zn(SC(6)F(5))(2)] (7: R = p-tolyl, 8: R = mesityl) with a [Zn-S](infinity) backbone. Chelating aldehydes (CA) yield mononuclear complexes with tetrahedral ZnNS(2)O coordination [(CA)Zn(SC(6)F(5))(2)] (9, CA = pyridine-2-carbaldehyde; 10, CA = 6-methylpyridine-2-carbaldehyde; 11, CA = 6-methoxypyridine-2-carbaldehyde; 12, CA = quinoline-2-carbaldehyde; 13, CA = 2-(dimethylamino)benzaldehyde). In contrast, N-methylimidazole-2-carbaldehyde (ImA) is coordinated twice in tetrahedral [(ImA)(2)Zn(SC(6)F(5))(2)] (14) lacking any Zn-O interactions. Pyridine-2,6-dicarbaldehyde (PDA) forms trigonal bipyramidal [(PDA)Zn(SC(6)F(5))(2)] (15) with ZnNO(2)S(2) ligation. The structures of 3, 4, 6, 8, 10, 11, 13, and 14 were determined crystallographically, and the structures of 5 and 15 were deduced from those of the corresponding ZnBr(2) complexes. The ZnNS(2)O coordination pattern observed for the enzyme has been reproduced to a very good approximation. In complexes 6 and 10, which are almost superimposable, it is realized for both the corresponding alcohol and aldehyde.