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1.
Am J Surg Pathol ; 48(3): 329-336, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38238977

ABSTRACT

The prognostic value of the traditional pathologic parameters that form part of the American Joint Committee on Cancer staging system and genetic classifications using monosomy chromosome 3 and structural alterations in chromosome 8 are well established and are part of the diagnostic workup of uveal melanoma (UM). However, it has not been fully clarified whether nuclear protein expression of the tumor suppressor gene BAP1 (nBAP1) by immunohistochemistry alone is as powerful a predictor of overall survival (OS) and/or disease-specific survival (DSS) as chromosome analysis. The protein expression of nBAP1 was evaluated in a retrospective cohort study of 308 consecutive patients treated by primary enucleation between January 1974 and December 2022. We correlated clinical, pathologic, and cytogenetic characteristics to identify the best prognostic indicators for OS and DSS. Loss of nBAP1 was detected in 144/308 (47%) of patients. Loss of nBAP1 expression was significantly associated with poor survival. In patients with disomy chromosome 3, nBAP1 negative is significantly associated with poorer OS but not DSS. We observed that older age (>63 years), presence of metastasis, and nBAP1 negative remained independent prognostic factors in multivariate analysis. nBAP1 protein expression proved to be a more reliable prognostic indicator for OS than the American Joint Committee on Cancer staging, M3 status, or The Cancer Genome Atlas classification in this cohort. This study provides support for accurate prognostication of UM patients in routine histology laboratories by immunohistochemistry for nBAP1 alone.


Subject(s)
Melanoma , Uveal Neoplasms , Humans , Prognosis , Retrospective Studies , Uveal Neoplasms/genetics , Uveal Neoplasms/diagnosis , Uveal Neoplasms/pathology , Melanoma/diagnosis , Ubiquitin Thiolesterase/genetics , Tumor Suppressor Proteins
2.
Br J Haematol ; 145(2): 212-20, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19236375

ABSTRACT

The optimal management of menorrhagia among women with abnormal laboratory haemostasis is uncertain. In a crossover study, 116 women with menorrhagia [pictorial blood assessment chart (PBAC) score >100], negative gynaecological evaluation and abnormal laboratory haemostasis were randomly assigned to either intranasal desmopressin (IN-DDAVP) or tranexamic acid (TA) therapy for two menstrual cycles. The subjects then crossed over to the second study drug for two additional cycles. Menstrual blood loss (MBL) was measured by PBAC scores at baseline and after each menstrual cycle. Quality of life (QOL) was assessed with four validated instruments. There was a statistically significant decrease in PBAC scores for both treatments. On average, the estimated decrease in the PBAC from baseline was -64.1 [95% confidence interval (CI) = -88.0, -40.3] for IN-DDAVP and -105.7 (95% CI = -130.5, -81.0) for TA. The decrease in PBAC score was greater for TA than IN-DDAVP (a difference of 41.6, P-value = 0.0002, 95% CI = 19.6, 63.6). The test for treatment-type effect was significant (P < 0.0001) suggesting a greater reduction in PBAC score with TA. Use of both IN-DDAVP and TA improved QOL by all four instruments. We conclude that both medications reduced MBL and improved QOL among females with menorrhagia and abnormal laboratory haemostasis, but TA proved more effective.


Subject(s)
Antifibrinolytic Agents/therapeutic use , Deamino Arginine Vasopressin/therapeutic use , Hemostatics/therapeutic use , Menorrhagia/drug therapy , Tranexamic Acid/therapeutic use , Administration, Intranasal , Administration, Oral , Adult , Antifibrinolytic Agents/adverse effects , Cross-Over Studies , Deamino Arginine Vasopressin/adverse effects , Female , Headache/chemically induced , Hemostatics/adverse effects , Humans , Menorrhagia/psychology , Prospective Studies , Quality of Life , Tranexamic Acid/adverse effects
3.
Am J Obstet Gynecol ; 198(2): 163.e1-8, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18226613

ABSTRACT

OBJECTIVE: A study was conducted to develop a short, easy to administer screening tool useful for stratifying women with unexplained menorrhagia for hemostatic testing for underlying bleeding disorders. STUDY DESIGN: One hundred forty-six women with a physician diagnosis of menorrhagia underwent comprehensive hemostatic testing for the diagnosis of bleeding disorders, including von Willebrand disease, platelet dysfunction, and coagulation factor deficiencies. A 12 page questionnaire of bleeding symptoms was administered. Bleeding symptoms with high predictive values for laboratory hemostatic abnormalities were combined and used as single variables to calculate sensitivity, specificity, and positive and negative predictive values in order to develop a short screening tool to identify females for testing and evaluation. RESULTS: A combination of 8 questions in 4 categories resulted in a sensitivity of 82% (95%CI 75-90) for bleeding disorders. Adding a pictorial blood assessment chart score > 100 increased the sensitivity of the screening tool to 95% (95%CI 91-99). CONCLUSION: These results demonstrate the feasibility of a simple questionnaire based screening tool to identify females for testing and evaluation for bleeding disorders.


Subject(s)
Hemorrhagic Disorders/diagnosis , Menorrhagia/diagnosis , Surveys and Questionnaires , Adolescent , Adult , Female , Hemorrhagic Disorders/complications , Hemorrhagic Disorders/physiopathology , Humans , Mass Screening/methods , Menorrhagia/etiology , Menorrhagia/physiopathology , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Severity of Illness Index
4.
Am J Public Health ; 96(9): 1618-22, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16873741

ABSTRACT

OBJECTIVES: The National Hemophilia Foundation and the Centers for Disease Control and Prevention conducted a national survey focusing on knowledge about, attitudes toward, and behaviors associated with key prevention activities among youths with hemophilia and used the data gathered to design a health promotion campaign. METHODS: A national, random sample of 459 patients was drawn from 20 hemophilia treatment centers and 8 hemophilia associations; 110 (24%) of the respondents were young people. A telephone questionnaire was used to measure knowledge, behaviors, and barriers to prevention. RESULTS: Thirty-six percent of the youth respondents believed that joint disease cannot be prevented; 60% managed hemophilia by avoiding physical activity. Only 31% of the respondents treated bleeding episodes within 1 hour. Although hepatitis was a clear threat to this hemophilic cohort, 78% did now know transmission routes for hepatitis C, and 67% did not know transmission routes for hepatitis B. CONCLUSIONS: Young people with chronic disorders need help understanding that they can prevent complications. We identified key messages for a hemophilia prevention campaign, including exercising to ensure healthy joints and treating bleeding episodes early and adequately.


Subject(s)
Health Knowledge, Attitudes, Practice , Hemophilia A/complications , Adolescent , Adult , Exercise , Female , Health Behavior , Health Surveys , Hemophilia A/therapy , Hepatitis B/transmission , Hepatitis C/transmission , Humans , Joint Diseases/etiology , Joint Diseases/prevention & control , Male , United States
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