Sepsis evaluations in hospitalized infants with bronchiolitis

OBJECTIVES

To define variation in the decision to perform a sepsis evaluation in hospitalized infants with bronchiolitis, to define predictors of the decision and to measure the clinical and cost outcomes.

METHODS

Retrospective chart review of all nonintensive care unit infants < or = 60 days with any discharge diagnosis of bronchiolitis (n = 282 from 1993 to 1995 in a 232-bed pediatric hospital. Process variables included temperature at sepsis work-up or Tmax if no sepsis workup. Outcome variables were charges, length of stay, sepsis workup and serious bacterial infection.

RESULTS

There was no difference in mean temperature between groups with or without sepsis evaluation (38.1 degrees C, P = 0.75). Of 282 infants 140 had a sepsis workup; 5 (1.8%) had serious bacterial infection. Infants with sepsis workup had an average total charge of $4507 and length of stay of 3.4 days compared with $2998 and 2.8 days for those without (P = 0.0001 and P = 0.002, respectively). A multivariate logistic regression model was constructed with sepsis workup as the dichotomous dependent variable. Significant (P < or = 0.05) predictor variables with a positive coefficient were: higher bronchiolitis score and normal chest roentgenogram. Significant variables with a negative coefficient were: admission diagnosis of bronchiolitis, chest roentgenogram typical for bronchiolitis and age > 28 days.

CONCLUSIONS

Temperature was not a predictor of sepsis evaluation. Infants with respiratory distress and normal chest roentgenogram were more likely to receive sepsis evaluations; those with recognized typical bronchiolitis and those > 28 days of age were less likely. Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious bronchiolitis.

Interference of sugars with the binding of biotin to streptavidin and avidin

Streptavidin and avidin have found widespread use as detection reagents in immunology, biochemistry and cell biology due to their high affinity binding to biotin, but the cellular functions of these proteins are not known. We have found that various sugars interfere with the binding of streptavidin and avidin to biotin. Mannose was most effective in inhibiting the binding to biotin followed by other saccharides. The inhibitory effect is most probably due to interactions of the sugars with residues in the binding pocket of streptavidin and avidin for biotin. These results show that great caution has to be exercised in the evaluation of experiments conducted with these detection reagents in the presence of sugars.

PDGF-induced phosphorylation of Tyr28 in the N-terminus of Fyn affects Fyn activation

Binding of platelet-derived growth factor (PDGF) to its receptors leads to the activation of members of the Src family of protein tyrosine kinases. We show here that Fyn, a member of the Src family, is phosphorylated on Tyr28 in the unique N-terminal part of the molecule after interaction with the intracellular domain of the PDGF beta-receptor. Activated Fyn furthermore undergoes autophosphorylation on Tyr30, Tyr39 and Tyr420. When Fyn mutants with Tyr28, Tyr30 or Tyr39 replaced with phenylalanine residues were transfected into NIH3T3 cells a decreased activation after PDGF stimulation was seen, suggesting a functional importance of the N-terminal tyrosine phosphorylation of Fyn.

[Abuse of benzodiazepines among heroin addicts in Copenhagen]

Abuse of benzodiazepines among heroin addicts in Copenhagen. The aim of this study was to investigate the extent of benzodiazepine abuse among heroin addicts, and to examine whether the heroin addicts with and without benzodiazepine abuse differed socially and psychiatrically. Social and medical information was drawn from the records for 98 heroin addicts who were registered for treatment at the institution Distriktscenter Vestre between 1.2-30.9.1994. Information about psychiatric admissions was taken from the Danish Psychiatric Register. The results showed that the heroin addicts with and without benzodiazepine abuse do not differ with regard to psychiatric data and basic demographic data. However, addicts with concomitant benzodiazepine ab-use were worse off concerning housing conditions, employment criminal records and amount and type of heroin abuse, and are thus in need of a more concerted treatment effort.

Cyberspace 101: taking a ride on the information superhighway

All you need to explore cyberspace is a computer, a modem, a phone line, and a local "on-ramp" to the infohighway. A litserv is an interactive mailing list that distributes information to a large number of people at the same time. Once you subscribe, you receive copies of all messages sent into listserv and have the opportunity to post questions and comments for other subscribers. Dietetics Online: A Network of Dietetic/Nutrition Professionals offers a range of cutting-edge services. Online marketing can reach a potentially larger audience for a fraction of the cost of traditional means and expand your business geographically.

[Low back pain problems among steelworkers]

The associations between low-back pain and occupational work loads, life-style factors, and sociodemographic factors were examined in 469 steel plant workers (436 males, 33 females), mean age (sd): 40 (12) years. Fifty-one per cent had experienced low-back pain during the preceding year. The strongest associations were found between recent low-back pain and domestic recreational activities (> or = h/wk vs 0-2 h/wk), and between recent low-back pain and work pace (too fast vs. adequate), odds ratios (95% confidence limits) being respectively 3.0 (1.5-5.8), and 2.3 (1.2-4.2). We considered a subject to have a particularly severe history of low-back pain if he or she due to low-back trouble (i) had ever been admitted to a hospital, (ii) had ever had to change work or, (iii) had had more than one week's sick-leave accumulated during the preceding year. There was a strong association between a severe low-back pain history and life-time occupational exposure to heavy and frequent lifting on the job. Forty-seven per cent of severe low-back pain events could be ascribed to heavy and frequent lifting, provided the associations were causal. We conclude that domestic recreational activities may be an important potential confounder in studies on occupational risk factors for low-back pain, and that, based on the results of this and of other studies, a case for prevention still seems to exist regarding lifting of heavy burdens in the work environment.

Cystic dysplasia of the rete testis: a benign congenital lesion associated with ipsilateral urological anomalies

PURPOSE

Cystic dysplasia of the rete testis is a benign congenital lesion that can mimic testicular cancer. We report 6 cases, review the literature, discuss the embryological etiology and make management recommendations.

MATERIALS AND METHODS

The records and pathology reports of 6 boys presenting with cystic dysplasia of the rete testis at 5 institutions were reviewed, as was the relevant literature.

RESULTS

Of the 6 cases 5 presented as scrotal masses in previously healthy boys and 1 as an abdominal mass in a newborn with multiple congenital anomalies. One patient had been followed from birth for a multicystic dysplastic kidney and 4 were found to have an ipsilateral absent kidney during evaluation. Development of the contralateral side was normal in most cases.

CONCLUSIONS

Cystic dysplasia of the rete testis is an unusual, benign congenital lesion that can mimic testicular cancer in presentation. The presence of ipsilateral renal anomalies, particularly renal agenesis, can suggest cystic dysplasia of the rete testis in the differential diagnosis preoperatively. Even if cystic dysplasia of the rete testis is suspected, we recommend inguinal exploration and early control of the spermatic cord in the event that neoplasia is identified. If possible, the goal of preserving as much normal testicular parenchyma as possible is desirable. Long-term followup for possible recurrence is recommended, particularly after local excision.

The role of p53 tumor suppressor gene and bcl-2 protooncogene in rat corpus luteum death

OBJECTIVE

The purpose of this study was to find out whether the mammalian corpus luteum undergoes genetically programmed cell death as evidenced by the positive or negative expression of specific biochemical markers of apoptosis (p53 and bcl-2).

STUDY DESIGN

Twenty-six immature 28-day-old female Sprague-Dawley rats were given 10 IU of pregnant mare's serum gonadotropin to induce ovulation and corpus luteum formation. Corpora lutea were collected on postovulatory days 8, 10, 12, and 14 and snap-frozen immediately. Determinations of apoptotic fragmentation of deoxyribonucleic acid were performed with use of samples radiolabeled at 3'-ends with deoxynucleotide alpha-phosphorus 32-deoxycytidine triphosphate (3000 Ci/mmol). Transcription of p53 and bcl-2 was determined by Northern blot analysis of total ribonucleic acid. Protein expression of p53 and bcl-2 was determined by Western blot analysis with a monoclonal rat antibody for p53 and a polyclonal rabbit antibody for bcl-2.

RESULTS

The nuclear fragmentation assay revealed formation of oligonucleosomes resulting in typical laddering of the deoxyribonucleic acid (corpus luteum) consistent with programmed cell death. Northern blot analysis of total ribonucleic acid prepared from immature (28-day-old) rat corpus luteum revealed the presence of a single p53 messenger ribonucleic acid transcript (2.1 kb) in all ages of corpus luteum studied from day 8 to day 14. Western blot analysis for p53 revealed a gradual reduction in p53 protein in corpus luteum from day 8 to day 12 until it became undetectable on day 14. Western blotting revealed expression of specific protein for bcl-2.

CONCLUSIONS

It appears that programmed cell death, as evidenced by formation of oligonucleosomes, occurs during mammalian luteal regression. The patterns of p53 ribonucleic acid expression in the corpus luteum suggest that the protein products of p53 and bcl-2 do not act in a diametric manner to regulate programmed cell death in the corpus luteum. The current results suggest that the mechanisms leading to programmed cell death in the mammalian corpus luteum may differ considerably from those in other organ systems.

Systemic immune changes following meal intake in humans

Food intake represents a high intestinal antigen exposition requiring host defense. Besides local immune activation, this defense includes a coordinate systemic immune response, which may serve to support local immunity. This study examined influences of a standardized high-protein meal on peripheral blood mononuclear cell counts; on the in vitro mitogen-stimulated production of tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, and interferon-gamma; on the in vivo plasma levels of tumor necrosis factor-alpha and interleukin-6; and on plasma concentrations of cortisol and growth hormone. Ten healthy men (18-35 yr) participated in two experimental sessions in a balanced order. On one occasion, subjects fasted; on the other, they received a high-protein meal at 1230. Blood was sampled every 15 min. Whereas the numbers of neutrophils and platelets were increased for more than 2.5 h after meal intake (P < 0.01) lymphocyte counts decreased (P < 0.01). Meal intake also decreased the production of interferon-gamma but did not affect the production and plasma levels of the other cytokines. Changes in immune cell distribution and function were accompanied by a strong postprandial rise in plasma cortisol concentrations. Some of the systemic immune changes, like the emigration of lymphocytes, probably into extravascular abdominal tissues, may serve to support local immune defense.

The mechanism of Class II correction in late Herbst treatment

The aim of this study was to analyze quantitatively the sagittal skeletal and dental changes contributing to Class II correction in patients treated with the Herbst appliance after the pubertal growth peak. The sample consisted of 21 subjects with a Class II, Division 1 malocclusion treated during the skeletal maturity stages MP3-H and -1, corresponding to a period after the maximum of pubertal growth (late treatment). A comparison was made with 22 Herbst subjects treated during the skeletal maturity stages MP3-E and -F, corresponding to a period before the maximum of pubertal growth (early treatment). Lateral head films from before and after Herbst therapy were analyzed, according to the method of Pancherz. As a result of the Herbst therapy, all patients attained a Class I or overcorrected Class I occlusal relationship. Class II molar correction averaging 6.1 mm was due to 37% skeletal and 63% dental changes. Overjet correction averaging 8.4 mm was due to 27% skeletal and 73% dental changes. Differences between the late and the early treated patients were only found for the dental changes. The upper anterior teeth were retroclined and the lower anterior teeth were proclined more in the late cases. The conclusion of the study was that the Herbst appliance is equally efficient in patients treated before and after the pubertal peak of growth. However, proclination of the lower incisors (anchorage loss) in late treated subjects is larger than in early treated subjects. This should be considered in treatment planning.

Long-term effects of Herbst treatment on the mandibular incisor segment: a cephalometric and biometric investigation

The purpose of this study was to analyze mandibular incisor changes during and after Herbst treatment with respect to tooth inclination and anterior crowding. The sample consisted of 24 Class II, Division 1 subjects (15 boys and 9 girls) treated with Herbst appliance. Dental casts and lateral head films from before and after treatment, 6 months after treatment and at the end of the growth period (at least 5 years after treatment) were analyzed. During treatment, the lower incisors were proclined (ILi/ML) an average of 10.8 degrees and the incisal edge (li) moved anteriorly by 3.2 mm. The available space and the irregularity index in the lower anterior region were in general unaffected by therapy. During the first posttreatment period of 6 months, the lower incisor inclination (ILi/ML) recovered an average of 7.9 degrees and the incisal edge (li) moved posteriorly by 2.5 mm. However, the available space was almost unchanged. During the second posttreatment period, i.e., from 6 months after treatment to the end of growth, the lower incisor inclination remained on average unchanged in relation to the mandibular plane (ILi/ML) but the teeth retroclined in relation to the nasion-sella line (ILi/NSL). The available space decreased (mean 0.8 mm, p < 0.01) and the irregularity index increased (mean 2.0 mm, p < 0.01). The correlation between changes in the ILi/NSL and in the NSL/ML angles was moderate (r = -0.57, p < 0.01), indicating that the reduction in the ILi/NSL angle was partly a result of anterior mandibular growth rotational changes. In conclusion, it can be said that the proclination of the lower front teeth during Herbst treatment did not result in incisor crowding after treatment. In a long-term perspective, the development of incisor crowding was thought to be associated with normal craniofacial growth changes.

Association of coatomer proteins with the beta-receptor for platelet-derived growth factor

The nonreceptor tyrosine kinase Src binds to and is activated by the beta-receptor for platelet-derived growth factor (PDGF). The interaction leads to Src phosphorylation of Tyr934 in the kinase domain of the receptor. In the course of the functional characterization of this phosphorylation, we noticed that components of 136 and 97 kDa bound to a peptide from this region of the receptor in a phosphorylation-independent manner. These components have now been purified and identified as alpha- and beta'-coatomer proteins (COPs), respectively. COPs are a family of proteins involved in the regulation of intracellular vesicle transport. In order to explore the functional significance of the interaction between alpha- and beta'-COP and the PDGF receptor, a receptor mutant was made in which the conserved histidine residue 928 was mutated to an alanine residue. The mutant receptor, which was unable to bind alpha- or beta'-COP, showed a normal ligand-induced autophosphorylation. The mutant receptor also behaved like the wildtype receptor with regard to biosynthesis and maturation, and mediated a mitogenic signal. The possible functional importance of the interaction between the PDGF beta-receptor and alpha- and beta'-COP, is discussed.

Transcriptional termination signals for RNA polymerase II in fission yeast

Transcription 'run-on' (TRO) analysis using permeabilized yeast cells indicates that transcription terminates between 180 and 380 bp downstream of the poly(A) site of the Schizosaccharomyces pombe ura4 gene. Two signals direct RNA polymerase II (pol II) to stop transcription: the previously identified 3' end formation signals located close to the poly(A) site and an additional downstream element (DSE) located at the region of termination. The downstream signal (135 bp) appears to act by pausing the elongating polymerase. TRO analysis indicates that elevated levels of transcribing polymerases accumulate over the DSE and that removal of this signal leads to transcription proceeding beyond the normal termination region. Furthermore, when inserted between two competing polyadenylation signals, this DSE increases the utilization of upstream poly(A) sites in vivo. We show that polymerase pausing over an extended region of template ensures termination of pol II transcription close to the poly(A) site.

Phosphorylation of a 72-kDa protein in PDGF-stimulated cells which forms complex with c-Crk, c-Fyn and Eps15

Ligand-induced activation of the beta-receptor for platelet-derived growth factor (PDGF) induces tyrosine phosphorylation of a number of downstream signaling proteins. In the present study, we used two-dimensional gel electrophoresis to characterize the spectrum of proteins phosphorylated in response to PDGF stimulation in porcine aortic endothelial cells expressing PDGF beta-receptors. Several previously known substrates for the PDGF beta-receptor were identified as well as a novel substrate of 72 kDa. The 72-kDa component could be co-immunoprecipitated in complex with the adaptor protein c-Crk, the non-receptor tyrosine kinase c-Fyn and the signaling molecule Eps15. The results obtained suggests that the 72-kDa protein might play an important role in signaling via the PDGF beta-receptor, coupling non-receptor tyrosine kinases of the Src family with c-Crk and Eps15.

Cyclin E-induced S phase without activation of the pRb/E2F pathway

In cells of higher eukaryotes, cyclin D-dependent kinases Cdk4 and Cdk6 and, possibly, cyclin E-dependent Cdk2 positively regulate the G1- to S-phase transition, by phosphorylating the retinoblastoma protein (pRb), thereby releasing E2F transcription factors that control S-phase genes. Here we performed microinjection and transfection experiments using rat R12 fibroblasts, their derivatives conditionally overexpressing cyclins D1 or E, and human U-2-OS cells, to explore the action of G1 cyclins and the relationship of E2F and cyclin E in S-phase induction. We demonstrate that ectopic expression of cyclin E, but not cyclin D1, can override G1 arrest imposed by either the p16INK4a Cdk inhibitor specific for Cdk4 and Cdk6 or a novel phosphorylation-deficient mutant pRb. Several complementary approaches to assess E2F activation, including quantitative reporter assays in live cells, showed that the cyclin E-induced S phase and completion of the cell division cycle can occur in the absence of E2F-mediated transactivation. Together with the ability of cyclin E to overcome a G1 block induced by expression of dominant-negative mutant DP-1, a heterodimeric partner of E2Fs, these results provide evidence for a cyclin E-controlled S phase-promoting event in somatic cells downstream of or parallel to phosphorylation of pRb and independent of E2F activation. They furthermore indicate that a lack of E2F-mediated transactivation can be compensated by hyperactivation of this cyclin E-controlled event.

Effects of sleep and circadian rhythm on human circulating immune cells

The role of nocturnal sleep for normal immune regulation and its relation to circadian rhythm was examined in 10 men participating in two 51-h sessions. One session included two regular wake-sleep cycles; the other included a night of sustained wakefulness followed by a night of recovery sleep. Blood was collected every 3 h to determine PBMC counts, including the enumeration of monocytes, NK cells, and lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, HLA-DR+). Production of IL-1beta, TNF-alpha, IL-2, and IFN-gamma was determined after stimulation of whole blood samples with LPS and PHA, respectively. Concentrations of IL-6 and cortisol were assessed in plasma. Enumeration of cells indicated significant circadian rhythms for all PBMC subsets under conditions of sustained wakefulness. Compared with sustained wakefulness, nocturnal sleep acutely reduced the numbers of monocytes, NK cells, and counts of all lymphocyte subsets. However, in the afternoon and evening of the day following sleep, counts of NK cells and lymphocytes were significantly higher than after nocturnal wakefulness, indicating that effects of sleep interacted with those of the circadian pacemaker. Sleep markedly enhanced production of IL-2 by T cells (CD3+) but did not influence production of IL-1beta and TNF-alpha, or IL-6 concentrations. Effects of sleep were not mediated by changes in cortisol. The decrease in monocytes, NK cells, and lymphocytes, together with an increased production of IL-2 during sleep, may serve to support ongoing immune defense in extravascular lymphoid tissue during a time of diminished acute Ag challenge.

Nonpsychotic thought disorder: objective clinical identification of somatization and antisocial personality in language patterns

This report describes a new method of using language patterns to identify somatization and antisocial personality (ASPD) disorders in clinical practice. A set of definitions describing characteristic speech patterns was developed to identify "nonpsychotic thought disorder" (NPTD). Speech patterns of subjects with somatization disorder and/or ASPD were compared with those of controls. Blind raters assessed audiotaped samples of speech obtained through open-ended interviews for instances of elements of NPTD. Women with somatization or ASPD had significantly more NPTD speech responses than controls, and women with both disorders showed the greatest amount. Antisocial men did not demonstrate more NPTD than controls, nor was somatization in men associated with NPTD. Clinical attention to speech patterns in patients may help alert clinicians to these disorders in women and serve as indicators for screening for these disorders. More study is needed to develop psychometric properties of the instruments on larger samples, and to identify speech indicators of personality disorder in men. It is likely that other personality disorders, e.g., borderline personality disorder, can be identified through speech patterns, and they deserve study with these methods.

Effects of sleep and circadian rhythm on human circulating immune cells

The role of nocturnal sleep for normal immune regulation and its relation to circadian rhythm was examined in 10 men participating in two 51-h sessions. One session included two regular wake-sleep cycles; the other included a night of sustained wakefulness followed by a night of recovery sleep. Blood was collected every 3 h to determine PBMC counts, including the enumeration of monocytes, NK cells, and lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, HLA-DR+). Production of IL-1beta, TNF-alpha, IL-2, and IFN-gamma was determined after stimulation of whole blood samples with LPS and PHA, respectively. Concentrations of IL-6 and cortisol were assessed in plasma. Enumeration of cells indicated significant circadian rhythms for all PBMC subsets under conditions of sustained wakefulness. Compared with sustained wakefulness, nocturnal sleep acutely reduced the numbers of monocytes, NK cells, and counts of all lymphocyte subsets. However, in the afternoon and evening of the day following sleep, counts of NK cells and lymphocytes were significantly higher than after nocturnal wakefulness, indicating that effects of sleep interacted with those of the circadian pacemaker. Sleep markedly enhanced production of IL-2 by T cells (CD3+) but did not influence production of IL-1beta and TNF-alpha, or IL-6 concentrations. Effects of sleep were not mediated by changes in cortisol. The decrease in monocytes, NK cells, and lymphocytes, together with an increased production of IL-2 during sleep, may serve to support ongoing immune defense in extravascular lymphoid tissue during a time of diminished acute Ag challenge.

Long-term effects of Class II correction in Herbst and Bass therapy

This study compared the initial and long-term skeletal and dental effects of Herbst and Bass appliance therapy for correction of Class II malocclusion. The sample comprised 18 pairs of boys matched for growth period at the time of therapy, with similar pre-treatment sagittal and vertical jaw base relationships. One boy in each pair was treated with the Herbst and the other with the Bass appliance. At follow-up, 15 boys of the Herbst group and 17 of the Bass group were available. Lateral cephalograms in centric occlusion taken before treatment, after 6 months of treatment and at the end of growth were analysed. After 6 months of treatment the Bass appliance seemed to have a greater effect on mandibular jaw base position. The correction of overjet and sagittal molar relationship was more complete in the Herbst patients due to dental changes. At follow-up varying effects both between and within pairs were observed. Overall, the skeletal and dental changes from start of treatment to end of growth were of the same magnitude. A restraining effect on the position of the maxilla was observed in both groups, somewhat more pronounced in the Bass sample. Both treatment methods are most useful in correction of severe Class II malocclusions. It was, however, difficult to find possible differences in treatment effects between the two methods due to great individual variations of growth.

Transport of propionate across the distal colonic epithelium of guinea pig in the presence and absence of bicarbonate and of chloride

Short-chain fatty acids (SCFA) are rapidly absorbed in the large intestine. However, the mechanisms involved have not been fully delineated. Findings indicate that absorption of SCFA occurs in the undissociated form as well as by an anion exchange, whereby marked species and segmental differences are present. The guinea pig distal colon has certain peculiarities. Unidirectional fluxes of propionate across guinea pig distal colon were studied under short-circuit current conditions in Ussing chambers. Removal of bicarbonate caused reduction of mucosal-to-serosal fluxes by 30%, serosal-to-mucosal fluxes were little affected. In chloride-free solution unidirectional fluxes were also reduced. However, in the presence of transepithelial chloride-gradients with the Cl(-)-free solution only at the luminal side, no such effects were seen. Findings support the presence of SCFA(-)-HCO3- exchange in guinea pig distal colon. Chloride seems not of major importance for SCFA transport.

Mutated p53 gene is an independent adverse predictor of survival in colon carcinoma

OBJECTIVE

To evaluate the impact of p53 gene mutations on long-term survival in patients with intermediate stage carcinoma of the colon.

DESIGN

Retrospective cohort study; median follow-up of 87 months.

SETTING

Tertiary care academic medical center.

PATIENTS

Mutational analysis was conducted in a single institution in 141 consecutive patients with resected stage II (n = 71) and stage III (n = 70) colon carcinoma. Archival pathology specimens were analyzed for point mutations of exons from the p53 gene by means of amplification and direct sequencing by polymerase chain reaction.

MAIN OUTCOME MEASURES

The impact of p53 mutations and of adverse histopathologic features (i.e., poor differentiation, lymphovascular invasion, or mucin production) on patient survival.

RESULTS

Median overall survival was 64 months (95 months for patients with stage II and 34 months for patients with stage III colon carcinoma; P = .001). Presence of a p53 mutation was the single most important risk factor associated with poorer survival in both patients with stage II (P = .02) and stage III colon carcinoma (P = .006) throughout the follow-up period. A p53 mutation increased the risk of death by 2.82 times in patients with stage II and by 2.39 times in patients with stage III colon carcinoma. There was an additive effect on the cumulative risk of death between p53 mutations and adverse histopathologic variables.

CONCLUSIONS

The presence of p53 mutations carries an independent adverse prognostic value in colon cancer. These findings imply that the applicability of mutational analysis in clinical practice is likely to affect therapeutic choices in the future.