First observation of top quark production in the forward region

Top quark production in the forward region in proton-proton collisions is observed for the first time. The W+b final state with W→μν is reconstructed using muons with a transverse momentum, p_{T}, larger than 25 GeV in the pseudorapidity range 2.0<η<4.5. The b jets are required to have 50<p_{T}<100  GeV and 2.2<η<4.2, while the transverse component of the sum of the muon and b-jet momenta must satisfy p_{T}>20  GeV. The results are based on data corresponding to integrated luminosities of 1.0 and 2.0  fb^{-1} collected at center-of-mass energies of 7 and 8 TeV by LHCb. The inclusive top quark production cross sections in the fiducial region are σ(top)[7  TeV]=239±53(stat)±33(syst)±24(theory)  fb,σ(top)[8  TeV]=289±43(stat)±40(syst)±29(theory)  fb.These results, along with the observed differential yields and charge asymmetries, are in agreement with next-to-leading order standard model predictions.

Measurement of the ratio of branching fractions B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ})

The branching fraction ratio R(D^{*})≡B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ}) is measured using a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ}. The semitauonic decay is sensitive to contributions from non-standard-model particles that preferentially couple to the third generation of fermions, in particular, Higgs-like charged scalars. A multidimensional fit to kinematic distributions of the candidate B[over ¯]^{0} decays gives R(D^{*})=0.336±0.027(stat)±0.030(syst). This result, which is the first measurement of this quantity at a hadron collider, is 2.1 standard deviations larger than the value expected from lepton universality in the standard model.

Observation of J/ψp Resonances Consistent with Pentaquark States in Λ_{b}^{0}→J/ψK^{-}p Decays

Observations of exotic structures in the J/ψp channel, which we refer to as charmonium-pentaquark states, in Λ_{b}^{0}→J/ψK^{-}p decays are presented. The data sample corresponds to an integrated luminosity of 3 fb^{-1} acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude analysis of the three-body final state reproduces the two-body mass and angular distributions. To obtain a satisfactory fit of the structures seen in the J/ψp mass spectrum, it is necessary to include two Breit-Wigner amplitudes that each describe a resonant state. The significance of each of these resonances is more than 9 standard deviations. One has a mass of 4380±8±29 MeV and a width of 205±18±86 MeV, while the second is narrower, with a mass of 4449.8±1.7±2.5 MeV and a width of 39±5±19 MeV. The preferred J^{P} assignments are of opposite parity, with one state having spin 3/2 and the other 5/2.

Observation of the B(s)(0)→η'η' Decay

The first observation of the B(s)(0)→η'η' decay is reported. The study is based on a sample of proton-proton collisions corresponding to 3.0  fb(-1) of integrated luminosity collected with the LHCb detector. The significance of the signal is 6.4 standard deviations. The branching fraction is measured to be [3.31±0.64(stat)±0.28(syst)±0.12(norm)]×10(-5), where the third uncertainty comes from the B(±)→η'K(±) branching fraction that is used as a normalization. In addition, the charge asymmetries of B(±)→η'K(±) and B(±)→ϕK(±), which are control channels, are measured to be (-0.2±1.3)% and (+1.7±1.3)%, respectively. All results are consistent with theoretical expectations.

Measurement of CP Violation in B0→J/ψK{S}^{0} Decays

Measurements are presented of the CP violation observables S and C in the decays of B(0) and Bover ¯]0 mesons to the J/ψK(S)(0) final state. The data sample corresponds to an integrated luminosity of 3.0  fb(-1) collected with the LHCb experiment in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, and contains a total of 41 560 selected B^{0} and B[over ¯]^{0} decays. The analysis of the time evolution of these decays yields S=0.731±0.035(stat)±0.020(syst) and C=-0.038±0.032(stat)±0.005(syst). In the standard model, S equals sin(2β) to a good level of precision. The values are consistent with the current world averages and with the standard model expectations.

Measurement of the [Formula: see text] production cross-section in proton-proton collisions via the decay [Formula: see text]

The production of the [Formula: see text] state in proton-proton collisions is probed via its decay to the [Formula: see text] final state with the LHCb detector, in the rapidity range [Formula: see text] and in the meson transverse-momentum range [Formula: see text]. The cross-section for prompt production of [Formula: see text] mesons relative to the prompt [Formula: see text] cross-section is measured, for the first time, to be [Formula: see text] at a centre-of-mass energy [Formula: see text] using data corresponding to an integrated luminosity of 0.7 fb[Formula: see text], and [Formula: see text] at [Formula: see text] using 2.0 fb[Formula: see text]. The uncertainties quoted are, in order, statistical, systematic, and that on the ratio of branching fractions of the [Formula: see text] and [Formula: see text] decays to the [Formula: see text] final state. In addition, the inclusive branching fraction of [Formula: see text]-hadron decays into [Formula: see text] mesons is measured, for the first time, to be [Formula: see text], where the third uncertainty includes also the uncertainty on the [Formula: see text] inclusive branching fraction from [Formula: see text]-hadron decays. The difference between the [Formula: see text] and [Formula: see text] meson masses is determined to be [Formula: see text].

Prognostic significance of gamma-glutamyltransferase in patients with resectable esophageal squamous cell carcinoma

Gamma-glutamyltransferase (GGT) is a membrane-bound enzyme involved in the glutathione metabolism. Studies suggested that GGT was a marker of apoptotic balance and modulated tumor progression, invasion and drug resistance. Recently, GGT was shown to be associated with the progression of high-grade esophageal epithelial dysplasia to invasive carcinoma. This study was conducted to investigate the value of pre-therapeutic serum GGT levels as prognostic parameter in esophageal squamous cell carcinoma. Six hundred thirty-nine resectable esophageal squamous cell carcinoma patients were recruited in this study and were stratified into two GGT risk groups. The association of pre-therapeutic serum GGT levels and clinical-pathological parameters was examined. Univariate and multivariate survival analyses were performed. GGT serum levels were associated with gender, smoking status, TNM stage and lymph node involvement. Higher pre-therapeutic serum GGT was found in males, smoker, advanced TNM stage and lymph node positive patients. Patients assigned to the low-risk group had higher 5-year overall survival rate (53.1% vs. 33.0%, P < 0.01) and disease-free survival rate (45.2% vs. 23.4%, P < 0.01) than the high-risk group. Patients with high-risk group of GGT had 1.568 (95% confidence interval [CI], 1.259 ∼ 1.952) times the risk of death and 1.582 (95% CI, 1.286 ∼ 1.946) times the risk of disease recurrence contrast with those with low-risk group of GGT. The pre-therapeutic serum GGT is a novel independent prognostic parameter for disease-free survival and overall survival in resectable esophageal squamous cell carcinoma.

Quantitative relationship between liver fat content and metabolic syndrome in obese children and adolescents

OBJECTIVE

Previous studies have shown a significant association between quantified liver fat content (LFC) and metabolic syndrome (MetS) in adults, but the nature of this association in obese paediatric populations is unclear. The aim of this study was to investigate the quantitative relationship of LFC to MetS and its individual components in obese children and adolescents.

DESIGN

A population-based cross-sectional study.

PATIENTS AND MEASUREMENTS

One hundred and eighty-nine Chinese obese paediatric subjects aged 5-16 years were enrolled. Measurements included MetS components, as defined by the Chinese-specific version of the International Diabetes Foundation MetS criteria (MetS-CHN2012), and LFC using proton magnetic resonance spectroscopy.

RESULTS

LFC was significantly higher in subjects with MetS [median 9.7% (interquartile range 4.5-19.9%)] than without MetS [5.7% (2.0-12.8%)] (P < 0.01). LFC was also positively associated with the total number of MetS components (P for trend <0.01). In analyses adjusted for traditional risk factors, increasing levels of LFC were associated with a greater risk of MetS, hypertriglyceridaemia and low high-density lipoprotein cholesterol (P < 0.05 for all associations), but were not associated with risk of hyperglycaemia or hypertension.

CONCLUSIONS

In obese Chinese paediatric patients, quantitative measures of LFC are positively associated with the risk of MetS, hypertriglyceridaemia and low high-density lipoprotein cholesterol, independent of traditional risk factors. These findings suggest that quantitatively measured LFC may be a clinically useful marker for identifying obese paediatric who are at increased risk of developing MetS and its components.

Clinical Safety and Preliminary Efficacy of Plasmid pUDK-HGF Expressing Human Hepatocyte Growth Factor (HGF) in Patients with Critical Limb Ischemia

OBJECTIVE

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease and a major unmet public health care need. This phase I clinical study was performed to assess the safety and preliminary efficacy of naked plasmid DNA (pUDK-HGF) expressing human hepatocyte growth factor (HGF) in patients with critical limb ischemia (CLI).

DESIGN

Twenty-one patients with CLI were enrolled and randomly divided into four dose groups (4-16 mg) to receive local injection of pUDK-HGF into ischemic calf and/or thigh muscles twice on days 1 and 15. Safety, including adverse events and physiological parameters, and preliminary efficacy, including pain severity score (VAS), ulcer size, transcutaneous oxygen pressure (TcPO2), and ankle brachial index (ABI), were evaluated throughout a 3 month follow up period.

RESULTS

All doses of pUDK-HGF were well tolerated by the patients. None of the adverse effects was considered to be related to pUDK-HGF injection. Two significant clinical results were observed after pUDK-HGF administration. The mean VAS value of all patients decreased from 4.52 at baseline to 0.30 (p < .01), and pain had disappeared in 14 out of 17 evaluable patients by day 91. Two of four ulcers had completely healed, with the other two patients having more than 25% ulcer size reduction in the long axis diameter. Of five patients with gangrene, one gangrenous wound had healed completely and two patients showed marked size reduction by day 91. The mean hemodynamic parameters (ABI, TcPO2) were also improved.

CONCLUSION

Intramuscular injection of pUDK-HGF is safe, and may provide symptomatic relief for CLI patients. A larger, randomized, double blinded phase II trial will provide more information on safety and efficacy.

Emergence of a new GII.17 norovirus variant in patients with acute gastroenteritis in Jiangsu, China, September 2014 to March 2015

From September 2014 to March 2015, 23 outbreaks of norovirus (NoV) acute gastroenteritis occurred in Jiangsu, China. Partial sequencing of the NoV capsid gene suggested that 16 of the 23 outbreaks were related to a new GII.17 variant. This variant was first detected in sporadic specimens in October 2014, and became predominant in February 2015. Analysis of the RNA-dependent RNA polymerase (RdRp), and complete capsid including the protruding domain P2 sequences confirmed this GII.17 variant as distinct from previously identified GII variants.

Gankyrin drives malignant transformation of chronic liver damage-mediated fibrosis via the Rac1/JNK pathway

Hepatocarcinogenesis is a complex process involving chronic liver injury, inflammation, unregulated wound healing, subsequent fibrosis and carcinogenesis. To decipher the molecular mechanism underlying transition from chronic liver injury to dysplasia, we investigated the oncogenic role of gankyrin (PSMD10 or p28^GANK) during malignant transformation in a transgenic mouse model. Here, we find that gankyrin increased in patients with cirrhosis. In addition to more severe liver fibrosis and tumorigenesis after DEN plus CCl₄ treatment, hepatocyte-specific gankyrin-overexpressing mice (gankyrin^hep) exhibited malignant transformation from liver fibrosis to tumors even under single CCl₄ administration, whereas wild-type mice merely experienced fibrosis. Consistently, enhanced hepatic injury, severe inflammation and strengthened compensatory proliferation occurred in gankyrin^hep mice during CCl₄ performance. This correlated with augmented expressions of cell cycle-related genes and abnormal activation of Rac1/c-jun N-terminal kinase (JNK). Pharmacological inhibition of the Rac1/JNK pathway attenuated hepatic fibrosis and prevented CCl₄-induced carcinogenesis in gankyrin^hep mice. Together, these findings suggest that gankyrin promotes liver fibrosis/cirrhosis progression into hepatocarcinoma relying on a persistent liver injury and inflammatory microenvironment. Blockade of Rac1/JNK activation impeded gankyrin-mediated hepatocytic malignant transformation, indicating the combined inhibition of gankyrin and Rac1/JNK as a potential prevention mechanism for cirrhosis transition.

Cancer stem cells: targeting tumors at the source

The cancer stem cell hypothesis states that tumors rely exclusively on the continued proliferation of a subset of cancer cells that originated from normal adult stem cells. These cells have two key traits: multipotency, and self-renewal. The prolonged lifespan of stem cells makes them perfect candidates for the accumulation of carcinogenic mutations that would convert them into cancer stem cells (CSCs) no longer responsive to the many regulatory pathways in place that are responsible for tight governance of proliferation and differentiation in normal stem cells. Comprehending what these regulatory pathways are, and how their derailment contributes to oncogenic transformation, can hold the key to finding new strategies to target CSCs in order to effectively treat cancer. Additionally, what environmental factors are involved in promoting or suppressing CSC tumorigenicity requires attention. The possibility that some cancers may have clonal origins in non-stem cell populations that were able to acquire stem cell-like properties, and the lack of complete cell autonomy in carcinogenesis, suggests that the CSC hypothesis is continually evolving. Continued research in this field can shed light on how effective selective elimination of CSCs as opposed to generalized targeting of cancer cells will be in the treatment of cancer.

Hematopoietic stem cells: cancer involvement and myeloid leukemia

Hematopoietic stem cells (HSCs) are rare multipotent cells that possess ability to self-renew and differentiate to progenitor cells, which give rise to all blood cell lineages. The process involves specific regulation of gene transcription and its deregulation resulting in imbalance between self-renew and differentiation, can lead to cellular transformation and cancers. Substantial evidence indicates that accumulated mutations in HSCs contribute to the initiation and pathogenesis of at least some hematopoietic cancers. In particular, myeloid leukemias have been extensively characterized with regard to HSC and progenitor involvement. Thus, as a focal point for scientific and therapeutic endeavours, formation of cancer cells from HSCs represents a critical area of investigation. Consequently, understanding how HSCs function and how they undergo to transformation, is of fundamental importance to get insight in their contribution to the hematopoietic cancer development.

Interactions between obesity-related copy number variants and dietary behaviors in childhood obesity

Copy number variants (CNVs) have been implicated as an important genetic marker of obesity, and gene-environment interaction has been found to modulate risk of obesity. To evaluate the associations between CNVs and childhood obesity, as well as the interactions between CNVs and dietary behaviors, we recruited 534 obese children and 508 controls from six cities in China and six candidate CNVs were screened through published genome-wide studies (GWAS) on childhood obesity. We found three loci (10q11.22, 4q25 and 11q11) to be significantly associated with obesity after false discovery rate (FDR) correction (all the p ≤ 0.05). Cumulative effect of the three positive loci was measured by the genetic risk score (GRS), showing a significant relationship with the risk of obesity (Ptrend < 0.001). The OR of obesity increased to 21.38 (95% CI = 21.19-21.55) among the 10q11.22 deletion carriers who had meat-based diets, indicating prominent multiplicative interaction (MI) between deletions of 10q11.22 and preference for a meat-based diet. Simultaneous deletions of 5q13.2 and duplications of 6q14.1 had significant MI with a preference for salty foods. Our results suggested that CNVs may contribute to the genetic susceptibility of childhood obesity, and the CNV-diet interactions modulate the risk of obesity.

Search for long-lived particles decaying to jet pairs

A search is presented for long-lived particles with a mass between 25 and 50 [Formula: see text] and a lifetime between 1 and 200[Formula: see text] in a sample of proton-proton collisions at a centre-of-mass energy of [Formula: see text] TeV, corresponding to an integrated luminosity of 0.62 [Formula: see text], collected by the LHCb detector. The particles are assumed to be pair-produced by the decay of a standard model-like Higgs boson. The experimental signature of the long-lived particle is a displaced vertex with two associated jets. No excess above the background is observed and limits are set on the production cross-section as a function of the long-lived particle mass and lifetime.

Measurement of Bc+ Production in Proton-Proton Collisions at √[s]=8 TeV

Production of Bc+ mesons in proton-proton collisions at a center-of-mass energy of 8 TeV is studied with data corresponding to an integrated luminosity of 2.0  fb-1 recorded by the LHCb experiment. The ratio of production cross sections times branching fractions between the Bc+→J/ψπ+ and B+→J/ψK+ decays is measured as a function of transverse momentum and rapidity in the regions 0<pT<20  GeV/c and 2.0<y<4.5. The ratio in this kinematic range is measured to be (0.683±0.018±0.009)%, where the first uncertainty is statistical and the second systematic.

Observation of two new Ξ(b)(-) baryon resonances

Two structures are observed close to the kinematic threshold in the Ξ(b)(0)π(-) mass spectrum in a sample of proton-proton collision data, corresponding to an integrated luminosity of 3.0  fb(-1), recorded by the LHCb experiment. In the quark model, two baryonic resonances with quark content bds are expected in this mass region: the spin-parity J(P)=(1/2)(+) and J(P)=(3/2)(+) states, denoted Ξ(b)('-) and Ξ(b)(*-). Interpreting the structures as these resonances, we measure the mass differences and the width of the heavier state to be m(Ξ(b)('-))-m(Ξ(b)(0))-m(π(-))=3.653±0.018±0.006  MeV/c(2), m(Ξ(b)(*-))-m(Ξ(b)(0))-m(π(-))=23.96±0.12±0.06  MeV/c(2), Γ(Ξ(b)(*-))=1.65±0.31±0.10  MeV, where the first and second uncertainties are statistical and systematic, respectively. The width of the lighter state is consistent with zero, and we place an upper limit of Γ(Ξ(b)('-))<0.08  MeV at 95% confidence level. Relative production rates of these states are also reported.

Determining the association between adipokine expression in multiple tissues and phenotypic features of non-alcoholic fatty liver disease in obesity

Objectives:

Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated disease, and in obesity adipokines are believed to be involved in the development of NAFLD. However, it is still not clear whether adipokines in the liver and/or adipose tissues can be related to the development of specific characteristics of NAFLD, such as steatosis and inflammation. We aimed to address this question by simultaneously examining the adipokine expression in three tissue types in obese individuals.

Methods:

We enrolled 93 severely obese individuals with NAFLD, varying from simple steatosis to severe non-alcoholic steatohepatitis. Their expression of 48 adipokines in the liver, visceral and subcutaneous adipose tissue (SAT) was correlated to their phenotypic features of NAFLD. We further determined whether the correlations were tissue specific and/or independent of covariates, including age, sex, obesity, insulin resistance and type 2 diabetes (T2D).

Results:

The expression of adipokines showed a liver- and adipose tissue-specific pattern. We identified that the expression of leptin, angiopoietin 2 (ANGPT2) and chemerin in visceral adipose tissue (VAT) was associated with different NAFLD features, including steatosis, ballooning, portal and lobular inflammation. In addition, the expression of tumor necrosis factor (TNF), plasminogen activator inhibitor type 1 (PAI-1), insulin-like growth factor 1 (somatomedin C) (IGF1) and chemokine (C-X-C motif) ligand 10 (CXCL10) in the liver tissue and the expression of interleukin 1 receptor antagonist (IL1RN) in both the liver and SAT were associated with NAFLD features. The correlations between ANGPT2 and CXCL10, and NAFLD features were dependent on insulin resistance and T2D, but for the other genes the correlation with at least one NAFLD feature remained significant after correcting for the covariates.

Conclusions:

Our results suggest that in obese individuals, VAT-derived leptin and chemerin, and hepatic expression of TNF, IGF1, IL1RN and PAI-1 are involved in the development of NAFLD features. Further, functional studies are warranted to establish a causal relationship.

Measurement of the semileptonic CP asymmetry in B0-B[over ¯]0 mixing

The semileptonic CP asymmetry in B0-B[over ¯]0 mixing, a(sl)(d), is measured in proton-proton collision data, corresponding to an integrated luminosity of 3.0  fb-1, recorded by the LHCb experiment. Semileptonic B0 decays are reconstructed in the inclusive final states D-μ+ and D*-μ+, where the D- meson decays into the K+π-π- final state and the D*- meson into the D[over ¯]0(→K+π-)π- final state. The asymmetry between the numbers of D(*)-μ+ and D(*)+μ- decays is measured as a function of the decay time of the B0 mesons. The CP asymmetry is measured to be a(sl)(d)=(-0.02±0.19±0.30)%, where the first uncertainty is statistical and the second systematic. This is the most precise measurement of a(sl)(d) to date and is consistent with the prediction from the standard model.

Precision measurement of CP violation in B(S)(0)→J/ΨK+K- decays

The time-dependent CP asymmetry in B(s)(0)→J/ψK+K- decays is measured using pp collision data, corresponding to an integrated luminosity of 3.0  fb-1, collected with the LHCb detector at center-of-mass energies of 7 and 8 TeV. In a sample of 96,000 B(s)(0)→J/ψK+K- decays, the CP-violating phase ϕs is measured, as well as the decay widths ΓL and ΓH of the light and heavy mass eigenstates of the B(s)(0)-B[over ¯]s0 system. The values obtained are ϕs=-0.058±0.049±0.006  rad, Γs≡(ΓL+ΓH)/2=0.6603±0.0027±0.0015  ps-1, and ΔΓs≡ΓL-ΓH=0.0805±0.0091±0.0032  ps-1, where the first uncertainty is statistical and the second, systematic. These are the most precise single measurements of those quantities to date. A combined analysis with Bs0→J/ψπ+π- decays gives ϕs=-0.010±0.039  rad. All measurements are in agreement with the standard model predictions. For the first time, the phase ϕs is measured independently for each polarization state of the K+K- system and shows no evidence for polarization dependence.

A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgical therapy: an observational study

BACKGROUND

Identifying patients with esophageal squamous cell carcinoma (ESCC) with negative prognostic factors, which have an extremely low survival rate, has been problematic.

METHODS

We retrospectively collected clinical data for 648 patients with lymph node-negative ESCC who were treated at the Sun Yat-Sen University Cancer Center from 1990 to 2005. Survival difference was compared using Kaplan-Meier analysis and multivariate Cox regression analysis.

RESULTS

We identified advancing age, smoking history, alcohol consumption history, decreased forced expiratory volume in 1 s (FEV1), surgical procedure, tumor location, number of resected lymph nodes, poor tumor differentiation, and surgical stage as independent prognostic risk factors. Furthermore, based on the results of multivariate analysis, we constructed a novel scoring system that included the factors of age, smoking history, alcohol consumption history, number of resected lymph nodes, tumor differentiation, and surgical stage. Risk score (RS) was computed with the scoring system, and patients were divided into Class A (RS: 0-5) and Class B (RS: 6-10). P < 0.001 indicated statistical significance. A significant difference (p < 0.001) demonstrated that Class B was strongly related to a low survival rate and poor prognosis.

CONCLUSION

We developed a new simple flexible scoring system of high prognostic significance, which has the potential to guide postoperative therapeutic strategies and follow-up frequency and to provide better prognostic information for patients and their families.

Intraoperative ultrasonography for the identification of thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer

The rate of vocal cord palsy following resection for esophageal carcinoma has increased due to lymphadenectomy around the recurrent laryngeal nerves (RLN). The aim of this pilot study was to assess the ability of intraoperative ultrasonography to detect thoracic RLN node metastases in patients with esophageal cancer. Intraoperative ultrasonography was performed during esophagectomy to assess whether RLN lymph nodes were metastatic in 10 patients with esophageal squamous cell cancer. All patients underwent RLN lymphadenectomy, and the nodes were assessed for metastasis. Three patients had pathological RLN lymph node metastases, of which one had right RLN node metastasis, and three had left RLN node metastases. For detecting right RLN lymph node metastasis, the sensitivity, specificity, and positive and negative predictive values of intraoperative ultrasonography were 100%, 33.3%, 14.3%, and 100%, respectively. For the detection of left RLN lymph node, these values were 100%, 85.7%, 75%, and 100%, respectively. This study suggests that intraoperative ultrasonography is feasible and safe to detect RLN lymph node metastases for patients with esophageal cancer. Further study will be performed to evaluate the validity and utility of this diagnostic technique.