Living with uncertainty: equivocal Pap test results and the evolution of ASC terminology

Communication of equivocal findings and their significance has been a significant challenge related to Pap testing throughout its history. Terminology to report these findings has changed considerably to accommodate the changes in understanding of cervical neoplasia, and to accommodate new management strategies, tests, and technologies. This article reviews the evolution of terminology for equivocal Pap test findings from the original Papanicolaou classification to the current the Bethesda System 2001 atypical squamous cells terminology, the implication and use of these terms, and the changing landscape of cervical neoplasia screening, which prompted these terminology changes. Emerging issues related to improving risk stratification through the introduction of additional terms and the impact of human papillomavirus testing may alter terminology of equivocal findings in the future.

Research methods for studying injecting drug users in a rural centre

Targeted sampling, multiple data collection methods and peer interviewers have been used with success for studies of injecting drug users (IDUs) in main cities. This paper reports the success of a trial of these research methods with IDUs in a rural centre. Recruitment via outreach (for individual interviews and for focus groups), street intercept and service-based surveys (methadone clinic and prison based surveys) were found to be viable and to vary in their success in recruiting subgroups of IDUs. Their use in combination is recommended so that the largest possible range of IDUs can be recruited. The close involvement of peer interviewers and of an advisory group in planning and implementing these data collections was essential. Advertising was not found to be successful for recruiting to a phone-in, for focus groups nor to a community forum. Concerns about anonymity, 'paranoia' and a general lack of a cohesive IDU community were barriers to recruitment.

Pediatric columnar lined esophagus vs Barrett's esophagus: is it the time for a consensus definition

We describe the clinical, endoscopic, and histological features of all cases of Barrett's esophagus (BE) diagnosed at our institution between 2000 and 2007 following the criteria of the British Society of Gastroenterology. This society defines BE as a segment of columnar metaplasia (CLO) (whether intestinalized or not) of any length, visible endoscopically above the gastroesophageal junction and confirmed histologically. The diagnosis was challenged after immunostaining for Cdx2 (marker of intestinal differentiation). Information was collected with respect to age, symptoms, treatment, and endoscopic and histological features. Twelve children (10 males and 2 females) with a median age of 11.7 (2 to 17) years had been diagnosed with CLO-BE. Histology confirmed BE in 31 of 38 endoscopies. The initial diagnosis was reviewed according to Cdx2 results in 10 of 12 patients: Cdx2 strongly expressed in 4 cases with intestinal metaplasia (the diagnosis of BE was maintained); was negative in 4 other patients with "CLO" mucosa (reviewed diagnosis was that of expansion of the gastric cardia into the distal esophagus); and 2 patients had occasional Cdx2-positive cells showing cardia-type mucosa with goblet cells (early BE?). The estimated prevalence of CLO-BE in the pediatric population of South Yorkshire (United Kingdom) is 0.0024%, 0.8% in children referred for endoscopy and 5.5% in the children with reflux esophagitis. Characterization of the BE and confirmation of intestinal differentiation may have prognostic implications that can impact the surveillance program. Our results showed that intestinal differentiation as demonstrated with Cdx2 was only seen if goblet cells were present. A consensus definition and further studies to understand the molecular mechanisms involved in the development of BE at this age are needed.

A Stream-Wetland-Riparian (SWR) index for assessing condition of aquatic ecosystems in small watersheds along the Atlantic slope of the eastern U.S

As part of a regional study by the Atlantic Slope Consortium (ASC) to develop ecological and socioeconomic indicators of aquatic ecosystem condition, we developed and tested a protocol for rapidly assessing condition of the stream, wetland, and riparian components of freshwater aquatic ecosystems. Aspects of hydrology, vegetation, in-stream and wetland characteristics, and on-site stressors were measured in the field. The resulting metrics were used to develop an index of overall condition, termed the Stream-Wetland-Riparian (SWR) Index. Values of this Index were compared to existing biotic indices and chemical measures, and to a Landscape Index created using satellite-based land cover data and a geographic information system (GIS). Comparisons were made at several levels of spatial aggregation and resolution, from site to small watershed. The SWR Index and associated Landscape Indices were shown to correlate highly with biological indicators of stream condition at the site level and for small contributing areas. The landscape patterns prevalent throughout the entire watershed do not necessarily match the patterns found adjacent to the stream network. We suggest a top-down approach that managers can use to sequentially apply these methods, to first prioritize watersheds based on a relative condition measure provided by the Landscape Index, and then assess condition and diagnose stressors of aquatic resources at the subwatershed and site level.

Trastuzumab not for ductal carcinoma in situ?

Ductal carcinoma in situ (DCIS) is a preinvasive breast lesion accounting for approximately 30% of all newly detected breast cancers in the US. DCIS has been separated into two groups by architecture (comedo versus noncomedo) and nuclear grade. The expression of biological markers in DCIS, however, would reflect the true biologic potential of the lesion. Patients with estrogen receptor (ER)-negative, human epidermal growth factor-2 (HER-2)-positive DCIS pose a treatment challenge. They are not candidates for tamoxifen; trastuzumab has an undetermined role in DCIS. In this report, we present a case of a 45-year-old woman diagnosed with invasive breast cancer and ER-negative/HER-2-positive DCIS who developed recurrence and progression of DCIS as manifested by a new palpable mass while receiving trastuzumab as part of adjuvant treatment for invasive breast cancer. The potential clinical implications are discussed.

A randomised controlled trial of a double layer of Allevyn compared to Jellonet and proflavin as a tie-over dressing for small skin grafts

INTRODUCTION

The tie-over dressing is used to encourage skin graft take by minimising dead space, reducing seroma and haematoma formation and by graft immobilisation. Various materials have been proposed, however we have compared one of the most popular, Jellonet with a bolster of proflavin-soaked cotton wool, to a newer dressing, Allevyn foam.

PATIENTS AND METHODS

Sixty patients were recruited and randomised into either group. Any patient requiring surgery involving a split or full thickness graft due to be carried out in the outpatient department on any site was invited to participate. Outcome measures included percentage take, pain on dressing removal (visual analogue scale) and infection. Ethical approval was obtained from the North and Mid Essex Local Research Ethics Committee.

RESULTS

There was no statistical difference in graft take between the two groups at day 5 (P=0.963). The Allevyn dressing was statistically more comfortable (P=0.0182).

DISCUSSION

We propose that Allevyn foam provides an effective and comfortable method for securing small split and full thickness skin grafts. While offering equal levels of graft take, improved levels of comfort may lend itself to use in sensitive areas such as the nose, ear and around the eye.

Convective flow effects on DNA biosensors

We explore theoretic limits of convective flux effects, as a function of species concentrations and sample volume, in biosensing systems containing target species with differing affinities. A finite element method is used to simulate mass transport of DNA through a microfluidic chamber to the sensing surface where hybridization of DNA is modeled using the corresponding kinetic equations. Our results show enhancements due to convection are controlled by the concentration and sample volume of the lower affinity species, while the upper-limit of the enhancements are determined by the concentration and sample volume of the higher affinity species. Additionally, enhancements are controlled by the degree of competition between the two species, which is related to the total fraction of binding sites used.

Competitive displacement of DNA during surface hybridization

Using real-time dual-color fluorescence detection, we have experimentally tracked individual target species during competitive DNA surface hybridization in a two-component sample. Our experimental results demonstrate displacement of the lower affinity species by the higher affinity species and corroborate recent theoretical models describing competitive DNA surface hybridization. Competition at probe sites complementary to one of the two DNA species was monitored in separate experiments for two different target pairs. Each pair differs in sequence by a single nucleotide polymorphism, and one pair includes a folding target. We propose a mechanistic interpretation of the differences between hybridization curves of targets in multi-component and single-component experiments.

beta-Catenin/Wnt signaling regulates expression of the membrane type 3 matrix metalloproteinase in gastric cancer

Activation of Wnt signaling through beta-catenin dysregulation occurs in numerous human tumors, including gastric cancer. The specific consequences of Wnt signaling in gastric cancer, however, are not well characterized. This study shows that the introduction of mutant beta-catenin into gastric cancer cell lines by adenoviral infection enhances invasiveness and proliferation and up-regulates the expression of the gene encoding the matrix metalloproteinase (MMP) family member membrane type 3 MMP (MT3-MMP). Up-regulation of MT3-MMP is critical to the invasive phenotype as shown by small interfering RNA (siRNA) studies. Immunohistochemical staining also showed that MT3-MMP was highly expressed in gastric cancers with activating beta-catenin mutations. These observations suggest that Wnt activation may contribute to gastric cancer progression by increasing the invasiveness of neoplastic cells in the stomach via up-regulation of MT3-MMP expression.