A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers

PURPOSE

Men with metastatic prostate cancer experience high levels of unmet supportive care needs in current healthcare delivery. We set out to determine the effectiveness of a multimodality supportive care (ThriverCare) intervention on the prevalence of unmet supportive care needs for men and their partner/caregivers.

METHODS

A prospective parallel group, pilot randomised controlled pilot trial in 4 hospitals in Scotland. 38 participants with radiologically proven metastatic prostate cancer disease and 10 partners/caregivers were recruited into the study. A two arm 1:1 study design compared the usual standard of care (SC) approach to SC plus ThriverCare intervention. The primary outcome was the Supportive Care Needs Survey at 3 months of intervention.

RESULTS

There was no statistical significant difference in the prevalence of unmet supportive care needs between the intervention group and the usual SC group at baseline p = 0.112, however a statistically significant difference was observed at 3 months, indicating that the prevalence of unmet supportive care needs were less in the intervention group (1.13, SD 2.5) compared to the usual SC (6.17, SD 7.05), p = 0.002.

CONCLUSION

ThriverCare appears to improve the supportive care experience of men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. Our results accentuate that no longer one size of care delivery fits all, care must be responsive and adaptable to meet the individual needs of people affected by cancer to thrive.

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi

BACKGROUND

Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates.

OBJECTIVES

To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction.

SELECTION CRITERIA

RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion.

DATA COLLECTION AND ANALYSIS

Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI).

MAIN RESULTS

Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately described the randomisation sequence, three studies were unclear on how they randomised, while one study had a high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a low risk of attrition bias, reporting bias, or other sources of bias identified.

AUTHORS' CONCLUSIONS

Compared with ESWL, ureteroscopic removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer hospital stay.

Coronavirus diseases 2019: Current biological situation and potential therapeutic perspective

Coronavirus Disease 2019 (COVID-19) caused by a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was first reported in Wuhan, China at the end of December 2019. SARS-CoV-2 is a highly pathogenic zoonotic virus and closely related to the Severe Acute Respiratory Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The COVID-19 was declared as a global pandemic due to its high infectiousness, and worldwide morbidities and mortalities. The Chinese scientists at the start of the outbreak reported genome sequences, which made the characterization of glycoproteins and other structural proteins possible. Moreover, researchers across the world have widely focused on understanding basic biology, developing vaccines, and therapeutic drugs against the COVID-19. However, until now, no promising treatment options, as well as vaccines, are available. In this review, we have described SARS-CoV-2's genome, transmission, and pathogenicity. We also discussed novel potential therapeutic agents that can help to treat the COVID-19 patients.

Sickle cell disease in childhood in Madina

BACKGROUND

Sickle cell disease (SCD) is a common disease in Saudi Arabia, with a high prevalence in the Eastern and Southern regions. This study reports on 53 cases of SCD encountered in the Madina area.

PATIENTS AND METHODS

In a retrospective study of 6000 pediatric patients, 53 children (0.88%) with sickle cell disease were admitted in the Maternity and Childrenâs Hospital at Madina, between November 1990 and October 1991. Of these, 39 patients (73.58%) were Saudis and 14 (26.41%) were non-Saudis.

RESULTS

Thirty-six patients were homozygous SS and 17 were sickle thalassemic. The main causes of admission were vaso-occlusive crisis (77.35%), infection (67.92%), acute chest syndrome (22.64%), anemia (12.6%), and cerebrovascular accident (9.43%). The lowest and highest age groups recorded in this study were six months and 12 years, respectively. About 70% of the patients are still being followed up, and none of the patients has died.

CONCLUSION

. This disease is one of the major causes of morbidity in this region of Saudi Arabia. Measures required include neonatal screening programs for the early detection of the disease, as well as research into new drugs to counter the disease.

Chromosomal aberrations in renal cell carcinoma: An overview with implications for clinical practice

Chromosomal instability and aberrations are known in many cancers including renal cell carcinoma. Detailed understanding of these changes has led to an improved drug discovery and continued developments in other therapeutic options. Chromosomal aberrations have a potential to be used to monitor disease including prognostication. There has been a growing experience in cytogenetic techniques and gap between clinic and laboratory has narrowed significantly in the recent past. Nevertheless, more work on validation of these techniques, establishing threshold and interobserver agreement needs to be carried out for these diagnostic/prognostic tests before utilizing them in clinics as a part of “personalized medicine” care. The review presented here is a summary of common genetic disorders in renal cancer and some of acquired genetic changes which can be used as biomarkers. The review also describes basics of commonly used genetic techniques for wider clinical community involved in the management of renal cancer.

Computer based receptogram approach: an objective way of assessing immunohistochemistry of androgen receptor staining and its correlation with hormonal response in metastatic carcinoma of prostate

AIMS

To categorise the immunostaining heterogeneity of androgen receptors in metastatic carcinoma of the prostate using a pattern oriented approach and to correlate the results with response to hormonal treatment.

METHODS

Paraffin wax embedded tumour sections from 85 patients with metastatic carcinoma of the prostate were processed for immunocytochemistry and stained for the androgen receptor using antiandrogen receptor antibodies. A computer based image analysis system was used to analyse the pattern of nuclear immunostaining in a minimum of 500 nuclei/slide. Depending on the nuclear receptor content and concentration, receptogram patterns were established for each specimen. The receptogram pattern was correlated with clinical response to hormonal treatment.

RESULTS

Clinical response to hormonal treatment was documented using prostate specific antigen as the marker into responders (good, fair, stable) and non-responders. Forty four of 48 patients who responded to hormonal treatment had type 1 (35) or type 3 (nine) receptograms, which are characterised by a unimodal peak or multimodal peaks within a narrow concentration range. Thirteen of the 18 patients who stabilised had type 1 or type 3 receptograms. Seventeen of the 19 patients who did not respond to hormonal treatment had either type 2 or type 4 receptograms, which are characterised by skewed or bimodal androgen receptor distribution. Positive and negative predictive values of receptograms were 96.5% and 63%, respectively.

CONCLUSIONS

Image analysis of androgen receptor immunostaining with a receptogram oriented approach provides important prognostic information that can be used to predict response to hormone treatment in patients with metastatic carcinoma of the prostate.

Therapeutic Transarterial Embolisation in the management of benign and malignant renal conditions

PURPOSE

The aim of this study was to critically appraise the efficacy and complications of Therapeutic Transarterial Embolisation (TAE) in various benign and malignant renal conditions.

MATERIAL AND METHODS

The records of all patients who underwent renal embolisation procedures, at a single institution, between March 1992 and March 2004, were reviewed. The patients were identified from hospital records via the procedure coding system and the radiology department procedures book and were analysed retrospectively. Twenty-nine patients were analysed, looking at indications, clinical outcome, complications and long-term results.

RESULTS

Twenty-nine patients underwent 35 embolisation procedures during this period. Fourteen patients with benign diseases underwent 17 embolisation procedures for haematuria or intractable pain. In the haematuria group, selective embolisation was used to treat bleeding post percutaneous nephrolithotomy (PCNL) (n=4), angiomyolipoma (n=2), arteriovenous (AV) malformation (n=l1), renal artery aneurysm (n=1) and renal trauma (n=2). In the renal pain group (n=3), non-selective embolisation was done. Two of these patients had recurrence of pain despite repeat embolisation and subsequently underwent nephrectomy. Fifteen patients with advanced renal malignancy, who were deemed unfit for surgery, underwent 18 embolisation procedures for symptomatic haematuria. Twelve of the 15 patients had successful outcomes with cessation of haematuria. Three patients required repeat embolisation procedures for continuing haematuria with success. There were no major embolisation-related complications. Minor complications were self-limiting and settled with conservative management.

CONCLUSION

Renal artery embolisation is effective in managing haematuria in benign and malignant renal conditions where indicated, with minor and easily treatable adverse effects

Complex renal cysts (Bosniak ≥IIF): interobserver agreement, progression and malignancy rates

Objective

The objective was to assess the interobserver agreement rate, progression rates and malignancy rates in the assessment of complex renal cysts (≥ Bosniak IIF) using a population-based database.

Methods

A regional database identified 452 complex renal cysts in 415 patients between 2009 and 2019. Each patient was tracked and followed up using a unique identifier and deterministic linkage methodology. The interobserver agreement rate between radiologists was calculated using a weighted kappa statistic. Progression and malignancy rates of cysts (Bosniak ≥IIF) over the 11-year period were calculated.

Results

The linear-weighted kappa value was 0.69 for all complex cysts. The rate of progression and regression of Bosniak IIF cysts was 4.6% (7/151) and 3.3% (5/151), respectively. All malignant IIF cysts progressed within 16 months of diagnosis. The malignancy rate of surgically resected Bosniak III and IV cysts was 79.3% (23/29) and 84.5% (39/46), respectively. Of all malignant tumours, 73.8% and 93.7% were of low ISUP grade and low stage, respectively.

Conclusions

This study further confirms that there is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification. The progression rate of Bosniak IIF cysts is low, but the malignancy rates of surgically resected Bosniak IIF, III and IV cysts are high. Benign cysts are frequently resected, and a very high proportion of histopathologically confirmed cancers in complex renal cysts are of low grade and stage.

Key Points

•There is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification.

•The rate of progression of Bosniak IIF cysts is low, and malignant cysts progress early during surveillance. Although the malignancy rates of resected Bosniak IIF, III and IV cysts are high, the rate of benign cyst resection is significant.

Electronic supplementary material

The online version of this article (10.1007/s00330-020-07186-w) contains supplementary material, which is available to authorized users.

Preventing bat-born viral outbreaks in future using ecological interventions

•Bats naturally host pathogenic viruses having epidemic and pandemic potentials. •Deforestation and expanding human population increase bat-human interactions. •Halting bat consumption, trade, and higher surveillance can stop future outbreaks.

Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

A 49-year-old man following a road traffic accident (RTA) had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter (SPC) drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection (Clavien Grade III) and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material (coil) in one arterial lumen.

Hydatid cyst of the pancreas: a case report and brief review

A 45-year-old male farmer had noticed a swelling of the left side of his hypochondrium that persisted for six months. He had no history of severe abdominal pain, jaundice, fever, or weight loss. On evaluation, the patient was found to have hydatid cyst of the pancreas. He was managed surgically. In this case report, we emphasize the preoperative diagnosis in hydatid cyst of the pancreas.

Surgical management for upper urinary tract transitional cell carcinoma

BACKGROUND

Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures.

OBJECTIVES

To determine the best surgical management option for upper tract transitional cell carcinoma.

SEARCH STRATEGY

A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings.

SELECTION CRITERIA

The following criteria that were considered for this review.Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors examined the search results independently to identify trials for inclusion.

MAIN RESULTS

We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P < 0.001) and mean time to discharge (2.3 days versus 3.7, P < 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups.

AUTHORS' CONCLUSIONS

There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach.

What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? A prospective longitudinal study

Background

Long-term complications of diabetes include cardiovascular disease, retinopathy, nephropathy, and neuropathy. Diabetic patients with prostate cancer could be at a high risk of radiation-induced acute proctitis following radical radiotherapy. Our aims were to analyse the incidence, severity, and duration of radiation proctitis in diabetic patients treated by radical radiotherapy and combined androgen deprivation for prostate cancer.

Material and methods

On the bases of inclusion and exclusion criteria 716 patients with prostate cancer were retrospectively recruited. Patients were stratified into diabetic patients and non-diabetic patients. The incidence, severity, and duration of proctitis were the main outcomes. A polynomial ordered logistic regression was fitted to determine the influence of diabetes status, age, blood pressures medication, co-morbidities, Gleason score, PSA after treatment, and tumour stage on the grades of proctitis. Time to resolution per year was modelled as a negative binomial generalised linear model.

Results

The overall mean age of patients was 67.44 (SD 6.77) years with a follow-up time of 3.36 (SD 2.05) years. Data exploratory analysis suggested that the only highly significant explanatory variable was the presence or absence of diabetes. Polynomial ordered logistic regression, however, showed that the presence (or not) of diabetes remained as the only significant predictor (t = -2.74; p = 0.0059) of severity of proctitis. A negative binomial generalised linear model showed that both grade of proctitis (z = -17.178; p < 0.001), and diabetes (z = -5.92; p < 0.001), were highly significant predictors of time to resolution.

Conclusions

Diabetic patients were significantly more likely to have proctitis after radical radiation therapy for prostate cancer. Diabetes was significantly associated with an induced risk of radiation induced proctitis and also with deceleration of its resolution.

Photodynamic versus white light-guided treatment of non-muscle invasive bladder cancer: a study protocol for a randomised trial of clinical and cost-effectiveness

INTRODUCTION

Bladder cancer is the most frequently occurring tumour of the urinary system. Ta, T1 tumours and carcinoma in situ (CIS) are grouped as non-muscle invasive bladder cancer (NMIBC), which can be effectively treated by transurethral resection of bladder tumour (TURBT). There are limitations to the visualisation of tumours with conventional TURBT using white light illumination within the bladder. Incomplete resections occur from the failure to identify satellite lesions or the full extent of the tumour leading to recurrence and potential risk of disease progression. To improve complete resection, photodynamic diagnosis (PDD) has been proposed as a method that can enhance tumour detection and guide resection. The objective of the current research is to determine whether PDD-guided TURBT is better than conventional white light surgery and whether it is cost-effective.

METHODS AND ANALYSIS

PHOTO is a pragmatic multicentre randomised controlled trial (open parallel group, non-masked and superiority trial) comparing the intervention of PDD-guided TURBT with standard white light resection in newly diagnosed intermediate and high risk NMIBC within the UK National Health Service setting. Clinical effectiveness is measured with time to recurrence. Cost-effectiveness is assessed within trial via the calculation of incremental cost per recurrence avoided and incremental cost per quality-adjusted life per year gained over 3 years and over long term through a modelling exercise over patients' lifetime.

ETHICS AND DISSEMINATION

Formal ethics review was undertaken with a favourable opinion, in line with UK regulatory procedures (REC reference number: 14/NE/1062). If reductions in time to recurrence is associated with long-term patient benefits, the cost-effectiveness evaluation will provide further evidence to inform adoption of the technology. Findings will be shared in lay media such as patient and charity forums and will be presented at key meetings and published in academic literature.Trial registration number ISRCTN84013636.

The COVID-19 infection in children and its association with the immune system, prenatal stress, and neurological complications

The Coronavirus disease 2019 (COVID-19)" caused by the "severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)" has caused huge losses to the world due to the unavailability of effective treatment options. It is now a serious threat to humans as it causes severe respiratory disease, neurological complications, and other associated problems. Although COVID-19 generally causes mild and recoverable symptoms in children, it can cause serious severe symptoms and death causing complications. Most importantly, SARS-CoV-2 can cause neurological complications in children, such as shortness of breath, myalgia, stroke, and encephalopathy. These problems are highly linked with cytokine storm and proinflammatory responses, which can alter the physiology of the blood-brain barrier and allow the virus to enter the brain. Despite the direct infection caused by the virus entry into the brain, these neurological complications can result from indirect means such as severe immune responses. This review discusses viral transmission, transport to the brain, the associated prenatal stress, and neurological and/or immunological complications in children.

Diagnosis and management of post-cesarean ureterouterine fistulae

Urinary leakage following obstetric or gynecologic surgery is a dreaded complication, most often caused by a urogenital fistula. Of these, uretero-uterine fistulae are relatively rare and pose a diagnostic and therapeutic dilemma. A 29-year-old woman presented with paradoxical incontinence of urine for 3 months. She had developed vaginal leakage of urine 2 weeks following an uneventful cesarean section. Conservative measures in the form of catheterization and bed rest did not relieve her symptoms. Subsequent examination and investigations revealed that she had a ureterouterine fistula. The case is discussed as well as the diagnostic modalities and treatment options.

Technologic developments in the field of photonics for the detection of urinary bladder cancer

Bladder cancer is a common cause of morbidity and mortality worldwide in an aging population. Each year, thousands of people, mostly men, are diagnosed with this disease, but many of them present too late to receive optimal treatment. As with all cancers, early diagnosis of bladder cancer significantly improves the efficacy of therapy and increases survival and recurrence-free survival rates. Ongoing research has identified many limitations about the sensitivity of standard diagnostic procedures in detecting early-stage tumors and precancerous changes. The consequences of this are often tumor progression and increased tumor burden, leading to a decrease in patient quality of life and a vast increase in treatment costs. The necessity for improved early detection of bladder cancer has spurred on research into novel methods that use a wide range of biological and photonic phenomena. This review will broadly discuss standard detection methodologies and their major limitations before covering novel photonic techniques for early tumor detection and staging, assessing their diagnostic accuracy for flat and precancerous changes. We will do so in the context of both cystoscopic examination and the screening of voided urine and will also touch on the concept of using photonic technology as a surgical tool for tumor ablation.

Detecting viral outbreaks in future using enhanced environmental surveillance

•Severe Acute Respiratory Syndrome Coronavirus 2 can be detected in the sewage system. •Sewage surveillance can estimate disease burden and recurrent epidemic dynamics. •Enhanced surveillance on sewage system can identify early warning calls.

Hematologic and biochemical differences between two free ranging Yangtze finless porpoise populations: The implications of habitat

The goals of this study were to compare the serum chemistry and hematology values of wild and semi-natural free-ranging Yangtze Finless Porpoises (Neophocaena asiaeorientalis ssp. asiaeorientalis) populations and to ascertain how these values change with the different environmental condition. For this study, samples were collected from 81 YFPs, 35 living in the wild and 46 living in a semi-natural reserve. Each population was divided into 8 life history categories; Male Calf, Female Calf, Juvenile Male, Juvenile Female, Adult Male, Pregnant, Lactating and Pregnant plus Lactating. Statistically significant differences in the various parameters were observed in the same life history categories for both populations. Generally, Lipid Profile, Hepatic Enzymes, Creatine Kinase, Red Blood Cells, Hemoglobin, Hematocrit and Neutrophils were significantly higher in the Tian-E-Zhou Oxbow population while, Creatinine, Phosphate, Lactate Dehydrogenase, Bilirubin and Lymphocytes were significantly higher in the Poyang Lake YFPs. Across the groups in the Tian-E-Zhou Oxbow population, a significant decrease in serum Albumin, Alkaline Phosphatase and Calcium, while a significant increase in the Neutrophils and Platelets was observed. Similarly, in the Poyang Lake, Alkaline Phosphatase levels in the Female Calves group, High Density Lipoprotein Cholesterol in Lactating group, basophil counts in Pregnant plus Lactating group, lymphocytes counts in Juvenile Females group and Globulin and Total Protein levels in Pregnant group were significantly higher. This study in health assessments can help us to understand the effect of sex, age, reproductive status and environmental conditions on the well-being of Yangtze Finless Porpoises.

Raman spectroscopy for accurately characterizing biomolecular changes in androgen-independent prostate cancer cells

Metastatic prostate cancer resistant to hormonal manipulation is considered the advanced stage of the disease and leads to most cancer-related mortality. With new research focusing on modulating cancer growth, it is essential to understand the biochemical changes in cells that can then be exploited for drug discovery and for improving responsiveness to treatment. Raman spectroscopy has a high chemical specificity and can be used to detect and quantify molecular changes at the cellular level. Collection of large data sets generated from biological samples can be employed to form discriminatory algorithms for detection of subtle and early changes in cancer cells. The present study describes Raman finger printing of normal and metastatic hormone-resistant prostate cancer cells including analyses with principal component analysis and linear discrimination. Amino acid-specific signals were identified, especially loss of arginine band. Androgen-resistant prostate cancer cells presented a higher content of phenylalanine, tyrosine, DNA and Amide III in comparison to PNT2 cells, which possessed greater amounts of L-arginine and had a B conformation of DNA. The analysis utilized in this study could reliably differentiate the 2 cell lines (sensitivity 95%; specificity 88%).