Clinicopathological Significance of Osteopontin in Cholangiocarcinoma Cases

Laohaviroj, Marut,Chamgramol, Yaovalux,Pairojkul, Chawalit,Mulvenna, Jason,Sripa, Banchob Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.1

Cholangiocarcinoma (CCA) is generally a rare primary liver tumor of the bile duct with extremely poor clinical outcomes due to late diagnosis. Osteopontin (OPN) is the most abundant expressed gene in intrahepatic CCA and its involvement in tumor aggressiveness suggests it could be a useful prognostic biomarker. However, the prognostic significance of OPN expression in CCA is still controversial. We therefore immunohistochemically studied OPN expression in 354 resected CCAs and correlated the results with patient clinicopathological parameters. OPN expression was separately scored according to the percentage of cancer cells or degree of stromal tissue staining and classified as low (score 0-1) and high (score 2-3). OPN expression in CCA cells was found in 177 out of 354 patients (56.5%), whereas stroma was positive in 185 out of 354 patients (52.3%). Univariate analysis with several of the aforementioned parameters revealed that stromal but not cancer cell OPN expression was significantly associated with tumor size, tumor direct invasion into normal liver parenchyma, regional lymph node metastasis and higher staging. The combination of cancer cell and stromal OPN expression demonstrated a positive trend for linkage with lymph node metastasis. Multivariate analysis identified gender, the presence of lymphatic permeation and lymph node metastasis, but not OPN expression, as independent prognostic factors. This study confirms the presence of stromal OPN expression in tumor aggressiveness but not survival in CCA patients.

Assessment of interhospital transport care for pediatric patients

Chaichotjinda, Krittiya,Chantra, Marut,Pandee, Uthen The Korean Pediatric Society 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.5

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur. Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors. Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017. Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipment-related adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; P=0.028). Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

Diagnostic Accuracy of Harris Imprint Index, Chippaux-Smirak Index, Staheli Index Compared With Talar-First Metatarsal Angle for Screening Arch of Foot

Paecharoen Siranya,Arunakul Marut,Tantivangphaisal Nuttharat 대한재활의학회 2023 Annals of Rehabilitation Medicine Vol.47 No.3

Objective To determine the diagnostic accuracy and reliability of the Harris imprint index (HII), Chippaux-Smirak index (CSI), and Staheli index (SI) compared with the talar-first metatarsal angle.Methods Data was collected at the orthotic and prosthetic clinic, Thammasat University Hospital from January 1, 2016 to August 31, 2020. The three footprints were measured by the rehabilitation physician and the orthotist. The talar-first metatarsal angle was measured by the foot and ankle orthopaedist.Results The data from 198 patients with 274 feet was analyzed. The diagnostic accuracy of the footprint triad showed that CSI was the most accurate in pes planus prediction, followed by HII and SI (area under the receiver operating characteristic curve [AUROC]=0.73, 0.68, 0.68, respectively). In pes cavus, HII was the most accurate, followed by SI and CSI (AUROC=0.71, 0.61, 0.60, respectively). For pes planus, the intra-observer reliability by Cohen’s Kappa was 0.92 for HII, 0.97 for CSI, and 0.93 for SI, the inter-observer reliability 0.82, 0.85, and 0.70, respectively. For pes cavus, the intra-observer reliability was 0.89 for HII, 0.95 for CSI, and 0.79 for SI, inter-observer reliability of 0.76, 0.77, and 0.66, respectively.Conclusion The accuracy of HII, CSI, and SI was fair in screening of pes planus and pes cavus. The intra- and inter-observer reliability were in the moderate to almost perfect range by Cohen’s Kappa.

Association of Serum HE4 with Primary Tumor Diameter and Depth of Myometrial Invasion in Endometrial Cancer Patients at Rajavithi Hospital

Prueksaritanond, Nisa,Cheanpracha, Patchara,Yanaranop, Marut Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: Although there are no biomarkers that are routinely used in endometrial cancer (EC) management, many studies have found that serum human epididymis protein 4 (HE4) is superior to cancer antigen 125 (CA125) in the detection of EC. The correlation of HE4 with two prognostic factors for EC, primary tumor diameter (PTD) and depth of myometrial invasion (DMI) may be useful in identifying EC patients at high risk of lymphatic dissemination. Objective: To evaluate the correlation of serum HE4 with PTD and DMI in patients with EC. Materials and Methods: A cross-sectional study was conducted on 70 EC patients who were scheduled for elective surgery at Rajavithi Hospital between 1st September 2013 and 30th May 2014. Preoperative serum levels of HE4 and CA125 were investigated, and then gross measurement of PTD was taken and postoperative pathologic slides were reviewed for DMI including histologic types, grading and staging. Results: Preoperative serum HE4 levels were strongly correlated with PTD (r=0.65, p<0.001) and moderately correlated with DMI (r=0.46, p<0.001). Moreover, serum HE4 levels were significantly elevated in EC patients with PTD >2 cm (p<0.001) and DMI > 50% (p=0.004). The performance of serum HE4 in identifying EC patients at low risk and high risk of lymph node metastasis was significantly better than that of CA125 (AUC 0.88 vs. 0.65, p=0.003). At an optimal cut-off value of 70 pM/L, serum HE4 had a sensitivity of 83.3% and a specificity of 80.0%. Conclusions: In EC patients, preoperative serum HE4 is significantly correlated with PTD and DMI. Serum HE4 levels could be useful in identifying endometrial cancer patients at high risk of lymphatic spread who would benefit from systemic lymphadenectomy at the cut-off value of 70 pM/L.

Impact of common genetic determinants of Hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: A transethnic genome-wide meta-analysis

Wheeler, Eleanor,Leong, Aaron,Liu, Ching-Ti,Hivert, Marie-France,Strawbridge, Rona J.,Podmore, Clara,Li, Man,Yao, Jie,Sim, Xueling,Hong, Jaeyoung,Chu, Audrey Y.,Zhang, Weihua,Wang, Xu,Chen, Peng,Marut Public Library of Science 2017 PLoS medicine Vol.14 No.9

<▼1><P><B>Background</B></P><P>Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated with erythrocyte traits) or glycemic (associated with other glucose-related traits). In this study, we tested the hypotheses that, in a very large scale GWAS, we would identify more genetic variants associated with HbA1c and that HbA1c variants implicated in erythrocytic biology would affect the diagnostic accuracy of HbA1c. We therefore expanded the number of HbA1c-associated loci and tested the effect of genetic risk-scores comprised of erythrocytic or glycemic variants on incident diabetes prediction and on prevalent diabetes screening performance. Throughout this multiancestry study, we kept a focus on interancestry differences in HbA1c genetics performance that might influence race-ancestry differences in health outcomes.</P><P><B>Methods & findings</B></P><P>Using genome-wide association meta-analyses in up to 159,940 individuals from 82 cohorts of European, African, East Asian, and South Asian ancestry, we identified 60 common genetic variants associated with HbA1c. We classified variants as implicated in glycemic, erythrocytic, or unclassified biology and tested whether additive genetic scores of erythrocytic variants (GS-E) or glycemic variants (GS-G) were associated with higher T2D incidence in multiethnic longitudinal cohorts (<I>N</I> = 33,241). Nineteen glycemic and 22 erythrocytic variants were associated with HbA1c at genome-wide significance. GS-G was associated with higher T2D risk (incidence OR = 1.05, 95% CI 1.04–1.06, per HbA1c-raising allele, <I>p</I> = 3 × 10<SUP>−29</SUP>); whereas GS-E was not (OR = 1.00, 95% CI 0.99–1.01, <I>p</I> = 0.60). In Europeans and Asians, erythrocytic variants in aggregate had only modest effects on the diagnostic accuracy of HbA1c. Yet, in African Americans, the X-linked <I>G6PD</I> G202A variant (T-allele frequency 11%) was associated with an absolute decrease in HbA1c of 0.81%-units (95% CI 0.66–0.96) per allele in hemizygous men, and 0.68%-units (95% CI 0.38–0.97) in homozygous women. The <I>G6PD</I> variant may cause approximately 2% (<I>N</I> = 0.65 million, 95% CI 0.55–0.74) of African American adults with T2D to remain undiagnosed when screened with HbA1c. Limitations include the smaller sample sizes for non-European ancestries and the inability to classify approximately one-third of the variants. Further studies in large multiethnic cohorts with HbA1c, glycemic, and erythrocytic traits are required to better determine the biological action of the unclassified variants.</P><P><B>Conclusions</B></P><P>As G6PD deficiency can be clinically silent until illness strikes, we recommend investigation of the possible benefits of screening for the <I>G6PD</I> genotype along with using HbA1c to diagnose T2D in populations of African ancestry or groups where <I>G6PD</I> deficiency is common. Screening with direct glucose measurements, or genetically-informed HbA1c diagnostic thresholds in people with G6PD deficiency, may be required to avoid missed or delayed diagnoses.</P></▼1><▼2><P>Ines Barroso and colleagues identify a genetic variant that leads to reduced levels of HbA1c in African American adults; 2% of this population are at risk of missed diagnosis for diabetes.</P></▼2><▼3><P><B>Author summary</B></P><P><B>Why was this study done?</B></P><P>Blood glucose binds in an irreversible manner to circulating hemoglobin in red blood cells (RBCs), generating “glycated hemoglobin,” called HbA1c. HbA1c is used to diagnose and monitor diabetes.</P><P>Previous large-scale human genetic studies have demonstrated that HbA1c is influenced by genetic variants. Some vari