Restricted ROC curves are useful tools to evaluate the performance of tumour markers.

In Clinical Epidemiology, receiver operating characteristic (ROC) analysis is a standard approach for the evaluation of the performance of diagnostic tests for binary classification based on a tumour marker distribution. The area under a ROC curve is a popular indicator of test accuracy, but its use has been questioned when the curve is asymmetric. This situation often happens when the marker concentrations overlap in the two groups under study in the range of low specificity, corresponding to a subset of values useless for classification purposes (non-informative values). The partial area under the curve at a high specificity threshold has been proposed as an alternative, but a method to identify an optimal cut-off that separates informative from non-informative values is not yet available. In this study, a new statistical approach is proposed to perform this task. Furthermore, a statistical test associated with the area under a ROC curve corresponding to informative values only (restricted ROC curve) is provided and its properties are explored by extensive simulations. Finally, the proposed method is applied to a real data set containing peripheral blood levels of six tumour markers proposed for the diagnosis of neuroblastoma. A new approach to combine couples of markers for classification purposes is also illustrated.

Fracture resistance of root filled molar teeth restored with glass fibre bundles.

AIM: To evaluate the effect of unidirectional or woven glass fibre tapes inserted into MOD cavity preparations on the fracture resistance of root filled molar teeth. METHODOLOGY: Extracted human molar teeth were randomly divided into six groups (n = 15) : G1 - sound teeth, control; G2 - MOD cavity preparation; G3 - MOD + root canal treatment (Endo); G4 - MOD + Endo + composite resin restoration (Resin); G5 - MOD + Endo + unidirectional fibre (UF) + Resin; G6 - MOD + ;Endo + woven fibre (WF) + Resin. The teeth were subjected to a compressive fracture test in a universal testing machine. After testing, two failure modes were classified: pulp chamber floor or cusp. RESULTS: The highest and the lowest mean fracture strengths were found in sound teeth (G1) (4960N) and MOD + root canal treatment (G3) (612.84N), respectively, with significant differences from the other groups (P < 0.05). The remaining groups had statistically similar means. In G5 and G6, there was a tendency for fracture to occur in the pulp chamber floor compromising tooth integrity. CONCLUSIONS: The insertion of glass fibres into MOD cavity preparations and restoring them with composite resin was not different than molar teeth filled with composite resin only in terms of fracture resistance. Fibres placed into MOD cavities do not reinforce teeth.

Drogas: cartilha sobre maconha, cocaína e inalantes: 2ª edição 2010

Publicação didática, ilustrada, da Secretaria Nacionalde Políticas sobre Drogas - SENAD, que responde às diversas perguntas sobre o uso de drogas. Pertence à série "Por dentro do Assunto".

Detection of GD2-positive cells in bone marrow samples and survival of patients with localised neuroblastoma.

The impact of bone marrow (BM) GD2-positive cells on survival has been evaluated in 145 Italian children with localised neuroblastoma (NB) evaluated at diagnosis by anti-GD2 immunocytochemistry. Nineteen of these (13.1%) were found to be BM GD2-positive, with the number of positive cells ranging between 1 and 155 out of 1 x 10(6) total cells analysed. Seven/19 (38.8%) GD2-positive vs 12/126 (9.5%) GD2-negative patients relapsed. The 5-year event-free survival (EFS) and overall survival of the GD2-positive patients was significantly worse than that of the GD2-negative ones (62.2 vs 89.9%, P<0.001; and 74.9 vs 95.9%, P=0.005, respectively). GD2 positivity was not associated to other known risk factors, and in particular to Myc-N amplification and 1p deletion. Among Myc-N-negative patients, the EFS of those negative for both GD2 and 1p deletion was significantly better than in children positive for either one of these two markers (EFS=96.9 vs 66.0%, P<0.001). In conclusion, GD2 positivity may represent a prognostic marker for patients with non-metastatic NB without Myc-N amplification, and its combination with genetic alterations might help identifying patients that require a more careful follow-up.

Angiogenesis in a human neuroblastoma xenograft model: mechanisms and inhibition by tumour-derived interferon-gamma.

Tumour progression in neuroblastoma (NB) patients correlates with high vascular index. We have previously shown that the ACN NB cell line is tumorigenic and angiogenic in immunodeficient mice, and that interferon-gamma (IFN-gamma) gene transfer dampens ACN tumorigenicity. As IFN-gamma represses lymphocyte-induced tumour angiogenesis in various murine models and inhibits proliferation and migration of human endothelial cells, we have investigated the antiangiogenic activity of tumour-derived IFN-gamma and the underlying mechanism(s). In addition, we characterised the tumour vasculature of the ACN xenografts, using the chick embryo chorioallantoic membrane assay. We show that the ACN/IFN-gamma xenografts had a lower microvessel density and less in vivo angiogenic potential than the vector-transfected ACN/neo. The vascular channels of both xenografts were formed by a mixed endothelial cell population of murine and human origin, as assessed by the FICTION (fluorescence immunophenotyping and interphase cytogenetics) technique. With respect to ACN/neo, the ACN/IFN-gamma xenografts showed more terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling-positive human and murine endothelial cells, suggesting that inhibition of angiogenesis by IFN-gamma was dependent on the induction of apoptosis, likely mediated by nitric oxide. Once the dual origin of tumour vasculature is confirmed in NB patients, the xenograft model described here will prove useful in testing the efficacy of different antiangiogenic compounds.

Alcohol use among adolescents in São Paulo, Brazil.

Drinking habits was studied in a sample of 3114 students from a low socioeconomic level and aging from 9 to 18 years. Males and females were equally represented in the sample. The survey showed that 27% were non-drinkers, 54% experimental drinkers, 14% moderate regular drinkers and 5% excessive regular drinkers. The excessive regular drinkers reported a higher proportion of heavy alcohol consumption among close relatives, mainly fathers. Sex and age-related differences were found in the drinking pattern. Males as well as oldest students were over represented among the drinkers excepted for excessive regular drinkers where no age difference was detected. This finding (same proportion of excessive regular drinkers in all age groups) was discussed taking into account the possibility that the high drop out rates in Brazilian schools could be introducing a bias in the figures found for the oldest adolescent groups. Beliefs about drinking consequences and location where most drinking occurs were also studied.