Effect of Codeposition of Polydopamine with Polyethylenimine or Poly(ethylene glycol) Coatings on Silver Nanoparticle Synthesis.

This study investigated the effects of polydopamine (PDA), PDA/polyethylenimine (PEI), and PDA/poly(ethylene glycol) (PEG) deposition on silver nanoparticle (AgNP) formation. PEI or PEG with different molecular weights was mixed with dopamine at different concentrations to obtain various PDA/PEI or PDA/PEG codepositions. These codepositions were soaked in silver nitrate solution to observe AgNPs generated on the surface and then to examine the catalytic activity of AgNPs for the reduction of 4-nitrophenol to 4-aminophenol. Results revealed that AgNPs on PDA/PEI or PDA/PEG codepositions were smaller and more dispersed than those on PDA coatings. Codeposition with 0.5 mg/mL polymer and 2 mg/mL dopamine generated the smallest AgNPs in each codeposition system. The content of AgNPs on PDA/PEI codeposition first increased and then decreased with an increase in the PEI concentration. PEI with a molecular weight of 600 (PEI600) generated a higher AgNP content than did PEI with a molecular weight of 10000. The AgNP content did not change with the concentration and molecular weight of PEG. Except for the codeposition with 0.5 mg/mL PEI600, codepositions produced less silver than did the PDA coating. The catalytic activity of AgNPs on all codepositions was better than that on PDA. The catalytic activity of AgNPs on all codepositions was related to the size of AgNPs. Smaller AgNPs exhibited more satisfactory catalytic activity. The codeposition with 0.5 mg/mL PEI600 had the highest rate constant (1.64 min-1). The systematic study provides insight into the relationship between various codepositions and AgNP generation and demonstrates that the composition of these codepositions can be tuned to increase their applicability.

Evaluation of an artificial intelligence algorithm for assisting the Paris System in reporting urinary cytology: A pilot study.

BACKGROUND: The Paris System for Reporting Urinary Cytology (TPS) has been shown to improve bladder cancer diagnosis. Advances in artificial intelligence (AI) may assist and improve the clinical workflow by applying TPS in routine diagnostic services. METHODS: A deep-learning-based algorithm was developed to identify urothelial cancer candidate cells using whole-slide images (WSIs). In the testing cohort, 131 urine cytology slides were retrospectively retrieved and analyzed using this AI algorithm. The authors compared the performance of one cytopathologist and two cytotechnologists using AI-assisted digital urine cytology. Then, the AI-assisted WSIs were evaluated in the clinical workflow. The cytopathologist first made a diagnosis by reviewing the AI-inferred WSIs and quantitative data (nuclear-to-cytoplasmic ratio and nuclear size) for each sample. After a washout period, the same cytopathologist made a diagnosis for the same samples using direct microscopy. All diagnosis results were compared with the expert panel consensus. RESULTS: The AI-assisted diagnosis by the two cytotechnologists and the one cytopathologist demonstrated performance results that were comparable to the expert panel consensus (sensitivity, 79.5% and 82.1% vs. 92.3%, respectively; specificity, 100% and 98.9% vs. 100%, respectively). Furthermore, the performance of the AI-assisted WSIs compared with the microscopic diagnosis by the cytopathologist demonstrated superior sensitivity (92.3% vs. 87.2%) and negative predictive value (96.8% vs. 94.8%). In addition, the AI-assisted reporting demonstrated near perfect agreement with the expert panel consensus (κ = 0.944) and the microscopic diagnosis (κ = 0.862). CONCLUSIONS: The AI algorithm developed by the authors effectively assisted TPS-based reporting by providing AI-inferred WSIs and quantitative data.

Key process indicators of mortality in the implementation of protocol-driven therapy for severe sepsis.

BACKGROUND/PURPOSE: Severe sepsis and septic shock are life-threatening disorders. Integrating treatments into a bundle strategy has been proposed to facilitate timely resuscitation, but is difficult to implement. We implemented protocol-driven therapy for severe sepsis, and analyzed retrospectively the key process indicators of mortality in managing sepsis. METHODS: Continuous quality improvement was begun to implement a tailored protocol-driven therapy for sepsis in a 24-bed respiratory intensive care unit (RICU) of Taichung Veterans General Hospital from January 2007 to February 2008. Patients, who were admitted to the RICU directly, or within 24 hours, were enrolled if they met the criteria for severe sepsis and septic shock. Disease severity [Acute Physiology and Chronic Health Evaluation (APACHE) II and lactate level], causes of sepsis, comorbidity and site of sepsis onset were recorded. Process-of-care indicators included resuscitation time (Tr-s), RICU bed availability (Ti-s) and the ratio of completing the elements of the protocol at 1, 2, 4 and 6 hours. The structure and process-of-care indicators reflated to mortality at 7 days after RICU admission and at RICU discharge were identified retrospectively. RESULTS: Eighty-six patients (mean age, 71 +/- 14 years, 72 men, 14 women, APACHE II, 25.0 +/- 7.0) were enrolled. APACHE II scores and lactate levels were higher for mortality than survival at 7 days after RICU admission (p < 0.01). For the process-of-care indicators, Ti-s (562.2 +/- 483.3 vs.1017.3 +/- 557.8 minutes, p = 0.03) and Tr-s (60.7 +/- 207.8 vs. 248.5 +/- 453.1 minutes, p = 0.07) were shorter for survival than mortality at 7 days after RICU admission. The logistic regression study showed that Tr-s was an important indicator. The ratio of completing the elements of protocols at 1, 2, 4 and 6 hours ranged from 70% to 90% and was not related to mortality. CONCLUSION: Protocol-driven therapy for sepsis was put into clinical practice. Early resuscitation and ICU bed availability were key process indicators in managing sepsis, to reduce mortality.

Clinical parameters associated with unsatisfactory specimens of conventional cervical smears.

Although The Bethesda System 2001 attempted to standardize the criteria for specimen adequacy, much confusion still exists, which includes the significance of unsatisfactory smears, the causes and clinical conditions related to unsatisfactory smears, and the appropriate management of unsatisfactory smears. The aim of this study is to find out the clinical factors associated with unsatisfactory cervical smears. We reviewed the medical charts of patients who received conventional Pap smears between March 2006 and August 2006 in a tertiary care center. After excluding 378 cases with incomplete demographic data, the clinical data of 7,059 cases were processed for analysis. Clinical parameters retrieved included: history of pelvic malignancy, pelvic irradiation, conization, hysterectomy, pregnancy status, within 3-months postpartum. Vaginal bleeding, abnormal vaginal discharge, intrauterine device, and cervical polyps found during pelvic examinations were also documented. The 1,397 cases with history of pelvic irradiation, pelvic malignancy, and hysterectomy were excluded. Finally, 5,662 cases were enrolled for data analysis. The relationship between clinical parameters and unsatisfactory smears were analyzed by Pearson's chi-square test with Yates' continuity correction and multivariate binary logistic regression test. The incidence of unsatisfactory smears was 4.5% (252/5,662). Clinical parameters correlated with unsatisfactory smears were postpartum status (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004), vaginal bleeding (OR = 2.02, 95% CI = 1.30-3.16, P = 0.002), and endocervical polyps (OR = 2.62, 95% CI = 1.39-4.947, P = 0.003). In conclusion, if any of these parameters are noted prior to obtaining a Pap smear, optimal collecting devices, better sampling techniques, and liquid-based cytology should be considered to decrease the incidence of unsatisfactory smears.

Should adequacy criteria in cervicovaginal cytology be modified after radiotherapy, chemotherapy, or hysterectomy?

BACKGROUND: The general criterion of an unsatisfactory Papanicolaou (Pap) test in the 2001 version of the Bethesda system is not applicable to patients after treatment with radiotherapy, chemotherapy, or hysterectomy. The current study was performed to determine whether specimen adequacy criteria for Pap tests should be modified for these conditions. METHODS: Consecutive patients who underwent conventional Pap tests between March and August 2006 were reviewed. The original reports were done according to the 2001 Bethesda system, with cellularity criteria modified in patients with a history of radiotherapy, chemotherapy, or hysterectomy. The slides of these patients were reviewed again. The degrees of cellularity, obscuring red blood cells, and inflammation were recorded. RESULTS: The final analyses included 7033 patients for which there were complete data. The original interpretation was unsatisfactory in 4.4% of all samples. When the 1337 slides obtained from patients with a history of radiotherapy, chemotherapy, and/or hysterectomy were reviewed using the general satisfactory threshold of >8000 squamous cells/slide and <75% of the epithelium obscured, the incidence of unsatisfactory Pap tests increased from 4.3% to 13.2% (176 of 1337 slides). The odds ratios for unsatisfactory Pap tests for a history of radiotherapy, chemotherapy, and age >50 years were 2.70, 2.51, and 1.39, respectively. The majority of unsatisfactory Pap tests were because of low cellularity. The lower limits of adequate cellularity after radiotherapy or chemotherapy can be set at 2000 cells/slide, which can lower the unsatisfactory rate while at the same time resulting in no increase in the false-negative rate. Hysterectomy alone was not found to be associated with unsatisfactory Pap tests. CONCLUSIONS: In patients who received pelvic radiotherapy or chemotherapy, the incidence of low-cellularity Pap tests was unacceptably high. A lower cellularity (estimated 2000 cell/slide) could be used as a satisfactory threshold.

Synergistic effect of focal adhesion kinase overexpression and hepatocyte growth factor stimulation on cell transformation.

Although an elevated level of focal adhesion kinase (FAK) has been observed in a variety of invasive human tumors, forced expression of FAK alone in cultured cells does not cause them to exhibit transformed phenotypes. Therefore, the role of FAK in oncogenic transformation remains unclear. In this study, we have demonstrated that FAK overexpression in Madin-Darby canine kidney epithelial cells rendered them susceptible to transformation by hepatocyte growth factor (HGF). Using various FAK mutants, we found that the simultaneous bindings of Src and p130(cas) were required for FAK to potentiate cell transformation. Expression of FAK-related nonkinase, kinase-deficient Src, or the Src homology 3 domain of p130(cas), which respectively serve as dominant negative versions of FAK, Src, and p130(cas), apparently reversed the transformed phenotypes of FAK-overexpressed cells upon HGF stimulation. Moreover, FAK overexpression was able to enhance HGF-elicited signals, leading to sustained activation of ERK, JNK, and AKT, which could be prevented by the expression of the Src homology 3 domain of p130(cas). Taken together, our results indicate that the synergistic effect of FAK overexpression and HGF stimulation leads to cell transformation and implicate a critical role of p130(cas) in this process.

Diagnosis of thyroid metastasis in cancer patients with thyroid mass by fine needle aspiration cytology and ultrasonography.

BACKGROUND: Thyroid metastasis is generally thought to be infrequent. To evaluate its occurrence, fine needle aspiration cytology and ultrasound of the thyroid gland were performed in nonthyroid cancer patients with thyroid mass. METHODS: A total of 20 nonthyroid cancer patients (6 males and 14 females with a mean age of 55 +/- 7 years) with thyroid mass were examined with thyroid ultrasound and fine needle aspiration cytology. Their underlying malignancies included lung cancer in 10 patients, breast cancer in 7 patients, cervical cancer in 2 patients and colon cancer in 1 patient. RESULTS: Thyroid metastases were diagnosed in 4 patients (20%), 2 with breast cancer and 2 with lung cancer. For 3 of them, thyroid ultrasound showed solitary hypoechoic nodule, and in 1 case, multiple nodular lesions were demonstrated in each lobe. In addition, neck lymph nodes were noted in 3 patients. In the remaining 16 cancer patients, thyroid ultrasound showed either multiple or solitary nodular goiter change with no neck lymph node involvement. Fine needle aspiration cytology (FNAC) yielded nonthyroid adenocarcinoma in 4 metastatic cases. The 2 breast cancer patients received finally total thyroidectomy and were still alive 1 year after operation. While in the other 2 lung cancer cases, only supportive treatment were given due to advanced stages and the patients died within months. CONCLUSIONS: Thyroid metastases could occur at a high frequency in nonthyroid cancer patients with thyroid mass from our small series. By combining FNAC with ultrasound, a clinical diagnosis of thyroid metastasis is attainable in cancer patients with thyroid mass.