Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells / Prevenção do câncer do colo uterino: Significado clínico das células glandulares atípicas

Abstract Objective To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Methods Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. Results A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. Conclusion The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.

Resumo Objetivo Determinar a prevalência de citologia com laudo de células glandulares atípicas (AGCs, na sigla em inglês) e analisar a significância clínica nas diferentes faixas etárias Métodos Estudo observacional retrospectivo, usando os dados arquivados no sistema do Instituto Nacional de Câncer no Brasil, que incluiu mulheres rastreadas entre janeiro de 2002 a dezembro de 2008. As mulheres incluídas tinham citologia com resultado de AGCs, que foram acompanhadas com colposcopia e nova citologia Resultados Um total de132,147 exames citopatológicos foram incluídos durante o período de estudo. Quinhentas e trinta e três mulheres com citologia de AGC foram identificadas e destas, 69.41% (370) foram encaminhadas para colposcopia e nova citologia. A prevalência de citologia de AGC na população estudada foi 0.4%. A maioria das mulheres (79.22%) com resultado citológico de AGC tinham idade entre 25 e 54 anos. A segunda citologia demonstrou 67.56% (250/370) de normalidade, 24.5% (91/370) de atipias escamosas, e 6.2% (23/370) de AGC. Na biopsia das mulheres com a 2ª citologia de AGC, 43.4% (10/23) tinham histologia normal, 43.4% (10/23) tinha lesões escamosas, 8.7% (2/23) tinha adenocarcinoma invasor e 1.2% (1/23) tinha laudo inconclusivo. Todas as mulheres com lesões intraepiteliais escamosas de alto grau (HSIL, na sigla em inglês) ou adenocarcinoma invasor (respectivamente 5 e 2pacientes), após a 2ª citologia com AGC, tinham 25 anos de idade ou mais. Conclusão A prevalência de citologia com AGC foi baixa na população estudada. Muitos casos de citologia com AGC apareceram em mulheres adultas, entre 25 e 54 anos de idade. Embora a maioria das pacientes tiveram histologia normal após seguimento, várias apresentaram lesões intraepiteliais escamosas ou glandulares invasoras.

Highly Expression and Purification of an Antigenic Region (D259-R462) of Adenylate Guanylate Cyclase Protein, Applicable for ELISA Test

Abstract Leptospirosis is a wide spread bacterial zoonosis that is common worldwide. The disease symptoms are mild or acute. Leptospira has pathogenic and non-pathogenic species; it has a lot of surface antigens. Adenylate Guanylate Cyclase (AGC) is a membrane protein that is found only in pathogenic species. In this study, the complete coding sequences of AGC protein of 242 pathogen serovars were investigated by bioinformatics tools. A Pattern was selected as a target sequence based on high prevalence pathogenic serovars in Iran Antigen sites; moreover, B-cell and T-cell epitopes were predicted by IEDB web server. An antigen site amino acid (D259-R462) in complete coding sequence of AGC protein was selected. This nucleotide related sequence was cloned into the pET32a+ expression vector. Expression of recombinant protein was optimized in E. coli strain Bl21-DE3 by 0.2mM IPTG after 16-hour incubation at 37 ͦ C and confirmed by 10% SDS-PAGE and western blotting. Antigenic peptide D259-R462 was highly expressed as Trx tag fusion protein. Recombinant peptide (rAcB) was purified by 6M urea from inclusion body with high extent yield 514.2 mg per 1000ml culture of E. coli. 20µg rAcB protein with montanide adjuvant was injected subcutaneously in BALB/c mice. Results showed that the recombinant peptide D259-R462 was produced significant antibody compared to adjuvant and PBS groups. The induced antibody in sera of immunized animal with Leptospira vaccine was detected by 250 ng of rAcB coated in ELISA microplate. This study demonstrated that antigenic region (D259-R462) of AGC protein might be useful for evaluation of antibody level in vaccinated animal.

An automatic gain control circuit to improve ECG acquisition

Abstract Introduction Long-term electrocardiogram (ECG) recordings are widely employed to assist the diagnosis of cardiac and sleep disorders. However, variability of ECG amplitude during the recordings hampers the detection of QRS complexes by algorithms. This work presents a simple electronic circuit to automatically normalize the ECG amplitude, improving its sampling by analog to digital converters (ADCs). Methods The proposed circuit consists of an analog divider that normalizes the ECG amplitude using its absolute peak value as reference. The reference value is obtained by means of a full-wave rectifier and a peak voltage detector. The circuit and tasks of its different stages are described. Results Example of the circuit performance for a bradycardia ECG signal (40bpm) is presented; the signal has its amplitude suddenly halved, and later, restored. The signal is automatically normalized after 5 heart beats for the amplitude drop. For the amplitude increase, the signal is promptly normalized. Conclusion The proposed circuit adjusts the ECG amplitude to the input voltage range of ADC, avoiding signal to noise ratio degradation of the sampled waveform in order to allow a better performance of processing algorithms.

Assessing the relationship among physicochemical properties of proteins with respect to hydrophobicity: A case study on AGC kinase superfamily.

Understanding the protein structures is crucial, as it is involved in every cellular activity. Several experimental techniques, such as X-Ray crystallography, nuclear magnetic resonance and electron microscopy are available to gain insight about the structure and function of a protein molecule. Gigantic data on protein structural and sequential information is deposited in various repositories regularly which provide us the scope for more theoretical studies. Hydrophobicity always plays a vital role in tertiary structure formation and behavior of a protein molecule. This study focuses on elucidating influence of several physicochemical properties on hydrophobicity of AGC kinase proteins. AGC kinase superfamily is selected due to its tremendous structural and functional variability and sequence data availability. A combined data mining and stochastic approach confirmed that out of 47 parameters, transmembrane tendency influences the target variable most, followed by percent buried residues, GRAVY (Grand Average Hydropathicity) and aliphatic index. Calculating the influence of different physicochemical parameters and their interrelation will aid tremendously in the future of protein science.

CT Findings of Acute Gangrenous Cholecystitis

PURPOSE: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. METHODS: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. RESULTS: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. CONCLUSION: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis

Clinical Predictive Factors for Acute Gangrenous Cholecystitis

PURPOSE: The postoperative morbidity and mortality for acute gangrenous cholecystitis (AGC) are higher than for acute nongangrenous cholecystitis (ANGC). However, preoperative predictive factors for the outcome of gangrenous cholecystitis have not been identified. The goal of this study was to determine the preoperative clinical predictive factors for the outcome of surgical treatment for acute gangrenous cholecystitis. METHODS: From January 2005 to December 2006, the medical records of 173 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed and analyzed retrospectively. RESULTS: Among 173 patients with acute cholecystits, 57 (32.9%) had pathologically confirmed gangrenous cholecystits. Six variables were found to be associated with gangrenous cholecystits by univariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, fever (> or =37 degrees), an increased white blood cell count (> or = 15,450/mm3) and glucose. Four variables were identified that were associated with gangrenous cholecystits by multivariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3). CONCLUSION: The results of this study suggest that patients with an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3) have an increased risk of gangrenous cholecystitis and require immediate surgery.

Clinical significance of atypical glandular cells on Pap smear / 부인종양

OBJECTIVE: We determine the rate of an atypical glandular cells (AGC) on cervical cytology and the incidence of clinical significant lesion on subsequent follow up biopsies. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells (AGC). METHODS: A total of 60,174 Pap smears were obtained between January 1st 2000 and December 31th 2005 at Ewha Womans University Mokdong Hospital. Among these smears, 26 patients had a diagnosis of AGC. Follow up was available for 23 patients (88.5%) and these patients had histologic follow up including cervical biopsy, endocervical curettage (ECC), and/or endometrial biopsy (EMB). RESULTS: Among 23 patients with AGC, eight (34.8%) were found to have a clinically significant malignant lesions on subsequent histologic follow up, including 2 endometrial adenocarcinoma cases, 1 cervical adenosquamous cell carcinoma case, 1 endocervical adenocarcinoma case, 2 vault adenocarcinoma cases, 1 MMMT case and 1 squamous cell carcinoma case. We found the differences in incidence of malignant lesions between premenopausal (23.5%) and postmenopausal (66.8%) patients with marginal significance (p=0.057). CONCLUSION: The incidence of AGC in Pap smear was 0.04%. The patients with AGC had a substantial risk of having a significant number of squamous or glandular, premalignant or malignant lesions. This study strongly suggests the need for the close follow up of patients with a diagnosis of AGC, especially in postmenopausal women.

The Results of Total Knee Arthroplasty with AGC(R) System(More than 5-Year Follow-up)

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of AGC(R)(Anatomical Graduated Components, Biomet, USA) total knee arthroplasty(TKA) retrospectively. MATERIALS AND METHODS: Out of 121 cases who underwent TKA with AGC(R) knee system, 90 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survial rate were evaluated. RESULTS: Average flexion contracure was improved from 10.4degrees preoperatively to 0.6degrees at final follow-up and average ROM was improved from 107.5 degrees preoperatively to 120.9 degrees at final follow-up (p<0.05). Average HSS score was improved from 52.2 preoperatively to 81.5 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 6.3 degrees varus preoperatively to 4.3 degrees valgus at final follow-up. There were 6 complications, including infection in three cases, patellar dislocation, supracondylar fracture and aseptic loosening in one case respectively. Survival rate was 96.7 percent. CONCLUSION: AGC(R) TKA showed excellent results and good survival rate at more than five years follow-up. However, more long-term follow-up should be necessary.