Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study.

AIMS: To examine the prevalence and person-level predictors of undiagnosed Type 2 diabetes among adults with elevated HbA1c values. METHODS: We identified adults without diabetes who had a first elevated HbA1c (index HbA1c ≥ 48 mmol/mol; ≥ 6.5%) between January 2014 and December 2015, and classified them by Type 2 diabetes diagnosis status at 1 year following this result. Multilevel modelling techniques were used to examine the association of individual demographic, clinical, and utilization characteristics with remaining undiagnosed. We quantified differences in early Type 2 diabetes care between diagnosed and undiagnosed individuals. RESULTS: Of the 18 356 adults with a first elevated index HbA1c , 30.2% remained undiagnosed with Type 2 diabetes 1 year later. Individuals with lower index HbA1c values [adjusted odds ratio (aOR) 5.95, 95% confidence interval (CI) 5.21-6.78 for 48 to <53 mmol/mol (6.5% to 7.0%); referent 53 to <64 mmol/mol (7.0% to <8.0%)], who were ≥ 70 years old (aOR 1.40, 95% CI 1.24-1.59; referent 50-59 years), and who had a prior prediabetes diagnosis (aOR 1.35, 95% CI 1.24-1.47; referent no prediabetes) had increased odds of remaining undiagnosed. After adjusting for age, race, and index HbA1c , remaining undiagnosed was associated with lower odds of initiating metformin (aOR 0.06, 95% CI 0.05-0.07). CONCLUSIONS: Almost one-third of adults with an elevated HbA1c value were not diagnosed with Type 2 diabetes within 1 year. Undiagnosed Type 2 diabetes, in turn, was associated with differences in early care. Strategies that leverage the electronic health record to facilitate earlier diagnosis may help reduce delays and allow for early intervention towards the goal of improved outcomes.

Structural and biophysical characterization of Rv3716c, a hypothetical protein from Mycobacterium tuberculosis.

Latent tuberculosis (TB) is the main hurdle in reaching the goal of "Stop TB 2050". Tuberculin skin and Interferon-gamma release assay tests used currently for the diagnosis of TB infection cannot distinguish between active disease and latent tuberculosis infection (LTBI) and hence new and sensitive protein markers need to be identified for the diagnosis. A protein Rv3716c from Mycobacterium tuberculosis (MtbRv3716c) has been identified as a potential surrogate marker for the diagnosis of LTBI. Here, we present characterization of MtbRv3716c (∼13 kDa) using both biophysical and X-Ray crystallographic methods. EMSA study showed that MtbRv3716c binds to double stranded DNA. X-ray diffraction data collected on a crystal of MtbRv3716c at 1.9 Å resolution was used for structure determination using the molecular replacement method. Significant electron density was not observed for the N-terminal 21 and C-terminal 41 residues in the final electron density map. The C- terminal disordered region is proline rich and displays characteristics of intrinsically disordered proteins. Although the crystal asymmetric unit contained a protomer, a tight dimer could be generated by the application of the crystal two-fold symmetry parallel to the b axis. Packing of dimers in the crystal is mediated by a cadmium ion (Cd2+) occurring at the interface of two dimers. Molecular packing analysis reveals large cavities that are probably occupied by the disordered segments of the N- and C-termini. Structural comparison with other homologous hypothetical DNA binding proteins (PDB codes: 1PUG, 1YBX) highlights structural features that might be significant for DNA binding.

Highly selective non-enzymatic electrochemical sensor based on a titanium dioxide nanowire-poly(3-aminophenyl boronic acid)-gold nanoparticle ternary nanocomposite.

A novel three component (titanium dioxide nanowire (TiO2 NW), poly(3-aminophenyl boronic acid) (PAPBA) and gold nanoparticles (Au NPs)) based ternary nanocomposite (TNC) (designated as TiO2 NW/PAPBA-Au TNC) was prepared by a simple two-stage synthetic approach and utilized for the fabrication of a non-enzymatic (enzyme-free) glucose (NEG) sensor. In stage 2, the PAPBA-Au NC was formed by oxidative polymerization of 3-APBA using HAuCl4 as oxidant on the surface of pre-synthesized TiO2 NW via electrospinning (stage 1). The formation of PAPBA-Au NC as the shell on the surface of the TiO2 NW (core) was confirmed by field emission scanning electron microscopy (FE-SEM). Notably, we obtained a good peak to peak separation, and a high peak current for the redox Fe(CN)6 3-/4- process indicating excellent electron transfer capability at the glassy carbon electrode (GCE)/TiO2 NW/PAPBA-Au TNC interface. Also, the fabricated TiO2 NW/PAPBA-Au TNC provides excellent electrocatalytic activity towards glucose detection in neutral (pH = 7.0) phosphate buffer solution. The detection of glucose was monitored using differential pulse voltammetry. The obtained sensitivity and detection limits are superior to many of the TiO2 based enzymatic and non-enzymatic glucose sensors reported in the literature. Furthermore, the TiO2 NW/PAPBA-Au TNC sensor is preferred because of its high selectivity to glucose in the presence of co-existing interfering substances and practical application for monitoring glucose in human blood serum samples.

Enhanced photoelectrochemical biosensing performances for graphene (2D) - Titanium dioxide nanowire (1D) heterojunction polymer conductive nanosponges.

In this work, an efficient photoelectrochemical (PEC) biosensing platform has been designed and developed based on graphene (G) through modifying it into an electroconductive polymer nanosponge (EPNS) and with the incorporation of titanium dioxide nanowires (TiO2 NW) (designated as TiO2 (G) NW@EPNS). Functioning as an efficient immobilization matrix for immobilization of the enzyme Cytochrome C (Cyt C), TiO2 (G) NW@EPNS delivers features for an efficient PEC biosensor, such as fast kinetics of direct electron transfer (DET) to the electrode and effective separation of photogenerated holes and electrons. TiO2 (G) NW@EPNS exhibited DET to the electrode with a highly heterogeneous electron transfer rate constant of 6.29±0.002s-1. The existence of TiO2, G and EPNS in conjunction facilitates DET between the electrode surface and the protein. The fabricated PEC nitrite ion (NO2-) biosensor showed superior analytical performances such as wide linear range (0.5-9000µM), lowest detection limit (0.225mM) and excellent specificity for NO2- in the presence other interferences at a very low bias potential (-0.11V). This study opens up the feasibility of fabricating a PEC biosensor for any analyte using a matrix comprising of G and a photoactive material and EPNS, because these components synergistically contribute to effective immobilization of on enzyme, DET to the electrode and simple read-out under the light.

A novel bismuth oxychloride-graphene hybrid nanosheets based non-enzymatic photoelectrochemical glucose sensing platform for high performances.

A novel non-enzymatic photoelectrochemical (PEC) glucose sensor was first constructed based on the unique two-dimensional (2D) bismuth oxychloride-graphene nanohybrid sheets (BiOCl-G NHS). We have utilized a facile hydrothermal approach for the preparation of BiOCl-G NHS. Results from cyclic voltammetric and differential pulse voltammetric measurements revealed that the BiOCl-G NHS electrode is capable of generating photocurrent for glucose when its surface is irradiated with a light source (wavelength=365nm). The photocurrents produced for the presence of glucose at the bias potential of +0.50V showed a linear dependence on glucose concentration in the range between 0.5 and 10mM and had a detection limit of 0.22mM. The PEC detection of glucose at BiOCl-G NHS was not influenced by the presence of other common interfering species. The glucose levels, as determined by the BiOCl-G NHS sensor, agreed well with those obtained by the commercial glucometers. This novel non-enzymatic PEC glucose sensor exhibited good performances, such as a wider concentration range (500µM-10mM), high sensitivity (1.878µMmM-1cm-2 (500µM-2mM) and 127.2µMmM-1cm-2 (2mM-10mM)), good selectivity, reproducibility (RSD=2.4%) and applicability to real sample (human serum).

Randomised controlled trial of alternative messages to increase enrolment in a healthy food programme among individuals with diabetes.

OBJECTIVES: We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes. METHODS: Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician's recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an 'enhanced active choice'(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message. RESULTS: We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6%) than the diabetes-specific message alone (7.6%, p=0.0016). CONCLUSIONS: Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes. TRIAL REGISTRATION NUMBER: NCT02462057.

A novel multicomponent redox polymer nanobead based high performance non-enzymatic glucose sensor.

The fabrication of a highly sensitive electrochemical non-enzymatic glucose sensor based on copper nanoparticles (Cu NPs) dispersed in a graphene (G)-ferrocene (Fc) redox polymer multicomponent nanobead (MCNB) is reported. The preparation of MCNB involves three major steps, namely: i) the preparation of a poly(aniline-co-anthranilic acid)-grafted graphene (G-PANI(COOH), ii) the covalent linking of ferrocene to G-PANI(COOH) via a polyethylene imine (PEI), and iii) the electrodeposition of Cu NPs. The prepared MCNB (designated as G-PANI(COOH)-PEI-Fc/Cu-MCNB), contains a conductive G-PANI(COOH), electron mediating Fc, and electrocatalytic Cu NPs that make it suitable for ultrasensitive non-enzymatic electrochemical sensing. The morphology, structure, and electro activities of MCNB were characterized. Electrochemical measurements showed that the G-PANI(COOH)-PEI-Fc/Cu-MCNB/GCE modified electrode exhibited good electrocatalytic behavior towards the detection of glucose in a wide linear range (0.50 to 15mM), with a low detection limit (0.16mM) and high sensitivity (14.3µAmM(-1)cm(-2)). Besides, the G-PANI(COOH)-PEI-Fc/Cu-MCNB/GCE sensor electrode did not respond to the presence of electroactive interferrants (such as uric acid, ascorbic acid, and dopamine) and saccharides or carbohydrates (fructose, lactose, d-isoascorbic acid, and dextrin), demonstrating its selectivity towards glucose. The fabricated NEG sensor exhibited high precision for measuring glucose in serum samples, with an average RSD of 4.3% and results comparable to those of commercial glucose test strips. This reliability and stability of glucose sensing indicates that G-PANI(COOH)-PEI-Fc/Cu-MCNB/GCE would be a promising material for the non-enzymatic detection of glucose in physiological fluids.

Fabrication of a novel dual mode cholesterol biosensor using titanium dioxide nanowire bridged 3D graphene nanostacks.

Herein, we fabricated a novel electrochemical-photoelectrochemical (PEC) dual-mode cholesterol biosensor based on graphene (G) sheets interconnected-graphene embedded titanium nanowires (TiO2(G)-NWs) 3D nanostacks (designated as G/Ti(G) 3DNS) by exploiting the beneficial characteristics of G and TiO2-NWs to achieve good selectivity and high sensitivity for cholesterol detection. The G/Ti(G) 3DNS was fabricated by the reaction between functionalized G and TiO2(G)-NWs. Cholesterol oxidase (ChOx) was subsequently immobilized in to G/Ti(G) 3DNS using chitosan (CS) as the binder and the dual mode G/Ti(G) 3DNS/CS/ChOx biosensor was fabricated. The electro-optical properties of the G/Ti(G) 3DNS/CS/ChOx bioelectrode were characterized by cyclic voltammetry and UV-vis diffuse reflection spectroscopy. The cyclic voltammetry of immobilized ChOx showed a pair of well-defined redox peaks indicating direct electron transfer (DET) of ChOx. The amperometric reduction peak current (at -0.05V) linearly increased with increase in cholesterol concentration. The G/Ti(G) 3DNS/CS/ChOx bioelectrode was selective to cholesterol with a remarkable sensitivity (3.82µA/cm(2)mM) and a lower detection limit (6µM). Also, G/Ti(G) 3DNS/CS/ChOx functioned as photoelectrode and exhibited selective detection of cholesterol under a low bias voltage and light irradiation. Kinetic parameters, reproducibility, repeatability, storage stability and effect of temperature and pH were evaluated. We envisage that G/Ti(G) 3DNS with its prospective characteristics, would be a promising material for wide range of biosensing applications.

Sulfated Titania-Silica Reinforced Nafion Nanocomposite Membranes for Proton Exchange Membrane Fuel Cells.

Sulfated titania-silica (SO4(2-)-/TiO2-SiO2) composites were prepared by a sol-gel method with sulfate reaction and characterized by X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDS). The nanometric diameter and geometry of the sulfated titania-silica (STS) was investigated by transmission electron microscopy (TEM). A small amount of the STS composite in the range of 0.5-3 wt% was then added as reinforcing into the Nafion membrane by water-assisted solution casting method to prepare STS reinforced Nafion nanocomposite membranes (STS-Nafion nanocomposite membranes). The additional functional groups, sulfate groups, of the nanocomposite membrane having more surface oxygenated groups enhanced the fuel cell membrane properties. The STS-Nafion nanocomposite membranes exhibited improved water uptake compared to that of neat Nafion membranes, whereas methanol uptake values were decreased dramatically improved thermal property of the prepared nanocomposite membranes were measured by thermogravimetric analysis (TGA). Furthermore, increased ion exchange capacity values were obtained by thermoacidic pretreatment of the nanocomposite membranes.

Synthesis of novel poly(amidoxime) grafted multiwall carbon nanotube gel and uranium adsorption.

This is the first report on the synthesis of a new functional nanocomposite gel containing amidoxime functionalized multiwall carbon nanotube (AO-MWNT-FNC GEL). The surface morphology of AO-MWNT-FNC GEL was investigated by field emission scanning electron microscopy. The modification of gel with amidoxine groups was confirmed by Fourier transform infra red spectroscopy. The AO-MWNT-FNC GEL provides effective binding with uranium ions as was ascertained by X-ray photoelectron spectroscopy. The AO-MWNT-FNC GEL was utilized as the new adsorbent for the recovery of uranium ions from aqueous solution. UV-visible spectroscopy was used to monitor the adsorption capacity of the AO-MWNT-FNC GEL toward uranium ions. The influence of initial uranium ion concentration and solution pH on the adsorption capacity of the AO-MWNT-FNC GEL were studied in batch experiments. The new FNC-GEL designed in this study is distinguished by higher adsorption capacity for uranium ions due to the synergistic contributions from high surface area of MWNT and the functional AO groups in FNC-GEL and exhibits potential for efficient recovery of uranium ions.

Passive approach for the improved dispersion of polyvinyl alcohol-based functionalized multi-walled carbon nanotubes/Nafion membranes for polymer electrolyte membrane fuel cells.

Multi-walled carbon nanotubes (MWCNTs) are regarded as ideal fillers for Nafion polymer electrolyte membranes (PEMs) for fuel cell applications. The highly aggregated properties of MWCNTs can be overcome by the successful cross-linking with polyvinyl alcohol (PVA) into the MWCNTs/Nafion membrane. In this study, a series of nanocomposite membranes were fabricated with the PVA-influenced functionalized MWCNTs reinforced into the Nafion polymer matrix by a solution casting method. Several different PVA contents were blended to f-MWCNTs/Nafion nanocomposite membranes followed by successful cross-linking by annealing. The surface morphologies and the inner structures of the resulting PVA-MWCNTs/Nafion nanocomposite membranes were then observed by optical microscopy and scanning electron microscopy (SEM) to investigate the dispersion of MWCNTs into the PVA/Nafion composite membranes. After that, the nanocomposite membranes were characterized by thermo-gravimetric analysis (TGA) to observe the thermal enhancement caused by effective cross-linking between the f-MWCNTs with the composite polymer matrixes. Improved water uptake with reduced methanol uptake revealed the successful fabrication of PVA-blended f-MWCNTs/Nafion membranes. In addition, the ion exchange capacity (IEC) was evaluated for PEM fuel cell (PEMFC) applications.

Non-covalent bonding interaction of surfactants with functionalized carbon nanotubes in proton exchange membranes for fuel cell applications.

Dispersion of functionalized multiwalled carbon nanotubes (MWCNTs) in proton exchange membranes (PEMs) was conducted via non-covalent bonding between benzene rings of various surfactants and functionalized MWCNTs. In the solution casting method, dispersion of functionalized MWCNTs in PEMs such as Nafion membranes is a critical issue. In this study, 1 wt.% pristine MWCNTs (p-MWCNTs) and oxidized MWCNTs (ox-MWCNTs) were reinforced in Nafion membranes by adding 0.1-0.5 wt.% of a surfactant such as benzalkonium chloride (BKC) as a cationic surfactant with a benzene ring, Tween-80 as a nonanionic surfactant without a benzene ring, sodium dodecylsulfonate (SDS) as an anionic surfactant without a benzene ring, or sodium dodecylben-zenesulfonate (SDBS) as an anionic surfactant with a benzene ring and their effects on the dispersion of nanocomposites were then observed. Among these surfactants, those with benzene rings such as BKC and SDBS produced enhanced dispersion via non-covalent bonding interaction between CNTs and surfactants. Specifically, the surfactants were adsorbed onto the surface of functionalized MWCNTs, where they prevented re-aggregation of MWCNTs in the nanocomposites. Furthermore, the prepared CNTs reinforced nanocomposite membranes showed reduced methanol uptake values while the ion exchange capacity values were maintained. The enhanced properties, including thermal property of the CNTs reinforced PEMs with surfactants, could be applicable to fuel cell applications.

A kinetic study on the formation of poly(4 aminodiphenylamine)/copper nanocomposite using UV-visible spectroscopy.

The course of the reaction between copper sulfate (CuSO4) and 4-aminodiphenylamine (4ADPA) was monitored by UV-visible spectroscopy in p-toluene sulfonic acid (p-TSA). Formation of poly(4-aminodiphenylamine)/copper nanoparticle composite (P4ADPA/CuNC) was witnessed through the steady increase in absorbance at 410, 580 and >700 nm. The absorbance at 410 nm as well as >700 nm are correlated to the amount of P4ADPA/CuNC formation and was subsequently used to determine the rate of formation of P4ADPA/CuNC (RP4ADPA/CuNC) at any time during the course of the reaction. RP4ADPA/CuNC shows a first-order dependence on [4ADPA] and a half-order dependence on [CuSO4]. A kinetic rate expression was established between RP4ADPA/CuNC and experimental parameters such as [4ADPA] and [CuSO4]. The rate constant for the formation of P4ADPA/CuNC was 8.98 × 10(-3) mol(-0.5) l(0.5) s(-1). Field emission scanning electron and transmission electron micrographs revealed that the morphology of the P4ADPA/CuNC was influenced by the reaction conditions.

Course of poly(4-aminodiphenylamine)/Ag nanocomposite formation through UV-vis spectroscopy.

Kinetics of chemical oxidative polymerization of 4-aminodiphenylamine (4ADPA) was followed in aqueous 1 M p-toluene sulfonic acid (p-TSA) using silver nitrate (AgNO3) as an oxidant by UV-vis spectroscopy. The medium was found to be clear and homogeneous during the course of polymerization. The absorbances corresponding to the intermediate and the polymer were followed for different concentrations of 4ADPA and AgNO3 and at different reaction time. The appearance of a band around 450 nm during the initial stages of polymerization corresponds to the plasmon resonance formed by the reduction of Ag+ ions. Rate of poly(4-aminodiphenylamine)/Ag nanocomposite (RP4ADPA/AgNC) was determined for various reaction conditions. R(P4ADP/AgNC) showed second order power dependence on 4ADPA and first order dependence on AgNO3. The observed order dependences of 4ADPA and AgNO3 on the formation of P4ADPA/AgNC were used to deduce a rate equation for the reaction. Rate constant for the reaction was determined through different approaches. The good agreement between the rate constants obtained through different approaches justifies the selection of rate equation.

Synthesis and characterization of polyaniline grafted multiwalled carbon nanotube loaded Nafion-silica nanocomposite membrane.

The preparation and characterization results of a new nanocomposite, polyaniline (PANI) grafted multiwalled carbon nanotube (MWNT) loaded Nafion-silica, (designated as Nafion-silica/MWNT-g-PANI), are reported in this paper. The preparation involves the formation of a silica network in a Nafion membrane and the subsequent loading of polyaniline-grafted multiwalled carbon nanotubes (MWNT-g-PANI) onto the Nafion-silica nanocomposite. The new nanocomposite, Nafion-silica/ MWNT-g-PANI, was characterized as to its morphology, structure and properties. The conductivity and methanol permeability of the nanocomposite membranes were evaluated.

Bioelectrocatalytic determination of nitrite ions based on polyaniline grafted nanodiamond.

Polyaniline chains were grafted onto nanodiamond (PANI-g-ND) through electrochemical polymerization of aniline in the presence of amine functionalized ND. A robust and effective composite film comprising PANI-g-ND/gold particles was subsequently prepared. Cytochrome c was successfully immobilized onto PANI-g-ND/Au film. Field emission scanning electron microscope (FESEM) image of PANI-g-ND/Au reveals the presence of fibrous PANI embedded into ND galleries with uniformly distributed Au clusters (∼1 µm). Direct electrochemistry and electrocatalysis of cyt c were investigated. PANI-g-ND/Au film showed an obvious direct electron transfer between cyt c and the underlying electrode. Cyclic voltammograms revealed that PANI-g-ND/Au/cyt c exhibited an excellent electrocatalysis towards the detection of nitrite ions. Differential pulse voltammetry of PANI-g-ND/Au/cyt c revealed a wide linear concentration range (0.5 µM-3 mM) for current responses, sensitivity (88.2 µA/mM) and low detection limit (0.16 µM) towards the electrochemical detection of nitrite ions.

One-pot construction of mediatorless bi-enzymatic glucose biosensor based on organic-inorganic hybrid.

A new methodology for the fabrication of bienzymatic amperometric glucose biosensor based on the use of an organic-inorganic hybrid is presented. The fabrication involves a self-assembly directed one-pot electrochemical process. Bi-enzymes, horseradish peroxidase (HRP) and glucose oxidase (GOx) are immobilized into the porous and electroactive silica-polyaniline hybrid composite through electrochemical polymerization of N[3-(trimethoxysilyl)propyl]aniline in the presence of enzymes. The modified electrode is designated as PTMSPA/HRP-GOx. The direct electron transfer of HRP is achieved at the modified electrode. Also, the electrode exhibits excellent bio-electro-catalytic activity for the reduction of hydrogen peroxide. The response current at PTMSPA/HRP-GOx modified electrode revealed a good linear relationship with concentration of glucose range between 1 and 20mM with a response time of 7s. Thus, the modified electrode shows the combined advantages of polyaniline and silica networks through synergistic influence from the individual components. The PTMSPA assembly has shown the potential for a third generation amperometric biosensor.

Pd (core)-Au (shell) nanoparticles catalyzed conversion of NADH to NAD+ by UV-vis spectroscopy--a kinetic analysis.

Kinetics of Pd (core)-Au (shell) nanoparticles (NPs) catalyzed transformation of dihydronicotinamide adenine dinucleotide (NADH) to NAD(+) was monitored by UV-vis spectroscopy. Pd (core)-Au (shell) NPs were prepared by microwave irradiation method. High resolution transmission electron microscopy image reveals the core-shell morphology. X-ray diffraction pattern shows the presence of distinct crystalline domains for Pd and Au. The changes in absorbances at 340 nm were followed for various time intervals. Rates of conversion of NADH to NAD(+) were determined for different conditions. The conversion of NADH to NAD(+) was to be first order with respect to NADH at lower concentrations (upto 0.04 mM) and pseudo-first-order beyond 0.04 mM. Rate constants for the Pd (core) Au-(shell) NPs catalyzed transformation of NADH to NAD(+) were deduced.

Ki-67 and outcome in clinically localised prostate cancer: analysis of conservatively treated prostate cancer patients from the Trans-Atlantic Prostate Group study.

Treatment decisions after diagnosis of clinically localised prostate cancer are difficult due to variability in tumour behaviour. We therefore examined one of the most promising biomarkers in prostate cancer, Ki-67, in a cohort of 808 patients diagnosed with prostate cancer between 1990 and 1996 and treated conservatively. Ki-67 expression was assessed immunohistochemically, in two laboratories, by two different scoring methods and the results compared with cancer-specific and overall survival. The power of the biomarker was compared with Gleason score and initial serum prostate-specific antigen (PSA). Both methods showed that Ki-67 provided additional prognostic information beyond that available from Gleason score and PSA: for the semi-quantitative method, Deltachi(2) (1 d.f.)=24.6 (P<0.0001), overall survival chi(2)=20.5 (P<0.0001), and for the quantitative method, Deltachi(2) (1 d.f.)=15.1 (P=0.0001), overall survival chi(2)=10.85 (P=0.001). Ki-67 is a powerful biomarker in localised prostate cancer and adds to a model predicting the need for radical or conservative therapy. As it is already in widespread use in routine pathology, it is confirmed as the most promising biomarker to be applied into routine practice.