Spermatozoa identification by the 3-plex MSRE-PCR assay: a collaborative exercise.

Identification of semen and spermatozoa is crucial in the forensic investigation of alleged sexual assault cases. In cases of alleged sexual assault where there is a long time gap between the incident and sample collection, or in cases of low sperm count, current methods have limitations of specificity, in the case of presumptive tests for semen, or the problem of recording spermatozoa by microscopy if they are few in number. A 3-plex MSRE-PCR (methylation-sensitive restriction enzyme-PCR) assay using a spermatozoa-specific DNA methylated marker to identify spermatozoa has been reported previously by our laboratory. A key advantage over current methods is the increased sensitivity and specificity. A transition from a research tool to operational use requires blind trial testing and inter-laboratory trials. We report on a collaborative exercise where reagents of the 3-plex MSRE-PCR were sent to six participating laboratories. Each laboratory used their own equipment, consumables, and the presumptive reagents conventionally for body fluid (such as acid phosphatase or PSA), DNA extraction, and quantification in practical casework. The reagents and protocol for the 3-plex MSRE-PCR assay and 9 samples were provided by the organizing laboratory. The participating laboratories were requested to fill in the questionnaire after testing. The reported results from all the six participating laboratories were concordant and the expected correct results for the presence of spermatozoa. These outcomes verified the reproducibility and feasibility of the 3-plex MSRE-PCR assay. The results also indicated that the 3-plex MSRE-PCR assay was readily accessible to forensic laboratories for integrating it into current forensic casework processes.

The Association between Cyclin Dependent Kinase 2 Associated Protein 1 (CDK2AP1) and Molecular Subtypes of Lethal Prostate Cancer.

Prostate cancer (PCa) is one of the most commonly diagnosed types of malignancy and is the second leading cause of cancer-related death in men in developed countries. Cyclin dependent kinase 2 associate protein 1(CDK2AP1) is an epigenetic and cell cycle regulator gene which has been downregulated in several malignancies, but its involvement in PCa has not yet been investigated in a clinical setting. We assessed the prognostic value of CDK2AP1 expression in a cohort of men diagnosed with PCa (n = 275) treated non-surgically by transurethral resection of the prostate (TURP) and studied the relationship between CDK2AP1 expression to various PCa molecular subtypes (ERG, PTEN, p53 and AR) and evaluated the association with clinical outcome. Further, we used bioinformatic tools to analyze the available TCGA PRAD transcriptomic data to explore the underlying mechanism. Our data confirmed increased expression of CDK2AP1 with higher Gleason Grade Group (GG) and metastatic PCa (p <0.0001). High CDK2AP1 expression was associated with worse overall survival (OS) (HR: 1.62, CI: 1.19−2.21, p = 0.002) and cause-specific survival (CSS) (HR: 2.012, CI 1.29−3.13, p = 0.002) using univariate analysis. When compared to each sub-molecular type. High CDK2AP1/PTEN-loss, abnormal AR or p53 expression showed even worse association to poorer OS and CCS and remained significant when adjusted for GG. Our data indicates that CDK2AP1 directly binds to p53 using the Co-Immunoprecipitation (Co-IP) technique, which was validated using molecular docking tools. This suggests that these two proteins have a significant association through several binding features and correlates with our observed clinical data. In conclusion, our results indicated that the CDK2AP1 overexpression is associate with worse OS and CSS when combined with certain PCa molecular subtypes; interaction between p53 stands out as the most prominent candidate which directly interacts with CDK2AP1.

Rapid ranging through evaluation of image distortion.

Distortion is an undesirable aberration found in optical imaging systems, necessitating numerical calibration. However, the fact that image distortion changes with observation distance can be used for ranging. This study developed a rapid, passive-ranging technique, which is simple, incurs low costs, results in minimal interference, and requires few parameters. After determining the location of reference points, the relationship between the normalized mean distortion of images and observation distance is described using two mathematical models, one of which is based on distortion theory and the other is derived from the curve fitting of the experimental results. Analyzing the instantaneous rate of image distortion can also assist in ranging. The proposed technique demonstrates high sensitivity at closer observation distances, but loses effectiveness as observation distances increase.

Rapid inspection method for measuring interior tilt and decenter in singlet lens.

The objective of this study was to present a high-speed, on-line means of measuring interior tilt and decentration in a singlet lens. We propose a noncontact method based on polarized optics, which provides inspection functions for the practical measurement of lenses. The proposed system was used to measure a tilted and decentered lens, and the results of which showed strong agreement with those obtained in theoretical predictions and CodeV simulations. The proposed method provides a wide field of inspection applicable to lenses with a diameter up to 70 mm. Measurement accuracy is of 0.14 deg/pixel in tilt, and 33 µm/pixel in decentration. Inspection time is only 0.78 s.

Optical imaging with spectrum aberration correction using a filtering macrolens.

A filtering macrolens was developed to simultaneously achieve macro-optical imaging and correct spectrum aberration. The macrolens was a doublet lens comprising a filtering lens and a close-up lens. The shape of the filtering lens was designed to eliminate the optical path differences between the light rays in the absorbing medium. The close-up lens was designed to decrease the effective focal length of an ordinary camera lens to provide high magnification capability and collimate the diverging beams through the filtering lens. Experimental results demonstrated that the spectrum uniformity of the macro-optical images was markedly improved by the filtering macrolens. This innovation may be used in finite conjugate optical systems.

Reduction of Viral and Bacterial Activity by Using a Self-Powered Variable-Frequency Electrical Stimulation Device.

Viruses and bacteria, which can rapidly spread through droplets and saliva, can have serious effects on people's health. Viral activity is traditionally inhibited using chemical substances, such as alcohol or bleach, or physical methods, such as thermal energy or ultraviolet-light irradiation. However, such methods cannot be used in many applications because they have certain disadvantages, such as causing eye or skin injuries. Therefore, in the present study, the electrical stimulation method is used to stimulate a virus, namely, coronavirus 229E, and two types of bacteria, namely, Escherichia coli and Staphylococcus aureus, to efficiently reduce their infectivity of healthy cells (such as the Vero E6 cell in a viral activity-inhibition experiment). The infectivity effects of the aforementioned virus and bacteria were examined under varying values of different electrical stimulation parameters, such as the stimulation current, frequency, and total stimulation time. The experimental results indicate that the activity of coronavirus 229E is considerably inhibited through direct-current pulse stimulation with a current of 25 mA and a frequency of 2 or 20 Hz. In addition, E. coli activity was reduced by nearly 80% in 10 s through alternating-current pulse stimulation with a current of 50 mA and a frequency of 25 Hz. Moreover, a self-powered electrical stimulation device was constructed in this study. This device consists of a solar panel and battery to generate small currents with variable frequencies, which has advantages of self-powered and variable frequencies, and the device can be utilized on desks, chairs, or elevator buttons for the inhibition of viral and bacterial activities.

Edge isolation of transparent conductive polymer (TCP) thin films on flexible substrates using UV laser ablation.

The purpose of this study was to directly use the writing techniques for the complex electrode edge isolation of transparent conductive polymer (TCP) thin films by a nanosecond pulsed UV laser processing system. The processing parameters including the laser pulse energy, the pulse repetition frequency, and the scan speed of galvanometers were examined to ablate the TCP films deposited on polyethylene terephtalate substrates of 188 microm thick. The thickness of TCP films was approximately 20 nm. The laser pulse repetition frequency and the scan speed of galvanometers were applied to calculate the overlapping rate of laser spots and to discuss the patterning region quality. Surface morphology, edge quality, and width and depth of edge isolated patterning structures after laser ablation process were measured by a three-dimensional confocal laser scanning microscope. In addition, the electrical conductivity of ablated TCP films was measured by a four-point probes instrument. After isolated line patterning was formed, the ablated TCP films with a better edge quality were obtained directly when the overlapping rate of laser spots, the scan speed, and the pulse repetition rate were 83.3%, 200 mm/s, and 40 kHz, respectively. The better surface morphology of electrode pattern structures was also obtained when the scan speed and the pulse repetition rate were 500 mm/s and 40 kHz, respectively.

Characterization of high density through silicon vias with spectral reflectometry.

Measurement and control is an important step for production-worthy through silicon vias etch. We demonstrate the use and enhancement of an existing wafer metrology tool, spectral reflectometer by implementing novel theoretical model and measurement algorithm for high density through-silicon via (HDTSV) inspection. It is capable of measuring depth and depth variations of array vias by Discrete Fourier Transform (DFT) analysis in one shot measurement. Surface roughness of via bottom can also be extracted by scattering model fitting. Our non-destructive solution can measure TSV profile diameters as small as 5 µm and aspect ratios greater than 13:1. The measurement precision is in the range of 0.02 µm. Metrology results from actual 3D interconnect processing wafers are presented.

Three-dimensional illumination system using dielectric liquid lenses.

A 25-pixel illumination system composed of a 5 × 5 dielectric liquid-lens (DLL) zoom module array, 25 light-emission diodes (LEDs), and a secondary optical lens demonstrates 3D light field manipulation. LEDs function as 2D illumination pixels while the DLL module array performs longitudinal illuminance adjustability by zooming each illumination pixel. A test on the similarity of two illuminance patterns between experiments and simulations shows a normalized cross correlation (NCC) higher than 0.8, indicating the feasibility of the system design. Also, the illumination system is further applied to correct a distorted light pattern on a 45° tilt screen as well as to perform light compensation on distance-differential objects.

Mechanical properties of Pt-Ir and Ni-Ir binary alloys for glass-molding dies coating.

In this study, the different compositions of Pt-Ir and Ni-Ir alloys were deposited by utilizing ion source assisted magnetron sputtering system (ISAMSS). The surface roughness and crystallite size of the Pt-Ir and Ni-Ir coatings were analyzed by atomic force microscopy (AFM) and X-ray diffraction (XRD), respectively. In addition, coatings were soaked at 700 degrees and maintained 10 min under N2 atmosphere using a glass-molding machine. The annealed coatings for oxidation test were examined by energy dispersive X-ray spectrometry (EDS) and for microhardness and reduced modulus test were evaluated by nanoindentation instrucment. The cross-sectional structures between the Pt-Ir and Ni-Ir coating layer and substrates were also examined by field emission scanning electron microscope (FESEM). The results show that surface roughness Ra from 1.25 nm to 3.426 nm was observed with increasing the Ni elements. However, the Ra is less than 2 nm measured in Ir-based coatings doped with Pt concentrations under this study. With increasing Pt and Ni doping, the microhardness of both coatings decreased significantly and the values of reduced modulus of Pt-Ir alloys are larger than that of Ni-Ir alloys. After oxidation process, the oxygen concentration of Pt-Ir coatings is less than that of Ni-Ir coatings and the Pt-Ir coatings exhibit superior properties including oxidation resistance, low surface roughness and high reduced modulus over Ni-Ir coatings, especially for the high Pt concentration coatings such as Pt-Ir 2 (55.25 at.% Pt) and Pt-Ir 3 (79.42 at.% Pt) coatings. The surface roughnesses of all specimens annealed at 700 degrees C were slightly larger than as-deposited coatings. Moreover, due to the serious oxidation occurred in Ni-Ir 3 (73.45 at.% Ni) coatings, the value of reduced modulus of this specimen coating is the lowest and the corrsponding Ra value is the largest compared with the rest of Ir-based coatings in the oxidation testing.

Surface Wettability and Electrical Resistance Analysis of Droplets on Indium-Tin-Oxide Glass Fabricated Using an Ultraviolet Laser System.

Indium tin oxide (ITO) is widely used as a substrate for fabricating chips because of its optical transparency, favorable chemical stability, and high electrical conductivity. However, the wettability of ITO surface is neutral (the contact angle was approximately 90°) or hydrophilic. For reagent transporting and manipulation in biochip application, the surface wettability of ITO-based chips was modified to the hydrophobic or nearly hydrophobic surface to enable their use with droplets. Due to the above demand, this study used a 355-nm ultraviolet laser to fabricate a comb microstructure on ITO glass to modify the surface wettability characteristics. All of the fabrication patterns with various line width and pitch, depth, and surface roughness were employed. Subsequently, the contact angle (CA) of droplets on the ITO glass was analyzed to examine wettability and electrical performance by using the different voltages applied to the electrode. The proposed approach can succeed in the fabrication of a biochip with suitable comb-microstructure by using the optimal operating voltage and time functions for the catch droplets on ITO glass for precision medicine application. The experiment results indicated that the CA of droplets under a volume of 20 µL on flat ITO substrate was approximately 92° ± 2°; furthermore, due to its lowest surface roughness, the pattern line width and pitch of 110 µm exhibited a smaller CA variation and more favorable spherical droplet morphology, with a side and front view CA of 83° ± 1° and 78.5° ± 2.5°, respectively, while a laser scanning speed of 750 mm/s was employed. Other line width and pitch, as well as scanning speed parameters, increased the surface roughness and resulted in the surface becoming hydrophilic. In addition, to prevent droplet morphology collapse, the droplet's electric operation voltage and driving time did not exceed 5 V and 20 s, respectively. With this method, the surface modification process can be employed to control the droplet's CA by adjusting the line width and pitch and the laser scanning speed, especially in the neutral or nearly hydrophobic surface for droplet transporting. This enables the production of a microfluidic chip with a surface that is both light transmittance and has favorable electrical conductivity. In addition, the shape of the microfluidic chip can be directly designed and fabricated using a laser direct writing system on ITO glass, obviating the use of a mask and complicated production processes in biosensing and biomanipulation applications.

Preference criteria for regorafenib in treating refractory metastatic colorectal cancer are the small tumor burden, slow growth and poor/scanty spread.

Given the unclear preference criteria for regorafenib in treating refractory metastatic colorectal cancer (mCRC), this study aimed to construct an algorithm in selecting right patients for regorafenib. This was a multicenter retrospective cohort study. Patients with pathology confirmed mCRC and administered with regorafenib for > 3 weeks were enrolled. Patients with good response were defined to have progression-free survival (PFS) of ≥ 4 months. The Kaplan-Meier plot was used to analyze survival. A Cox proportional hazards model was used to analyze univariate and multivariate prognostic factors and was visualized using forest plot. A clustering heatmap was used to classify patients according to responses. The decision tree and nomogram were used to construct the approaching algorithm. A total of 613 patients was analyzed. The median PFS and overall survival (OS) were 2.7 and 10.6 months, respectively. The partial response and stable disease rate are 2.4% and 36.4%. The interval between metastasis (M1) and regorafenib, metastatic status (number, liver, and brain), and CEA level were independent prognostics factors of PFS that classifies patients into three groups: good, bad and modest-1/modest-2 group with PFS > = 4 months rates of 51%, 20%, 39% and 30%, respectively. Results were used to develop the decision tree and nomogram for approaching patients indicated with regorafenib. The preference criteria for regorafenib in treating patients with refractory mCRC are small tumor burden (CEA), slow growth (interval between metastasis and regorafenib) and poor/scanty spread (metastatic status: number and sites of metastasis): The 3S rules.TRIAL registration ClinicalTrials.gov Identifier: NCT03829852; Date of first registration (February 11, 2019).

The Effects of Neoadjuvant Treatment on the Tumor Microenvironment in Rectal Cancer: Implications for Immune Activation and Therapy Response.

BACKGROUND: Because more than one neoadjuvant treatment is available for advanced rectal cancer, the aim of this study was to compare the differential clinical and pathologic effects of different combinations of chemoradiation regimens, treatment sequencing, and timing to surgery on patient outcomes. PATIENTS AND METHODS: Between January 2015 and October 2018, 126 newly diagnosed patients with rectal cancer with magnetic resonance imaging-based cT3-4 or N+ rectal disease for curative-intent treatment received 1 of 4 neoadjuvant regimens, followed by immediate surgery or delayed surgery. Whole post-neoadjuvant surgical specimens were assessed by 3-dimensional digital whole-tumor microarray imaging and immunostaining in pathology to analyze the global tumor pathologic regression grades, residual tumor distribution patterns, the extent of lymphovascular permeation, lymph node positivity, and the overall density of lymphocyte infiltration in the tumor microenvironment. These factors were further examined to identify possible correlations with clinical outcomes. RESULTS: Among the 4 neoadjuvant treatment groups, including 2 conventional regimens, we found a significant increase of stromal CD3+ and CD8+ immune infiltrates in the postneoadjuvant tumor microenvironment in the 3 groups with delayed surgery after different chemoradiation regimens compared with the group with immediate surgery after a short course of RT alone. Independent of neoadjuvant chemoradiation regimens, the post-induction high-intermediate-low stromal-infiltrating CD8+ T-cell densities corresponded to tumor regression grades, distant metastasis rates, and disease-free survival and were prognostic factors for the further stratification of patients with American Joint Committee on Cancer stage III rectal cancer into different risk groups after surgery. CONCLUSION: The effectiveness of induction strategies on tumor remission and disease recurrence in advanced rectal cancer was significantly correlated with an enhanced cytotoxic immune response in the tumor microenvironment.

Fabrication of Hydrophilic Surface on Rigid Gas Permeable Contact Lenses to Enhance the Wettability Using Ultraviolet Laser System.

The widely used rigid gas permeable (RGP) contact lenses provide higher oxygen permeability and tear exchange rate than do soft contact lenses. However, their wettability warrants improvement to enhance the wearing comfort. This study used UV laser (wavelength = 355 nm) to modify the surface properties of RGP contact lenses with materials of Boston XO® (Bausch & Lomb Incorporated). Briefly, the mesh pattern was fabricated on the RGP contact lens surface by using the laser and smoothed by using oxygen plasma; the enhanced hydrophilic efficiency was analyzed using contact angle measurement. The experiment results indicated that the contact angle of the lens material decreased by approximately 10°-20° when the pitch of mesh pattern was <50 µm under a 500-mm/s scanning speed. The oxygen plasma enhanced surface wettability with a decreased contact angle (40°). The hydrophilic characteristic of the UV laser and oxygen plasma-treated surface was twice that of oxygen plasma-treated and untreated surfaces. In the future, RGP contact lens edges could be treated with UV laser and oxygen plasma to enhance the tear wettability and wearing comfort.

Prevalence of Germline Mutations in Cancer Susceptibility Genes in Patients With Advanced Renal Cell Carcinoma.

Importance: Identification of patients with hereditary renal cell carcinoma (RCC) is important for cancer screening and, in patients with advanced disease, for guiding treatment. The prevalence of cancer-related germline mutations in patients with advanced RCC and the phenotypes associated with some rare mutations are unknown. Objectives: To examine the prevalence of germline mutations in both known RCC predisposition genes and other cancer-associated genes and to identify clinical and pathologic factors associated with germline mutations. Design, Setting, and Participants: In this cohort study conducted from October 1, 2015, to July 31, 2017, 254 of 267 patients with advanced (American Joint Committee on Cancer stage III or IV) RCC who were seen in medical oncology or urology clinics agreed to germline sequencing and disclosure of results under an institutional protocol of matched tumor-germline DNA sequencing. Main Outcomes and Measures: Mutation prevalence and spectrum in patients with advanced RCC were determined. Clinical characteristics were assessed by mutation status. Results: Of the 254 patients (median age [range], 56 [13-79] years; 179 [70.5%] male; 211 [83.1%] non-Hispanic white), germline mutations were identified in 41 (16.1%); 14 (5.5%) had mutations in syndromic RCC-associated genes (7 in FH, 3 in BAP1, and 1 each in VHL, MET, SDHA, and SDHB). The most frequent mutations were CHEK2 (n = 9) and FH (n = 7). Of genes not previously associated with RCC risk, CHEK2 was overrepresented in patients compared with the general population, with an odds ratio of RCC of 3.0 (95% CI, 1.3-5.8; P = .003). Patients with non-clear cell RCC were significantly more likely to have an RCC-associated gene mutation (9 [11.7%] of 74 vs 3 [1.7%] of 177; P = .001), and 8 (10.0%) had a mutation in a gene that could guide therapy. Of patients with mutations in RCC-associated genes, 5 (35.7%) failed to meet current clinical guidelines for genetic testing. Conclusions and Relevance: Of patients with non-clear cell RCC, more than 20% had a germline mutation, of which half had the potential to direct systemic therapy. Current referral criteria for genetic testing did not identify a substantial portion of patients with mutations, supporting the role of a more inclusive sequencing approach.

Interaction of the Coxsackie and adenovirus receptor (CAR) with the cytoskeleton: binding to actin.

The Coxsackie and adenovirus receptor (CAR) is a cell adhesion molecule that is highly expressed in the developing brain. CAR is enriched in growth cone particles (GCP) after subcellular fractionation. In GCP, we identified actin as an interaction partner of the cytoplasmic domain of CAR. In vivo, actin and CAR co-immunoprecipitate and co-localize. In vitro, the binding is direct, with a K(d) of approximately 2.6 microM, and leads to actin bundling. We previously demonstrated that CAR interacts with microtubules. These data suggest a role for CAR in processes requiring dynamic reorganization of the cytoskeleton such as neurite outgrowth and cell migration.

SPINK1 Overexpression in Localized Prostate Cancer: a Rare Event Inversely Associated with ERG Expression and Exclusive of Homozygous PTEN Deletion.

SPINK1 is proposed as potential prognostic marker in prostate cancer (PCA). However, its relation to PTEN and ERG in localized PCA remains unclear. The study population consisted of two independent cohorts of men treated by radical prostatectomy for localized PCA (discovery n = 218 and validation n = 129). Patterns of association between SPINK1 and each of ERG and PTEN were evaluated by immunohistochemistry and fluorescence in situ hybridization. Associations between SPINK1 expression and various pathologic parameters and clinical outcome were also investigated. SPINK1 was expressed in 15.3 % and 10.9 % of cases in the discovery and validation cohort, respectively. SPINK expression was observed in 5.56 % of high-grade prostatic intraepithelial neoplasia and 1.1 % of adjacent morphologically benign prostatic glands. SPINK1 and ERG expression were almost exclusive, with only 1.0 % of the cases co-expressing both in the same core sample. SPINK1 interfocal and within-core heterogeneity was noted in 29.2 % and 64.6 % of cases, respectively. SPINK1 expression was not significantly associated with PTEN deletion in the two cohorts (p = 0.871 for discovery cohort and p = 0.293 for validation cohort). While SPINK1 expression did occur with hemizygous PTEN deletion, there was a complete absence of SPINK1 expression in PCA showing homozygous PTEN deletion, which was confirmed in the validation cohort (p = 0.02). Despite SPINK1's association with higher Gleason score (>7) (p = 0.02), it was not associated with other pathological parameters or biochemical recurrence post-radical prostatectomy. We documented absolute exclusivity between SPINK1 overexpression and homozygous PTEN deletion in localized PCA. SPINK1 and ERG expressions are exclusive events in PCA. SPINK1 is not of added prognostic value in localized PCA.

SPINK1 expression in relation to PTEN and ERG in matched primary and lymph node metastatic prostate cancer: Implications for biomarker development.

BACKGROUND: SPINK1, ERG, and PTEN are proposed prognostic biomarkers in prostate cancer (PCA). However, their relations and patterns of expression in primary and metastatic lymph node (LN) PCAs are not fully explored. METHODS: A tissue microarray of matched primary PCA and LN metastasis was constructed from 36 patients. SPINK1, ERG, and PTEN expression statuses were assessed by immunohistochemistry and correlated with each other. RESULTS: SPINK1 and ERG were expressed in 25% and 42.7% of primary PCA cases, respectively. PTEN loss of any degree was observed in 91.7% of primary PCA cases, with 54.2% showing complete loss. In primary PCA, 12.5% of the cases showed SPINK1+/ERG-phenotype, 16.7% showed SPINK1+/ERG+phenotype, 25.0% showed SPINK1-/ERG+phenotype, and 45.8% showed SPINK1-/ERG-phenotype. All PCAs with expression of either SPINK1 or ERG also exhibited PTEN loss, whereas PCA without PTEN loss (2 cases) expressed neither SPINK1 nor ERG. In primary PCA, evaluation of combined ERG and SPINK1 status, but not SPINK1 individually, was associated with a significant difference in proportion of Gleason patterns (P = 0.013), with the SPINK1+/ERG+and SPINK1-/ERG-phenotypes represented more in Gleason pattern>7 PCAs. In LN metastases, the overall SPINK1 protein expression frequency was significantly lower (6.5% of cases) compared with primary PCA (P = 0.03). Only 16.7% of cases with positive SPINK1 expression in primary PCA maintained expression in LN metastases. The down-regulated SPINK1 expression in LN was primarily because of a reduction in the SPINK1+/ERG+PCA subpopulation to 3.5% of cases (P = 0.16 compared with primary PCA). The frequencies of ERG expression and PTEN loss were relatively stable in primary PCA and LN metastases. CONCLUSION: SPINK1 expression is dynamically regulated with up-regulation in primary sites of nodal metastatic PCA and down-regulation in LN metastases. The increased SPINK1 expression in primary site of nodal metastatic PCA is secondary to an increased frequency of SPINK1+/ERG+tumors. In primary PCAs, the SPINK1+/ERG+phenotype is associated with higher Gleason grade, suggesting that this phenotype may mark a more aggressive PCA subpopulation with higher risk of LN metastases.

A General Cutoff Level Combined With Personalized Dynamic Change of Serum Carcinoembryonic Antigen Can Suggest Timely Use of FDG PET for Early Detection of Recurrent Colorectal Cancer.

PURPOSE: FDG PET that has been used is good for diagnosing asymptomatic colorectal cancer (CRC) recurrence in patients with elevated serum carcinoembryonic antigen (CEA) level. However, there is no reference level of CEA rise that would universally suggest the necessity of a PET study. The purpose of this retrospective study was to identify the high-risk group of CRC recurrence through an examination of the dynamics of the CEA level rise as a recurrence indicator. PATIENTS AND METHODS: Between July 2002 and May 2010, 112 patients (59 men, 53 women; age, 18-87 years) had FDG PET for suspicious CRC recurrence indicated by elevated CEA level. We reviewed the PET results and the medical records for recurrence verification and calculated the ratio of increase and the velocity of change in CEA levels for risk stratification. RESULTS: The patient-based sensitivity, specificity, and accuracy of PET are 96.6%, 91.3%, and 95.5%, respectively. The probability of recurrence positively correlated with the CEA level rise and the newly diagnosed disease stage. Carcinoembryonic antigen level greater than 13 ng/mL indicated significantly higher risks of recurrence. In patients with CEA level rise of 13 ng/mL or less, an increase over 3.34 times the individualized baseline also indicated high risks of recurrence. CONCLUSIONS: A posttreatment CEA level rise to greater than 13 ng/mL is suggestive of the optimal use of FDG PET, and so is a mild increase below 13 ng/mL at an increase rate over 3.34.