Evaluation of lymph node numbers for adequate staging of Stage II and III colon cancer

<p>Abstract</p> <p>Background</p> <p>Although evaluation of at least 12 lymph nodes (LNs) is recommended as the minimum number of nodes required for accurate staging of colon cancer patients, there is disagreement on what constitutes an adequate identification of such LNs.</p> <p>Methods</p> <p>To evaluate the minimum number of LNs for adequate staging of Stage II and III colon cancer, 490 patients were categorized into groups based on 1-6, 7-11, 12-19, and ≥ 20 LNs collected.</p> <p>Results</p> <p>For patients with Stage II or III disease, examination of 12 LNs was not significantly associated with recurrence or mortality. For Stage II (HR = 0.33; 95% CI, 0.12-0.91), but not for Stage III patients (HR = 1.59; 95% CI, 0.54-4.64), examination of ≥20 LNs was associated with a reduced risk of recurrence within 2 years. However, examination of ≥20 LNs had a 55% (Stage II, HR = 0.45; 95% CI, 0.23-0.87) and a 31% (Stage III, HR = 0.69; 95% CI, 0.38-1.26) decreased risk of mortality, respectively. For each six additional LNs examined from Stage III patients, there was a 19% increased probability of finding a positive LN (parameter estimate = 0.18510, p < 0.0001). For Stage II and III colon cancers, there was improved survival and a decreased risk of recurrence with an increased number of LNs examined, regardless of the cutoff-points. Examination of ≥7 or ≥12 LNs had similar outcomes, but there were significant outcome benefits at the ≥20 cutoff-point only for Stage II patients. For Stage III patients, examination of 6 additional LNs detected one additional positive LN.</p> <p>Conclusions</p> <p>Thus, the 12 LN cut-off point cannot be supported as requisite in determining adequate staging of colon cancer based on current data. However, a minimum of 6 LNs should be examined for adequate staging of Stage II and III colon cancer patients.</p

Hemoglobin A1c as screening for gestational diabetes mellitus in Nordic Caucasian women

BACKGROUND: Gestational diabetes mellitus (GDM) increases the risk for preeclampsia and macrosomia. GDM is conventionally diagnosed by an oral glucose tolerance test (OGTT). Hemoglobin A1c (HbA1c) is a marker for the average glucose level the last 2–3 months. We aimed to study if HbA1c alone or in combination with patient characteristics can be used to screen for GDM and reduce the number of OGTTs, and whether it could predict preeclampsia or birth weight. METHODS: 855 women from a previous study on the effect of exercise on GDM prevalence were eligible, whereof 677 were included. GDM was diagnosed by WHO 1999 criteria (GDM-WHO) and modified IADPSG criteria (GDM-IADPSG), at pregnancy weeks 18–22 and 32–36. HbA1c analyzed at pregnancy weeks 18–22 and 32–36, variables from patient history and clinical examination were considered for logistic regression models. The diagnostic accuracy was assessed by ROC curve analysis. RESULTS: Accumulated GDM prevalence was 6.7 % by WHO and 7.2 % by modified IADPSG criteria. Nearly a third could potentially have avoided an OGTT by using HbA1c to exclude GDM-IADPSG with a sensitivity of 88 % at week 18–22 and 97 % at week 32–36. Further, 16 % could have avoided an OGTT with a sensitivity of 96 % using HbA1c at week 18–22 to exclude GDM-IADPSG throughout pregnancy. HbA1c was not accurate at diagnosing GDM-IADPSG, and it was inaccurate at screening for GDM-WHO at any time point. Adding other predictors did not increase the number of potentially avoidable OGTTs significantly. HbA1c was not significantly associated with preeclampsia or birth weight. CONCLUSIONS: HbA1c could potentially reduce the number of OGTTs

Microstructural characterisation of syntactic foams

Three types of hollow microspheres with different average diameters (100-150 mu m) and two aluminium alloys as matrix material were used to produce metal matrix syntactic foams (MMSFs) by pressure infiltration. The phases, which formed at matrix-filler interface, were investigated by X-ray diffraction (XRD) and energy dispersive spectrometry (EDS). The investigation showed that in syntactic foams, with the Al99.5 matrix, an exchange reaction took place between the matrix and the amorphous components of ceramic hollow microspheres. The reaction resulted in significant formation of alumina and Si precipitates. Because of this diffusion reaction, the hollow microspheres' walls were degraded. In the case of the AlSi12 matrix the reaction was suppressed by the considerable Si content of the matrix. Therefore, the wall of the hollow microspheres remained unharmed and no real interface layer was found