Prognostic features of teratomas with malignant transformation: a clinicopathological study of 21 cases

PURPOSE: Teratomas with malignant transformation comprise up to 6% of metastatic teratomas. The prognosis of patients with these tumors can vary considerably. We delineate factors that may be related to prognosis in a cohort of men with teratoma with malignant transformation. MATERIALS AND METHODS: We analyzed pathological features, treatment, response, recurrence, time to recurrence, subsequent followup and survival for 21 patients (median age 28 years) diagnosed with teratoma with malignant transformation during a 7-year period at our institution. RESULTS: Malignant nongerm cell elements were present in the primary tumor in 11 cases (52%). Of 18 patients with testicular primaries 17 (94%) presented with metastatic disease. Despite aggressive treatment with surgery and chemotherapy 17 of 21 cases (81%) recurred (median time 6 months). Overall, 5 patients (24%) died of disease (median survival 23 months), 5 (24%) are alive with metastases (median followup 41 months) and 11 (52%) have no evidence of disease (median followup 50 months). Progression/recurrence was substantially greater for 2 of 2 cases with a mediastinal origin, 3 of 4 with rhabdomyosarcomatous differentiation and 5 of 6 with neural differentiation compared with the remainder of the cohort (p < 0.05). CONCLUSIONS: Teratomas with malignant transformation are usually metastatic at presentation, have a high recurrence rate and are more aggressive than teratomas without malignant transformation. Prognosis is especially poor for mediastinal teratomas with malignant transformation and for those with neural or rhabdomyosarcomatous differentiation. Complete surgical resection of residual or recurrent disease appears to offer the best chance for prolonged survival.     

Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis

PURPOSE: Testicular microlithiasis is a clinical syndrome in which men present with innumerable testicular calcifications. Indirect evidence suggests that this syndrome may be associated with an increased risk of germ cell neoplasia. The incidence and types of testicular calcification in normal and diseased testes is unknown. MATERIALS AND METHODS: A series of 131 orchiectomy specimens were reviewed, including 79 germ cell tumors, and 100 entirely embedded autopsy testes in men with no known testicular pathology. RESULTS: Two types of calcifications were identified. Hematoxylin bodies, consisting of amorphous calcific debris, were present in 6 cases associated with germ cell tumors. In contrast, laminated calcifications were found not only in association with germ cell tumors (35 cases), but also in 2 of 4 cryptorchid testes and 6 of the remaining 145 testes (4%). Of these calcifications 61% were multiple. When laminated calcifications were associated with germ cell tumors there was an increased incidence of extension beyond the tunica albuginea (43 versus 21%) and lymphatic invasion (52 versus 17%, p = 0.046 and 0.012, respectively). CONCLUSIONS: Testicular calcifications are heterogeneous. Hematoxylin bodies are specific for germ cell tumors but laminated calcifications, while more common in germ cell tumors, also occur in otherwise normal testes. The pathological criteria for testicular microlithiasis should include the identification of multiple laminated calcifications within seminiferous tubules.     

Sex-Based Impact of Creatine Supplementation on Depressive Symptoms,Brain Serotonin and SSRI Efficacy in an Animal Model of Treatment-Resistant Depression

Background: Rates of major depressive disorder (MDD) increase with living at altitude. In our model, rats housed at moderate altitude (in hypobaric hypoxia) exhibit increased depression-like behavior, altered brain serotonin and a lack of antidepressant response to most selective serotonin reuptake inhibitors (SSRIs). A forebrain deficit in the bioenergetic marker creatine is noted in people living at altitude or with MDD. Methods: Rats housed at 4500 ft were given dietary creatine monohydrate (CRMH, 4% w/w, 5 weeks) vs. un-supplemented diet, and impact on depression-like behavior, brain bioenergetics, serotonin and SSRI efficacy assessed. Results: CRMH significantly improved brain creatine in a sex-based manner. At altitude, CRMH increased serotonin levels in the female prefrontal cortex and striatum but reduced male striatal and hippocampal serotonin. Dietary CRMH was antidepressant in the forced swim test and anti-anhedonic in the sucrose preference test in only females at altitude, with motor behavior unchanged. CRMH improved fluoxetine efficacy (20 mg/kg) in only males at altitude: CRMH + SSRI significantly improved male striatal creatine and serotonin vs. CRMH alone. Conclusions: Dietary CRMH exhibits sex-based efficacy in resolving altitude-related deficits in brain biomarkers, depression-like behavior and SSRI efficacy, and may be effective clinically for SSRI-resistant depression at altitude. This is the first study to link CRMH treatment to improving brain serotonin.     

A Comprehensive Tool for Modeling CMOS Image-Sensor-Noise Performance

Accurate modeling of image noise is important in understanding the relative contributions of multiple-noise mechanisms in the sensing, readout, and reconstruction phases of image formation. There is a lack of high-level image-sensor system modeling tools that enable engineers to see realistic visual effects of noise and change-specific design or process parameters to quickly see the resulting effects on image quality. This paper reports a comprehensive tool, written in MATLAB, for modeling noise in CMOS image sensors and showing the effect in images. The tool uses accepted theoretical/empirical noise models with parameters from measured process-data distributions. Output images from the tool are used to demonstrate the effectiveness of this approach in determining the effects of various noise sources on image quality     

Efficacy of Eribulin Plus Gemcitabine Combination in L-Sarcomas

Although the overall survival of advanced soft-tissue sarcoma (STS) patients has increased in recent years, the median progression-free survival is lower than 5 months, meaning that there is an unmet need in this population. Among second-line treatments for advanced STS, eribulin is an anti-microtubule agent that has been approved for liposarcoma. Here, we tested the combination of eribulin with gemcitabine in preclinical models of L-sarcoma. The effect in cell viability was measured by MTS and clonogenic assay. Cell cycle profiling was studied by flow cytometry, while apoptosis was measured by flow cytometry and Western blotting. The activity of eribulin plus gemcitabine was evaluated in in vivo patient-derived xenograft (PDX) models. In L-sarcoma cell lines, eribulin plus gemcitabine showed to be synergistic, increasing the number of hypodiploid events (increased subG1 population) and the accumulation of DNA damage. In in vivo PDX models of L-sarcomas, eribulin combined with gemcitabine was a viable scheme, delaying tumour growth after one cycle of treatment, being more effective in leiomyosarcoma. The combination of eribulin and gemcitabine was synergistic in L-sarcoma cultures and it showed to be active in in vivo studies. This combination deserves further exploration in the clinical context.     

Receiver operating characteristic curves for analysis of the results of cervicovaginal smears. A useful quality improvement tool

OBJECTIVES: To assess the value of receiver operating characteristic curves (ROCs) as a tool for improvement in the evaluation of cervicovaginal smear results. DESIGN: We reviewed the results of cervicovaginal smear interpretation for 1 year by 10 different cytopathologists working in the same laboratory (total number of cases, 45,356) and compared them with results of histologic evaluation of corresponding biopsies (n = 2090, 4.6%), the latter taken to be the gold standard. Receiver operating characteristic curves were generated for the laboratory as a whole and for individual cytopathologists. RESULTS: Analysis of these receiver operating characteristic curves was surprisingly informative. They showed that cytopathologists with different diagnostic thresholds could be distinguished from each other. A difference in diagnostic threshold could be distinguished from a difference in diagnostic accuracy. CONCLUSIONS: We conclude that while receiver operating characteristic curves for cervicovaginal smear interpretation have limitations, the results can be used for quality improvement.     

Reference block updating when tracking with block matchingalgorithm

An important problem when using the block matching algorithm to track objects is how to update the reference block to take account of the changing target appearance. A variety of update strategies are reported and compared     

Stain resistance in resilient sheet flooring applications: The role of the plasticizer

Stain resistance, or more properly, appearance retention, is a complex phenomenon in resilient sheet flooring applications. The process can be complex, involving the plasticizer, the overall toughness (or abrasion resistance) of the wear layer, and the thermoplastic nature of plasticized PVC. This paper explores the plasticizer related portions of the stain resistance phenomenon. Data are presented to illustrate relationships between stain resistance and plasticizer structure, concentration, extraction resistance, volatility, and solubility parameter.     

Semi-automatic foreground/background segmentation of motion picture images and image sequences

Segmentation of images into foreground (an actor) and background is required for many motion picture special effects. To produce these shots, the unwanted background must be removed so that none of it appears in the final composite shot. The standard approach requires the background to be a blue screen. Systems that are capable of segmenting actors from more natural backgrounds have been proposed, but many of these are not readily adaptable to the resolution involved in motion picture imaging. An algorithm is presented that requires minimal human interaction to segment motion picture resolution images. Results from this algorithm are quantitatively compared with alternative approaches. Adaptations to the algorithm, which enable segmentation even when the foreground is lit from behind, are described. Segmentation of image sequences normally requires manual creation of a separate hint image for each frame of a sequence. An algorithm is presented that generates such hint images automatically, so that only a single input is required for an entire sequence. Results are presented that show that the algorithm successfully generates hint images where an alternative approach fails.     

Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer

CONTEXT: Interstitial radiation (implant) therapy is used to treat clinically localized adenocarcinoma of the prostate, but how it compares with other treatments is not known. OBJECTIVE: To estimate control of prostate-specific antigen (PSA) after radical prostatectomy (RP), external beam radiation (RT), or implant with or without neoadjuvant androgen deprivation therapy in patients with clinically localized prostate cancer. DESIGN: Retrospective cohort study of outcome data compared using Cox regression multivariable analyses. SETTING AND PATIENTS: A total of 1872 men treated between January 1989 and October 1997 with an RP (n = 888) or implant with or without neoadjuvant androgen deprivation therapy (n = 218) at the Hospital of the University of Pennsylvania, Philadelphia, or RT (n = 766) at the Joint Center for Radiation Therapy, Boston, Mass, were enrolled. MAIN OUTCOME MEASURE: Actuarial freedom from PSA failure (defined as PSA outcome). RESULTS: The relative risk (RR) of PSA failure in low-risk patients (stage T1c, T2a and PSA level < or =10 ng/mL and Gleason score < or =6) treated using RT, implant plus androgen deprivation therapy, or implant therapy was 1.1 (95% confidence interval [CI], 0.5-2.7), 0.5 (95% CI, 0.1-1.9), and 1.1 (95% CI, 0.3-3.6), respectively, compared with those patients treated with RP. The RRs of PSA failure in the intermediate-risk patients (stage T2b or Gleason score of 7 or PSA level >10 and < or =20 ng/mL) and high-risk patients (stage T2c or PSA level >20 ng/mL or Gleason score > or =8) treated with implant compared with RP were 3.1 (95% CI, 1.5-6.1) and 3.0 (95% CI, 1.8-5.0), respectively. The addition of androgen deprivation to implant therapy did not improve PSA outcome in high-risk patients but resulted in a PSA outcome that was not statistically different compared with the results obtained using RP or RT in intermediate-risk patients. These results were unchanged when patients were stratified using the traditional rankings of biopsy Gleason scores of 2 through 4 vs 5 through 6 vs 7 vs 8 through 10. CONCLUSIONS: Low-risk patients had estimates of 5-year PSA outcome after treatment with RP, RT, or implant with or without neoadjuvant androgen deprivation that were not statistically different, whereas intermediate- and high-risk patients treated with RP or RT did better then those treated by implant. Prospective randomized trials are needed to verify these findings.