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By: E. Hamid, M.B.A., M.B.B.S., M.H.S.
Clinical Director, Michigan State University College of Osteopathic Medicine
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The classical methods of analysis are affected by weak intra-class homogeneity and by unbalanced classes since very few samples are generally available for the rarer pathologies. Although the molecular signatures of thyroid tumours can be very heterogeneous, they allowed a classification (Figure 2), dividing the tumours into three distinct groups: benign/normal, malignant and oncocytic. Moreover, thanks to the almost complete set of thyroid tumour classes included in our study, the results may be 51 Classification des lesions thyroidiennes generalized to the whole range of thyroid tumours, from the benign/normal to the malignant and oncocytic tumours. Microfollicular thyroid adenoma presented a signature different from that of macrofollicular adenoma or follicular carcinoma. The malignant evolution of the microfollicular adenoma is still under discussion (Schmid et al. However, we may consider microfollicular thyroid adenoma as a distinct subtype because its gene expression reflects its pathogenesis even though we do not know the impact of this specific profile on the tumoral outcome. The two types of thyroid tumour should therefore be considered as belonging to the same class on the basis of global gene expression analysis. The identification of pathologic tissue by its morphological features is not always precise. In the case of thyroid tumours, significant interand intra-observer variations have been reported (Hirokawa et al. Gene mutations and rearrangements can define a class and its evolution more precisely than the morphology, as has been demonstrated in the case of papillary and follicular thyroid carcinomas (Giordano et al. However, some histotypes, such as oncocytic carcinomas, escape this molecular classification (Nikiforova et al. Several authors have evaluated the usefulness of biomarker combinations for the diagnosis of suspicious thyroid tumours (Ito et al. However, biomarker combinations have 52 Classification des lesions thyroidiennes failed to make a significant contribution in clinical practice. We postulate that the weak specificity of the markers may be compensated by the definition of the functional profiles of thyroid tumours. Gene and protein expression levels differed with only two of the nine markers, confirming the relevance of the genes selected. The development of new antibodies against better protein markers may lead to more accurate diagnoses of suspicious lesions. However, the advantages would be rapidly limited by the number of antibodies usable in practice. Our study shows that the classification of thyroid lesions based on gene expression patterns is a useful complement for the pathologic classification (Figure 4). We therefore preferred to use the geometric accuracy G, which is unbiased and more intuitive (Kubat, 1998). Based on forward selection and univariate tests, the identification of the 12 molecular classes of follicular thyroid tumour demonstrated good predictive accuracy. The meta-analysis of thyroid tumour microarray data may be compromised by partial gene chip compatibility and differences in data processing techniques (Eszlinger et al. Our data set circumvents these difficulties and it would be worth using to test classifier algorithms based on multivariate gene selection methods.
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Collaborator the resident should be able to work with other team members from different specialties on a combined project. Manager the resident should understand the cost of research and be able to set a budget plan. Scholar fi the resident should compare his/her data to those previously collected and determine differences. Other Subspecialty Rotations these rotations might be incorporated into the surgical pathology rotations or be taken as separate rotations, depending on the hospital in which the resident is rotating. During each rotation, the resident will gain unique experience in patient diagnosis and care in regard to diagnostic pathology. Please refer to the section on teaching and academic activity for further details and guidelines for conducting a journal club presentation. Internal Educational Material Mandatory Activities Each institution is requested to provide or allow the resident to attend the following educational activities that are arranged by the local committees: For R1 Residents: Basic Pathology and Histotechnology (eight weeks) For All Residents (venue to be announced for each session): fi Academic Half Day (twice a month) Presently bi-monthly and in some regions once weekly, at least four to six hours of formal training time should be reserved for resident academic half day. Formal teaching time is planned in advance with an assigned tutor, time slots, and a venue. A master-list for suggested and recommended academic half-day lectures is provided in Appendix B. The lectures will be scheduled throughout two years and will be repeated every two years. A schedule for the current academic year with the venue and speaker should be provided at the beginning of every academic year. Journal clubs Guidelines for Anatomic Pathology Journal Club Goals of Journal Club: fi Teach critical appraisal fi Keep current with the medical literature fi Provide a foundation for evidencefibased practice fi Review landmark or controversial papers Characteristics of successful journal clubs fi Presented by residents or fellows and actively supervised by staff fi Attendance is mandatory o Residents and fellows fi Meetings last for less than 60 minutes o Protected time (preferably pager off! Purpose fi Research question, study objective, and specific hypothesis: fi Do the authors provide a clear and specific question and hypothesisfi Optional Activities fi Each institution must encourage the following educational activities: fi the resident is encouraged to present at least once a year at the local, national, or international pathology meeting. Continuous Appraisal this assessment is conducted toward the end of each training rotation throughout the academic year and at the end of each academic year as continuous assessment in the form of formative and summative evaluation. The assessment tools, in the form of a logbook, are assessed at the end of each year by the chairs of the local committees (Appendix E).
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If foetal blood pH is acidotic it indicates significant foetal hypoxia and the need for emergency C-section * Generally it is preferable to describe specific signs in lieu of declaring fetal distress that include: 1. In the past, estrogen administration followed by repeat cytology was suggested to help distinguish atypical atrophic epithelium, which matured into normal squamous epithelium with estrogen therapy, from true intraepithelial neoplasia, which is not affected by estrogen. Options for C/S anesthesia: -neuraxial: spinal or epidural -general: used if contraindicated or time precludes regional blockade. Most patients who develop recurrent or persistent disease are diagnosed within 6 months of therapy. If the patient appears disease-free at the 6-month visit, yearly visits are recommended. Progesterone inhibits the growth of the lining of the womb before menstruation, which lessens the bleeding during menstruation. Progesterone tablets are taken between the 7th and 21st days of the menstrual cycle. Not clear 32mother after delivery sees snakes crawling into her baby bed: Postpartum psychosis Answer: A, no other choices but the choice goes with Qs Explanation: Post partum psychosis: onset of psychotic symptoms over 24-72 h within the first month postpartum, can present in the context of depression. If a discharge is present, it is typically thin, homogeneous, malodorous, and grayis. Constitutional symptoms include fever, headache, malaise, and myalgia (prominent in the first 3-4 days). Local symptoms include pain, itching, dysuria, vaginal and urethral discharge, and tender lymphadenopathy. Clinical features in women: Herpetic vesicles appear on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus. Ulcers are seen more commonly than vesicles at the time of presentation because of the frailty and thin walls of the vesicles. The cervix is involved in 70%-90% of cases and is characterized by ulcerative or necrotic cervical mucosa. Kegel exercises, also known as pelvic floor muscle training References. Diagnosis of a chromosome-21 translocation in the fetus or newborn is an indication for karyotype analysis of both parents. If one parent carries a balanced translocation, the recurrence risk depends on the sex of the carrier parent and the specific chromosomes that are fused. If the proband has trisomy 21, the likelihood of a trisomy 21 pregnancy is minimally increased for family members other than the parents. Cervical cancer may be detected in a biopsy performed during colposcopy for an abnormal Pap smear, or it may be visible to the naked eye when the doctor performs a speculum exam. After making a diagnosis, classify the stage of the cancer according to how far the disease has spread into the lining of the cervix, throughout the cervix, or beyond.
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