Histopathologic examination alone can be inadequate for diagnosis of certain melanocytic neoplasms. Recently, a 23-gene expression signature was clinically validated as an ancillary diagnostic test to differentiate benign nevi from melanoma. The current study assessed the performance of this test in an independent cohort of melanocytic lesions against clinically proven outcomes. Archival tissue from primary cutaneous melanomas and melanocytic nevi was obtained from four independent institutions and tested with the gene signature. Cases were selected according to pre-defined clinical outcome measures. Malignant lesions were defined as stage I-III primary cutaneous melanomas that produced distant metastases (metastatic to sites other than proximal sentinel lymph node(s)) following diagnosis of the primary lesion. Melanomas that were metastatic at the time of diagnosis, all re-excisions, and lesions with <10% tumor volume were excluded. Benign lesions were defined as cutaneous melanocytic lesions with no adverse long-term events reported. Of 239 submitted samples, 182 met inclusion criteria and produced a valid gene expression result. This included 99 primary cutaneous melanomas with proven distant metastases and 83 melanocytic nevi. Median time to melanoma metastasis was 18 months. Median follow-up time for nevi was 74.9 months. The gene expression score differentiated melanoma from nevi with a sensitivity of 93.8% and a specificity of 96.2%. The results of gene expression testing closely correlate with long-term clinical outcomes of patients with melanocytic neoplasms. Collectively, this provides strong evidence that the gene signature adds valuable adjunctive information to aid in the accurate diagnosis of melanoma. .

Rapid detection of group A (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% ( = 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement = 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index = 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the overutilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

We report two cases of deaths resulting from complications of odontogenic infections/submandibular space infections. In one case, the decedent had a history of toothache as well as facial and tongue swelling; autopsy revealed inflammation involving the tongue and larynx. In the second case, the decedent had a history of toothache, and at autopsy there was spread of infection to the mediastinum. Ludwig's angina is a form of submandibular space infection, which often is a result of odontogenic infection. The infection can spread into the deep spaces of the neck, producing complications including edema of the tongue and pharynx (causing airway obstruction), descending mediastinitis, pericarditis, necrotizing fasciitis, pleural empyema, and pneumonia. Gross findings at autopsy might reveal a dental abscess or other forms of infection of the head and neck, necrosis of the neck muscles and larynx, and infrequently, infection extending to the chest cavity. Microscopically, there is acute inflammation with necrosis and/or granulation tissue predominantly within the fascia. Without treatment, submandibular space infections can be life threatening and progression to death can be swift. These cases demonstrate the lethal effects of odontogenic infections. Without a clinical history of toothache or dental abscess, one can be alerted to a possible submandibular space infection by identifying isolated necrosis of the neck musculature.

The synthesis and blood glucose lowering properties of the first vanadium-vitamin B(12) bioconjugates are reported.