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PubMed2000

Multiple sleep latency test and polysomnography in diagnosing Kleine-Levin syndrome and periodic hypersomnia.

Kleine-Levin syndrome and periodic hypersomnia are often misdiagnosed initially because there is no objective test for these conditions. To determine the value of the Multiple Sleep Latency Test and polysomnography in this respect, the authors studied four patients with Kleine-Levin syndrome or periodic hypersomnia who had taken the Multiple Sleep Latency Test and undergone polysomnography during the symptomatic episode and/or during the asymptomatic interval. During but not between symptomatic episodes, the Multiple Sleep Latency Test revealed abnormal sleep latencies in all patients, and polysomnography revealed increased rapid eye movement propensity in one patient and a reduction in delta-sleep in two patients. In conclusion, the Multiple Sleep Latency Test and polysomnography are useful in diagnosing Kleine-Levin syndrome and periodic hypersomnia, especially when administered in a standardized fashion during and after the symptomatic period. The authors recommend that polysomnography and the Multiple Sleep Latency Test be performed no earlier than the second night after the onset of a symptomatic episode and the following day to reveal maximal hypersomnolence, and more than 2 weeks after a symptomatic episode to represent the asymptomatic interval.

Adolescent↗

PubMed1998

Vibration perception threshold: are multiple sites of testing superior to single site testing on diabetic foot examination?

Vibration perception threshold (VPT) values, measured at different anatomic locations on the foot and ankle, and the time to assess VPT and sensory perception using two difference modalities in 102 diabetic patients were compared. VPT was evaluated at the great toe, fifth metatarsal and ankle. Differences in VPT at these three sites, in addition to differences in duration of testing comparing single site (great toe) to multiple sites, and to standard SWMF testing were assessed. No significant difference in VPT between the great toe and fifth metatarsal was found for patients both with and without loss of protective sensation (LOPS). Mean VPT was significantly higher at the ankle compared with both the great toes and fifth metatarsals. However, the difference between ankle and great toe was not significant between patients with and without LOPS [3.9 +/- 11.2 (12%) vs. 3.0 +/- 10.8 (16%) volts, respectively, p > 0.6]. Testing of one site took approximately half the time of Semmes-Weinstein 10-gram monofilament wire SWMF testing (40.5 +/- 16.9 vs. 22.3 +/- 9.1 seconds, p < 0.01) and less than one third the time of three-site VPT testing (10.5 +/- 26.1 vs. 22.3 +/- 9.1 seconds, p < 0.01). There may not be a significant practical benefit in multiple site VPT testing when compared with single site testing on the great toe alone. The value of multiple site testing is further called into question when one notes that the great toe VPT remains the only site tested for sensitivity and specificity for ulceration.

Diabetic Foot↗

PubMed2001

Allele-specific amplification for preimplantation genetic diagnosis (PGD) of spinal muscular atrophy.

We have developed a new allele-specific amplification method for the preimplantation genetic diagnosis (PGD) of spinal muscular atrophy (SMA; Werdnig-Hoffmann disease) from a single cell. This method is based on the detection of the deletion of exon 7 of the telomeric copy of the survival motor neurone (SMN(t)) gene. An oligonucleotide was designed to be specific to the SMN(t) nucleotidic sequence with exonic mismatch G (for SMN(t))-->A (for SMN(c)) at its 3' end. This test produces reliable PCR products in 95% of single lymphoblasts (85/88) tested as well as in 16/16 blastomeres from normal controls. Specificity analysis showed that we were able to detect homozygous deletion of the SMN(t) gene in 99% of single lymphoblasts (103/104) from a SMA patient. No contamination was detected in 68 blanks tested. Multiple cell and DNA dilution analysis revealed that the test is accurate and specific up to 100 pg DNA and should thus also be suitable for PGD at the blastocyst stage. This rapid procedure requires a single round of fluorescent PCR and no restriction digestion, while previously described single cell methods include nested PCR followed by restriction enzyme digestion. Two PGD cycles for SMA using this procedure were performed in our centre.

Adult↗

PubMed1992

Nuclear pleomorphism, a strong prognostic factor in axillary node-negative small invasive breast cancer.

We have evaluated established risk factors (tumor size, menopausal status, receptor status, tumor histology, and grading according to Bloom & Richardson including subfactor analysis) as well as local therapeutic procedures in a series of 121 patients with axillary node-negative (ANN) breast cancer stage T1a and T1b. The patients were operated on at a single institution (Department of Surgery, Hanuschkrankenhaus, Vienna) from 1969 to 1989. After a median observation time of 185 months, a total of 16 patients (13%) had a recurrence; of these, 6 had died of the primary disease by the control date (Dec 1, 1990). Grading (distant recurrence-free survival (DRFS) p = 0.01, overall survival (OS) p = 0.006, mitosis rate (DRFS p = 0.006, OS p = 0.02), and particularly nuclear pleomorphism (DRFS p = 0.0002, OS p = 0.00001) proved to have prognostic impact on distant recurrence-free survival and/or overall survival (Mantel-Cox log rank test; level of significance: p = 0.006 after adjustment for multiple testing by Bonferroni correction). Therapeutic procedures had a borderline-significant impact on local recurrence (p = 0.09). No other parameters had statistically significant impact. Thus, our long-term analysis confirms the superior prognostic relevance of histologic grading and nuclear pleomorphism in patients with ANN breast cancer stage T1a and T1b.

Adult↗

PubMed2000

13C-phenylalanine and 13C-methacetin breath test to evaluate functional capacity of hepatocyte in chronic liver disease.

BACKGROUND: To grade liver damage, Child-Pugh classification is used but these tests do not reflect the quantitative functional hepatic reserve. AIMS: 13C-Phenylalanine Breath Test and 13C-Methacetin Breath Test are evaluated as possible tools, being both safe and easy to perform, to quantify functional hepatic reserve in chronic liver disease patients. PATIENTS: Both tests were performed in 48 healthy volunteers and 48 chronic liver disease patients. METHODS: Breath samples were collected after taking 13C-Phenylalanine (100 mg) and 13C-Methacetin (75 mg). 13CO2 enrichment was measured using mass spectrometry RESULTS: Both tests discriminated the hepatic function, decreasing results of the 13CO2 enrichment agreeing with the increasing severity of the hepatic patient (13C-Phenylalanine Breath Test multiple correlation coefficient: 0.72, global p<0.001; Methacetin Breath Test: 0.73, p<0.001). Correlation between 13C-Phenylalanine Breath Test and Methacetin Breath Test was 0.63, p<0.001. If both tests were pathological, the sensitivity for the diagnosis of hepatic dysfunction was high (98%), although the specificity decreased to 60%. Best results were obtained at 30 minutes with 13C-Phenylalanine Breath Test and at 10 minutes with Methacetin Breath Test. CONCLUSIONS: Both 13C-Phenylalanine Breath Test and Methacetin Breath Test are safe and easy tests to perform and both are able to discriminate the hepatic functional capacity between the different groups studied.

Acetamides↗

PubMed2001

Indication of linkage and genetic heterogeneity of asthma according to age at onset on chromosome 7q in 107 French EGEA families.

It is generally believed that an early age at the onset of disease is associated with a stronger genetic component. Our aim here was to investigate both linkage and genetic heterogeneity of asthma, the latter corresponding to different genotype relative risks of a putative linked gene according to age at onset of asthma. This analysis was conducted in 107 French EGEA families with at least two asthmatic siblings, considering 157 markers that were part of our previous genome screen, using the TTS (the Triangle Test Statistic) which has been developed to detect both linkage and intra-sibpair genetic heterogeneity. This test has been applied to 38 asthmatic sib-pairs discordant for age at the onset of asthma. To confirm the existence of genetic heterogeneity, we also used the predivided sample test (PST) which compares the IBD (identity by descent) distribution of marker alleles between asthmatic sib-pairs concordant (67) and discordant (38) for the age at onset. The cutoff point used for the age at onset was 4 years, the median age at onset in our sample of asthmatic sibs. Linkage and genetic heterogeneity for a region located on chromosome 7q (at 109 cM from pter) were indicated by both tests, TTS (P=0.005, P>0.5 after correction for multiple testing) and PST (P=0.0001, 0.015 after correction). These results suggest a genetic factor on 7q involved in asthma with genotype relative risks differing according to age at onset of disease.

Age of Onset↗

PubMed2002

Human leptin locus (LEP) alleles and BMI in Samoans.

OBJECTIVES: Because of their location in known candidate gene regions for obesity the associations between six microsatellite markers (D2S2170, D2S144, D2S1268, D2S1788, D2S1348 and a tetranucleotide repeat in the 3' UTR of the LEP locus) and body mass index (BMI) were studied in adult Samoans. DESIGN: The study was designed to detect differences in the proportion of alleles at the six microsatellite markers between two groups of adult Samoans at the extremes of the longitudinal BMI distribution. SUBJECTS AND MEASUREMENTS: The 181 unrelated Samoan participants were 25-55 y of age, reported that all four grandparents were Samoan, resided in American Samoa (AS) or Samoa (S) and were without diagnosed hypertension or type 2 diabetes. Initial statistical analysis was based on chi(2) tests of independence between marker allele frequencies and BMI status at each marker. The association of individual alleles with BMI status was tested by aggregating a marker's allelic data into a two-by-two contingency table and applying a two-tailed version of Fisher's exact test, with a Bonferroni correction to account for the multiple testing implicit in the procedure. RESULTS: There were no significant differences in allele frequencies at any of the markers between AS and S, as expected from our prior population genetic analyses. Only the LEP gene 3'-tetranucelotide repeat was associated (P<0.006) with BMI status. The distribution of the marker alleles at the LEP locus was significantly associated with the BMI groups (P<0.01), due to the low frequency of allele 226 in the high BMI group. The same pattern of association was found in sub-group analyses with low BMI individuals from AS and high BMI individuals from S. CONCLUSION: These findings indicate that the leptin 3'-tetranucleotide repeat is associated with high BMI in adult Samoans, with allele 226 having a low frequency in the high BMI group.

3' Untranslated Regions↗

PubMed1998

[Incidence and predisposing factors of persistent backache after lumbar catheter epidural anesthesia in a non-obstetrical settingø].

OBJECTIVE: To determine the incidence of long term backache after lumbar epidural anesthesia with catheter (EPA) in the non-obstetrical setting. DESIGN: Prospective 1-year follow-up study. PATIENTS: All patients scheduled for elective arthroscopical surgery of the knee performed under EPA (n = 195). INTERVENTIONS: A first questionnaire was sent to each patient three months after the operation. To chose patients reporting persistent backache after three months, a second questionnaire was sent one year after the operation. MEASUREMENTS: Back pain before, within 5 days and at the time of the inquiry, i.e., three months and one year after EPA as well as patient satisfaction with the regional anesthetic. Statistic: contingency tables with Fisher's exact test (for categorical variables) and an unpaired t-Test (for continuous variables), p < 0.01 after adjustment for multiple testing (Bonferroni's method). MAIN RESULTS: Response rate was 67%. Before EPA 23 patients (17.5%) complained of back pain. The short term incidence of back pain (i.e, within 5 days after EPA) was 24 out of 131 patients (18.3%) and not associated with pre-epidural back pain (p = 0.036, n.s.). 15 out of 131 patients (11.5%) reported persistent back pain after three months, 13 of them had complained of back pain before EPA (p < 0.0001). Thus, the incidence of new back pain 3 months after EPA was only 1.5%. 7 of the 15 patients returned the second questionnaire: 6 reported still persistent back pain, and all had complained of back pain before EPA. Age, height, weight, sex, duration of anesthesia and operation were not associated with long term back pain. Despite persistent back pain after three months 10 out of 15 patients would opt again for EPA. CONCLUSION: The incidence of long term backache after EPA in the non-obstetrical setting is 11.5% and almost exclusively associated with pre-existing back pain. Biometrical factors seem to play no role. In patients with pre-existing back pain satisfaction with the anesthetic procedure might be improved by improving informed consent.

Anesthesia, Epidural↗

PubMed1997

Breast cancer clusters in the northeast United States: a geographic analysis.

High breast cancer mortality rates have been reported in the northeastern part of the United States, with recent attention focused on Long Island, New York. In this study, the authors investigate whether the high breast cancer mortality is evenly spread over the Northeast, in the sense that any observed clusters of deaths can be explained by chance alone, or whether there are clusters of statistical significance. Demographic data and age-specific breast cancer mortality rates for women were obtained for all 244 counties in 11 northeastern states and for the District of Columbia for 1988-1992. A recently developed spatial scan statistic is used, which searches for clusters of cases without specifying their size or location ahead of time, and which tests for their statistical significance while adjusting for the multiple testing inherent in such a procedure. The basic analysis is adjusted for age, with further analyses examining how the results are affected by incorporating race, urbanicity, and parity as confounding variables. There is a statistically significant and geographically broad cluster of breast cancer deaths in the New York City-Philadelphia, Pennsylvania, metropolitan area (p = 0.0001), which has a 7.4% higher mortality rate than the rest of the Northeast. The cluster remains significant when race, urbanicity, and/or parity are included as confounding variables. Four smaller subclusters within this area are also significant on their own strength: Philadelphia with suburbs (p = 0.0001), Long Island (p = 0.0001), central New Jersey (p = 0.0001), and northeastern New Jersey (p = 0.0001). The elevated breast cancer mortality on Long Island might be viewed less as a unique local phenomenon and more as part of a more general situation involving large parts of the New York City-Philadelphia metropolitan area. The several known and hypothesized risk factors for which we could not adjust and that may explain the detected cluster are most notably age at first birth, age at menarche, age at menopause, breastfeeding, genetic mutations, and environmental factors.

Breast Neoplasms↗

PubMed2006

JPEG2000 compression of thin-section CT images of the lung: effect of compression ratio on image quality.

PURPOSE: To assess retrospectively the effect of the Joint Photographic Experts Group 2000 (JPEG2000) compression ratio on the quality of thin-section computed tomographic (CT) images. MATERIALS AND METHODS: In this institutional review board-approved investigation (protocol 238/2004), thin-section CT images were subjected to irreversible JPEG2000 compression by using five compression ratios (3:1, 5:1, 7:1, 9:1, and 11:1). Three radiologists independently evaluated 60 thin-section CT images, of various diseases, that were obtained with single-detector (weighted dose index, 14.4 mGy) and multidetector (weighted dose index, 9.8 mGy) CT. Toggling between the original and compressed images, readers had to identify the original image by using a forced-choice two-alternative model and to subjectively rank the quality of what they believed to be the compressed image. To assess the reader's ability to distinguish the compressed from the original image, a binomial test was used. Bonferroni correction was applied for all multiple tests. RESULTS: Images compressed with a ratio of 3:1 were not distinguishable from original images (P > .2 for all readers). With use of the 5:1 ratio, minor differences in appearance between the compressed and original images were seen by one of the three readers. With use of higher compression ratios (>/=7:1), all readers (P < .001) recognized the original image. The quality of more than 90% of the images compressed with a 7:1 or higher ratio was substantially degraded. Single-detector and multidetector CT results were not significantly different. CONCLUSION: The highest ratio that yielded visually lossless compression of thin-section CT images was 3:1. With the 5:1 ratio, there was minor image quality loss, while use of higher compression ratios (>/=7:1) caused substantial degradation of image quality and potential loss of diagnostic information.

Adult↗

PubMed2001

Chlamydia trachomatis and Pap testing from a single, fluid-based sample. A multicenter study.

OBJECTIVE: To determine the potential for both Pap testing and the Chlamydia direct fluorescence assay (DFA) from a single sample using the fluid-based ThinPrep Pap Test method (Cytyc Corporation, Boxborough, Massachusetts). STUDY DESIGN: Conventional DFA was compared to ThinPrep DFA in a direct-to-vial, double-blinded, multicenter protocol. Cervical scrapings were collected for the ThinPrep Pap Test, and then a second swab was used to collect an endocervical sample for a conventional DFA test. The DFA slide prepared from the ThinPrep Test and the conventional DFA sample prepared from the endocervical swab were evaluated independently. Discrepant cases were adjudicated by testing residual specimens using a Chlamydia direct DNA method. RESULTS: Combining 636 adequate cases (94% of the total collected), 582 (91.5%) were negative on both slides, 43 (6.8%) positive by both and 11 (1.7%) discrepant. The prevalence of Chlamydia was 7.9% based on the conventional DFA method (range, 4.3-10.9%). McNemar's two-tailed test indicated the results not to be statistically different (P > .05). Adjudication favored ThinPrep 45% of the time and conventional 55%. Specimen adequacy favored ThinPrep with high statistical significance (McNemar's test, P > .01). CONCLUSION: A second slide prepared from the same vial of cells as that used for the ThinPrep Pap Test can be used for Chlamydia testing by DFA. Fluid-based collection could allow multiple tests from a single sample.

Adolescent↗

PubMed2005

A simplified algorithm for the laboratory detection of lupus anticoagulants: utilization of two automated integrated tests.

Diagnosis of antiphospholipid antibody syndrome includes laboratory testing for lupus anticoagulants (LAs). Guidelines for testing have been published, but approaches vary, often incorporating multiple tests. We evaluated the performance of the activated partial thromboplastin time using 2 reagents, a dilute Russell viper venom time, and a hexagonal phospholipid assay for detecting LAs in 105 adults. Of the patients, 26 were taking anticoagulants at the time of testing. Based on findings, an algorithm was derived for optimal detection of LAs using 2 easily performed, automated, integrated test systems. Of 105 patient samples, 30 (28.6%) were positive for LAs, using the algorithm interpretive criteria. Of these 30 positive results, 10 were detected in the 26 patients taking anticoagulants. Analysis by chi2 showed no difference in performance of the integrated tests between samples from patients taking and not taking anticoagulants. The algorithm is offered as a means for standardization of laboratory testing for LAs.

Algorithms↗

PubMed1997

Pregnancy outcomes following false-positive multiple marker screening tests.

Pregnancy outcomes in women with a false-positive midtrimester multiple marker screening test (MMST) were reviewed. A genetic database was used to identify all women > or = age 30 who had a MMST at 15-20 weeks of gestation, a targeted ultrasound, and amniocentesis, and complete pregnancy outcome data. All patients with an abnormal fetal ultrasound (US) or karyotype were excluded. The incidence of adverse outcomes (defined as fetal death, preterm delivery, or a birth weight less than the 10th percentile for gestational age), in those women with a positive MMST (risk of Down's syndrome > or = 1:190) was compared to the incidence of adverse outcomes in control women with negative MMST. Chi-square analysis and Fisher's exact tests were used for comparisons as appropriate. Complete data was available from 1135 women. Seventy-seven percent were over age 35. Two hundred and forty-six women (22%) had a positive multiple marker test. No significant differences in outcomes were discovered after comparisons to controls: fetal death 1 of 246 (0.4%) versus 12 of 889 (1.3%), p = 0.32; preterm delivery 32 of 246 (13.0%) versus 147 of 889 (16.5%), p = 0.17; birth weight less than the 10th percentile, 9 of 246 (3.7%) versus 30 of 889 (3.4%), p = 0.83. Our data suggest that women > or = age 30 with a false-positive MMST and a normal midtrimester obstetrical sonogram are not at an increased risk for adverse pregnancy outcomes in later gestation.

Adult↗

PubMed2002

An autoregressive repeatability animal model for test-day records in multiple lactations.

Test-day (TD) models are becoming a standard for genetic evaluation of production traits in dairy cattle. Various approaches to model covariances between TD records include random regression, autoregressive repeatability, orthogonal polynomials, and models based on character processing. The applicability of these models is mainly associated with the number of parameters to estimate, incorporation of multiple lactations, and the accuracy of correlations generated by the cow's repeated expression of milking performance (TD yields) within and across lactations. We define and evaluate a multiple-lactation, autoregressive-repeatability model that disentangles environmental effects due to cow within and between lactations. Simulated records either included or ignored a long-term environmental effect between lactations. Our autoregressive TD animal model correctly detected presence and the absence of this effect and accurately recovered the assumed variance components and correlations underlying the data (10 parameters for three lactations). Estimates of variance components and autocorrelation coefficients were obtained using DFREML-simplex methodology. Given the value of this approach to reduce the size of residual variance components, autoregressive animal models are a preferable alternative to classical methods based on cumulative lactation yield to improve milk production in dairy cattle.

Animals↗

PubMed2005

On the sample size requirement in genetic association tests when the proportion of false positives is controlled.

With respect to the multiple-tests problem, recently an increasing amount of attention has been paid to control the false discovery rate (FDR), the positive false discovery rate (pFDR), and the proportion of false positives (PFP). The new approaches are generally believed to be more powerful than the classical Bonferroni one. This article focuses on the PFP approach. It demonstrates via examples in genetic association studies that the Bonferroni procedure can be more powerful than the PFP-control one and also shows the intrinsic connection between controlling the PFP and controlling the overall type I error rate. Since controlling the PFP does not necessarily lead to a desired power level, this article addresses the design issue and recommends the sample sizes that can attain the desired power levels when the PFP is controlled. The results in this article also provide rough guidance for the sample sizes to achieve the desired power levels when the FDR and especially the pFDR are controlled.

Algorithms↗

PubMed2003

Ecological validity of a simplified version of the multiple errands shopping test.

Shallice and Burgess (1991) reported the utility of the Multiple Errands Test (MET) in discriminating executive deficits in three frontal lobe patients with preserved high IQ, who were otherwise unimpaired on tests of executive function. The aim of this study was to ascertain the value of a simplified version of the MET (MET-SV) for use with the range of people more routinely encountered in clinical practice. Main findings were as follows: 1) The test discriminated well between neurological patients and controls, and the group effects remained when the difference in current general cognitive functions (WAIS-R FSIQ) was taken into account. 2) The best predictors of performance in the healthy control group (n = 46) were age and the number of times participants asked for help (with more requests associated with poorer performance). 3) In the neurological group, two clear patterns of failure emerged, with performance either characterized by rule breaking or failure to achieve tasks. These two patterns were associated with different dysexecutive symptoms in everyday life. 4) The patients not only made more errors than controls, but also different ones. A scoring method that took this into account markedly increased test sensitivity. 5) Many patients passed traditional tests of executive frontal lobe function but still failed the MET-SV. This pattern was strongly associated with observed dysexecutive symptoms in everyday life. The results demonstrate the clinical utility of the test, and suggest that there are two common and independent sources of failure on multitasking tests in a general neurological population: memory dysfunction, and initiation problems.

Adult↗

PubMed2004

Lack of multiplicative transitivity in person trade-off responses.

BACKGROUND: The person trade-off (PTO) is a technique for eliciting preferences for resource allocation across patient groups. In principle PTO responses should satisfy a requirement of multiplicative transitivity, i.e. that if people consider treatment of 1 in state A to be equivalent to treating 10 in state B, and 1 in state B to be equivalent to 10 in state C, then they should find 1 in state A equivalent to 100 in state C. Earlier studies addressing labelled diseases (specific diagnoses), have shown multiplicative intransitivity of the PTO responses. Our purpose was to test multiplicative transitivity in the case of health states described with the EuroQol instrument only and to find a possible framing effect such as the number of persons in the reference intervention. METHODS: Forty-four master degree students were asked to fill in a questionnaire addressing four chronic health states. Their task consisted in (1). ranking the states by severity, (2). valuing each of them by the means of the time trade-off, and (3). doing the PTO for all the 10 possible pairwise combinations of the four chronic states plus a fatal one. In a subsequent questionnaire the number of persons in the reference intervention in the PTO was increased from 10 to 100. Multiplicative transitivity was studied in subjects who demonstrated a willingness to trade off and consistency in ranking individual values. RESULTS: None of the 39 subjects included satisfied a minimum multiplicative transitivity requirement in PTO responses. Internal consistency was not improved when the PTO involved health states close to each other in terms of severity, nor when the prevention of death was not the reference intervention. For the 22 subjects having answered both types of questionnaire, increasing the number of persons in the reference intervention did not improve multiplicative transitivity. CONCLUSIONS: The PTO holds promise as a useful method for determining social preferences for priority setting, inasmuch as it captures distributive concerns that individual utility techniques such as the time trade-off do not address. But the lack of multiplicative transitivity in PTO responses is unsatisfactory, and ways to reduce this problem need to be explored.

Cost-Benefit Analysis↗

PubMed2002

Associations between gene expressions in breast cancer and patient survival.

We analyzed associations between gene expression in breast cancer and patient survival for 8024 genes from a previously published microarray data set. Analysis of survival, by using the logrank test, was performed automatically for each gene. After correcting for multiple testing, we identified 95 genes whose expression was significantly associated with patient survival. The independent prognostic value of the genes ranking the highest in univariate analysis, together with clinical parameters, was assessed by Cox multivariate regression analysis. The P-values from these logrank tests were also mapped to chromosomal positions and compared with previously reported amplicon regions. We used PubGene web tools to identify groups of genes that had co-occurred in the literature and whose expression patterns were associated with survival. Our analyses demonstrate the comprehensiveness of the microarray technology with respect to measuring gene expression and indicate that the technology may be used to screen for potential clinical markers.

Breast Neoplasms↗