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It is important to note that all of the isolates analyzed in this study were shown to possess the plcR inactivating mutation as detected by the PCR assay described in Easterday et al.[16].[16]
Furthermore, the combination of MSI and BRAF mutation, as detected for the MSI tumor described, is most frequently found for CpG island methylation phenotype 1 (CIMP1) tumors which are associated with MLH1 promoter methylations [21], [26].
In careful analyses of the earliest lesions (as illustrated in Fig. 2D F), p53 mutation, as detected by IHC positivity, consistent with protein stabilization, seemed to precede AKT activation/phosphorylation, and AR expression was maintained in early lesions.
Dabrafenib is a specific BRAF V600 inhibitor (BRAFi) approved by the US FDA as a single agent treatment for unresectable or metastatic melanoma in patients with the BRAF V600E mutation as detected by an FDA-approved test [ 36].
Genomic analysis of the isolated CTCs revealed a heterogeneous population where some CTCs showed the same TP53 mutation as detected in the breast and chest wall skin tumor biopsies; meanwhile, other CTCs showed a different TP53 mutation, and some the wild-type allele.
Moreover, among the 223 PSs detected at T1, 127 positions were not present at T0, 54 positions displayed the same mutation as detected at T0 but with a >1.5-fold increase in mutation frequency and 35 positions displayed a >1.5-fold decrease in mutation frequency compared with observations at T0 (fig. 1).
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DNA investigations revealed the same two heterozygous mutations as detected in patient 1. Patient 3, the youngest brother, is 24 years old.
Afatinib is currently approved in the USA for the first-line treatment of patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or exon 21 substitution mutations as detected by an FDA-approved test [ 62].
Based on data establishing that EGFR TKIs confer the most benefit when used in molecularly selected patients, erlotinib was granted an additional indication by the FDA in May 2013 for first-line treatment of patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or exon 21 (L858R) mutations as detected by an FDA-approved test 4.
Finally, the HACD1 mutation in humans as detected in our patients differs from that identified in dogs leading directly to the variability in clinical stigmata between species.
Given that mutation and accumulation, as detected by IHC, may be telling us different things (Bazan et al, 2002), it would be sensible if future studies combined both methods of assessment.
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