Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children

Abstract

Background

Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens.

Methods

Cohort study analysis of children, aged 2-17 years, treated for Helicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative ¹³C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary.

Results

One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than 90% between the prescribed and the ingested drugs was observed in 109 children, between 50 and 90% in eight, less than 50% in 11 while these data were unknown for 2/130. A successful eradication was achieved for 89.9% of patients that received at least 90% of the prescribed drugs, whereas the eradication rate for nonadherent patients was 36.6%. Adherence above 90% was significantly higher in the absence of chronic concomitant disease, in the absence of adverse event and results in a significantly higher eradication rate. With the proposed strategy and an adherence higher than 90%, eradication was obtained in 98/109 children, the rate being only significantly superior to 90% with the sequential regimen.

Conclusion

Adherence to therapy is a very important factor for the outcome and has to be assessed when evaluating the outcome of an H. pylori eradication regimen in order to understand the reasons of treatment failure. As we treated only after evaluation of the resistance of the H. Pylori strains, we were expecting to reach the given objective of 90% successful treatment. Children with adherence to treatment above 90% had a successful outcome of 89,9%, whereas nonadherent had a successful outcome of 36,8%. This is the first time that adherence has been assessed accurately.

http://ift.tt/2nyqJEL

Infant skin maturation: Preliminary outcomes for color and biomechanical properties

Background

Newborn infant skin changes after birth but studies have focused on the epidermal barrier. Dermal properties are relevant for care, but literature on postnatal changes is sparse. We further characterized skin maturational changes in lightness, color and response to biomechanical stress.

Methods

Normal skin sites from subsets of participants in a trial on the progression and stage of infantile hemangiomas were retrospectively examined. Standardized photographs were analyzed as L*, a*, and b* images. Biomechanics were measured with the Cutometer^®.

Results

Color changed significantly with increasing age. Skin was darker and redder at 2.0 vs. 5.4, 8.5 and 12.8 months. Yellow color increased, with higher values at 12.8 vs. 2.0, 3.5 and 5.4 months. Chest tissue was consistently more elastic than arm and face sites, with significantly higher elasticity for the youngest and oldest age groups. Biological elasticity, elastic recovery, and total recovery were significantly greater for the oldest subjects. Viscoelasticity and elastic deformation were lower at 5.5 vs. 8.8 and 17.6 months. Arm viscoelastic creep was highest at 2.8 months.

Conclusion

Skin maturation continues into year two. Increasing elasticity and decreasing viscoelasticity may reflect increased collagen structure/function. The findings have implications for prevention of skin injury associated with mechanical forces.

http://ift.tt/2nu1iYf

In vivo cleansing efficacy of biodegradable exfoliating beads assessed by skin bioengineering techniques

Background/purpose

The plastic microbeads, used in many cleansers, will be banned in cosmetic and personal care products within 2017 since they are non-degradable and can disturb the living organisms in water reservoirs. Various choices of biodegradable beads are commercially available, but their efficacy has not been proven yet. This study aimed to compare the cleansing efficacy in dirt and sebum removal aspects of three types of exfoliating beads.

Methods

The gel scrubs with polyethylene (PE) beads, mannan beads or wax beads, were formulated and evaluated for their stability. The in vivo evaluation was done in 38 healthy volunteers and the skin irritation, efficacy for dirt and sebum removal were measured by Mexameter^®, Colorimeter^®, and Sebumeter^®, respectively.

Results

The selected gel scrubs did not cause an irritation in any volunteers. The differences in dirt residues between before and after scrubbing were not statistically significant among three gel scrubs and the similar result was also reported in the sebum removal study.

Conclusion

All gel scrubs demonstrated the comparable cleansing efficacy in term of dirt and sebum removal. Thus, mannan beads and wax beads may be replaced non-biodegradable PE beads to achieve the similar cleansing effect.

http://ift.tt/2mySvPZ

Hail, Glorious St Patrick Hail, glorious Saint Patrick, dear saint of our Isle, On us thy poor children bestow a sweet smile; And now thou art high in the mansions above, On Erin's green valleys look down in thy love. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. Hail, glorious Saint Patrick, thy words were once strong Against Satan's wiles and an infidel throng; Not less is thy might where in heaven thou art; O, come to our aid, in our battle take part. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. In the war against sin, in the fight for the faith, Dear saint, may thy children resist unto death; May their strength be in meekness, in penance, their prayer, Their banner the cross which they glory to bear. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. Thy people, now exiles on many a shore, Shall love and revere thee till time be no m

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Unhealthful Food-and-Beverage Advertising : Targeted Marketing, Vulnerable Groups, Dietary Intake, and Poor Health.

http://orlhealth.blogspot.com/2017/03/unhealthful-food-and-beverage.html

Abstract

Unhealthful food-and-beverage advertising often targets vulnerable groups. The extent of such advertising in subway stations has not been reported and it is not clear how ad placement may relate to subway ridership or community demographics, or what the implications might be for diets and diet-related health in surrounding communities. Riding all subway lines (n = 7) in the Bronx, NY, USA, investigators systematically assessed all print ads (n = 1586) in all stations (n = 68) in 2012. Data about subway ridership came from the Metropolitan Transportation Authority. Demographic data on surrounding residential areas came from the U.S. Census Bureau. Data on dietary intake and diet-related conditions came from a city health-department survey. There were no ads promoting "more-healthful" food-or-beverage items (i.e., fruits, vegetables, whole grains, nuts, water or milk). There were many ads for "less-healthful" items (e.g., candies, chips, sugary cereals, frozen pizzas, "energy" drinks, coffee confections, hard alcohol, and beer). Ad placement did not relate to the number of riders entering at stations. Instead, exposure to food-or-beverage ads generally, and to "less-healthful" ads particularly (specifically ads in Spanish, directed at youth, and/or featuring minorities), was directly correlated with poverty, lower high-school graduation rates, higher percentages of Hispanics, and/or higher percentages of children in surrounding residential areas. Correlations were robust to sensitivity analyses. Additional analyses suggested correlations between ad exposures and sugary-drink consumption, fruit-and-vegetable intake, and diabetes, hypertension, and high-cholesterol rates. Subway-station ads for "less-healthful" items were located disproportionately in areas home to vulnerable populations facing diet and diet-related-health challenges. The fact that uneven ad placement did not relate to total rider counts suggests ads were not directed at the largest possible audiences but rather targeted to specific groups.

KEYWORDS:

Advertising; Black-African American; Children; Diabetes; Diet-related diseases; Dyslipidemia; Food and Beverages; Fruits and vegetables; Hypertension; Latino/Hispanic; Nutrition; Obesity; Socio-economic status; Sugar-sweetened beverages; Vulnerable groups

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Optical Coherence Tomography Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy.

Background: Optical coherence tomography angiography (OCTA) has demonstrated good utility in qualitative analysis of retinal and choroidal vasculature and therefore may be relevant in the diagnostic and treatment efforts surrounding nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Retrospective, cross-sectional study of 10 eyes of 9 patients with a previous or new diagnosis of NAION that received imaging with OCTA between November 2015 and February 2016. Two independent readers qualitatively analyzed the retinal peripapillary capillaries (RPC) and peripapillary choriocapillaris (PCC) for flow impairment. Findings were compared with automated visual field and structural optical coherence tomography (OCT) studies. Results: Flow impairment seen on OCTA in the RPC corresponded to structural OCT deficits of the retinal nerve fiber layer (RNFL) and ganglion cell layer complex (GCC) in 80% and 100% of eyes, respectively, and to automated visual field deficits in 90% of eyes. Flow impairment seen on OCTA in the PCC corresponded to structural OCT deficits of the RNFL and GCC in 70% and 80% of eyes, respectively, and to visual field deficits in 60%-80% of eyes. Conclusions: OCTA can noninvasively visualize microvascular flow impairment in patients with NAION. (C) 2017 by North American Neuro-Ophthalmology Society

http://ift.tt/2nLd1xw

Non-arteritic Jaw Claudication.

A 60-year-old woman with decreased visual acuity in her right eye and right-sided jaw claudication was found to have ocular ischemic syndrome secondary to complete occlusion of the brachiocephalic artery. Although jaw claudication is often considered to be pathognomonic for giant cell arteritis, it has a broad differential diagnosis including both vascular and nonvascular conditions. (C) 2017 by North American Neuro-Ophthalmology Society

http://ift.tt/2mV3Ahz

Carbon quantum dots as fluorescence resonance energy transfer sensors for organophosphate pesticides determination

Publication date: 15 August 2017
Source:Biosensors and Bioelectronics, Volume 94
Author(s): Xiaoli Wu, Yang Song, Xu Yan, Chengzhou Zhu, Yongqiang Ma, Dan Du, Yuehe Lin
Carbon quantum dots (CQDs) obtained from natural organics attract significant attention due to the abundance of carbon sources, varieties of heteroatom doping (such as N, S, P) and good biocompatibility of precursor. In this study, tunable fluorescence emission CQDs originated from chlorophyll were synthesized and characterized. The fluorescence emission can be effectively quenched by gold nanoparticles (Au NPs) via fluorescence resonance energy transfer (FRET). Thiocholine, which was produced from acetylthiocholine (ATC) by the hydrolysis of butyrylcholinesterase (BChE), could cause the aggregation of Au NPs and the corresponding recovery of FRET-quenched fluorescence emission. The catalytic activity of BChE could be irreversibly inhibited by organophosphorus pesticides (OPs), thus, the recovery effect was reduced. By evaluating the fluorescence emission intensity of CQDs, a FRET-based sensing platform for OPs determination was established. Paraoxon was studied as an example of OPs. The sensing platform displayed a linear relationship with the logarithm of the paraoxon concentrations in the range of 0.05–50μgL⁻¹ and the limit of detection (LOD) was 0.05μgL⁻¹. Real sample study in tap and river water revealed that this sensing platform was repeatable and accurate. The results indicate that the OP sensor is promising for applications in food safety and environmental monitoring.



http://ift.tt/2mVwvSA

Human genetics and sleep behavior

Publication date: June 2017
Source:Current Opinion in Neurobiology, Volume 44
Author(s): Guangsen Shi, David Wu, Louis J Ptáček, Ying-Hui Fu
Why we sleep remains one of the greatest mysteries in science. In the past few years, great advances have been made to better understand this phenomenon. Human genetics has contributed significantly to this movement, as many features of sleep have been found to be heritable. Discoveries about these genetic variations that affect human sleep will aid us in understanding the underlying mechanism of sleep. Here we summarize recent discoveries about the genetic variations affecting the timing of sleep, duration of sleep and EEG patterns. To conclude, we also discuss some of the sleep-related neurological disorders such as Autism Spectrum Disorder (ASD) and Alzheimer's Disease (AD) and the potential challenges and future directions of human genetics in sleep research.



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Increased incidence trend of low - grade and high-grade neuroendocrine neoplasms

Abstract

Purpose

The incidence of neuroendocrine neoplasms is increasing. This work aimed at: (i) establishing worldwide incidence trend of low-grade neuroendocrine neoplasms; (ii) defining the incidence and temporal trend of high-grade neuroendocrine neoplasms in USA utilizing the Surveillance Epidemiology and End Results database; (iii) comparing trends for low-grade vs. high-grade neuroendocrine neoplasms.

Methods

We conducted a literature search on MEDLINE and Scopus databases and incidence trends were plotted for 1973-2012. The Surveillance Epidemiology and End Results database was used to identify incidence rates in USA for 1973-2012. Incidence rates were stratified according to histological grade, gender and ethnicity. Trends were summarized as annual percent change and corresponding 95% confidence interval.

Results

11 studies were identified involving 72,048 cases; neuroendocrine neoplasm incidence rates increased over time in all countries for all sites, except for appendix. In Surveillance Epidemiology and End Results low-grade neuroendocrine neoplasm incidence rate increased from 1.09 in 1973 to 3.51 per 100,000 in 2012. During this interval, high-grade neuroendocrine neoplasm incidence rate increased from 2.54 to 10.52 per 100,000. African Americans had the highest rates of digestive neuroendocrine neoplasms with male prevalence in high-grade.

Conclusions

Our data indicate an increase in the incidence of neuroendocrine neoplasms as a worldwide phenomenon, affecting most anatomical sites and involving both low-grade and high-grade neoplasms.

http://ift.tt/2m7YpMr

Liver-Resident NK Cells: The Human Factor

Publication date: Available online 16 March 2017
Source:Trends in Immunology
Author(s): Victoria Male
Mouse liver contains two natural killer (NK) cell populations, one of which recirculates while the other is tissue resident. Following this discovery, several groups have sought to identify liver-resident NK (lrNK) cells in humans. Here, I present an overview of recent advances in the field.



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The Role of Pancreatic Preproglucagon in Glucose Homeostasis in Mice

Publication date: Available online 16 March 2017
Source:Cell Metabolism
Author(s): Adam P. Chambers, Joyce E. Sorrell, April Haller, Karen Roelofs, Chelsea R. Hutch, Ki-Suk Kim, Ruth Gutierrez-Aguilar, Bailing Li, Daniel J. Drucker, David A. D'Alessio, Randy J. Seeley, Darleen A. Sandoval
Glucagon-like peptide 1 (GLP-1) is necessary for normal gluco-regulation, and it has been widely presumed that this function reflects the actions of GLP-1 released from enteroendocrine L cells. To test the relative importance of intestinal versus pancreatic sources of GLP-1 for physiological regulation of glucose, we administered a GLP-1R antagonist, exendin-[9-39] (Ex9), to mice with tissue-specific reactivation of the preproglucagon gene (Gcg). Ex9 impaired glucose tolerance in wild-type mice but had no impact on Gcg-null or GLP-1R KO mice, suggesting that Ex9 is a true and specific GLP-1R antagonist. Unexpectedly, Ex-9 had no effect on blood glucose in mice with restoration of intestinal Gcg. In contrast, pancreatic reactivation of Gcg fully restored the effect of Ex9 to impair both oral and i.p. glucose tolerance. These findings suggest an alternative model whereby islet GLP-1 also plays an important role in regulating glucose homeostasis.

Graphical abstract

Teaser

GLP-1 is necessary for normal gluco-regulation, and it has been widely presumed that this function is the action of peptide released from enteroendocrine L cells. The data from Chambers et al. challenge this dogma and find that intestinally produced GLP-1 is dispensable, while pancreatic production of GLP-1 is necessary for gluco-regulation.


http://ift.tt/2nftLjV

Increased incidence trend of low - grade and high-grade neuroendocrine neoplasms

Abstract

Purpose

The incidence of neuroendocrine neoplasms is increasing. This work aimed at: (i) establishing worldwide incidence trend of low-grade neuroendocrine neoplasms; (ii) defining the incidence and temporal trend of high-grade neuroendocrine neoplasms in USA utilizing the Surveillance Epidemiology and End Results database; (iii) comparing trends for low-grade vs. high-grade neuroendocrine neoplasms.

Methods

We conducted a literature search on MEDLINE and Scopus databases and incidence trends were plotted for 1973-2012. The Surveillance Epidemiology and End Results database was used to identify incidence rates in USA for 1973-2012. Incidence rates were stratified according to histological grade, gender and ethnicity. Trends were summarized as annual percent change and corresponding 95% confidence interval.

Results

11 studies were identified involving 72,048 cases; neuroendocrine neoplasm incidence rates increased over time in all countries for all sites, except for appendix. In Surveillance Epidemiology and End Results low-grade neuroendocrine neoplasm incidence rate increased from 1.09 in 1973 to 3.51 per 100,000 in 2012. During this interval, high-grade neuroendocrine neoplasm incidence rate increased from 2.54 to 10.52 per 100,000. African Americans had the highest rates of digestive neuroendocrine neoplasms with male prevalence in high-grade.

Conclusions

Our data indicate an increase in the incidence of neuroendocrine neoplasms as a worldwide phenomenon, affecting most anatomical sites and involving both low-grade and high-grade neoplasms.

http://ift.tt/2m7YpMr

Serum Fibroblast Growth Factor 1 is Associated with the Decreased Risk of Obesity in Human

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-104532

As a transducer of PPARγ signaling, recent evidence supports that fibroblast growth factor 1 (FGF1) mediates adipose tissue remodeling and insulin sensitivity. This study is to assess the role of serum FGF1 in obesity. A hospital-based case-control study of 154 subjects was conducted. Serum level of FGF1 was measured by enzyme-linked immunosorbent assay. The serum level of FGF1 in the lean (119.0 [103.1–146.1] pg/ml) was higher than it in the subjects with overweight/obesity (111.9 [80.3–127.4] pg/ml, P=0.009). Binary logistic regression models found a reverse association between serum FGF1 level and the risk of overweight/obesity (adjusted odds ratio=0.990, 95% confidence interval [0.981–0.998], P=0.019). Furthermore, serum FGF1 reversely correlated with body mass index (r=−0.176, P=0.029), systolic blood pressure (r=−0.224, P=0.005), diastolic blood pressure (r=−0.185, P=0.022) and triglycerides (r=−0.162, P=0.044). Multiple stepwise linear regression analysis found serum level of FGF1 was dependent on anti-diabetic drugs, hemoglobin A1C, body mass index and sex. Serum level of FGF1 is associated with the decreased risk of obesity in human.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: die Kunst der guten Anästhesie und Analgesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 166-167
DOI: 10.1055/s-0043-103395

Georg Thieme Verlag KG Stuttgart · New York

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DSL und DGS begrüßen Gesetz zur Verordnung von Cannabis als Medizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 163-163
DOI: 10.1055/s-0043-103360

Georg Thieme Verlag KG Stuttgart · New York

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Zwei Fragen zur Sepsis: Selen? Procalcitonin?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 157-157
DOI: 10.1055/s-0043-103029

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: Anästhesie bei fetaler Chirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 204-213
DOI: 10.1055/s-0042-105989

Die Fetalchirurgie stellt für den Anästhesisten eine herausfordernde operative Disziplin dar, da sowohl die schwangerschaftsbedingten Veränderungen der Mutter, die Physiologie des Feten sowie die komplexen chirurgischen Bedürfnisse beachtet werden müssen. Unter anderem sind neben der Erhaltung eines stabilen Perfusionsdruckes zugunsteneiner adäquaten plazentaren Versorgung des Feten, eine ausgeglichene Oxygenierung und Ventilation, ein konsequentes Temperaturregime sowie die Diagnostik und Therapie eines potentiellen mütterlichen Lungenödems Hauptaugenmerk des anästhesiologischen Managements in der Fetalchirurgie. Der Artikel erläutert die Grundlagen der Fetalchirurgie, anästhesierelevante hämodynamische und respiratorische Veränderungen während der Schwangerschaft sowie das anästhesiologische Procedere.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Ist eine lungenprotektive Beatmung auch im OP sinnvoll?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 158-159
DOI: 10.1055/s-0043-103425

Georg Thieme Verlag KG Stuttgart · New York

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Anästhesie in der Gefäßchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 164-164
DOI: 10.1055/s-0042-120960

Georg Thieme Verlag KG Stuttgart · New York

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Epidurale Kortikosteroide bei Schmerzen durch Bandscheibenvorfall?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 159-160
DOI: 10.1055/s-0043-103424

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: hypertensive Erkrankungen in der Schwangerschaft

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 184-195
DOI: 10.1055/s-0042-105990

Hypertensive Schwangerschaftserkrankungen sind eine der häufigsten Schwangerschaftskomplikationen und nach wie vor mit einer hohen Morbidität und Mortalität für Mutter und Kind verbunden. Obwohl 99 % aller mütterlichen Todesfälle in Entwicklungsländern auftreten, sterben auch in den Industrienationen nach wie vor Frauen an den Folgen hypertensiver Schwangerschaftserkrankungen. Diese umfassen die vorbestehende chronische Hypertonie sowie die in der Schwangerschaft neu auftretenden Pathologien wie schwangerschaftsinduzierte Hypertonie und Präeklampsie. Die physiologischen Veränderungen in der Schwangerschaft erschweren die frühzeitige Unterscheidung zwischen harmlosen Beschwerden und potenziell lebensbedrohlichen Zuständen. Nur durch interdisziplinäre Zusammenarbeit aller in der Geburtshilfe tätigen Fachpersonen kann eine adäquate Versorgung dieser Frauen sichergestellt werden. Der vorliegende Artikel stellt die Ausprägungsformen, Diagnostik und Therapie verständlich dar und diskutiert in diesem Zusammenhang die wichtigsten neuen Erkenntnisse zu hypertensiven Schwangerschaftserkrankungen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Elektive Hüft-TEP: Reduziert Tranexamsäure den Blutverlust?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 160-161
DOI: 10.1055/s-0043-103027

Georg Thieme Verlag KG Stuttgart · New York

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Kasuistik: Late-onset Small-Fiber-Neuropathie nach kritischer Erkrankung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 220-226
DOI: 10.1055/s-0043-102813

Eine 43-jährige Patientin, mit Z. n. schwerer Sepsis und Entwicklung einer Critical-Illness-Myopathie/Polyneuropathie, stellt sich nach 5 Monaten mit einer akut aufgetretenen Allodynie/Hyperalgesie vor. Diese betrifft alle 4 Extremitäten distal, mit deutlicher Betonung im Versorgungsgebiet der Nn. ulnarii. Nach differenzialdiagnostischer Abklärung wird die Diagnose einer „Late-onset Small-Fiber-Neuropathie nach Critical Illness" gestellt. Small-Fiber-Neuropathien, bei kritischer Erkrankung und auch im Follow-up, einhergehend mit neuropathischen Beschwerden, konnten in einigen neueren Studien gezeigt werden. Pathophysiologisch ist am ehesten eine Dysfunktion der spannungsabhängigen Natriumkanäle, im Rahmen einer erhöhten Insulinresistenz während der kritischen Erkrankung, zu vermuten. Therapeutisch sind somit Kühlung, Carbamazepin/Oxcarbazepin, trizyklische Antidepressiva und serielle Injektionen mit Lokalanästhetika am ehesten zu empfehlen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Mehrfachresistenter Acinetobacter baumannii häufig inadäquat behandelt

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 161-161
DOI: 10.1055/s-0043-103026

Georg Thieme Verlag KG Stuttgart · New York

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Ein Muss für alle Notfallmediziner

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 164-164
DOI: 10.1055/s-0042-104427

Georg Thieme Verlag KG Stuttgart · New York

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Angriff der Antibiotika

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-162
DOI: 10.1055/s-0043-103355

Georg Thieme Verlag KG Stuttgart · New York

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Erforderliches Wissen kompakt vermittelt

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 165-165
DOI: 10.1055/s-0042-114762

Georg Thieme Verlag KG Stuttgart · New York

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Terrorgefahr: Mediziner fordern Tourniquets in Rettungswagen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-162
DOI: 10.1055/s-0043-103357

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: kombinierte Spinal-Epidural-Analgesie (CSE)

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 168-182
DOI: 10.1055/s-0042-105988

Die CSE verbindet einen schnellen Wirkeintritt mit suffizienter Analgesie infolge intrathekaler Applikation mit der Möglichkeit einer zeitlich unbegrenzten neuraxialen geburtshilflichen Schmerzlinderung über den liegenden EDK. Eine Überlegenheit der CSE über die EDA lässt sich vor allem aus dem schnellen Wirkeintritt, der exzellenten Analgesie, der fehlenden motorischen Blockade nach alleiniger intrathekaler Opioidgabe, der geringeren Rate an unilateralen Blockaden und der geringeren Notwendigkeit epiduraler Nachinjektionen ableiten. Häufigste Nebenwirkung ist Pruritus, welcher harmlos ist und in der Regel keiner therapeutischen Intervention bedarf. Auch wenn sich keine Auswirkungen auf Sectiorate und APGAR-Werte zeigen, muss die erhöhte Rate fetaler Bradykardien nach CSE beachtet werden. Die Reduktion dieser fetalen Bradykardien und auch die Prolongation der Analgesie nach intrathekaler Gabe durch geeignete Medikamentenkombinationen oder Additiva sollte Gegenstand zukünftiger Forschung sein.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Berufsbegleitende Weiterbildung zum Manager für klinische Notfall- und Akutmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-163
DOI: 10.1055/s-0043-103358

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: die peripartale Kardiomyopathie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 196-203
DOI: 10.1055/s-0042-101049

Die peripartale Kardiomyopathie (PPCM) ist eine idiopathische Herzinsuffizienz mit Auftreten gegen Ende der Schwangerschaft und in den Monaten postpartal. Andere Ursachen müssen ausgeschlossen sein. Der aktuelle Wissensstand zur PPCM wird anhand eines Mini-Literatur-Reviews aufgearbeitet. Besonderes Augenmerk gilt dem peripartalen anästhesiologischen Management sowie dem Fall einer akuten respiratorischen Insuffizienz nach erfolgter Sectio caesarea im Rahmen einer PPCM mit schwer reduzierter linksventrikulärer Funktion und linksführender kardialer Dekompensation.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Erforschung lebender Schäume für die Wundheilung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 163-163
DOI: 10.1055/s-0043-100284

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Geburtshilfe: Anästhesie bei EXIT-Prozedur

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 214-219
DOI: 10.1055/s-0042-105986

Die Ex-utero-Intrapartum-Treatment-(EXIT-)Prozedur wird im Rahmen einer erweiterten Sectio caesarea beispielsweise bei fetaler Atemwegsanomalie durchgeführt. Dazu ist die Aufrechterhaltung der uteroplazentaren Versorgung des Feten bei optimaler Uterusrelaxation erforderlich. Eine „balancierte" Anästhesie, Tokolyse und maternale arterielle Blutdruckeinstellung in engen Grenzen wird empfohlen. Das fetale Standardmonitoring umfasst dabei die Pulsoxymetrie und Echokardiografie. Es werden die physiologischen Besonderheiten und anästhesiologischen Ziele der EXIT-Prozedur und Möglichkeiten der Anästhesieführung dargestellt sowie ein Ausblick auf mögliche Neuerungen gegeben.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Magnetic resonance perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant lesions: six case reports

Abstract

The perfusion and diffusion properties of a tumor are important clues in evaluating its growth potential and predicting its histological type, such as benign or malignant. Tumor perfusion can be estimated by assessing time-dependent changes in the intratumoral levels of the contrast agent during dynamic contrast-enhanced magnetic resonance (MR) imaging, whereas tumor diffusion can be estimated by assessing intratumoral water diffusivity on diffusion-weighted MR imaging. Granulomatous diseases with different etiologies occur in various head and neck regions, including the mandible, maxillary sinus, salivary glands, and lymph nodes. However, the perfusion and diffusion properties of granulomatous diseases in the head and neck regions are not well documented. In this study, we assessed the time–signal intensity curves and apparent diffusion coefficients of six granulomatous diseases of various histological types that appeared in the soft tissues of the head and neck. Our data show that the perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant diseases, highlighting the need for careful interpretation of MR perfusion and diffusion findings to distinguish between granulomatous diseases and cancers of the head and neck region. Clinicians should pay particular attention to blood examination and biopsy results when interpreting imaging findings.

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Comparative cone-beam computed tomography evaluation of the osseous morphology of the temporomandibular joint in temporomandibular dysfunction patients and asymptomatic individuals

Abstract

Objective

We examined the bone components of the temporomandibular joint (TMJ) in asymptomatic individuals and patients with temporomandibular dysfunction (TMD) using cone-beam computed tomography (CBCT).

Methods

Two hundred asymptomatic individuals and 200 patients with TMD were included in this study. Condyle position, eminence height, eminence inclination, condyle shape, and fossa shape were assessed on CBCT images of the 800 temporomandibular joints.

Results

The eminence inclination (P < 0.05), eminence height (P < 0.0001), mediolateral width of condyle (P < 0.0001), and anterior joint space (P < 0.0001) were significantly greater in male subjects compared with female subjects in both the asymptomatic group and TMD group. Comparisons of the asymptomatic group and TMD group revealed significant differences in the anterior joint space (P < 0.0001), ratio of anterior joint space to posterior joint space (P < 0.001), posterior joint space (P < 0.05), eminence inclination (P < 0.05), eminence height (P < 0.05), condyle shape (P < 0.0001), and fossa shape (P < 0.05).

Conclusions

The present analyses suggest that a steeper articular eminence inclination may be risk factor for TMD. The presence of TMD was associated with the condyle position in the TMJ.

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Diagnostic accuracy of magnetic resonance imaging and clinical signs of temporomandibular joint disorders: a 10-year research update review

Abstract

Objectives

To review the past 10 years of research in the diagnostic accuracy of magnetic resonance imaging (MRI) and clinical signs of temporomandibular joint (TMJ) disorders with pain, sound, and function limitation in the existing literature.

Methods

A review of the literature was performed to search for all articles published between 2006 and 2016, and those that met the selection criteria were examined.

Results

The MRI results ranged from 25.3 to 69% for findings in TMJ with sound, 17–74.5% for findings in TMJ with function limitation, and 13.3–77% for findings in TMJ with pain. The reasons for the TMJ symptoms were variable and MRI findings for temporomandibular disorders were seen in asymptomatic patients as well as symptomatic patients. No singular outcome measure can be suggested as a predictor for TMJ symptoms on MRI images.

Conclusions

To increase study comparability with MRI, a standardized terminology and evidence-based guidelines are required for correlations of clinical symptoms and MRI findings.

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An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Karishma Patel Bhangare, Alan David Kaye, Nebojsa Nick Knezevic, Kenneth D. Candido, Richard D. Urman

Teaser

The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. An extensive literature focused on new treatments for CLBP. Their safety and efficacy were evaluated and are described in detail in this review. The investigation identified new treatments for CLBP including chemonucleolysis, platelet-rich plasma injections, artemin, tanezumab, and stem cells. Further research and innovation are needed to implement these methods into practice and assess clinical significance. The current evidence suggests that there are promising new agents for the treatment of CLBP.


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Revisiting Oxycodone Analgesia

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Xiulu Ruan, Ken F. Mancuso, Alan David Kaye

Teaser

Oxycodone, a semisynthetic opioid analgesic, is widely used in clinical practice. Oxycodone and morphine seem to be equally effective and equipotent; however, morphine is 10 times more potent than oxycodone when given epidurally. This article provides an updated review of the basic pharmacology of oxycodone with a special focus on pharmacokinetic/pharmacodynamics properties. The controversy regarding oxycodone-mediated effects for visceral pain via agonism and the possible role of peripheral opioid analgesia are discussed in the present investigation in an attempt to propose a plausible explanation to the perplexing question of oxycodone analgesia.


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Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Kenneth D. Candido, Oscar J. Perozo, Nebojsa Nick Knezevic

Teaser

Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. The primary mechanism of action of corticosteroids involves regulation of nuclear expression of genes involved in inflammatory pathways and other systemic effects. Metaanalyses have added purposeful perioperative indications, clarified misconceptions, and established protocols for administering these drugs. Some indications, doses, clinical considerations, and adverse effects need to be further studied.


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Thinking locally: Environmental reconstruction of Middle and Later Stone Age archaeological sites in Ethiopia, Kenya, and Zambia based on ungulate stable isotopes

Publication date: May 2017
Source:Journal of Human Evolution, Volume 106
Author(s): Joshua R. Robinson
Our knowledge of the Pleistocene environments of Africa consists primarily of data at a scale too coarse to capture the full habitat variation important to hominins 'on the ground.' These environments are complex, highly variable, and poorly understood. As such, data from individual sites are a needed addition to our current paleoenvironmental reconstructions. This study offers a site-based approach focusing on stable isotope analyses of fossil faunal tooth enamel from three archaeological sites in tropical Africa. Carbon and oxygen stable isotope data are reported from the sites of Porc Epic, Ethiopia, Lukenya Hill, Kenya, and Kalemba Rockshelter, Zambia. Stable isotope data from tooth enamel are used to measure two environmental variables: (1) aridity based on oxygen isotope composition and (2) dietary reconstructions of fossil ungulates based on the relative proportions of C3 browse and C4 graze in the diet. These data allow for a preliminary assessment of existing models that attempt to explain the behavioral and technological variation characteristic of the transition between the Middle and Later Stone Ages. Results indicate spatial and temporal variation in aridity and phytogeography in tropical Africa during the Pleistocene, suggesting that no single model is likely to provide an explanation for the transition at all sites across Africa.



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Increased F-FDG uptake in bilateral gynecomastia secondary to feminizing adrenal tumor: A rare case report and review of literature

Priyanka Verma, Gaurav Malhotra, Sneha Kothari, Rajlaxmi Jagtap, Ramesh V Asopa

Indian Journal of Nuclear Medicine 2017 32(2):145-147

A 21 year old male who presented with painful enlargement of both the breasts and a hyperestrogenic state, was found to harbor a heterogeneous mass arising from the right adrenal on contrast enhanced Computed Tomography abdomen. The mass was hypermetabolic with no regional, nodal or distant metastases on Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography /Computed Tomography examination. Notably, substantial tracer uptake was seen in bilateral gynecomastia. The patient underwent a right adrenalectomy with the histopathology report confirming adrenocortical carcinoma. This case demonstrates utility of FDG PET/CT in adrenocortical carcinoma. However, when interpreting FDG PET/CT as a staging tool in oncological male patients, one should consider gynecomastia as a possible cause for increased FDG uptake in the breast as it may lead to a false positive interpretation.

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68Ga-DOTA-D Phe1-Tyr3-octreotide (DOTATOC)-PET/CT in a suspected case of recurrent meningioma

Sachin Jain, Ashwani Gupta, Anurag Jain

Indian Journal of Nuclear Medicine 2017 32(2):164-164



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Tc-99m ethylenedicysteine and Tc-99m dimercaptosuccinic acid scintigraphy-comparison of the two for detection of scarring and differential cortical function

Anitha Dharmalingam, Shwetal U Pawar, Sandesh V Parelkar, Suruchi S Shetye, Mangala K Ghorpade, Gundu H Tilve

Indian Journal of Nuclear Medicine 2017 32(2):93-97

Context: The differential cortical function obtained by Tc-99m EC is comparable to that of Tc-99m DMSA. However, identification of scars on Tc-99m EC images needs to be studied. Aims: The aim of the study is to evaluate role of Tc-99m EC for detection of scarring and differential cortical function by comparing with Tc-99m DMSA. Settings and Design: Prospective observational study of recurrent UTI; minimum 6 weeks after acute episode; when urine examination is negative for pus cells. Materials and Methods: Forty-seven children with normal positioned kidneys underwent Tc-99m EC and DMSA scintigraphy. The DRF and cortical phase images of both studies in the same image matrix size were evaluated by two independent observers for scarring; Tc-99m DMSA was considered as the gold standard. Statistical analysis used: MS Excel 2007 and GraphPad Instat V3.1 and ROC analysis. Results: There was no significant difference in the detection of scarring using two studies with Cohen's kappa coefficient (κ) 0.932. The sensitivity and specificity of Tc-99m EC for detection of scarring was 98.75% and 99.15%, respectively. There was good agreement between the differential cortical function calculated using two studies. Conclusions: The summed Tc-99m EC images with an acceptable high image contrast allow detection of cortical scarring in patients with normal kidney positions. It is an excellent single-modality comprehensive investigational agent for renal parenchymal defects, function, and excretion evaluation with the added advantages of lower cost, convenience, and low radiation exposure to the child.

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Peritoneal super scan on 18F - FDG PET-CT in a patient of burkitt's lymphoma

Shambo Guha Roy, Girish Kumar Parida, Sarthak Tripathy, Abhinav Singhal, Shamim Ahmed Shamim, Madhavi Tripathi

Indian Journal of Nuclear Medicine 2017 32(2):155-156

Peritoneal lymphomatosis is seen less frequently, but when seen, it is mostly associated with aggressive variants of malignancies. FDG uptake has been reported in peritoneal lymphomatosis both in DLBCL and Burkitt's lymphoma. We report a case of Burkitt's lymphoma with involvement of entire peritoneum, which looks like a "peritoneal super scan" on FDG PET-CT.

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Comparison of SPECT/CT and planar lympho-scintigraphy in sentinel node biopsies of oral cavity squamous cell carcinomas

Piyush Chandra, Sanket Dhake, Sneha Shah, Archi Agrawal, Nilendu Purandare, Venkatesh Rangarajan

Indian Journal of Nuclear Medicine 2017 32(2):98-102

Introduction: Evidence supporting the use of Sentinel node biopsy (SNB) for nodal staging of early oral squamous cell carcinomas (OSCC) appears to be very promising. Pre-operative lymphatic mapping using planar lymphoscinitigraphy (PL) with or without SPECT/CT in the SNB procedure is useful in sentinel node localization and for planning appropriate surgery. Recently, a large prospective multi-centric study evaluating SNB in cutaneous melanoma, breast and pelvic malignancies, demonstrated that adding SPECT to PL leads to surgical adjustments in a considerable number of patients. Our aim of this study was to evaluate the incremental value of additional SPECT/CT over PL alone in SNB for OSCC. Materials and Methods: This was a retrospective analysis of 44 patients (40- tongue, 4- buccal mucosa) with T1-T2, clinically N0 oral cavity SCC who underwent sentinel node biopsy procedure. PL and SPECT lymphoscinitigraphy images were compared for pre-operative mapping of sentinel nodes. Results: Using a handheld gamma probe, a total of 179 sentinel nodes were harvested, with a mean of 4.06 per patient. PL revealed 75 hotspots with a mean of 1.70 per patient, and SPECT/CT revealed 92 hotspots with a mean of 2.09 per patient. Additional hotpots were identified in 14 patients on SPECT/CT, which included 4 patients, where PL did not detect any sentinel nodes. Conclusion: Pre-operative SPECT/CT in addition to planar lympho-scinitigraphy in sentinel node biopsies of oral cavity SCC detects more number of sentinel nodes compared to planar imaging alone. The higher sensitivity of SPECT combined with better anatomical localization using diagnostic CT may further improve the precision of SNB procedure.

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Image findings of rare case of peritoneal carcinomatosis from non small cell lung cancer and response to erlotinib in F-18 FDG positron emission tomography/computed tomography

Koramadai Karuppusamy Kamaleshwaran, Jephy Joseph, Radha krishnan Kalarikal, Ajit Sugunan Shinto

Indian Journal of Nuclear Medicine 2017 32(2):140-142

Lung cancer is currently one of the most common malignancies in the world. Metastatic disease is observed in ~ 40% of patients with lung cancer, with the most common sites of metastasis being the bone, liver, brain and adrenal glands. Peritoneal carcinomatosis (PC) is defined as the progression of the primary cancer to the peritoneum. PC is a rare clinical event in lung cancer. Tyrosine kinase inhibitors targeting the epidermal growth factor receptor (EGFR), such as erlotinib are used for the treatment of patients with advanced non-small cell lung cancer (NSCLC). F-18 FDG PET/CT has proven capable of predicting response to therapy with erlotinib. We present a rare F-18 FDG PET/CT image findings of a 45 year old male with NSCLC with PC treated with erlotinib showing response to the treatment.

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Development and validation of the suprathreshold stochastic resonance-based image processing method for the detection of abdomino-pelvic tumor on PET/CT scans

Kartik Saroha, Anil Kumar Pandey, Param Dev Sharma, Abhishek Behera, Chetan Patel, Chandrashekhar Bal, Rakesh Kumar

Indian Journal of Nuclear Medicine 2017 32(2):103-109

Purpose: The detection of abdomino-pelvic tumors embedded in or nearby radioactive urine containing 18F-FDG activity is a challenging task on PET/CT scan. In this study, we propose and validate the suprathreshold stochastic resonance-based image processing method for the detection of these tumors. Methods: The method consists of the addition of noise to the input image, and then thresholding it that creates one frame of intermediate image. One hundred such frames were generated and averaged to get the final image. The method was implemented using MATLAB R2013b on a personal computer. Noisy image was generated using random Poisson variates corresponding to each pixel of the input image. In order to verify the method, 30 sets of pre-diuretic and its corresponding post-diuretic PET/CT scan images (25 tumor images and 5 control images with no tumor) were included. For each sets of pre-diuretic image (input image), 26 images (at threshold values equal to mean counts multiplied by a constant factor ranging from 1.0 to 2.6 with increment step of 0.1) were created and visually inspected, and the image that most closely matched with the gold standard (corresponding post-diuretic image) was selected as the final output image. These images were further evaluated by two nuclear medicine physicians. Results: In 22 out of 25 images, tumor was successfully detected. In five control images, no false positives were reported. Thus, the empirical probability of detection of abdomino-pelvic tumors evaluates to 0.88. Conclusion: The proposed method was able to detect abdomino-pelvic tumors on pre-diuretic PET/CT scan with a high probability of success and no false positives.

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Extensive visceral calcification demonstrated on 99mTc-MDP bone scan in patient with carcinoma penis and hypercalcemia of malignancy

Sunny J Gandhi, Bhavdeep Rabadiya

Indian Journal of Nuclear Medicine 2017 32(2):150-152

Hypercalcemia is a common life-threatening complication associated with several malignancies. Parathyroid-related peptide has been shown to cause hypercalcemia in several solid tumors but rarely in penile cancer. We report a case of penile cancer with hypercalcemia causing metastatic visceral calcification in lungs, liver, and stomach detected on bone scan without significant abnormalities on CT scan.

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Clinical utility of gallium-68 PSMA PET/CT scan for prostate cancer

Kumaraswamy G Kallur, Prashanth G Ramachandra, Krishnappa Rajkumar, Shivakumar S Swamy, Indiresh Desai, Raghavendra M Rao, Shekhar Gowda Patil, PS Sridhar, Nagaraj Madhusudhan, Raghunath S Krishnappa, Veerendra Bhadrasetty, Hemantha M Kumara, SD Santhosh, Basavalingaiah S Ajaikumar

Indian Journal of Nuclear Medicine 2017 32(2):110-117

Background: Prostate cancer is biologically and clinically a heterogeneous disease that makes imaging evaluation challenging. One of the important challenges in this cancer is to detect recurrent disease. Biochemical response using Prostate Specific Antigen (PSA) and Imaging using several PET tracers have poor sensitivity and specificity. Therefore, we analyse the role of Ga68-PSMA (Prostate Specific Membrane Antigen) imaging in prostate cancer, which is a new PET tracer. Methods: In this study, we evaluated PET scans of 262 patients with diagnosis of prostate cancer. These patients were scanned using Ga68-PSMA for either staging or response evaluation. Results: 336 PSMA scans were performed. Ga68-PSMA scan resulted in the detection of extra-prostatic disease in 53.2% of cases when done at baseline before commencing any treatment. The sensitivity of Ga68-PSMA at baseline with histopathological diagnosis was 95% with 95% CI ranging from 86% to 98%. The positive predictive value was high at 98% with 95% CI ranging from 91% to 99%. In 26 (10%) patients who had surgical castration, Ga68-PSMA scan was able to detect disease progression / castration resistance in 100% of cases. The outcome of castration-resistant prostate cancer was compared with other cases where castration was not done. In those who did not undergo castration, there was a significantly better response by hormone therapy (p &#61; 0.03) and radiotherapy (p &#61; 0.01) on Ga68-PSMA. The sensitivity of Ga68-PSMA response with biochemical response was 66.7% with 95% CI ranging between 46 %- 82.7%. Ga68-PSMA response did not correlate with biochemical response. Conclusion: Ga68-PSMA has good sensitivity for diagnosis, staging, restaging, evaluation of therapy response and prognostication in prostate cancer.

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PSMA expression in multinodular thyroid neoplasm on simultaneous Ga-68-PSMA PET/MRI

Amarnath Jena, Shuaib Zaidi, Vikas Kashyap, Abhishek Jha, Sangeeta Taneja

Indian Journal of Nuclear Medicine 2017 32(2):159-161

PSMA PET is increasingly being used in imaging of recurrent prostate carcinoma. A case with suspected recurrent Prostate carcinoma (PCa), raised PSA (Prostate specific antigen) and suspected spinal metastases was referred for whole body Ga-68-PSMA PET/MRI. The study revealed PSMA avid recurrent prostate mass and extensive osseous metastases. Abnormal PSMA uptake in the thyroid gland prompted USG-guided FNAC which revealed Hurthle cell neoplasm. Histopathological examination (HPE) of excised gland showed multiple Hurthle cell adenomas in both lobes of thyroid along with foci of papillary thyroid carcinoma which on immunohistochemistry were thyroglobulin positive and PSA negative.

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Metastatic brachial plexopathy with brain and spinal metastasis in a case of recurrent breast carcinoma demonstrated on 18F-FDG PET/CT

Sunny J Gandhi, Bhavdeep Rabadiya

Indian Journal of Nuclear Medicine 2017 32(2):118-121

We report a case of a 56-year-old woman diagnosed with infiltrating ductal carcinoma of the left breast, who had undergone left modified radical mastectomy followed by radiotherapy and adjuvant chemotherapy. FDG PET-CT showed metastatic brachial plexopathy with intra-spinal and extra-axial brain metastasis. Metastatic brachial plexopathy along with brain and spinal metastasis is a rare condition with very less incidence. The scan also showed left para-sternal anterior chest wall recurrence with antero-superior mediastinal metastasis.18FDG-PET scanning is a useful tool in evaluation of patients with suspected metastatic plexopathy. It may also be useful in distinguishing between radiation-induced and metastatic plexopathy. Typical pattern of FDG uptake and dual time point imaging may increase specificity and require further evaluation.

http://ift.tt/2mUW0Uj

Estimation of whole body radiation exposure to nuclear medicine personnel during synthesis of 177lutetium-labeled radiopharmaceuticals

Geetanjali Arora, Rajesh Mishra, Praveen Kumar, Madhav Yadav, Sanjana Ballal, Chandrasekhar Bal, Nishikant Avinash Damle

Indian Journal of Nuclear Medicine 2017 32(2):89-92

Purpose of the Study: With rapid development in the field of nuclear medicine therapy, radiation safety of the personnel involved in synthesis of radiopharmaceuticals has become imperative. Few studies have been done on estimating the radiation exposure of personnel involved in the radio labeling of 177Lu-compounds in western countries. However, data from the Indian subcontinent are limited. We have estimated whole body radiation exposure to the radiopharmacist involved in the labeling of: 177Lu-DOTATATE, 177Lu-PSMA-617, and 177Lu-EDTMP. Materials and Methods: Background radiation was measured by keeping a pocket dosimeter around the workbench when no radioactive work was conducted. The same pocket dosimeter was given to the radiopharmacist performing the labeling of 177Lu-compounds. All radiopharmaceuticals were synthesized by the same radiopharmacist with 3, 1 and 3 year experience, respectively, in radiolabeling the above compounds. Results: One Curie (1 Ci) of 177Lu was received fortnightly by our department. Data were collected for 12 syntheses of 177Lu-DOTATATE, 8 syntheses of 177Lu-PSMA-617, and 3 syntheses of 177Lu-EDTMP. Mean time required to complete the synthesis was 0.81, 0.65, and 0.58 h, respectively. Mean whole body radiation exposure was 0.023 ± 0.01 mSv, 0.01 ± 0.002 mSv, and 0.002 ± 0.0006 mSv, respectively. Overall mean radiation dose for all the three 177Lu-compounds was 0.014 mSv. Highest exposure was obtained during the synthesis of 177Lu-DOTATATE. Conclusion: Our data suggest that the manual radiolabeling of 177Lu compounds is safe, and the whole body radiation exposure to the involved personnel is well within prescribed limits.

http://ift.tt/2nKwfDB

FDG PET-CT: Need for vigilance in patients treated with bleomycin

Anna N Paschali, Gopinath Gnanasegaran, Gary J Cook

Indian Journal of Nuclear Medicine 2017 32(2):122-124

Bleomycin-induced interstitial lung disease is not a rare complication of treatment and may prove to be fatal if not suspected early in its course. As FDG PET-CT has become an essential clinical tool for interim and end-of-treatment response assessment in oncology, it is important that radiologists/nuclear medicine specialists be aware of the features of this potentially treatable condition so that treatment can be instigated during an early reversible phase before pulmonary damage has occurred. Herein, we report two cases of bleomycin toxicity featuring different patterns on the treatment-response assessment FDG PET-CT scan.

http://ift.tt/2mUW1Yk

F-18-Fluorodeoxyglucose positron emission tomography/computed tomography appearance of extramedullary hematopoesis in a case of primary myelofibrosis

Anirban Mukherjee, Chandrasekhar Bal, Madhavi Tripathi, Chandan Jyoti Das, Shamim Ahmed Shamim

Indian Journal of Nuclear Medicine 2017 32(2):143-144

A 44-year-old female with known primary myelofibrosis presented with shortness of breath. High Resolution Computed Tomography thorax revealed large heterogeneously enhancing extraparenchymal soft tissue density mass involving bilateral lung fields. F-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed mildly FDG avid soft tissue density mass with specks of calcification involving bilateral lung fields, liver, and spleen. Subsequent histopathologic evaluation from the right lung mass was suggestive of extramedullary hematopoesis.

http://ift.tt/2nKwfn5

Image findings of a rare case of neuroendocrine tumor metastatic to orbital extraocular muscle in Gallium-68 DOTANOC positron emission tomography/computed tomography and therapy with lutetium-177 DOTATATE

Koramadai Karuppusamy Kamaleshwaran, Jephy Joseph, Indra Upadhya, Ajit Sugunan Shinto

Indian Journal of Nuclear Medicine 2017 32(2):125-127

Metastatic tumor is one of several etiologies of space-occupying masses in the orbit that accounts for 1-13% of all orbital masses. In the adult patient population, breast cancer is the most common tumor to metastasize to the orbit, followed by metastasis from the lung, prostate, and gastrointestinal tract. Carcinoid tumors are rare neuroendocrine neoplasms derived from enterochromaffin cells, which are found primarily in the gastrointestinal tract and bronchial tree. Liver metastases are the classic presentation of distant disease. Although rare, metastatic carcinoid to the extraocular muscles (EOMs) has been relatively well described in both retrospective case reports and clinical series in the ophthalmology literature, but not in nuclear medicine. Positron emission tomography/computed tomography (PET/CT) using Ga-68-labeled somatostatin-analogues have shown superiority over other modalities for imaging of Neuroendocrine tumor We describe a case of bilateral EOM metastasis from carcinoid lung in Ga-68 DOTANOC PET/CT and treatment with Lu -177 DOTATATE.

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Cerebral toxoplasmosis masquerading CNS lymphoma on FDG PET-CT in post renal transplant patient

Anirban Mukherjee, Chandrasekhar Bal, Madhavi Tripathi, Chandan Jyoti Das, Shamim Ahmed Shamim

Indian Journal of Nuclear Medicine 2017 32(2):148-149

20 year old post renal transplant patient developed recurrent episodes of seizure. MRI revealed focal lesion in right parieto-occipital lobe with perilesional edema. FDG PET-CT revealed multiple hypermetabolic lesions in bilateral cerebral hemisphere. Subsequent biopsy from the lesion demonstrated bradyzoites of Toxoplasma gondii with inflammatory cells and thereby, a confirmatory diagnosis of cerebral toxoplasmosis was made. This case demonstrates the fact that increased FDG uptake in cerebral lesions in post transplant patient should be interpreted with caution and confirmed with histopathological correlation.

http://ift.tt/2nKwcYr

Hepatic pseudolesion in SVC obstruction - 99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

Reddy Ravikanth, Arun George, Babu Philip

Indian Journal of Nuclear Medicine 2017 32(2):128-129

An area of increased activity in segment IV of liver (quadrate lobe) on 99mTc-sulfur colloid (TSC) scans has been well documented in patients with superior vena cava obstruction. Similarly intense enhancement of the quadrate lobe in the arterial phase may be seen on computed tomography in patients of superior vena cava syndrome. We present this imaging finding in a case of malignant thymoma causing superior vena cava syndrome and discuss the physiological cause and importance of this sign.

http://ift.tt/2mUWn1a

Primary germ cell tumor of testes with extensive lymph nodal and splenic metastases masquerading lymphoma on 18-F-FDG PET/CT

Sarthak Tripathy, Anirban Mukherjee, Chandrasekhar Bal, Madhavi Tripathi, Saumyaranjan Mallick, Shamim Ahmed Shamim

Indian Journal of Nuclear Medicine 2017 32(2):153-154

Germ cell tumors (GCT) account for the 95% of the malignancies associated with testes. They are the most common solid malignancies affecting the males in the age group of 15–35 years. It is known to be bilateral in 3% of cases. We herein present FDG PET-CT findings of a case with biopsy proven GCT with multiple lymph nodal and splenic metastases mimicking lymphomatous neoplasm.

http://ift.tt/2nKDeMO

Unsuspected active ulcerative colitis in a patient with dermatomyositis: A rare association detected on 18F-FDG PET/CT during the search for an occult malignancy

Sampanna Jung Rayamajhi, Arun Kumar Reddy Gorla, Rajender Kumar Basher, Ashwani Sood, Bhagwant Rai Mittal

Indian Journal of Nuclear Medicine 2017 32(2):130-132

Dermatomyositis is an inflammatory myopathy with the characteristic features of skin rash and myopathy. We here present a known case of dermatomyositis evaluated with 18F-FDG PET/CT for the presence of any occult malignancy. The scan was negative for the presence of any malignancy. However, it revealed multiple intensely FDG avid colonic strictures that were later proven on colonoscopic biopsy to be ulcerative colitis. Also, a well-known association of bilateral sacroilitis was simultaneously demonstrated on the scan. The present case demonstrates that 18F-FDG PET/CT imaging can serve as a one-stop shop imaging modality in dermatomyositis by facilitating detection of occult primary if any and by providing insight into other rare systemic associations.

http://ift.tt/2mUXMof

Unusual presentation of rare cardiac tumor: The role of F-18-fluorodeoxyglucose positron emission tomography/computed tomography

Sameer Kamalakar Taywade, Nishikant Avinash Damle, Madhavi Tripathi, ST ArunRaj, Averilicia Passah, Amarinder Singh Malhi, Sanjeev Kumar, Chandrasekhar Bal

Indian Journal of Nuclear Medicine 2017 32(2):157-158

Primary cardiac tumors are rare with angiosarcoma being the most common among malignant cardiac tumor. We present a case of 30-year-old female patient in whom F-18-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a necrotic mass in right atrium with multiple fluorodeoxyglucose avid lesions in both upper and lower alveolus, liver, multiple bones, and bilateral lungs. Patient underwent biopsy from gum swelling which revealed metastatic angiosarcoma.

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Familial Gastrointestinal Stromal Tumor with Germline KIT Mutations Accompanying Hereditary Breast and Ovarian Cancer Syndrome

Background: Familial gastrointestinal stromal tumor (GIST) is a rare disease with germline mutations in the c-kit gene (KIT) or platelet-derived growth factor receptor alpha gene (PDGFRA). We had encountered multiple GISTs in the stomach and small intestine during a screening of ovarian cancer for a woman with hereditary breast and ovarian cancer syndrome (HBOC) with breast cancer susceptibility gene II (BRCA2) mutations. The aim of this study was to examine this case in detail. Case Report: A 65-year-old woman diagnosed with HBOC harboring BRCA2 mutations was found to have multiple tumors in the stomach and small intestine by abdominal screening. All tumors were resected, and KIT gene mutations (p.Trp557Leu and p.Lys558Glu) in exon 11 were detected in all tumors and peripheral blood leukocytes. The patient was diagnosed with familial GIST. Conclusion: This was an extremely rare case in which familial GIST with germline KIT gene mutations co-existed with HBOC.

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Problem Solving in Older Cancer Patients: A case-study based reference and learning resource

http://ift.tt/2nsXs1E

The role of IL-7 in Immunity and Cancer

Interleukin-7 (IL-7) is a cytokine that has been known since long in immunology, mainly regarding its effects on T-cells and B-cells. IL-7 has been demonstrated to be necessary for both B-cell and T-cell proliferation and lack of IL-7 causes immature immune cell arrest. Interestingly, in recent years, certain studies have strongly suggested that the role of IL-7 is far beyond the field of immunology, it might have direct or indirect effect on cancer. This review aims to summarize the role of IL-7 in immunity and its role in the pathogenesis of neoplasia.

http://ift.tt/2mxN2sF

Prognostic Factors and Treatment of Early-stage Small-cell Lung Cancer

Background/Aim: Only 0.1-0.17% of all lung cancer patients are diagnosed with stage I or II small cell lung cancer (SCLC). Radiochemotherapy remains the standard treatment for limited stage disease. This study focused on prognostic factors in early stage SCLC treated with radiochemotherapy. Patients and Methods: Seven factors in eight patients with early stage SCLC were analyzed concerning the impact on overall survival, namely gender, age, Karnofsky performance score, N-category, UICC-stage, concurrent chemotherapy and prophylactic cranial irradiation (PCI). Results: Median overall survival was 46 months. On univariate analysis, UICC stage I (48 vs. 24 months, p=0.022) and PCI (48 vs. 20 months, p=0.004) were significantly associated with improved overall survival. On multivariate analysis, PCI was an independent positive prognostic factor (p<0.001). Conclusion: UICC stage and PCI were identified as significant predictors of survival in early stage SCLC. PCI qualified as an independent positive prognostic factor and should be administered in early-stage SCLC.

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Synchronous Endometrial and Ovarian Cancer in Young Women: Case Report and Review of the Literature

Background: Young women with endometrial cancer (EC) have an increased risk of synchronous ovarian cancer. The prognosis of women with synchronous endometrial and ovarian cancer (SEOC) is good. A high proportion of affected women have hereditary non-polyposis colon cancer syndrome (HNPCC). Case presentation: We present the case of a 45-year-old woman with histologically proven endometrioid adenocarcinoma of the endometrium (pT1B, G2, R0 without lymphovascular space invasion). She underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Final histology revealed a synchronous bilateral endometrioid ovarian cancer (pT1A, G2, R0). HNPCC analysis by immunohistochemistry showed no microsatellite instability in MSH2, MSH6, MLH1, and PMS2. No adjuvant therapy was administered, clinical follow-up with regular gynecological examinations was recommended. In a systematic literature review, 2,904 cases of women with SEOC were identified with 1,035 (36%) of them being premenopausal or <50 years of age. The proportion of women with SEOC among all reported EC cases was 842/23,498 (3%) and the proportion of young women with SEOC among all reported EC cases was 261/23,498 (1%). In summary, microsatellite instability and subsequent mutations in mismatch repair genes compatible with HNPCC were identified in 6/15 (40%) women analyzed. The mean recurrence-free and overall survival times of young women with SEOC were 1.9 (min 0.2, max 3) and 4.0 (min 0.2, max 22.1) years, respectively. Conclusion: Young women with EC have a high risk of synchronous ovarian cancer. Thus, in young women with EC, bilateral salpingo-oophorectomy or careful histological assessment of both ovaries are recommended in order to confirm or rule out SEOC. HNPCC testing should be offered to all women.

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Expression of Indoleamine 2,3-Dioxygenase Gene Is a Feature of Poorly Differentiated Non-muscle-invasive Urothelial Cell Bladder Carcinomas

Aim: To evaluate indoleamine 2,3-dioxygenase (IDO) gene expression in non-muscle-invasive urothelial cell bladder carcinoma (NMIBC). Patients and Methods: Seventy-four patients undergoing surgical treatment for NMIBC were enrolled in the study. IDO gene expression was assessed by quantitative real-time polymerase chain reaction (qRT-PCR). Results: IDO gene expression was detectable significantly more frequently (48/74, 64.86% vs. 5/21, 23.81%, p<0.001) and to significantly higher extents (p=0.01) in cancer tissues than in normal bladder mucosa. IDO gene expression was observed significantly more frequently in large (p=0.02), high-grade (p=0.05) and stage T1 (p=0.03) than in small, low-grade and stage Ta tumors. Expression levels were also significantly higher in large, high-grade and stage T1 tumors (p<0.01, p=0.05 and p=0.03, respectively). A direct positive correlation between IDO gene expression in tumor tissues and tumor size (R=0.24, p=0.04), grade (R=0.23, p=0.05) and stage (R=0.25, p=0.03) was detected. Multivariate analysis suggested a trend (p=0.08) towards longer overall survival in patients bearing tumors that did not express IDO gene. Conclusion: These data indicate that IDO gene expression is a feature of aggressive NMIBC, suggesting a potential immunosuppressive role of IDO.

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Anti-metastatic Efficacy of Traditional Chinese Medicine (TCM) Ginsenoside Conjugated to a VEFGR-3 Antibody on Human Gastric Cancer in an Orthotopic Mouse Model

Background/Aim: The aim of the present study was to investigate the efficacy of a traditional Chinese medicine (TCM), VEGFR-3 antibody-conjugated ginsenoside Rg₃nanoemulsion (VRIN), targeting lymphangiogenesis, on the inhibition of tumor growth and metastasis in an orthotopic mouse model of human gastric cancer. Materials and Methods: An orthotopic nude-mouse model of gastric cancer was established with the red fluorescent protein (RFP)-expressing human gastric cancer cell line NUGC-4-RFP. The tumor-bearing mice were treated with vehicle (0.2 ml normal saline every other day, iv), 5-FU (20 mg/kg once a week, i.p.) and VRIN (1 mg/kg every other day, i.v.). Real-time fluorescence imaging was performed to assess tumor inhibition in each group. Metastasis was evaluated by open fluorescence imaging at autopsy. The expression of lymphangiogenesis-related factors VEGF-C, VEDF-D and VEGFR-3 in the tumors were analyzed by immunohistochemistry and real-time RCP. Results: VRIN and 5-FU significantly inhibited primary tumor growth as compared to vehicle control (p<0.05). However, significant inhibition of lymph-node metastasis was only found in the VRIN-treated group (p<0.05). The expression of VEGF-C, VEGF-D and VEGFR-3 in the tumor was suppressed by VRIN treatment (p<0.05). Expression of VEGF-D and VEGFR-3 in the 5-FU-treated group was not significantly increased (p>0.05). No obvious toxicity was found in VRIN- and 5-FU-treated groups. Conclusion: Lymphangiogenesis-targeted ginsenoside Rg₃immune-nanoemulsion inhibited tumor growth and reduced lymphatic metastasis by suppressing expression of VEGF-C, VEGF-D and VEGFR-3 in an orthotopic mouse model of human gastric cancer. Our study demonstrates the potential of TCM as an effective targeted treatment for metastatic gastric cancer.

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Concurrent Chemotherapy Improves the Overall Survival of Patients Irradiated for Locally Recurrent Bladder Cancer

Aim: To investigate the predictive value of several factors, including concurrent chemotherapy, for overall survival of patients irradiated for locally recurrent bladder cancer. Patients and Methods: Thirty patients irradiated for local recurrence of bladder cancer were included; 14 received concurrent chemotherapy. Ten factors were analyzed for overall survival: gender, age, period from bladder cancer diagnosis to irradiation of local recurrence, Karnofsky performance scale, tumour grading, pack-years smoked, smoking during radiotherapy, radiation dose, interruption of radiotherapy and concurrent chemotherapy. Results: On univariate analyses, significantly longer overall survival was found for those with age ≤76 years (p=0.024), better performance status (p<0.001) and those treated with concurrent chemotherapy (p<0.001). On Cox regression analysis, concurrent chemotherapy remained significantly associated with survival (risk ratio 3.82, p=0.013); a trend for association was found for performance status (risk ratio 2.50, p=0.076). Conclusion: Addition of concurrent chemotherapy to radiotherapy for locally recurrent bladder cancer resulted in improved overall survival. Concurrent radiochemotherapy should be considered when this is clinically reasonable for such patients.

http://ift.tt/2ntciVE

Hydrogen Peroxide Enhances TGF{beta}-mediated Epithelial-to-Mesenchymal Transition in Human Mammary Epithelial MCF-10A Cells

Aim: This study investigated the effect of reactive oxygen species (ROS) on transforming growth factor (TGF)-β-mediated epithelial-to-mesenchymal transition (EMT) in order to clarify the influence of ROS and TGFβ on the induction of dysplasia and ultimately, tumorigenesis. Materials and Methods: Confluent MCF-10A human mammary epithelial cells were treated with H₂O₂ for 1 h, then reseeded at low density in the presence of TGFβ and cultured until confluence. Results: Hydrogen peroxide (H₂O₂, 250 μM) enhanced TGFβ-mediated EMT, as evidenced by increased expression of EMT-associated transcription factors, which was accompanied by increased nuclear localization of phosphorylated SMAD family member 2 (SMAD2) and up-regulation of the TGFβ signaling pathway components mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK). Pharmacological inhibition of MEK/ERK signaling partly reversed the effects of H₂O₂. Conclusion: H₂O₂ enhances TGFβ-mediated EMT via SMAD and MEK/ERK signaling.

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Cardio-Oncology. 1st Edition

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Treatment of Hematological Malignancies with Glycyrrhizic Acid

The current study examined the effectiveness of glycyrrhizic acid (GA) in reducing cell viability and inducing apoptosis in human chronic myeloid leukemia (CML) in vitro and a mouse lymphoma in vivo. Additionally, we assessed GA as a candidate for combinational therapy in CML along with the current frontline treatment, imatinib (IM). Treatment of K562 CML cells with GA alone resulted in significant induction of apoptosis and loss of cell viability. GA was well tolerated by peripheral blood mononuclear cells (PBMCs) up to 2 mM doses which were subsequently used in combination with IM. Co-treatment of CML with GA and IM greatly enhanced the levels of apoptosis in human CML. The effectiveness of GA was not limited to in vitro studies as treatment of EL-4 lymphoma-bearing mice with GA (50 or 500 mg/kg/day) led to significant dose-related decrease in tumor burden that correlated with a significant increase in the level of apoptotic tumors in vivo. The broad activity of GA against different tumor cell types, its tolerance by PBMCs and synergistic effects when combined with IM suggests that GA may be a viable candidate for combinational treatment strategies in CML and other hematological malignancies.

http://ift.tt/2mxU7cD

Immunotherapy for Gastrointestinal Cancer

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Antimetastatic Efficacy of the Combination of Caffeine and Valproic Acid on an Orthotopic Human Osteosarcoma Cell Line Model in Nude Mice

Aim: We have previously reported that caffeine can enhance chemotherapy efficacy of bone and soft tissue sarcoma via cell-cycle perturbation. Valproic acid has histone deacetylase (HDAC) inhibitory activity. We have also reported the anti-tumor efficacy of combination treatment with caffeine and valproic acid against osteosarcoma primary tumors in a cell-line orthotopic mouse model. Materials and Methods: In this study, we performed combination treatment of caffeine and valproic acid on osteosarcoma cell lines in vitro and in spontaneous and experimental lung metastasis mouse models of osteosarcoma. Survival of 143B-RFP human osteosarcoma cells after exposure to caffeine and valproic acid for 72 hours was determined using the WST-8 assay. IC₅₀ values and combination indices were calculated. Mouse models of primary osteosarcoma and spontaneous lung metastasis were obtained by orthotopic intra-tibial injection of 143B-RFP cells. Valproic acid, caffeine, and combination of both drugs were administered from day 7, five times a week, for four weeks. Six weeks after orthotopic injection, lung samples were excised and observed with a fluorescence imaging system. A mouse model of experimental lung metastasis was obtained by tail vein injection of 143B-RFP cells. The mice were treated with these agents from day 0, five times a week for four weeks. Results: Both caffeine and valproic acid caused concentration-dependent cell kill in vitro. Synergistic efficacy of the combination treatment was observed. In the spontaneous lung-metastasis model, the number of lung metastasis was 9.0±2.6 in the untreated group (G1); 10.8±2.9 in the caffeine group (G2); 10.0±3.1 in the valproic-acid group (G3); and 3.0±1.1 in the combination group (G4); (p=6.78E-5 control vs. combination; p=0.006 valproic acid vs. combination; p=0.003 caffeine vs. combination). In the experimental lung-metastasis model, the combination group significantly reduced lung metastases and improved overall survival (p=0.0005). Conclusion: Efficacy of the combination of caffeine and valproic acid was observed in vitro and in spontaneous and experimental lung-metastasis mouse models of osteosarcoma.

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First-line Bevacizumab and Paclitaxel for HER2-negative Metastatic Breast Cancer: A French Retrospective Observational Study

Aim: To assess outcomes in patients treated with first-line bevacizumab-containing therapy for human epidermal growth factor receptor (HER)2-negative metastatic breast cancer (mBC) at a single centre with a homogenous standard-of-care. Patients and Methods: Information on patient and disease characteristics, efficacy, and safety was extracted from computer-based records of all patients receiving first-line bevacizumab–paclitaxel at the Curie Institute, Paris, France, between 2008 and 2011. Results: Median progression-free survival in the 116 treated patients was 13.2 months; median overall survival was 38.4 months. Corresponding values were 9.0 and 18.8 months, respectively, in patients with triple-negative mBC, and 19.4 and 58.8 months, respectively, in patients receiving maintenance endocrine therapy. No new safety signals were seen. Conclusion: Outcomes in patients treated with bevacizumab–paclitaxel at our center were consistent with efficacy in prospective clinical trials, with notable activity in poor-prognosis disease. Maintenance endocrine or oral therapy with bevacizumab after paclitaxel discontinuation was associated with long-term disease control.

http://ift.tt/2ntk7en

Mast Cells in Mammary Carcinogenesis: Host or Tumor Supporters?

Background/Aim: The effects of mast cells on carcinogenesis is not yet fully understood. This work aimed to disclose the role of mast cells in mammary carcinogenesis in a rat model. Materials and Methods: Mammary tumors were induced by the administration of N-methyl-N-nitrosourea (MNU) in three groups of rats. Animals from one group were treated with ketotifen immediately after MNU administration, and animals from another only received ketotifen after the development of the first mammary tumor. The biochemical profile was determined. Mammary tumors were evaluated by histopathology and immunohistochemistry. Results: Animals from ketotifen-treated groups developed fewer mammary tumors, higher number of mammary lesions and had lower histamine levels when compared to non-treated animals. Animals treated with ketotifen immediately after MNU exhibited the lowest proliferative and apoptotic indexes. Conclusion: The mainly positive effect of the inhibition of mast cell degranulation seems to be the reduction of tumor proliferation when the mast cell degranulation was inhibited before tumor development.

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Systemic Inflammatory Response After Preoperative Chemoradiotherapy Can Affect Oncologic Outcomes in Locally Advanced Rectal Cancer

Aim: Systemic inflammatory response (SIR) has been reported to be an important determinant of disease progression and survival in patients with colorectal cancer. This study investigated the prognostic relevance of changes in the platelet count on survival and the predictive value of changes in platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) on the pathological tumor response to preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Patients and Methods: From 2006 to 2015, 291 consecutive patients with LARC who were treated with preoperative CRT followed by curative surgery at the Kyungpook National University Medical Center (Daegu, Korea) were retrospectively analyzed. A cut-off value of 370x10³/μl for the platelet count was used and a PLR ≥235 was defined as high. Any change in the PLR or NLR was calculated based on subtracting the pre-CRT PLR or NLR from the post-CRT values. Results: A total of 17.5% patients had stage II and 82.5% had stage III LARC. Initially high NLR and PLR were significantly associated with poor clinical outcomes. Patients who maintained a high platelet count after CRT also had an advanced pathological stage (p=0.028), low pathological complete response rate (p=0.048), and high relapse rate (p=0.021). For patients with an initially low PLR, the multiple logistic regression analysis revealed that a high PLR change (odds ratio (OR)=2.301, 95% confidence interval (CI)=1.269-4.174; p=0.006) and clinical stage II compared to stage III (OR=1.878, 95% CI=1.231-2.865; p=0.003) were significant independent markers predictive of a good response to CRT. Conclusion: The present results suggest that platelet and PLR change after preoperative CRT, along with the initial platelet count, can be used as prognostic and predictive markers for the oncological outcomes in patients with LARC.

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Induction of Apoptosis in Human Oral Keratinocyte by Doxorubicin

Background/Aim: We have previously reported that doxorubicin (DXR) showed much higher cytotoxicity against human oral squamous cell carcinoma cell lines compared to normal human mesenchymal normal oral cells (gingival fibroblast, periodontal ligament fibroblast, pulp cell), yielding high tumor-specificity. However, we unexpectedly found that doxorubicin showed potent cytotoxicity against human normal oral keratinocytes and primary gingival epithelial cells. In the present study, we investigated the reproducibility, underlining mechanisms and generality of this unexpected finding. Materials and Methods: Viable cell number was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method, fine cell structure by transmission electron microscopy and apoptosis induction by western blot analysis. Results: Doxorubicin induced keratinocyte toxicity, regardless of cell density and concentration of FBS in the culture medium. Doxorubicin induced apoptosis (characterized by the loss of cell surface microvilli, chromatin condensation, nuclear fragmentation and caspase-3 activation) in keratinocytes. A total of 11 anticancer drugs showed similar keratinocyte toxicity. Alkaline extract of the leaves of Sasa senanensis Rehder partially alleviated the DXR-induced keratinocyte cytotoxicity by promoting cell growth. Conclusion: The present study suggested that oral keratinocyte toxicity is a novel adverse effect of most anticancer agents.

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Impact of Maintenance Therapy for Patients with Non-small Cell Lung Cancer in a Real-world Setting

Background: The purpose of this study was to explore the role of maintenance therapy for patients with advanced non-small cell lung cancer (NSCLC) in a real-world setting. Patients and Methods: This was a prospective observational cohort multicenter study. Eligible patients were observed from initiation of first-line platinum-based chemotherapy until final follow-up. Results: Between 2010 and 2011, a total of 864 patients were enrolled in this study. The primary study population was 396 patients who had progressive disease during observation after first-line chemotherapy without maintenance. Of these, 113 patients (29%) did not receive second-line therapy. In contrast, only 18% of patients who had progressive disease during maintenance therapy missed second-line therapy. Overall survival of patients without maintenance who received second-line therapy was similar to that of those who received maintenance, but no second-line therapy. Conclusion: Maintenance therapy for patients with advanced NSCLC might be an appropriate strategy to maximize the chance of receiving more active therapy.

http://ift.tt/2mUN7K8

Peroxiredoxin Expression of Human Osteosarcoma Cells Is Influenced by Cold Atmospheric Plasma Treatment

Background/Aim: To evaluate the potential involvement of redox-specific signalling pathways in cold atmospheric plasma (CAP)-induced apoptosis on human osteosarcoma cells. Materials and Methods: Osteosarcoma cell lines were treated with CAP with or without antioxidative agents and seeded in cell culture plates. Cell proliferation was determined by counting viable cells. Carrier gas-treated cells served as control. Peroxiredoxin (PRX) 1-3 expression and secretion were assessed. Results: CAP treatment exhibited strongly attenuated proliferation rates. This effect was significantly attenuated by the addition of N-acetylcysteine (NAC). CAP-treated cells exhibited an increase of PRX 1 and 2 10 sec after treatment. The ratio of oxidized to reduced PRX1 and PRX2 was significantly altered with increasing cellular concentration of the oxidized dimer. Conclusion: Antioxidant supplementation with NAC increases proliferation of CAP-treated osteosarcoma cells, implicating an involvement of redox signalling. Activation of PRX1 and -2 indicate CAP affects redox homeostasis.

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Book Reviews

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The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults

Abstract

Objectives

The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated.

Materials and methods

In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann–Whitney U test.

Results

The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01).

Conclusions

Subjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience.

Clinical relevance

One-year use of chewing gums provides an effective means for the prevention of caries disease.

Trial registration number

NCT02310308

http://ift.tt/2nsIw3t

Association between maternal exposure to tobacco, presence of TGFA gene, and the occurrence of oral clefts. A case control study

Abstract

Objective

To determine the association between maternal tobacco use or exposure, presence of variant transforming growth factor alpha (TGFA) gene, and the occurrence of oral clefts.

Methods

The present case control study was carried out for 5 months in three tertiary government hospitals in Chennai city with a sample of 100 children (50 children with non syndromic cleft and 50 control) aged 0–24 months. The details of maternal risk factors during the period of gestation were recorded from case and control parents through a pre-validated questionnaire, following which blood samples from 92 children (46 case and 46 controls) based on consent were obtained and evaluated for TGFA gene polymorphism.

Results

A significant number of case mothers (48%) were exposed to secondhand smoke during the period of gestation than their control counterparts (24%) (P = 0.01) with an odds ratio of 2.46 (95% CI = 0.99–6.08). Electrophoresis of the restriction fragment length polymorphism (RFLP) product revealed the presence of the homozygous C1C1 allele in all the tested 92 samples with no homozygous C2C2 allele or heterozygous C1C2 allele.

Conclusion

The present study has highlighted the role of passive smoking in the causation of non syndromic oral clefts in a developing country like India; however, the involvement of TGFA in causing the same disease in an ethnically Dravidian Indian population is uncertain.

Clinical significance

The study has brought into forth the role of passive smoking in the development of oral clefts thereby warranting an effective public health policy to tackle the same.

http://ift.tt/2mxqet3

Hereditary vitamin D-resistant rickets in Lebanese patients: the p.R391S and p.H397P variants have different phenotypes

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Giant parathyroid adenoma associated with severe hypercalcemia in an adolescent patient

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://ift.tt/2nwM9Cg

Analysis of growth hormone receptor gene expression in tall and short stature children

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://ift.tt/2mUfSXF

Bei individualisierter und interdisziplinär abgewogener Behandlung intrakranieller Befunde dürfen Behandlungskosten kein primäres Entscheidungskriterium sein

http://ift.tt/2neIRqd

Morphea and Eosinophilic Fasciitis: An Update

Abstract

Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud's phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.

http://ift.tt/2nwDu2y

Widely used non-ionic surfactant 4-nonylphenol: showing genotoxic effects in various tissues of Channa punctatus

Abstract

The present study investigated the intertissue differences in genotoxicity induction in the fish, Channa punctatus, in response to 4-nonylphenol. The lethal concentration of 50 (LC₅₀) was estimated using a semi-static system. Fish were subjected to three sublethal concentrations of 4-nonylphenol (NP) for 24, 48, 72, and 96 h. Liver, gill, and kidney tissues were analyzed, and the genotoxicity was estimated using the micronucleus test and the comet assay. The frequency of micronucleated cells (MNCs), binucleated cells (BNCs), aberrant cells, and tail moment (TM) increased significantly. The time for maximum induction of genotoxicity for all the parameters considered in the micronucleus assay was 72 h of exposure, whereas the TM was highest at 24 h of exposure followed by a decline. The gill and liver showed higher genotoxicity than kidney tissue demonstrating organ-specific susceptibilities to NP in fish C. punctatus.

http://ift.tt/2mTYv9t

Concentrations of trace metals in tissues of Chionoecetes crabs ( Chionoecetes japonicus and Chionoecetes opilio ) caught from the East/Japan Sea waters and potential risk assessment

Abstract

The concentrations of trace metals (As, Cd, Co, Cu, Fe, Hg, Pb, and Zn) were measured in muscle and hepatopancreas of two Chionoecetes crabs (Chionoecetes japonicus and C. opilio) caught from the East/Japan Sea (EJS) in order to assess the potential health risk by the consumption of deep sea crabs. The highest metal concentrations in muscle and hepatopancreas were As and Fe, respectively, while the lowest metal concentration in two tissues was Pb. The mean concentrations of Cd, Co, Cu, Fe, and Pb in Chionoecetes crabs were one or two orders of magnitude higher in hepatopancreas than in muscles. The mean concentrations of As, Cu, and Hg in muscle and hepatopancreas were relatively higher in C. japonicus than in C. opilio. The estimated daily intakes (EDI) of all metals in muscle were below 0.1% of the provisional tolerable daily intake (PTDI) adopted by the Joint FAO/WHO Expert Committee on Food Additives. Similarly, the target hazard quotient (THQ) of all trace metals in muscle was less than 1.0. These results imply that Chionoecetes crabs caught from EJS do not have an adverse impact on the Korean health. Based on the mean metal concentrations, PTDI, and THQ, the daily maximum permissible intakes of C. japonicus and C. opilio were estimated to be approximately 240 and 410 g/day, respectively.

http://ift.tt/2mxlaVH

Cadmium adsorption, chelation and compartmentalization limit root-to-shoot translocation of cadmium in rice ( Oryza sativa L.)

Abstract

Strategies to reduce cadmium (Cd) in rice grain, below concentrations that represent serious human health concerns, require that the mechanisms of Cd distribution and accumulation within rice plants be established. Here, a comprehensive hydroponic experiment was performed to investigate the differences in the Cd uptake, chelation and compartmentalization between high (D83B) and low (D62B) Cd-accumulation cultivars contrasting in Cd accumulation in order to establish the roles of these processes in limiting Cd translocation from root to shoot. D83B showed 3-fold higher Cd accumulation in the shoots than the cultivar D62B. However, a short-term Cd uptake experiment showed more Cd uptake by D62B than by D83B. The distribution of Cd in roots and shoots differed significantly. D83B translocated 38% of total Cd taken up to the shoots, whereas D62B retained most of the Cd in the roots. D62B had higher amounts of non-protein thiols (NPTs) and glutathione (GSH) than D83B. The NPT and Cd distribution ratio (CDR) in the anionic form in the roots of D62B increased gradually as Cd concentration increased. In D83B, in contrast, levels of CDR in the cationic form increased significantly from 22.10 to 43.37%, while NPT only increased slightly. Furthermore, the percentage of Cd ions retained in thiol-rich peptides, especially in the HMW complexes, was significantly higher in D62B compared with D83B. However, D83B possessed a greater proportion of potentially mobile (cationic) Cd in the roots and showed superior Cd translocation from root to shoot. Taken as a whole, the results presented in this study revealed that Cd chelation, compartmentalization and adsorption contribute to the Cd retention in roots.

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Occurrence and photodegradation of methylmercury in surface water of Wen-Rui-Tang River network, Wenzhou, China

Abstract

The spatial distribution and seasonal variations of methylmercury (MeHg) in Wen-Rui-Tang (WRT) River network were investigated by monitoring the MeHg concentrations in surface water samples collected from 30 sites across the river network over four seasons. Detection frequencies and concentrations of MeHg were generally higher in January, indicating that low sunlight irradiation, wind speed, and temperature conditions might enhance the persistence of MeHg in surface water. The MeHg levels varied with sampling locations, with the highest concentrations being observed in the industrial area especially around wastewater outfall, revealing that the mercury contamination in WRT River mainly comes from the industrial wastewater. Photodegradation of MeHg in WRT River surface water and the effects of natural constituents such as fulvic acid (FA), ferric ions (Fe³⁺), nitrate (NO₃⁻), and dissolved oxygen on the MeHg photodegradation in aqueous solutions were studied under the simulated sunlight. The experimental data indicated that the indirect photodecomposition of MeHg occurred in WRT River surface water. Photodegradation of MeHg in FA solution was initiated by triplet ³FA* or MeHg-FA* via electron transfer interaction under light irradiations. The Fe³⁺ and NO₃⁻ can absorb light energy to produce ·OH and enhance the photochemical degradation of MeHg. The MeHg photodecompositions in FA, nitrate, and Fe³⁺ solutions were markedly accelerated after removing the dissolved oxygen.

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