Δευτέρα 28 Ιανουαρίου 2019
Transarterial radioembolization in patients with hepatocellular carcinoma of intermediate B2 substage
Abstract
Purpose
Patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B according to the Barcelona Clinic Liver Cancer classification) are a heterogeneous group with different degrees of liver function impairment and tumour burden. The recommended treatment is transarterial chemoembolization (TACE). However, patients in this group may be judged as poor candidates for TACE because the risk-benefit ratio is low. Such patients may receive transarterial radioembolization (TARE) only by entering a clinical trial. Experts have proposed that the stage could be further divided into four substages based on available evidence of treatment benefit. We report here, for the first time, the outcome in patients with BCLC-B2 substage HCC treated with TARE.
Methods
A retrospective analysis of the survival of 126 patients with BCLC-B2 substage HCC treated with TARE in three European hospitals was performed.
Results
Overall median survival in patients with BCLC-B2 substage was not significantly different in relation to tumour characteristics; 19.35 months (95% CI 8.27–30.42 months) in patients with a single large (>7 cm) HCC, and 18.43 months (95% CI 15.08–21.77 months) in patients with multinodular HCC (p = 0.27). However, there was a higher proportion of long-term survivors at 36 months among those with a single large tumour (29%) than among those with multiple tumours (16.8%).
Conclusion
Given the poor efficacy of TACE in treating patients with BCLC-B2 substage HCC, TARE treatment could be a better choice, especially in those with a large tumour.
http://bit.ly/2MCfx6X
Comparison of 18 F-GE-180 and dynamic 18 F-FET PET in high grade glioma: a double-tracer pilot study
Abstract
Background
PET represents a valuable tool for glioma imaging. In addition to amino acid tracers such as 18F-FET, PET targeting the 18-kDa mitochondrial translocator-protein (TSPO) is of high interest for high-grade glioma (HGG) imaging due to its upregulation in HGG cells. 18F-GE-180, a novel TSPO ligand, has shown a high target-to-background contrast in HGG. Therefore, we intra-individually compared its uptake characteristics to dynamic 18F-FET PET and contrast-enhanced MRI in patients with HGG.
Methods
Twenty HGG patients (nine IDH-wildtype, 11 IDH-mutant) at initial diagnosis (n = 8) or recurrence (n = 12) were consecutively included and underwent 18F-GE-180 PET, dynamic 18F-FET PET, and MRI. The maximal tumour-to-background ratios (TBRmax) and biological tumour volumes (BTV) were evaluated in 18F-GE-180 and 18F-FET PET. Dynamic 18F-FET PET analysis included the evaluation of minimal time-to-peak (TTPmin). In MRI, the volume of contrast-enhancement was delineated (VOLCE). Volumes were spatially correlated using the Sørensen–Dice coefficient.
Results
The median TBRmax tended to be higher in 18F-GE-180 PET compared to 18F-FET PET [4.58 (2.33–8.95) vs 3.89 (1.56–7.15); p = 0.062] in the overall group. In subgroup analyses, IDH-wildtype gliomas showed a significantly higher median TBRmax in 18F-GE-180 PET compared to 18F-FET PET [5.45 (2.56–8.95) vs 4.06 (1.56–4.48); p = 0.008]; by contrast, no significant difference was observed in IDH-mutant gliomas [3.97 (2.33–6.81) vs 3.79 (2.01–7.15) p = 1.000]. Only 5/20 cases showed higher TBRmax in 18F-FET PET compared to 18F-GE-180 PET, all of them being IDH-mutant gliomas. No parameter in 18F-GE-180 PET correlated with TTPmin (p > 0.05 each). There was a tendency towards higher median BTVGE-180 [32.1 (0.4–236.0) ml] compared to BTVFET [19.3 (0.7–150.2) ml; p = 0.062] with a moderate spatial overlap [median Sørensen–Dice coefficient 0.55 (0.07–0.85)]. In MRI, median VOLCE [9.7 (0.1–72.5) ml] was significantly smaller than both BTVFET and BTVGE180 (p < 0.001 each), leading to a poor spatial correlation with BTVGE-180 [0.29 (0.01–0.48)] and BTVFET [0.38 (0.01–0.68)].
Conclusion
PET with 18F-GE-180 and 18F-FET provides differing imaging information in HGG dependent on the IDH-mutational status, with diverging spatial overlap and vast exceedance of contrast-enhancement in MRI. Combined PET imaging might reveal new insights regarding non-invasive characterization of tumour heterogeneity and might influence patients' management.
http://bit.ly/2sVhWR6
Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis
Abstract
Purpose
Hyperparathyroidism (HPT) is a common endocrine disorder caused by hyperfunctioning parathyroid glands (HP). The correct detection and localization of HP is challenging but crucial, as it may guide surgical treatment, particularly in patients with primary HPT. There is a growing body of data regarding the role of radiolabelled choline positron emission tomography (PET) in this setting. Therefore, we performed a systematic review and meta-analysis of the diagnostic performance of this method in detecting HP in patients with HPT.
Methods
This systematic review and meta-analysis was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE and Cochrane Library databases for studies published through May 2018 was performed using the following search algorithm: (a) "choline" or "fluorocholine" or "F-choline" or "C-choline" or "FCH" or "CH" or "FECH" or "FMCH" and (b) "PET" or "positron emission tomography" and (c) "parathyroid" or "hyperparathyroidism". The diagnostic performance of radiolabelled choline PET was expressed as sensitivity and positive predictive value (PPV) on a per-patient and per-lesion basis and as detection rate (DR) on a per-patient basis, with pooled proportion and 95% confidence interval (95% CI) obtained using a random-effects model.
Results
Eighteen studies were included in the systematic review. Fourteen articles (517 patients) were selected for the meta-analysis. The meta-analysis provided the following results on a per-patient analysis analysis: sensitivity 95% (95% CI: 92–97%), PPV 97% (95% CI: 95–98%) and DR 91% (95% CI: 87–94%). On a per-lesion analysis, pooled sensitivity and PPV were 92% (95% CI: 88–96) and 92% (95% CI: 89–95%), respectively. No significant heterogeneity was found among the selected studies.
Conclusions
Radiolabelled choline PET demonstrated excellent diagnostic performance in detecting HP in patients with HPT. Large multicentre studies and cost-effectiveness analyses are needed to better define the role of this imaging method in this setting.
http://bit.ly/2sRLgIl
Regulation of human brown adipose tissue by adenosine and A 2A receptors – studies with [ 15 O]H 2 O and [ 11 C]TMSX PET/CT
Abstract
Purpose
Brown adipose tissue (BAT) has emerged as a potential target to combat obesity and diabetes, but novel strategies to activate BAT are needed. Adenosine and A2A receptor (A2AR) agonism activate BAT in rodents, and endogenous adenosine is released locally in BAT as a by-product of noradrenaline, but physiological data from humans is lacking. The purpose of this pilot study was to investigate the effects of exogenous adenosine on human BAT perfusion, and to determine the density of A2ARs in human BAT in vivo for the first time, using PET/CT imaging.
Methods
Healthy, lean men (n = 10) participated in PET/CT imaging with two radioligands. Perfusion of BAT, white adipose tissue (WAT) and muscle was quantified with [15O]H2O at baseline, during cold exposure and during intravenous administration of adenosine. A2AR density of the tissues was quantified with [11C]TMSX at baseline and during cold exposure.
Results
Adenosine increased the perfusion of BAT even more than cold exposure (baseline 8.3 ± 4.5, cold 19.6 ± 9.3, adenosine 28.6 ± 7.9 ml/100 g/min, p < 0.01). Distribution volume of [11C]TMSX in BAT was significantly lower during cold exposure compared to baseline. In cold, low [11C]TMSX binding coincided with high concentrations of noradrenaline.
Conclusions
Adenosine administration caused a maximal perfusion effect in human supraclavicular BAT, indicating increased oxidative metabolism. Cold exposure increased noradrenaline concentrations and decreased the density of A2AR available for radioligand binding in BAT, suggesting augmented release of endogenous adenosine. Our results show that adenosine and A2AR are relevant for activation of human BAT, and A2AR provides a future target for enhancing BAT metabolism.
http://bit.ly/2MIabaA
Highly favourable outcomes with peptide receptor radionuclide therapy (PRRT) for metastatic rectal neuroendocrine neoplasia (NEN)
Abstract
Purpose
Rectal neuroendocrine neoplasia (NEN) is more common than other NEN origins, but is less commonly metastatic. However, when present, distant disease carries a particularly poor prognosis. Evidence guiding optimal treatment of such patients is lacking. We assessed PRRT outcomes in patients with somatostatin receptor (SSTR) positive metastatic rectal NEN from two referral centres.
Methods
Patients treated with PRRT were retrospectively reviewed. Morphologic (RECIST 1.1), SSTR imaging responses and toxicity were assessed 3 months post-PRRT. Kaplan-Meier estimate was used to determine progression-free survival (PFS) and overall survival (OS) from start of PRRT.
Results
Twenty-seven consecutive patients (M = 20, age 31-81 years) were reviewed. The majority (70%) had ENETs grade 2 disease (19 patients), three had Grade 3, one Grade 1, and four not documented. Overall, 63% (10/16 patients with available FDG PET/CT) had FDG avid disease. Twenty-six patients were treated for disease progression. Most had 177Lu-DOTA-octreotate with median cumulative activity of 30 GBq, median four cycles. 14 patients had radiosensitising chemotherapy (5FU or capecitabine). At 3 months post-PRRT, CT disease control rate (DCR) was 96%: partial response was observed in 70% (19/27) and stable disease in 26%. All but one had partial SSTR imaging response. The median PFS was 29 months. Ten patients died, with median overall survival 81 months with a median follow-up of 67 months. Seventeen patients had further treatments after initial PRRT (10 had further cycles of PRRT). Three patients had grade 3 lymphopenia, without significant renal toxicity, MDS or leukaemia.
Conclusion
Our results indicate high efficacy and morphologic responses with minimal toxicity and very encouraging survival from PRRT in patients with metastatic rectal NEN despite the adverse prognostic features of this cohort. Further prospective PRRT trials are warranted in this subgroup.
http://bit.ly/2MIa272
Influence of lanreotide on uptake of 68 Ga-DOTATATE in patients with neuroendocrine tumours: a prospective intra-patient evaluation
Abstract
Introduction
Somatostatin receptor imaging with PET is the standard of care for patients with a neuroendocrine tumour (NET). Since therapy and imaging with somatostatin analogues utilize the same receptor, current guidelines recommend withdrawing long-acting somatostatin analogues for 3-4 weeks prior to somatostatin receptor PET imaging. The aim of this study is to prospectively assess the effect of lanreotide use on the uptake of 68Ga-DOTATATE intra-individually 1 day prior to and 1 day post injection of lanreotide.
Methods
Thirty-four patients with metastatic and/or unresectable NET and currently on lanreotide therapy for at least 4 months were included in the study. A 68Ga-DOTATATE PET/CT scan was performed on the day before and the day after lanreotide injection. In each patient 68Ga-DOTATATE uptake (SUVmax, mean, peak) was assessed in both tumour lesions and normal tissue. All scans were assessed by two blinded nuclear medicine physicians for visual analysis. Paired T-tests were performed to determine the differences between the scans.
Results
Of the 34 patients included, 31 were available for analyses in which 190 tumour lesions were measured. Uptake of 68Ga-DOTATATE in tumour lesions was increased significantly after lanreotide, but decreased significantly in the liver, spleen, and thyroid gland resulting in a higher tumour-to-liver ratio.
Conclusion
Lanreotide injection prior to 68Ga-DOTATATE PET/CT does not result in decreased tumour uptake. In contrast, tumour uptake was increased, whereas the uptake in normal organs is decreased, leading to an increased tumour-to-liver ratio. However, these differences were small and not deemed clinically relevant. These results strongly suggest that discontinuation of lanreotide injections in the weeks prior to 68Ga-DOTATATE PET examinations is unnecessary and does not compromise nuclear medicine imaging results.
http://bit.ly/2MI9VIE
Safety and efficacy of targeted alpha therapy with 213 Bi-DOTA-substance P in recurrent glioblastoma
Abstract
Treatment options for recurrent glioblastoma multiforme (GBM) are very limited. GBM cells express high levels of the GPCR neurokinin type 1 receptor (NK-1R), and a modified substance P can be used as its ligand for the tumor cell targeting. Targeted alpha therapy with DOTA-Substance P labeled with the short range alpha emitter 213Bi allows for selective irradiation and killing of tumor cells.
Material and methods
Twenty patients with recurrent GBM were included into the study following a standard therapy. 1–2 intracavitary or intratumoral port-a-cath systems were stereotactically inserted. Patients were treated with 1–7 doses of 213Bi-DOTA-Substance P (213Bi-DOTA-SP) in 2-month intervals. 68Ga-DOTA-Substance P (68Ga-DOTA-SP) was co-injected with 213Bi-DOTA-SP to assess the biodistribution using PET/CT. Therapeutic response was monitored with performance status and MRI imaging.
Results
Treatment with activity up to 11.2 GBq 213Bi-DOTA-SP was well tolerated with only mild and transient adverse reactions. The median progression free survival was 2.7 months. The median overall survival from the first diagnosis was 23.6 months and median survival after recurrence was 10.9 months. The median survival time from the start of 213Bi-DOTA-SP was 7.5 months.
Conclusions
Treatment of recurrent GBM with 213Bi-DOTA-SP is safe and well tolerated. The median overall survival after recurrence of 10.9 months compares favorably to the available alternative treatment options. Once the supply of high activity 225Ac/213Bi radionuclide generators is secured, targeted alpha therapy with 213Bi-DOTA-SP may evolve as a promising novel option to treat recurrent GBM.
http://bit.ly/2sPRGrs
FET PET reveals considerable spatial differences in tumour burden compared to conventional MRI in newly diagnosed glioblastoma
Abstract
Purpose
Areas of contrast enhancement (CE) on MRI are usually the target for resection or radiotherapy target volume definition in glioblastomas. However, the solid tumour mass may extend beyond areas of CE. Amino acid PET can detect parts of the tumour that show no CE. We systematically investigated tumour volumes delineated by amino acid PET and MRI in patients with newly diagnosed, untreated glioblastoma.
Methods
Preoperatively, 50 patients with neuropathologically confirmed glioblastoma underwent O-(2-[18F]-fluoroethyl)-l-tyrosine (FET) PET, and fluid-attenuated inversion recovery (FLAIR) and contrast-enhanced MRI. Areas of CE were manually segmented. FET PET tumour volumes were segmented using a tumour-to-brain ratio of ≥1.6. The percentage overlap volumes, and Dice and Jaccard spatial similarity coefficients (DSC, JSC) were calculated. FLAIR images were evaluated visually.
Results
In 43 patients (86%), the FET tumour volume was significantly larger than the CE volume (21.5 ± 14.3 mL vs. 9.4 ± 11.3 mL; P < 0.001). Forty patients (80%) showed both increased uptake of FET and CE. In these 40 patients, the spatial similarity between FET uptake and CE was low (mean DSC 0.39 ± 0.21, mean JSC 0.26 ± 0.16). Ten patients (20%) showed no CE, and one of these patients showed no FET uptake. In five patients (10%), increased FET uptake was present outside areas of FLAIR hyperintensity.
Conclusion
Our results show that the metabolically active tumour volume delineated by FET PET is significantly larger than tumour volume delineated by CE. Furthermore, the results strongly suggest that the information derived from both imaging modalities should be integrated into the management of patients with newly diagnosed glioblastoma.
http://bit.ly/2MI9RIU
Personalized 177 Lu-octreotate peptide receptor radionuclide therapy of neuroendocrine tumours: initial results from the P-PRRT trial
Abstract
Purpose
Peptide receptor radionuclide therapy (PRRT) is mostly administered using a fixed injected activity (IA) per cycle. This empiric regime results in highly variable absorbed doses to the critical organs and undertreatment of the majority of patients. We conceived a personalized PRRT protocol in which the IA is adjusted to deliver a prescribed absorbed dose to the kidney, with the aim to safely increase tumour irradiation. We herein report on the initial results of our prospective study of personalized PRRT, the P-PRRT Trial (NCT02754297).
Methods
PRRT-naïve patients with progressive and/or symptomatic neuroendocrine tumour (NET) were scheduled to receive a four-cycle induction course of 177Lu-octreotate with quantitative SPECT/CT-based dosimetry. The IA was personalized according to the glomerular filtration rate and the body surface area for the first cycle, and according to the prior renal Gy/GBq for the subsequent cycles. The prescribed renal absorbed dose of 23 Gy was reduced by 25–50% in case of significant renal or haematological impairment. Responders were allowed to receive consolidation or maintenance cycles, for each of which 6 Gy to the kidney were prescribed. We simulated the empiric PRRT regime by fixing the IA at 7.4 GBq per cycle, with the same percentage reductions as above. Radiological, molecular imaging, biochemical, and quality of life responses, as well as safety, were assessed.
Results
Fifty-two patients underwent 171 cycles. In 34 patients who completed the induction course, a median cumulative IA of 36.1 (range, 6.3–78.6) GBq was administered, and the median cumulative kidney and maximum tumour absorbed doses were 22.1 (range, 8.3–24.3) Gy and 185.7 (range: 15.2–443.1) Gy respectively. Compared with the simulated fixed-IA induction regime, there was a median 1.26-fold increase (range, 0.47–2.12 fold) in the cumulative maximum tumour absorbed dose, which was higher in 85.3% of patients. In 39 assessable patients, the best objective response was partial response in nine (23.1%), minor response in 14 (35.9%), stable disease in 13 (33.3%) and progressive disease in three patients (7.7%). In particular, 11 of 13 patients (84.6%) with pancreatic NET had partial or minor response. The global health status/quality of life score significantly increased in 50% of patients. Acute and subacute side-effects were all of grade 1 or 2, and the most common were nausea (in 32.7% of patients) and fatigue (in 30.8% of patients) respectively. Subacute grade 3 or 4 toxicities occurred in less than 10% of patients, with the exception of lymphocytopenia in 51.9% of patients, without any clinical consequences however. No patient experienced severe renal toxicity.
Conclusions
Personalized PRRT makes it possible to safely increase tumour irradiation in the majority of patients. Our first results indicate a favourable tolerance profile, which appears similar to that of the empiric regime. The response rates are promising, in particular in patients with NET of pancreatic origin.
http://bit.ly/2sUMqD3
Comprehensive anatomical and functional imaging in patients with type I neurofibromatosis using simultaneous FDG-PET/MRI
Abstract
Purpose
To demonstrate the clinical use of FDG-PET/MRI for monitoring enlargement and metabolism of plexiform neurofibromas (PNF) in patients with neurofibromatosis type 1 (NF1), in whom the development of a malignant peripheral nerve sheath tumor (MPNST) is often a life limiting event.
Methods
NF1 patients who underwent a simultaneous FDG-PET/MRI examination in our institution from September 2012 to February 2018 were included. Indication was suspicion of malignant transformation of a PNF to MPNST. A maximum of six peripheral nerve lesions per patient were defined as targets. Standardized uptake values (SUV) and apparent diffusion coefficients (ADC) were measured. The presence of target sign and contrast-medium enhancement was visually recorded. Growth rates were estimated comparing prior or follow-up examinations and correlated with FDG uptake and ADC values. The presence of CNS lesions in cerebral T2 weighted images was recorded.
Results
In 28 NF1 patients a total number of 83 peripheral nerve tumors, 75 benign PNFs and eight MPNSTs, were selected as target lesions. The SUVs of MPNSTs were significantly higher than the SUVs of PNF (3.84 ± 3.98 [SUVmean MPNSTs] vs. 1.85 ± 1.03 [SUVmean PNF], P < .01). Similarly, lesion SUVmean-to-liver SUVmean ratios significantly differed between MPNSTs and PNF (3.20 ± 2.70 [MPNSTs] vs. 1.23 ± 0.61 [PNF]; P < .01). For differentiation between still benign PNF and MPNSTs, we defined SUVmax ≥ 2.78 as a significant cut-off value. Growth rate of PNF correlated significantly positively with SUVmean (rs = .41; P = .003). MRI parameters like ADCmean (1.87 ± 0.24 × 10−3 mm2/s [PNF] vs. 1.76 ± 0.11 × 10−3 mm2/s [MPNSTs]; P > .05], contrast medium enhancement (P = .50) and target sign (P = .86) did not differ between groups.
Conclusion
Simultaneous FDG-PET/MRI is a comprehensive imaging modality for monitoring PNF in NF1 patients. The combined acquisition of both morphologic information in MRI and metabolic information in PET enables the correlation of lesion growth rates with metabolic activity and to define SUV thresholds of significance to identify malignant transformation, which is of utmost clinical significance.
http://bit.ly/2MFfMhA
The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma
Abstract
Purpose
Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma.
Methods
These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the "2018 Sentinel Node Biopsy in Head and Neck Consensus Conference".
Conclusion
The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.
http://bit.ly/2FTTLLz
Additional value of integrated 18 F-choline PET/4D contrast-enhanced CT in the localization of hyperfunctioning parathyroid glands and correlation with molecular profile
Abstract
Purpose
The localization of hyperfunctioning parathyroid gland(s) (HPTG) in patients with primary hyperparathyroidism (PHPT) with negative or inconclusive first-line imaging is a significant challenge. This study aimed to evaluate the role of integrated 18F-choline PET/4D contrast-enhanced computed tomography (4DCeCT) in these patients, compare its detection rate and sensitivity with those of 18F-choline PET/CT and (4DCeCT), and analyse the association between choline metabolism and morphological, biochemical and molecular parameters of HPTG.
Methods
We prospectively enrolled 44 PHPT patients with negative or inconclusive first-line imaging. 18F-Choline PET/CT and 4DCeCT were performed at the same time, and integrated 18F-choline PET/4DCeCT images were obtained after coregistration. Experienced physicians examined the images. The SUVratio and degree of contrast enhancement were recorded for each positive finding. Histopathology, laboratory and multidisciplinary follow-up were used as the standard of reference. Both the detection rates and sensitivities of the three imaging modalities were calculated retrospectively. Immunohistochemistry was performed to evaluate the molecular profile of HPTGs.
Results
18F-Choline PET/4DCeCT was positive in 32 of 44 patients with PHPT (detection rate 72.7%), and 31 of 31 surgically treated patients (sensitivity 100%). These results were significantly (p < 0.05) better than those of 18F-choline PET/CT (56.8% and 80%, respectively) and those of 4DCeCT (54.5 and 74%, respectively). A significant correlation between SUV and calcium level was found. In a multivariate analysis, only calcium level was significantly associated with 18F-choline PET/4DCeCT findings. SUVratio and Ki67 expression were significantly correlated.
Conclusion
Integrated 18F-choline PET/4DCeCT should be considered as an effective tool to detect PHPT in patients with negative or inconclusive first-line imaging. Choline metabolism is correlated with both calcium level and Ki67 expression in HPTG.
http://bit.ly/2sUMqmx
Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience
Abstract
Purpose
Radioembolization (RE) is a promising treatment option for biliary tract cancers (BTC). We report here the largest series to date using this treatment modality.
Methods
We retrospectively studied data from 64 patients treated outside prospective clinical trial at our institution. We studied baseline characteristics as potential prognostic factors. We studied dose delivered to the tumor as predictive factors of outcomes in patients not receiving concomitant chemotherapy.
Results
The Progression-Free Survival and Overall Survival (OS) were 7.6 months [95% Confidence Interval (CI): 4.6–10.6] and 16.4 months [95% CI: 7.8–25.0] in the whole cohort. The factors independently associated with OS in multivariable analysis were the primary localization of ICC (HR = 0.27, 95% CI: 0.11–0.68, p = 0.005) and a PS > 0 (HR = 2.21, 95% CI: 1.11–4.38, p = 0.024). During follow-up, 12 patients (19%) underwent surgery following downstaging, with a median OS of 51.9 months. In patients not treated with concomitant chemotherapy (n = 31), OS was significantly higher in patients with a dose delivered to the tumor 260Gy or higher than in patients with a dose delivered to the tumor lower than 260Gy (median 28.2 vs 11.4 months, log-rank p = 0.019).
Conclusion
Our results confirm that RE is a promising treatment modality in BTC. A high proportion of patients could be downstaged to surgery, with promising long-term survival. Dose delivered to the tumor correlated with clinical outcomes when chemotherapy was not used concomitantly.
http://bit.ly/2FUloUL
Platelet‐rich plasma and microneedling improves hair growth in patients ofandrogenetic alopecia when used as an adjuvant to minoxidil
Summary
Background
Platelet‐rich plasma (PRP) is a popular procedure for the treatment of androgenetic alopecia (AGA).
Aim
To ascertain the role of minoxidil 5% lotion alone versus minoxidil 5% lotion and PRP versus minoxidil 5% lotion, PRP with microneedling in AGA.
Material and methods
Ninety‐three AGA patients with Hamilton‐Norwood score 1‐5 were grouped into three groups A, B, and C. Patients in group A (control group) were treated with minoxidil 5% lotion twice daily (n = 31), whereas patients in group B underwent treatment with minoxidil 5% lotion twice daily and PRP (n = 31), and group C patients received minoxidil 5% lotion twice daily, PRP, and microneedling (n = 31). Baseline and post‐treatment photographs were taken along with dermoscopic evaluation. Selection of the dermoscopic variables included in the evaluation process was based on the published literature and dermoscopists' expertise and experience. Hair pull test was performed before and during follow‐up.
Results
Post‐treatment, hair pull test was negative in 27 patients (87.1%, P < 0.01) of group C, 20 patients (64.5%, P < 0.05) of group B, and 15 patients (48.4%) of group A. Hair growth was better appreciated in group C (26/31) compared to groups B (17/31)and A (10/31).The patients' self‐satisfaction score on a Likert scale was more than seven (high satisfaction) in 24/31 patients in group C. There was a statistically significant difference between three groups in terms of hair pull test, terminal‐to‐vellus hair ratio, and patient satisfaction score as determined by one‐way ANOVA.
Conclusion
PRP with microneedling is better in comparison with PRP alone or minoxidil monotherapy in patients with AGA.
http://bit.ly/2HDJ3KL
Comment on: ‘Treatment of psoriasis with ustekinumab in a patient with HIV‐related Kaposi sarcoma’
Abstract
We read with great interest the recent article by Wang et al.1 reporting on a psoriatic patient co‐affected by HIV‐related Kaposi's sarcoma (KS), whose poorly controlled psoriasis was successfully treated with ustekinumab, a fully monoclonal antibody that targets the common p40 subunit shared by interleukins (IL)‐12 and IL‐23. Interestingly, despite the evidences supporting the role of IL‐12 in inhibiting tumorigenesis,2 the authors reported no KS progression after a 16‐month follow‐up.
This article is protected by copyright. All rights reserved.
http://bit.ly/2TltEjC
Vulvar squamous cell carcinoma: a clinico‐dermoscopic correlation
Abstract
Squamous cell carcinoma (SCC) is the most common malignant vulvar tumor.1 It primarily affects post‐menopausal women; its precursor lesions are vulvar intraepithelial neoplasia (VIN), in particular the "differentiated" subtype, and/or human papillomavirus (HPV) infection.1 The final diagnosis of vulvar SCC is made by histopathology, which is similar to that of SCC affecting other body areas, distinguishing between well differentiated forms and poorly differentiated tumors.
This article is protected by copyright. All rights reserved.
http://bit.ly/2BaxOEa
Liquid chromatography–mass spectrometry is effective for Analysis of Ergosterol in Fungus Infected Nails
Abstract
Background
The identification of onychomycosis is mainly based on clinical diagnosis with auxiliary diagnostic methods such as KOH microscopy, PAS staining, or mold culture. However, they are limited by the sensitivity and specificity of each type of method. Therefore, our aim is to develop a new test method using the common end product – ergosterol – test to see if it can be used as a new diagnostic tool.
Materials and Methods
We collected consecutive data from 20 subjects with nail problems. After the clinical diagnosis, the subjects received a KOH microscopy test and the extraction of specimens for the mass spectrometer test to check for the presence of ergosterol.
Results
Among the 20 cases collected, seven came out positive by the mass spectrometry test. Four of them were suspected as onychomycosis, whereas one of the remaining three subjects was presumed to be dry nail and the other two as onycholysis. It is obvious that it is easier for the mass spectrometer test to find composites.
Conversely, among the five clinically diagnosed onychomycosis, four came out positive by mass spectrometer whereas the other one was detected negative by KOH and mass spectrometer. Three other subjects were positive with KOH test with mass spectrometer test also resulting to be positive.
Conclusion
The detection of the presence of ergosterol by a mass spectrometer is one of the good tools for confirming onychomycosis. However, there is a need to conduct studies to verify the sensitivity and specificity of the mass spectrometer method.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Tird1p
Eccrine Porocarcinoma in a patient with Schöpf–Schulz–Passarge syndrome
Abstract
Histological analysis of the lesion proved to be challenging. An initial punch biopsy showed an ulcerated tumour comprised of islands of monomorphic cells with duct formation pushed deep into the dermis, and a lace‐like pattern of infiltration. At this point a diagnosis of eccrine porocarcinoma was favoured over poroma due to the presence of desmoplastic response and focal infiltrative growth pattern.
This article is protected by copyright. All rights reserved.
http://bit.ly/2B8bmLD
A retrospective review of twelve patients with trichotillomania treated in a psychodermatology service
Summary
Trichotillomania is a condition characterised by the pulling of hair from anywhere on the body and is classified as an obsessive‐compulsive and related disorder. Patients with hair disorders are commonly referred to psychodermatology services, and can represent a management challenge. Few publications exist that report outcomes for patients with trichotillomania in real clinical practice. We report twelve such patients seen within our own psychodermatology service, who were managed using a variety of treatment strategies. The rate of defaulting of appointments was high, but improvements were seen in patients engaging with services.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Tpc8vb
Lower limb cellulitis: low diagnostic accuracy and underdiagnosis of risk factors
Abstract
Accurate diagnosis and recognition of predisposing factors has been shown to be challenging in lower limb cellulitis. Assessment of 1746 consecutive cellulitis patients presenting to a UK university hospital showed increasing overdiagnosis with only 31.9% of referred patients with confirmed lower‐limb cellulitis between 2015‐2018. Recognition of at least one predisposing factor increased from 61% to 89% following introduction of more specific screening questions. This identified a need for better primary care dermatology education and the benefit of a proforma with specific screening questions for reversible predisposing factors for lower limb cellulitis.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Bal1Bq
Modeling the relationship between gross capital formation and CO 2 (a)symmetrically in the case of Pakistan: an empirical analysis through NARDL approach
Abstract
This paper tries to ensure the relationship between gross capital formation (GCF) and carbon dioxide (CO2) emissions in the case of Pakistan for the period 1980–2016 by employing Non-Linear Auto Regressive Distribution Lag (NARDL) model under the expansion of Environmental Kuznets hypothesis (EKC) while controlling for coal and oil consumption variables as a potential factors of CO2 emissions. Our main objective is to check whether or not the effect of changes in GCF on CO2 emissions is asymmetric or symmetric for Pakistan that is among one of the main contributors to CO2 emissions in Asia, as the emissions were grown by 15.6 million tonnes or 8.5% increase in percentage terms in 2016. Our result confirms the existence of an asymmetric effect of GCF shocks on CO2 emissions both in the short and long-terms. Moreover, our empirical finding also suggests that coal and oil consumptions have a significant contribution to CO2 emissions both in the short and long-terms. Further, our results also significantly support the existence of the EKC hypothesis both in the long and short-terms. That confirms the inverted U-shaped connection among per capita growth and CO2 emissions in Pakistan. In the last, our study suggests that the implementation and use of clean energies and technologies are vital for controlling pollution in Pakistan.
http://bit.ly/2Rn4TSt
Phytoremediation potential and control of Phragmites australis as a green phytomass: an overview
Abstract
Phragmites australis (common reed) is one of the most extensively distributed emergent plant species in the world. This plant has been used for phytoremediation of different types of wastewater, soil, and sediments since the 1970s. Published research confirms that P. australis is a great accumulator for different types of nutrients and heavy metals than other aquatic plants. Therefore, a comprehensive review is needed to have a better understanding of the suitability of this plant for removal of different types of nutrients and heavy metals. This review investigates the existing literature on the removal of nutrients and heavy metals from wastewater, soil, and sediment using P. australis. In addition, after phytoremediation, P. australis has the potential to be used for additional benefits such as the production of bioenergy and animal feedstock due to its specific characteristics. Determination of adaptive strategies is vital to reduce the invasive growth of P. australis in the environment and its economic effects. Future research is suggested to better understand the plant's physiology and biochemistry for increasing its pollutant removal efficiency.
http://bit.ly/2G43wWR
The impact of sustainability performance indicators on financial stability: evidence from the Russian oil and gas industry
Abstract
Considering the dearth of research on the impact of sustainability reporting practices on financial stability in the context of transition economies, this study aims to explore sustainability reporting practices of top oil and gas companies in Russia and investigate the effects of sustainability performance indicators on financial stability in the context of a given emerging economy. The study is based on panel data analysis of sustainability performance indicators and financial data of forty-five largest oil and gas companies listed on the Russian Trading Stock Exchange over the period 2012–2016. Data on sustainability performance were collected through analyzing sustainability reports and annual reports, while financial data were obtained from audited financial statements downloaded from company websites. The empirical results indicate that companies improve their sustainability performance indicators in order to manage risk and improve their financial stability. The results also show that firm-specific characteristics, such as financial capacity, leverage, firm size, and firm age, are important underlying factors affecting the degree of financial distress and financial stability. The findings of the study provide managers and practitioners with useful aspects of sustainability performance indicators to improve financial stability and mitigate financial distress. Additionally, investors and practitioners should consider other underlying factors, including financial capacity, leverage, firm size, and firm age, that may influence financial stability. Finally, the findings are useful for policymakers and regulators in promoting Global Reporting Initiative guidelines which will ultimately lead to sustainable development and financial stability in the context of emerging markets.
http://bit.ly/2FTEPNt
Seasonal ecotoxicological monitoring of freshwater zooplankton in Bir Mcherga dam (Tunisia)
Abstract
Dams represent large semi-closed reservoirs of pesticides and various organic and inorganic pollutants from agricultural and human activities, and their monitoring should receive special attention. This study evaluated the environmental health status of Bir Mcherga dam using zooplankton species. The dam has a capacity of 130 Mm3 and its waters are used for irrigation, water drinking supply, and fishery. Copepods and cladocerans (crustaceans) were collected in situ monthly between October and August 2012. Oxidative stress (CAT, MDA), neurotoxicity (AChE), and genotoxicity (micronucleus test) biomarkers were analyzed in two zooplankton species: Acanthocyclops robustus and Diaphanosoma mongolianum. High values of cells with a micronucleus were observed during summer. AChE activities were inhibited during early winter and summer. The high seasonal variability of CAT and MDA levels indicates that zooplankton is continuously exposed to different oxidative stresses. These results suggest that there is an obvious and continuous multi-faceted stress in Bir Mcherga reservoir and, consequently, an urgent monitoring of freshwater environments in Tunisia is needed, particularly those intended for human consumption and irrigation.
http://bit.ly/2RSlkv8
Effect of Vicia faba L. var. minor and Sulla coronaria (L.) Medik associated with plant growth-promoting bacteria on lettuce cropping system and heavy metal phytoremediation under field conditions
Abstract
Researches involving the use of association between legumes and PGPBs (plant growth-promoting bacteria) in heavy metal phytoremediation process were mainly performed for soils highly contaminated. However, even in agriculture soils, with moderate or low contamination levels, plants can accumulate high rates of heavy metals. So, food chain contamination by these metals presents a real threat to animal and human health. This work aimed to evaluate the use of two legumes/PGPB symbioses; Vicia faba var. minor and Sulla coronaria have been inoculated with specific heavy metal-resistant inocula in a crop rotation system with Lactuca sativa as a following crop, in order to assess their effects on soil fertility, lettuce yield, and heavy metal content. Our results showed that legume inoculation significantly enhanced their biomass production, nitrogen and phosphorus content. The use of our symbioses as green manure before lettuce cultivation, as a rotation cropping system, affected positively soil fertility. In fact, we recorded a higher organic matter content, with rapid decomposition in the soil of inoculated plots. Besides, results demonstrated a greater nitrogen and phosphorus content in this soil, especially in the plot cultivated with inoculated V. faba var. minor. The improvement of soil fertility enhanced lettuce yield and its nitrogen and phosphorus content. Moreover, inoculated legumes extracted and accumulated more heavy metals than non-inoculated legumes. Our symbioses play the role of organic trap for heavy metals, making them unavailable for following crops. These facts were supported by lettuce heavy metal content, showing a significant decrease in metal accumulation, mainly zinc and cadmium, in edible parts. Results showed the usefulness of the studied symbioses, as a main part of a rotation system with lettuce. Our symbioses can be suggested for agriculture soil phytoremediation, aiming to enhance non-legume crop yield and limit heavy metal translocation to food chain.
http://bit.ly/2CPGrnu
Improved Jayaweera-Mikkelsen model to quantify ammonia volatilization from rice paddy fields in China
Abstract
Current estimates of China's ammonia (NH3) volatilization from paddy rice differ by more than twofold, mainly due to inappropriate application of chamber-based measurements and improper assumptions within process-based models. Here, we improved the Jayaweera-Mikkelsen (JM) model through multiplying the concentration of aqueous NH3 in ponded water by an activity coefficient that was determined based on high-frequency flux observations at Jingzhou station in Central China. We found that the improved JM model could reproduce the dynamics of observed NH3 flux (R2 = 0.83, n = 228, P < 0.001), while the original JM model without the consideration of activity of aqueous NH3 overstated NH3 flux by 54% during the periods of fertilization and pesticide application. The validity of the improved JM model was supported by a mass-balance-based indirect estimate at Jingzhou station and the independent flux observations from the other five stations across China. The NH3 volatilization losses that were further simulated by the improved JM model forced by actual wind speed were in general a half less than previous chamber-based estimates at six stations. Difference in wind speed between the inside and outside of the chamber and insufficient sampling frequency were identified as the primary and secondary causes for the overestimation in chamber-based estimations, respectively. Together, our findings suggest that an in-depth understanding of NH3 transfer process and its robust representation in models are critical for developing regional emission inventories and practical mitigation strategies of NH3.
http://bit.ly/2Biu43B
Multifunctional diesel exhaust emission soot coated sponge for water treatment
Abstract
We demonstrated that a pollutant and waste, diesel exhaust emission soot (DEES) can be used as an absorbent to remove oil and organic pollutants from wastewater. The diesel exhaust emission soot coated sponge (DEES sponge) was prepared using the dip-coating method. Prepared DEES sponge was found hydrophobic in nature as the contact angle between water drop and its surface was recorded to be 147°. The DEES sponge showed high absorption capacity with various oils, without any surface modifications and pretreatments. Highest oil absorption capacity was found to be 39 g/g for engine oil. Excellent separation efficiency was recorded (max. 98.5% for engine oil). It shows promising recyclability having 95% efficiency even after 10 cycles. DEES sponge also demonstrated the capability to be used as an adsorbent due to its ability to absorb pollutants like methylene blue (MB), ciprofloxacin, and detergent from the water. It was able to adsorb 93% of the dye MB from its aqueous solution having concentration of 15 μM.
http://bit.ly/2RkOC0s
Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma
Abstract
Purpose
To investigate the swallowing status and its impact on quality of life (QOL) in patients who underwent radiotherapy for nasopharyngeal carcinoma (NPC).
Methods
In this study, 334 patients with NPC who underwent radiotherapy were reviewed. Clinical characteristics, videofluoroscopic swallowing studies (VFSSs), and scores of the World Health Organization quality of life-BREF (WHOQOL-BREF) were retrospectively analyzed for all patients.
Results
In this study, 143 of 334 (42.8%) patients showed dysphagia. The nodular stage N3 of NPC, neoadjuvant and concurrent chemotherapy were clinical predictors for dysphagia. VFSS of patients with dysphagia showed a high incidence of vallecular residue (100%), apraxia (99%), premature bolus loss (98%), bolus formation (98%), pyriform sinus residue (95%), and mastication (94%). Moreover, WHOQOL-BREF scores for the physical health, psychological, and environment domains were lower of the dysphagia group than those of the control group (P < 0.01). Videofluoroscopic dysphagia scale scores showed significant negative correlations with scores for the physical health (R = −0.66, P < 0.01), psychological (R = −0.70, P < 0.01), social relationships (R = −0.56, P < 0.01), and environment (R = −0.61, P < 0.01) domains of WHOQOL-BREF.
Conclusions
Radiotherapy-induced dysphagia is common in NPC patients and is correlated with poor quality of life. Patients, caregivers, and clinical physicians should be aware of these adverse effects and provide timely treatment for radiotherapy-induced dysphagia in collaboration with cross-disciplinary colleagues.
http://bit.ly/2MEhtvG
Clinical safety and efficacy of salvage reirradiation for upper abdominal malignancies
Abstract
Purpose
Reirradiation has the potential to provide effective local control of upper abdominal malignancies. This study aimed to evaluate the safety and efficacy of reirradiation for upper abdominal malignancies.
Methods
A total of 42 patients with a history of prior radiotherapy (RT) received reirradiation for abdominal malignancies between 2005 and 2017. Each patient's medical records, contours, and dose distribution for both RT courses were reviewed. The median dose of the prior RT was 50.0 Gy (range, 30.0–60.0 Gy) and the median dose of reirradiation was 45.0 Gy (range, 15.0–75.0 Gy).
Results
With a median follow-up of 10.9 months, the median infield-failure-free survival (IFFS) rate was 9.2 months. Gross tumor volume (GTV) significantly related to IFFS in both the univariate (p = 0.009) and multivariate analyses (p = 0.024), and patients with a GTV of <60.0 mL had an improved IFFS (p = 0.001). Four patients experienced ≥grade 3 late toxicities. In the retrospective dose reconstruction analysis in these patients, the cumulative dose to the most exposed 2 cc (D2cc) of the duodenum was >60.0 Gy (range, 60.1–73.7 Gy). In the univariate analysis, the D2cc of the duodenum and a preexisting duodenal ulcer identified using endoscopy prior to reirradiation significantly correlated with late severe toxicity (p = 0.021 and 0.017, respectively).
Conclusions
Reirradiation for upper abdominal malignancies could be safely performed for patients without preexisting gastrointestinal morbidity unless the duodenum received excessive radiation doses. Reirradiation could also provide substantial IFFS, especially for patients with a GTV of <60.0 mL.
http://bit.ly/2sVjF93
Risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy and radiotherapy in young and old Asian women with breast cancer
Abstract
Purpose
The risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy (CT) and radiotherapy (RT) is yet to be investigated in a large-scale randomized controlled trial with an adequate sample size of young and old women with breast cancer.
Patients and methods
To compare the occurrence of major heart events (heart failure and coronary artery disease) in patients with breast cancer, 3489 women who underwent surgical resection of the breast tumor were retrospectively selected from the Taiwan National Health Insurance Research Database. The patients were categorized into the following groups based on their treatment modalities: group 1 (n = 1113), no treatment; group 2 (n = 646), adjuvant RT alone; group 3 (n = 705), adjuvant anthracycline-based CT alone; and group 4 (n = 1025), combined adjuvant RT and anthracycline-based CT.
Results
The mean patient age was 50.35 years. Subsequent coronary artery disease and heart failure were identified in 244 (7.0%) and 206 (5.9%) patients, respectively. All three adjuvant therapies were significant independent prognostic factors of major heart events (adjusted hazard ratio [95% confidence interval]: 1.47 [1.24–1.73]; 1.48 [1.25–1.75], and 1.92 [1.65–2.23] in groups 2, 3, and 4, respectively). In patients aged ≥50 years with breast cancer who underwent surgery, the log-rank p values of groups 2 and 3 after adjustment were 0.537 and 0.001, respectively.
Conclusion
Adjuvant RT can increase cardiotoxicity in patients with breast cancer, particularly when used in combination with anthracycline-based CT. Therefore, it should be offered with optimal heart-sparing techniques, particularly in younger patients with good prognosis and long life expectancy.
http://bit.ly/2sRa0As
Heparin treatment mitigates radiation-induced oral mucositis in mice by interplaying with repopulation processes
Abstract
Purpose
To investigate the mechanistic background of the muco-protective effect of systemic heparin treatment on the development of radiation-induced oral mucositis in mice.
Materials and methods
Fractionated irradiation was given to the snouts of male C3H/Neu mice over 2 weeks (10 × 3 Gy), either alone or in combination with daily subcutaneous application of unfractionated or low molecular weight heparin (40 or 200 I.U./mouse, respectively). Over this course of 14 days, groups of mice (n = 3) were sacrificed every second day, their tongues excised and processed for histological analysis. The epithelial radiation response with and without heparin treatment was evaluated in terms of tissue morphology, proliferation and expression of cell contact molecules.
Results
Systemic treatment with heparins significantly reduced the cellular effects of irradiation to the oral epithelium. Heparin treated animals showed significantly higher total epithelial cell numbers and thickness throughout the study course. Bromodeoxyuridine (BrdU) incorporation analyses revealed that markedly more epithelial cells retained their proliferative capacity in the beginning of the first treatment week, but the proliferation of the mucosa was not stimulated during the rest of the study course. The expression of the adherens junction protein β‑catenin was slightly elevated in heparin treated animals, on day 2 the increase was statistically significant. The expression of e‑cadherin and occludin was mostly unaffected by the concomitant heparin treatment.
Conclusion
The findings of this study indicate an interplay of additional heparin treatment with the repopulation processes, leading to an earlier onset of this adaptive radiation response in oral mucosa. Importantly, we could demonstrate that the protective potential of heparin did not rely on stimulation of normal tissue proliferation. Since both heparin preparations are already approved for clinical use, they are considered as promising candidates for future clinical studies.
http://bit.ly/2MAlQIr
Stereotactic body radiotherapy of central lung malignancies using a simultaneous integrated protection approach
Abstract
Aim
It is recognized that stereotactic body radiotherapy (SBRT) for centrally located lung metastases is affected by higher rates of severe toxicity. In the present study, we report the clinical outcomes following a novel intensity-modulated radiotherapy prescription dose, termed simultaneous integrated protection (SIP), for nearby organs at risk (OARs).
Materials and methods
The prescribed total doses of SBRT were 70 Gy in 10 fractions and 60 Gy in 8 fractions. For ultra-centrally located lesions, a dose of 60 Gy in 10 fractions was delivered. The main planning instructions were: (1) to remain within the limits of the given dose constraints for an OAR; (2) to make use of the maximum possible dose to the OARs to minimize dose inhomogeneity for the Planning Target Volume (PTV). SBRT-related toxicity was prospectively assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. The primary clinical endpoint was the SBRT-related toxicity. Secondary endpoint was local control.
Results
Forty patients affected by a single central malignancy were analyzed. The median follow-up was 20 months (range, 6–58 months). Acute and late clinical pulmonary toxicity ≥grade 2 was recorded in 2 out of 40 patients (5%) and 3 out of 40 patients (7%), respectively. No patient experienced cardiac toxicity. No narrowing or stenosis of any airway or vessel was registered. One-year local control rate was 91%. The median time to local progression was 13 months (range, 6–46 months).
Conclusion
SBRT using a PTV-SIP approach for single central lung metastases achieved low SBRT-related toxicity with acceptable local control.
http://bit.ly/2MC7s2e
A possible role of biogenic silica in esophageal cancer in North China?
Abstract
Certain areas in North China have the highest incidence of esophageal squamous cell carcinoma (ESCC) in the world, which has not seen convincing explanation by any risk factor yet. Biogenic silica in millet bran was linked to ESCC in the early 1980s but the hypothesis was largely dismissed because of the lack of geographic correlation between millet consumption and ESCC. Later epidemiological studies disclosed the linkage of wheat consumption in North China to ESCC instead. Now, we hypothesize silica phytoliths (silicified bodies that have definite shapes) from wheat chaff are a major etiologic factor of ESCC in this region. This hypothesis is supported by the potentially high abundance of silica phytoliths on the bracts of wheat (Triticum aestivum) in North China due to favorable Si-accumulation genotype, arid climate, and siallitic soil with bioavailable Si. These silica phytoliths can contaminate wheat flour and cause repeated local injuries in the esophagus and stimulate proliferation by providing anchorage.
http://bit.ly/2Rpc6S2
An efficient method to determine the Hydrophile‐lipophile Balance of surfactants using the phase inversion temperature deviation of CiEj/n‐octane/water emulsions
Abstract
Objective
The aim of this study was to develop a fast and an efficient method to determine the Hydrophile‐Lipophile Balance (HLB) number of cosmetic and pharmaceutics surfactants.
Methods
This method is based on the deviation of the phase inversion temperature induced by the addition of the test compound, with respect to the phase inversion temperature of a reference system, which includes an ethoxylated surfactant. This method is called PIT‐deviation.
Results
Three calibration curves are set up with three reference ethoxylated surfactants. These calibration curves make it possible to evaluate the interfacial behavior of certain chemicals. More particularly, these curves make it possible to easily determine the surfactant HLB.
Conclusion
In this study, a fast and accurate method has been developed to determine the hydrophilic‐lipophilic balance (HLB) number of amphiphilic chemicals. This new method can be applied to establish an HLB number of all commercial amphiphilic ingredients. Compounds which have a PIT‐deviation close to zero are also discussed.
This article is protected by copyright. All rights reserved.
http://bit.ly/2FRAvOR
Presence of bacteroidales as a predicator of human enteric viruses in Haihe River of Tianjin City, China
Abstract
Traditional microbe indicators including total bacteria, total coliforms, fecal coliforms, Escherichia coli, enterococci, and F+ coliphage are all frequently used to characterize the microbial contamination state of water bodies for their correlation with pathogenic bacteria. However, these indicators have a poor relationship with viruses, which pose serious threat to economic and human health. Alternative indicators such as bacteroidales may be suitable complementary alternatives to traditional microbe indicators and are being increasingly reported. In the present study, water was analyzed for selected sites along Haihe River in Tianjin for traditional indicators, an alternative indicator (bacteroidales), pathogenic bacteria (Salmonella, Escherichia coli (E. coli) O157:H7, and Vibrio parahaemolyticus), viruses (enteric adenovirus, norovirus, enterovirus, poliovirus and rotavirus), and physicochemical parameters. Results indicated that traditional microbe indicators detected in this study showed good correlation with pathogenic bacteria, and the alternative indicator (bacteroidales) had a surprisingly good relationship with viral presence. We propose that bacteroidales might be a suitable complementary indicator for viral contamination in water bodies.
http://bit.ly/2WmUOZn
Outcome and molecular characteristics of non-invasive encapsulated follicular variant of papillary thyroid carcinoma with oncocytic features
Abstract
Purpose
In 2016, non-invasive encapsulated follicular variant of papillary thyroid carcinoma (NI-EFVPTC) was renamed as noninvasive thyroid follicular neoplasm with papillary-like nuclear features (NIFTP). However, as the study cohort did not mention tumors with oncocytic features, such lesions are still labeled by some as FVPTC. It is therefore crucial to evaluate the outcome and molecular profile of oncocytic NI-EFVPTC.
Methods
A multi-institutional clinico-pathologic review was conducted to select 61 patients having oncocytic NI-EFVPTC. A detailed molecular profile was carried out in 15 patients.
Results
Oncocytic NI-EFVPTCs predominantly affected women in their 50s. There was no distant metastasis, lymph node metastases, or structural recurrence in the entire cohort. Among patients with ≥5 years of FU, all 33 individuals did not recur with a median FU of 10.2 years. Oncocytic NI-EFVPTC commonly had RAS (33%) mutations, a high frequency of mitochondrial DNA mutations (67%) and multiple chromosomal gains/losses (53%). No fusion genes were detected.
Conclusions
Oncocytic NI-EFVPTC, when stringently selected for, lacks metastasis at presentation and follows an extremely indolent clinical course, even when treated conservatively with lobectomy alone without RAI therapy. These tumors share a similar mutational profile as NIFTP, FVPTC, and follicular neoplasm and are predominantly RAS-related. Like Hurthle cell neoplasms, they harbor a high frequency of mitochondrial DNA mutations, which contribute to the oncocytic cytomorphology. However, they lack the widespread chromosomal alterations observed in Hurthle cell carcinoma. Consideration should be given to include oncocytic NI-EFVPTCs as NIFTP in order to avoid overtreatment of these highly indolent tumors.
http://bit.ly/2B6RLLY
Outcome and molecular characteristics of non-invasive encapsulated follicular variant of papillary thyroid carcinoma with oncocytic features
Abstract
Purpose
In 2016, non-invasive encapsulated follicular variant of papillary thyroid carcinoma (NI-EFVPTC) was renamed as noninvasive thyroid follicular neoplasm with papillary-like nuclear features (NIFTP). However, as the study cohort did not mention tumors with oncocytic features, such lesions are still labeled by some as FVPTC. It is therefore crucial to evaluate the outcome and molecular profile of oncocytic NI-EFVPTC.
Methods
A multi-institutional clinico-pathologic review was conducted to select 61 patients having oncocytic NI-EFVPTC. A detailed molecular profile was carried out in 15 patients.
Results
Oncocytic NI-EFVPTCs predominantly affected women in their 50s. There was no distant metastasis, lymph node metastases, or structural recurrence in the entire cohort. Among patients with ≥5 years of FU, all 33 individuals did not recur with a median FU of 10.2 years. Oncocytic NI-EFVPTC commonly had RAS (33%) mutations, a high frequency of mitochondrial DNA mutations (67%) and multiple chromosomal gains/losses (53%). No fusion genes were detected.
Conclusions
Oncocytic NI-EFVPTC, when stringently selected for, lacks metastasis at presentation and follows an extremely indolent clinical course, even when treated conservatively with lobectomy alone without RAI therapy. These tumors share a similar mutational profile as NIFTP, FVPTC, and follicular neoplasm and are predominantly RAS-related. Like Hurthle cell neoplasms, they harbor a high frequency of mitochondrial DNA mutations, which contribute to the oncocytic cytomorphology. However, they lack the widespread chromosomal alterations observed in Hurthle cell carcinoma. Consideration should be given to include oncocytic NI-EFVPTCs as NIFTP in order to avoid overtreatment of these highly indolent tumors.
http://bit.ly/2B6RLLY
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