Scholar : Laryngotracheal reconstruction - νέα αποτελ

[HTML] Laryngotracheal resection for benign stenosis

C Vanni, D Massullo, AM Ciccone, A D'Andrilli… - Shanghai Chest, 2018

… stiches are visible; (B) three months after laryngotracheal resection; complete patency of the
reconstructed airway with … in this field has proved that it is possible to resect and primarily
reconstruct up to … Single-staged laryngotracheal reconstruction for idiopathic tracheal stenosis …

Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children

S Miura, B Wieczorek, H Lenker, SR Kudchadkar - Journal of Intensive Care Medicine, 2018

Background: Early mobilization of patients in the adult intensive care unit (ICU) is associated
with improved functional outcomes and shorter ICU stay. Although...

Parameters For Evaluation and Treatment of Patients With Cleft Lip/Palate or Other Craniofacial Differences

S Video, S Knowledge, S Stats - The Cleft Palate-Craniofacial Journal, 2017

Skip to main content. Menus. SAGE Journals. Profile logged-in. Search. MENU. Browse;
Resources: Authors; Librarians; Editors; Societies. My Tools: My Alerts; My Saved Searches;
My Favorite Journals; My Account. Advanced Search. IN THIS JOURNAL …

 

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Scholar : Myringotomy and tubes - νέα αποτελέσματα

Parameters For Evaluation and Treatment of Patients With Cleft Lip/Palate or Other Craniofacial Differences

S Video, S Knowledge, S Stats - The Cleft Palate-Craniofacial Journal, 2017

Skip to main content. Menus. SAGE Journals. Profile logged-in. Search. MENU. Browse;
Resources: Authors; Librarians; Editors; Societies. My Tools: My Alerts; My Saved Searches;
My Favorite Journals; My Account. Advanced Search. IN THIS JOURNAL …

Pediatric Otitis Media: An Update

LA Kirk - Physician Assistant Clinics

… After removing ME fluid, a tympanostomy tube is inserted into the myringotomy to maintain
ventilation of the middle ear. Short-acting grommet tubes have small flanges on either side of
the TM. Longer-acting T tubes have longer tube length and longer flanges, which sit on the …

 

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Scholar : ΠΑΛΙΝΔΡΟΜΗΣΗ - νέα αποτελέσμ

Η διαστρωματική σχέση των αναμενόμενων αποδόσεων και κινδύνων με χρήση της ασυμμετρίας και της κύρτωσης

Θ Νιώρας - 2017

[DOC] Execution of Measurements for Determining the Parameters Affecting the Thermochemical Treatment of Biomass and the Adsorption/Desoprtion of Dyes.

ON Kopsidas

ODYSSEAS N. KOPSIDAS. Economist – Civil Engineer MSc, PhD Candidate. Execution of
Measurements for Determining the Parameters Affecting the Thermochemical Treatment of
Biomass and the Adsorption/Desoprtion of Dyes. PIRAEUS 2016. Οδυσσέας Κοψιδάς …

 

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Scholar : intitle:Bioprinting - νέα αποτελέσματα

[HTML] Bioprinting of skin constructs for wound healing

P He, J Zhao, J Zhang, B Li, Z Gou, M Gou, X Li - Burns & Trauma, 2018

Abstract Extensive burns and full-thickness skin wounds are difficult to repair. Autologous
split-thickness skin graft (ASSG) is still used as the gold standard in the clinic. However, the
shortage of donor skin tissues is a serious problem. A potential solution to this problem is to

Silk‐Based Bioinks for 3D Bioprinting

S Chawla, S Midha, A Sharma, S Ghosh - Advanced Healthcare Materials, 2018

Abstract 3D bioprinting field is making remarkable progress; however, the development of
critical sized engineered tissue construct is still a farfetched goal. Silk fibroin offers a
promising choice for bioink material. Nature has imparted several unique structural features

 

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Scholar : Laryngomalacia - νέα αποτελέσματα

[HTML] Successful management of steroid‐resistant vascular tumors associated with the Kasabach–Merritt phenomenon using sirolimus

X Tan, J Zhang, S Zhou, Z Liu, T Zhang, J Xia - The Journal of Dermatology, 2018

… 10 Schroeder U, Lauten M, Stichtenoth G et al. Laryngomalacia and complicated, life-threatening
mTOR-positive Kaposiform heman- gioendothelioma cured by Supraglottoplasty and sirolimus.
Klin Padiatr 2014; 226: 362–368. 11 Kai L, Wang Z, Yao W et al …

Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES)

S Vetter‐Laracy, B Osona, A Roca, JA Peña‐Zarza… - Pediatric Pulmonology

… FEES findings: (1) Unexpected anatomic abnormalities; (2) Signs of GERD in the larynx like
laryngeal edema/erythema, inter-arytenoid mucosal redundancy or pachyderma, laryngomalacia
and inflammatory changes of the vocal cords; (3) Amount of saliva secretions …

 

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Scholar : Cricotracheal resection - νέα αποτελέσματα

[HTML] Laryngotracheal resection for benign stenosis

C Vanni, D Massullo, AM Ciccone, A D'Andrilli… - Shanghai Chest, 2018

… during the operation depending on the surgical approach and the extension of the segment to
be resected … Apropos of 9 resections in 15 cases of acute respiratory insufficiency … Tracheal and
cricotracheal resection for laryngotracheal stenosis: experience in 54 consecutive cases …

 

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Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis

Publication date: Available online 19 January 2018
Source:Radiotherapy and Oncology
Author(s): Nicholas G. Zaorsky, Charles T. Lee, Eddie Zhang, Thomas J. Galloway
Background and purposeTo compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin.Materials and methodsStudies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED3) and cosmetic outcomes.ResultsA total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED3 of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88–100%) vs 79% (95% CI: 60–82%), p < 0.05. Similar results were found for "good" cosmesis at BED3 >100 Gy. No difference in "poor" cosmesis was noted at any BED3. LR was <7% for both at one year.ConclusionBT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.



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Photon vs. proton radiochemotherapy: Effects on brain tissue volume and perfusion

Publication date: Available online 19 January 2018
Source:Radiotherapy and Oncology
Author(s): Jan Petr, Ivan Platzek, Frank Hofheinz, Henri J.M.M. Mutsaerts, Iris Asllani, Matthias J.P. van Osch, Annekatrin Seidlitz, Pawel Krukowski, Andreas Gommlich, Bettina Beuthien-Baumann, Christina Jentsch, Jens Maus, Esther G.C. Troost, Michael Baumann, Mechthild Krause, Jörg van den Hoff
Background and purposeTo compare the structural and hemodynamic changes of healthy brain tissue in the cerebral hemisphere contralateral to the tumor following photon and proton radiochemotherapy.Materials and methodsSixty-seven patients (54.9 ±14.0 years) diagnosed with glioblastoma undergoing adjuvant photon (n = 47) or proton (n = 19) radiochemotherapy with temozolomide after tumor resection underwent T1-weighted and arterial spin labeling MRI. Changes in volume and perfusion before and 3 to 6 months after were compared between therapies.ResultsA decrease in gray matter (GM) (−2.2%, P<0.001) and white matter (WM) (−1.2%, P<0.001) volume was observed in photon-therapy patients compared to the pre-radiotherapy baseline. In contrast, for the proton-therapy group, no significant differences in GM (0.3%, P = 0.64) or WM (−0.4%, P = 0.58) volume were observed. GM volume decreased with 0.9% per 10 Gy dose increase (P<0.001) and differed between the radiation modalities (P<0.001). Perfusion decreased in photon-therapy patients (−10.1%, P = 0.002), whereas the decrease in proton-therapy patients, while comparable in magnitude, did not reach statistical significance (−9.1%, P = 0.12). There was no correlation between perfusion decrease and either dose (P = 0.64) or radiation modality (P = 0.94).ConclusionsOur results show that the tissue volume decrease depends on radiation dose delivered to the healthy hemisphere and differs between treatment modalities. In contrast, the decrease in perfusion was comparable for both irradiation modalities. We conclude that proton therapy may reduce brain-volume loss when compared to photon therapy.



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Palliative radiotherapy for locally advanced non-metastatic head and neck cancer: A systematic review

Publication date: Available online 19 January 2018
Source:Radiotherapy and Oncology
Author(s): Muhammad Shahid Iqbal, Charles Kelly, Josef Kovarik, Bojidar Goranov, Ghazia Shaikh, David Morgan, Werner Dobrowsky, Vinidh Paleri
Objectives: The objective of this systematic review was to identify and appraise the existing evidence of role of palliative radiotherapy for locally advanced non-metastatic head and neck cancer. Methods: A systematic search of the literature was conducted using Medline, Embase and Cochrane databases and relevant references were included. Results: Literature search revealed a wide variation in dose fractionation regimens. Reported outcomes showed high efficacy and low rate of significant side effects, except in studies utilising higher doses of radiotherapy where higher grade toxicities were seen. Reported median overall survival was in the range of 3.3–17 months, but most studies reported median survival of around 6 months. Conclusions: The choice of palliative radiotherapy varies significantly. This is in contrast to regimens of curative radiotherapy for locally advanced head and neck cancer, which are well standardised. Given the reported relatively short overall survival of this patient group, an ideal treatment should be of the shortest possible duration whilst ensuring effective palliation and minimal side effects. Future well designed trials are needed to evaluate quality of life and duration of side effects in addition to survival and severity of toxicities in this group of patients.



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Treatment outcome and prognostic factors for adult patients with medulloblastoma: The Rare Cancer Network (RCN) experience

Publication date: Available online 17 January 2018
Source:Radiotherapy and Oncology
Author(s): Banu Atalar, Mahmut Ozsahin, Jason Call, Aleksandra Napieralska, Serra Kamer, Salvador Villa, Petek Erpolat, Laura Negretti, Yasmin Lassen-Ramshad, Cem Onal, Serap Akyurek, Gamze Ugurluer, Brigitta G. Baumert, Stephanie Servagi-Vernat, Robert C. Miller, Enis Ozyar, Terence T. Sio
Background and purposeThe optimal treatment for adults with newly diagnosed medulloblastoma (MB) has not been defined. We report a large series of cases from the Rare Cancer Network.Material and methodsThirteen institutions enrolled 206 MB patients who underwent postoperative radiotherapy (RT) between 1976 and 2014. Log-rank univariate and Cox-modeled multivariate analyses were used to analyze data collected.ResultsMedian patient age was 29 years; follow-up was 31 months. All patients had the tumor resected; surgery was complete in 140 (68%) patients. Postoperative RT was given in 202 (98%) patients, and 94% received craniospinal irradiation (CSI) and, usually, a posterior fossa boost. Ninety-eight (48%) patients had chemotherapy, mostly cisplatin and vincristine-based. The 10-year local control, overall survival, and disease-free survival rates were 46%, 51%, and 38%, respectively. In multivariate analyses, Karnofsky Performance Status (KPS) ≥80 and CSI were significant for disease-free and overall survival (P ≤ .04 for all); receiving chemotherapy and KPS ≥80 correlated with better local-control rates.ConclusionsPatients with high KPS who received CSI had better rates of disease-free and overall survival. Chemotherapy was associated with better local control. These results may serve as a benchmark for future studies designed to improve outcomes for adults with medulloblastoma.



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A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy

Publication date: Available online 17 January 2018
Source:Radiotherapy and Oncology
Author(s): Zsuzsanna Kahán, Ferenc Rárosi, Szilvia Gaál, Adrienn Cserháti, Krisztina Boda, Barbara Darázs, Renáta Kószó, Ferenc Lakosi, Ákos Gulybán, Philippe A. Coucke, Zoltán Varga
Background and purposeThe benefit of reduced radiation heart exposure in the prone vs. supine position individually differs. In this prospective cohort study, the goal was to develop a simple method for the operation of a validated model for the prediction of preferable treatment position during left breast radiotherapy.Material and methodsIn 100 cases, a single CT slice was utilized for the collection of the needed patient-specific data (in addition to body mass index, the distance of the LAD from the chest wall and the area of the heart included in the radiation fields at the middle of the heart in the supine position). Outcome was analyzed in relation to the full CT series acquired in both positions and dosimetric data.ResultsGreat consistency was found between the tested and original method regarding sensitivity and specificity. The prioritization of LAD dose, and the use of heart dose and position-specific dose constraints as safety measures ensure sensitivity and specificity values of 82.8% and 87.3%, respectively. In an additional "routine clinical practice" series of 60 patients the new method seemed feasible in routine clinical practice. External testing on a 28-case series indicated similar accuracy.ConclusionWe consider this simple clinical tool appropriate for assisting individual positioning aiming at maximum heart protection during left breast irradiation.



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Optimization of combined proton–photon treatments

Publication date: Available online 19 January 2018
Source:Radiotherapy and Oncology
Author(s): Jan Unkelbach, Mark Bangert, Karen De Amorim Bernstein, Nicolaus Andratschke, Matthias Guckenberger
PurposeProton treatment slots are a limited resource. Therefore, we consider combined proton–photon treatments in which most fractions are delivered with photons and only a few with protons. We demonstrate how both modalities can be combined to optimally capitalize on the proton's ability to reduce normal tissue dose.MethodsAn optimal combined treatment must account for fractionation effects. We therefore perform simultaneous optimization of intensity-modulated proton (IMPT) and photon (IMRT) plans based on their cumulative biologically effective dose (BED). We demonstrate the method for a sacral chordoma patient, in whom the gross tumor volume (GTV) abuts bowel and rectum.ResultsIn an optimal combination, proton and photon fractions deliver similar doses to bowel and rectum to protect these dose-limiting normal tissues through fractionation. However, proton fractions deliver, on average, higher doses to the GTV. Thereby, the photon dose bath is reduced. An optimized 30-fraction treatment with 10 IMPT fractions achieved more than 50% of the integral dose reduction in the gastrointestinal tract that is possible with 30 IMPT fractions (compared to 33% for a simple proton–photon combination in which both modalities deliver the same target dose).ConclusionsA limited number of proton fractions can best be used if protons hypofractionate parts of the GTV while maintaining near-uniform fractionation in dose-limiting normal tissues.



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Ototoxicity and cochlear sparing in children with medulloblastoma: Proton vs. photon radiotherapy

Publication date: Available online 17 January 2018
Source:Radiotherapy and Oncology
Author(s): Arnold C. Paulino, Anita Mahajan, Rong Ye, David R. Grosshans, M. Fatih Okcu, Jack Su, Mary Frances McAleer, Susan McGovern, Victor A. Mangona, Murali Chintagumpala
PurposeTo compare ototoxicity rates between medulloblastoma patients treated with protons vs. photons.Materials and methodsThe study included 84 children diagnosed with medulloblastoma treated with either passively scattered protons (n = 38) or photons (n = 46). Patients underwent maximal safe resection followed by craniospinal irradiation, posterior fossa and/or tumor bed boost and chemotherapy according to one of 3 multi-institutional trials. Median audiogram follow-up was 56 months for protons and 66 months for photons.ResultsMean cochlear dose (Dmc) was lower in patients treated with protons for both standard (p < 0.0001) and high-risk disease (p < 0.001). Grade 3 and 4 ototoxicity was seen in 7 of 75 (9.3%) and 9 of 91 (9.9%) ears (Brock, p = 0.91), 13 of 75 (17.3%) and 19 of 91 (20.9%) ears (POG, p = 0.56), and 15 of 75 (20.0%) and 21 of 91 (23.1%) ears (SIOP Boston, p = 0.63) with protons and photons respectively.ConclusionsWhile cochlear doses were lower in the proton group, patients treated with either protons or photons had similar Grade 3 and 4 ototoxicity rates.



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Response to ‘Perilesional edema in brain cancer: Independent prognosticator or epiphenomenon of biomolecular signature?’

Publication date: Available online 16 January 2018
Source:Radiotherapy and Oncology
Author(s): Hsiang-Kuang Tony Liang, Wen-Yih Isaac Tseng




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Differences in lung injury after IMRT or proton therapy assessed by 18FDG PET imaging

Publication date: Available online 16 January 2018
Source:Radiotherapy and Oncology
Author(s): Nadya Shusharina, Zhongxing Liao, Radhe Mohan, Amy Liu, Andrzej Niemierko, Noah Choi, Thomas Bortfeld
Background and purposeTo compare lung injury among non-small cell lung cancer (NSCLC) patients treated with IMRT or proton therapy as revealed by ¹⁸F-FDG post-treatment uptake and to determine factors predictive for clinically symptomatic radiation pneumonitis.Material and methodsFor 83 patients treated with IMRT or proton therapy, planning CT and follow up ¹⁸F-FDG PET-CT were analyzed. Post-treatment PET-CT was aligned with planning CT to establish a voxel-to-voxel correspondence between PET and planning dose images. ¹⁸F-FDG uptake as a function of radiation dose to normal lung was obtained for each patient. PET image-derived parameters as well as demographic, clinical, treatment and dosimetric patient characteristics were correlated with clinical symptoms of pneumonitis.ResultsThe dose distributions for the two modalities were significantly different; V5 was higher for IMRT, whereas V60 was higher for protons. The mean lung dose (MLD) was similar for the two modalities. The slope of linear ¹⁸F-FDG-uptake – dose response did not differ significantly between the two modalities. The MLD, slope, and 95th percentile of SUV were identified as three major factors associated with radiation pneumonitis.ConclusionsDespite significantly different dose distributions for IMRT and for protons, the slope of the SUV–dose linear regression line previously shown to be associated with RP did not differ between IMRT and protons. Patients who developed radiation pneumonitis had statistically significantly higher MLD and higher slope regardless of treatment modality.



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Monitoring early changes in rectal tumor morphology and volume during 5 weeks of preoperative chemoradiotherapy – An evaluation with sequential MRIs

Publication date: Available online 16 January 2018
Source:Radiotherapy and Oncology
Author(s): Doenja M.J. Lambregts, Ahmed Bani Yassien, Max J. Lahaye, Anja Betgen, Monique Maas, Geerard L. Beets, Uulke A. van der Heide, Baukelien van Triest, Regina G.H. Beets-Tan
PurposeTo assess early changes in rectal tumor volume and morphology on sequential MRIs performed during 5 weeks of chemoradiotherapy.Materials and methodsThirteen patients underwent weekly T2W-MRI during 5 weeks of preoperative radiotherapy (total 50 Gy), starting after the first week of radiation. Two radiologists visually evaluated tumor volume and morphology and one reader manually segmented tumors for each time point to quantitatively calculate tumor volumes. Evolution in tumor volume/morphology was assessed over time and compared between good responders (tumor regression grade (TRG) 1–2) and poor responders (TRG 3–5).ResultsTumor volumes decreased significantly during radiation. Early signs of response were also visually apparent: in the majority of good responders an early fibrotic transformation (week 2–3) as well as a visually estimated early volume reduction of >1/3 (week 1–2), was observed while these early changes only occurred in a minority of poor responders.ConclusionResults of this exploratory pilot study suggest that changes in rectal tumor morphology (fibrosis) and volume can already be observed early during radiation, both when measured quantitatively and when assessed visually. These changes appear to be indicative of the final treatment outcome.



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Standard whole prostate gland radiotherapy with and without lesion boost in prostate cancer: Toxicity in the FLAME randomized controlled trial

Publication date: Available online 11 January 2018
Source:Radiotherapy and Oncology
Author(s): Evelyn M. Monninkhof, Juliette W.L. van Loon, Marco van Vulpen, Linda G.W. Kerkmeijer, Floris J. Pos, Karin Haustermans, Laura van den Bergh, Sofie Isebaert, Gill M. McColl, Robert Jan Smeenk, Juus Noteboom, Iris Walraven, Petra H.M. Peeters, Uulke A. van der Heide
PurposeTo compare toxicity rates in patients with localized prostate cancer treated with standard fractionated external beam radiotherapy (EBRT) with or without an additional integrated boost to the macroscopically visible tumour.Material and methodsFLAME is a phase 3 multicentre RCT (NCT01168479) of patients with pathologically confirmed localized intermediate or high-risk prostate cancer. The standard treatment arm (n = 287) received a dose to the entire prostate of 77 Gy in 35 fractions. The dose-escalated treatment arm (n = 284) received 77 Gy in 35 fractions to the entire prostate, with an integrated boost up to 95 Gy to the multi-parametric MRI-defined (macroscopic) tumour within the prostate. Treatment related toxicity was measured using the CTCAE version 3.0. Grade 2 or worse GU or GI events up to two years were compared between groups by presenting proportions and by Generalized Estimating Equations (GEE) analyses for repeated measures.ResultsNinety percent of the 571 men randomly assigned between September 2009 and January 2015 had high-risk disease (Ash 2000), of whom nearly 66% were prescribed hormonal therapy up to three years. Median follow-up was 55 months at the time of this analysis. Toxicity prevalence rates for both GI and GU increased until the end of treatment and regressed thereafter, with no obvious differences across treatment groups. Late cumulative GI toxicity rates were 11.1% and 10.2% for the standard and dose-escalated group, respectively. These rates were 22.6% and 27.1% for GU toxicity. GEE analyses showed that both GU toxicity and GI toxicity (≥grade 2) up to two years after treatment were similar between arms (OR 1.02 95%CI 0.78–1.33p = 0.81 and (OR 1.19 95%CI 0.82–1.73p = 0.38), respectively.ConclusionsIn intermediate- and high-risk prostate cancer patients, focal dose escalation integrated with standard EBRT did not result in an increase in GU and GI toxicity when compared to the standard treatment up to two years after treatment. This suggests that the described focal dose escalation technique is safe and feasible.



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Perilesional edema in brain cancer: Independent prognosticator or epiphenomenon of biomolecular signature?

Publication date: Available online 10 January 2018
Source:Radiotherapy and Oncology
Author(s): Valerio Nardone, Claudia Vinciguerra, Antonio Federico, Alfonso Cerase, Luigi Pirtoli, Paolo Tini




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Concurrent chemoradiotherapy alone is feasible for esophageal squamous cell carcinoma patients not suitable for surgery

Publication date: Available online 10 January 2018
Source:Radiotherapy and Oncology
Author(s): Yongshun Chen, Jun Wang




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Consolidation chemotherapy after definite concurrent chemoradiation in patients with non-operable esophageal cancer: Is it useful?

Publication date: Available online 10 January 2018
Source:Radiotherapy and Oncology
Author(s): Antoine Adenis, Florence Castan, Thierry Conroy




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Liraglutide ameliorates palmitate-induced insulin resistance through inhibiting the IRS-1 serine phosphorylation in mouse skeletal muscle cells

Abstract

Objective

A reduction in insulin-stimulated glucose uptake in skeletal muscles is a characteristic of insulin resistance and type 2 diabetes mellitus (T2DM). The glucagon-like peptide (GLP)-1 agonist liraglutide can reduce blood glucose levels in individuals with T2DM. However, its effect on insulin-induced glucose metabolism in the skeletal muscle of insulin resistance is unknown. We investigated the effects and action mechanisms of liraglutide on insulin resistance (IR) in the skeletal muscle cells treatment with palmitic acid (PA).

Methods

The cell-surface GLUT4myc levels were determined by an antibody-coupled colorimetric assay. The phosphorylation levels of Akt, PI3K(p85α), AS160, IRS1, IKK, and JNK were determined by western blotting. The quantifications of mRNA levels of TNFα, IL-1β, and IL-6 were determined by real-time PCR. Analysis of variance was used for data analysis.

Results

PA elevated not only phosphorylation of JNK, IRS1 serines, and IKKα/β, but also the expression of IL-6, TNFα and IL-1β in C2C12–GLUT4myc cells. PA can reduce phosphorylation of IRS1 tyrosine. These effects of PA were reversed by liraglutide. In addition, liraglutide can reverse PA-decreased insulin-stimulated cell-surface GLUT4 levels, Akt, PI3K(p85α), and AS160 phosphorylation.

Conclusions

Liraglutide can enhance insulin-induced GLUT4 translocation by inhibiting IRS1 serine phosphorylation in PA-treated muscle cells.

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Dosimetric parameters predicting contralateral liver hypertrophy after unilobar radioembolization of hepatocellular carcinoma

Abstract

Purpose

This study aimed at identifying prior therapy dosimetric parameters using ^99mTc-labeled macro-aggregates of albumin (MAA) that are associated with contralateral hepatic hypertrophy occurring after unilobar radioembolization of hepatocellular carcinoma (HCC) performed with ⁹⁰Y–loaded glass microspheres.

Methods

The dosimetry data of 73 HCC patients were collected prior to the treatment with ⁹⁰Y–loaded microspheres for unilateral disease. The injected liver dose (ILD), the tumor dose (TD) and healthy injected liver dose (HILD) were calculated based on MAA quantification. Following treatment, the maximal hypertrophy (MHT) of an untreated lobe was calculated.

Results

Mean MHT was 35.4 ± 40.4%. When using continuous variables, the MHT was not correlated with any tested variable, i.e., injected activity, ILD, HILD or TD except with a percentage of future remnant liver (FRL) following the ⁹⁰Y–microspheres injection  (r = −0.56). MHT ≥ 10% was significantly more frequent for patients with HILD ≥ 88 Gy, (52% of the cases), i.e., in 92.2% versus 65.7% for HILD < 88 Gy (p = 0.032). MHT ≥ 10% was also significantly more frequent for patients with a TD ≥ 205 Gy and a tumor volume (VT) ≥ 100 cm³ in patients with initial FRL < 50%. MHT ≥10% was seen in 83.9% for patients with either an HILD ≥ 88 Gy or a TD ≥ 205 Gy for tumors larger than 100cm³ (85% of the cases), versus only 54.5% (p = 0.0265) for patients with none of those parameters. MHT ≥10% was also associated with FRL and the Child-Pugh score. Using multivariate analysis, the Child-Pugh score (p < 0.0001), FRL (p = 0.0023) and HILD (p = 0.0029) were still significantly associated with MHT ≥10%.

Conclusion

This study demonstrates for the first time that HILD is significantly associated with liver hypertrophy. There is also an impact of high tumor doses in large lesions in one subgroup of patients. Larger prospective studies evaluating the MAA dosimetric parameters have to be conducted to confirm these promising results.

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Reply to ‘Single high dose versus repeated bone-targeted radionuclide therapy’

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Incidental identification of osteoid osteoma by 68 Ga-PSMA PET/CT

http://ift.tt/2rQM2Ib

Is the whole larger than the sum of the parts? Integrated PET/MRI as a tool for response prediction

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177 Lu-PSMA-617 radioligand therapy in mCRPC: ready for phase III trial?

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FDG PET/CT radiomics for predicting the outcome of locally advanced rectal cancer

Abstract

Purpose

The aim of this study was to investigate the prognostic value of baseline ¹⁸F-FDG PET/CT textural analysis in locally-advanced rectal cancer (LARC).

Methods

Eighty-six patients with LARC underwent ¹⁸F-FDG PET/CT before treatment. Maximum and mean standard uptake values (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), histogram-intensity features, as well as 11 local and regional textural features, were evaluated. The relationships of clinical, pathological and PET-derived metabolic parameters with disease-specific survival (DSS), disease-free survival (DFS) and overall survival (OS) were assessed by Cox regression analysis. Logistic regression was used to predict the pathological response by the Dworak tumor regression grade (TRG) in the 66 patients treated with neoadjuvant chemoradiotherapy (nCRT).

Results

The median follow-up of patients was 41 months. Seventeen patients (19.7%) had recurrent disease and 18 (20.9 %) died, either due to cancer progression (n = 10) or from another cause while in complete remission (n = 8). DSS was 95% at 1 year, 93% at 2 years and 87% at 4 years. Weight loss, surgery and the texture parameter coarseness were significantly associated with DSS in multivariate analyses. DFS was 94 % at 1 year, 86 % at 2 years and 79 % at 4 years. From a multivariate standpoint, tumoral differentiation and the texture parameters homogeneity and coarseness were significantly associated with DFS. OS was 93% at 1 year, 87% at 2 years and 79% after 4 years. cT, surgery, SUVmean, dissimilarity and contrast from the neighborhood intensity-difference matrix (contrast_NGTDM) were significantly and independently associated with OS. Finally, RAS-mutational status (KRAS and NRAS mutations) and TLG were significant predictors of pathological response to nCRT (TRG 3-4).

Conclusion

Textural analysis of baseline ¹⁸F-FDG PET/CT provides strong independent predictors of survival in patients with LARC, with better predictive power than intensity- and volume-based parameters. The utility of such features, especially coarseness, should be confirmed by larger clinical studies before considering their potential integration into decisional algorithms aimed at personalized medicine.

http://ift.tt/2GpBQt2

Head to head comparison of [ 18 F] AV-1451 and [ 18 F] THK5351 for tau imaging in Alzheimer’s disease and frontotemporal dementia

Abstract

Purpose

Tau accumulation is a core pathologic change in various neurodegenerative diseases including Alzheimer's disease and frontotemporal lobar degeneration-tau. Recently, tau positron emission tomography tracers such as [¹⁸F] AV-1451 and [¹⁸F] THK5351 have been developed to detect tau deposition in vivo. In the present study, we performed a head to head comparison of these two tracers in Alzheimer's disease and frontotemporal dementia cases and aimed to investigate which tracers are better suited to image tau in these disorders.

Methods

A cross-sectional study was conducted using a hospital-based sample at a tertiary referral center. We recruited eight participants (two Alzheimer's disease, four frontotemporal dementia and two normal controls) who underwent magnetic resonance image, amyloid positron emission tomography with [¹⁸F]-Florbetaben and tau positron emission tomography with both THK5351 and AV-1451. To measure regional AV1451 and THK5351 uptakes, we used the standardized uptake value ratios by dividing mean activity in target volume of interest by mean activity in the cerebellar hemispheric gray matter.

Results

Although THK5351 and AV-1451 uptakes were highly correlated, cortical uptake of AV-1451 was more striking in Alzheimer's disease, while cortical uptake of THK5351 was more prominent in frontotemporal dementia. THK5351 showed higher off-target binding than AV-1451 in the white matter, midbrain, thalamus, and basal ganglia.

Conclusions

AV-1451 is more sensitive and specific to Alzheimer's disease type tau and shows lower off-target binding, while THK5351 may mirror non-specific neurodegeneration.

http://ift.tt/2rGoIwq

Striking lack of visualization of striatum on 18 F-FDG brain PET in chorea-acanthocytosis

http://ift.tt/2GnpNwq

18 F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment

Abstract

Purpose

Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of ¹⁸F–fluorodeoxyglucose positron emission tomography (¹⁸F–FDG PET) for predicting tumour progression during sorafenib treatment.

Methods

We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing ¹⁸F–FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.

Results

Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.

Conclusion

Pretreatment tumour metabolic activity assessed by ¹⁸F–FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.

http://ift.tt/2rKuBJc

Absolute number of new lesions on 18 F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab

Abstract

Purpose

Evaluation of response to immunotherapy is a matter of debate. The aim of the present study was to evaluate the response of metastatic melanoma to treatment with ipilimumab by means of ¹⁸F-FDG PET/CT, using the patients' clinical response as reference.

Methods

The final cohort included in the analyses consisted of 41 patients with metastatic melanoma who underwent ¹⁸F-FDG PET/CT before and after administration of ipilimumab. After determination of the best clinical response, the PET/CT scans were reviewed and a separate independent analysis was performed, based on the number and functional size of newly emerged ¹⁸F-FDG-avid lesions, as well as on the SUV changes after therapy.

Results

The median observation time of the patients after therapy was 21.4 months (range 6.3–41.9 months). Based on their clinical response, patients were dichotomized into those with clinical benefit (CB) and those without CB (No-CB). The CB group (31 patients) included those with stable disease, partial remission and complete remission, and the No-CB group (10 patients) included those with progressive disease. The application of a threshold of four newly emerged ¹⁸F-FDG-avid lesions on the posttherapy PET/CT scan led to a sensitivity (correctly predicting CB) of 84% and a specificity (correctly predicting No-CB) of 100%. This cut-off was lower for lesions with larger functional diameters (three new lesions larger than 1.0 cm and two new lesions larger than 1.5 cm). SUV changes after therapy did not correlate with clinical response. Based on these findings, we developed criteria for predicting clinical response to immunotherapy by means of ¹⁸F-FDG PET/CT (PET Response Evaluation Criteria for Immunotherapy, PERCIMT).

Conclusion

Our results show that a cut-off of four newly emerged ¹⁸F-FDG-avid lesions on posttherapy PET/CT gives a reliable indication of treatment failure in patients under ipilimumab treatment. Moreover, the functional size of the new lesions plays an important role in predicting the clinical response. Validation of these results in larger cohorts of patients is warranted.

http://ift.tt/2Gr0qKm

Visualization of multiple organ amyloid involvement in systemic amyloidosis using 11 C-PiB PET imaging

Abstract

Purpose

To investigate the utility of Pittsburgh compound B (PiB) positron emission tomography (PET) imaging for evaluating whole-body amyloid involvement in patients with systemic amyloidosis.

Methods

Whole-body ¹¹C-PiB PET was performed in seven patients with systemic immunoglobulin light-chain (AL) amyloidosis, seven patients with hereditary transthyretin (ATTRm) amyloidosis, one asymptomatic TTR mutation carrier and three healthy controls. The correlations between clinical organ involvement, radiological ¹¹C-PiB uptake and histopathological findings were analysed for each organ.

Results

Organ involvement on ¹¹C-PiB PET imaging showed good correlations with the clinical findings for the heart and stomach. Abnormal tracer uptake was also observed in the spleen, lachrymal gland, submandibular gland, sublingual gland, lymph node, brain, scalp, extraocular muscles, nasal mucosa, pharynx, tongue and nuchal muscles, most of which were asymptomatic. Physiological tracer uptake was universally observed in the urinary tract (kidney, renal pelvis, ureter and bladder) and enterohepatic circulatory system (liver, gallbladder, bile duct and small intestine) in all participants. Most of the patients and one healthy control subject showed asymptomatic tracer uptake in the lung and parotid gland. The peripheral nervous system did not show any tracer uptake even in patients with apparent peripheral neuropathy. Histological amyloid deposition was confirmed in biopsied myocardium and gastric mucosa where abnormal ¹¹C-PiB retention was observed.

Conclusions

¹¹C-PiB PET imaging can be used clinically in the systemic evaluation of amyloid distribution in patients with AL and ATTRm amyloidosis. Quantitative analysis of ¹¹C-PiB PET images may be useful in therapy evaluation and will reveal whether amyloid clearance is correlated with clinical response.

http://ift.tt/2rLgPWH

Third-line treatment and 177 Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review

Abstract

Aims

There is a controversy as to the relative efficacy of ¹⁷⁷Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of our systematic review was to elucidate whether ¹⁷⁷Lu-PSMA RLT and third-line treatment have similar effects and adverse effects (PROSPERO ID CRD42017067743).

Methods

The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in Pubmed and Embase selected articles up to September 2017. A search in ClinicalTrials.gov indicated ongoing studies. The meta-analysis used the random-effects model.

Results

Twelve studies including 669 patients reported ¹⁷⁷Lu-PSMA RLT. Overall, 43% of the patients had a maximum decline of PSA of ≥50% following treatment with ¹⁷⁷Lu-PSMA RLT. The treatment with ¹⁷⁷Lu-PSMA-617 and ¹⁷⁷Lu-PSMA for imaging and therapy (I&T) had mainly transient adverse effects. Sixteen studies including 1338 patients reported third-line treatment. Overall, 21% of the patients had a best decline of PSA of ≥50% following third-line treatment. After third-line treatment with enzalutamide and cabazitaxel, adverse effects caused discontinuation of treatment for 10% to 23% of the patients. ¹⁷⁷Lu-PSMA RLT gave a best PSA decline ≥50% more often than third-line treatment (mean 44% versus 22%, p = 0.0002, t test). ¹⁷⁷Lu-PSMA RLT gave objective remission more often than third-line treatment (overall 31 of 109 patients versus 43 of 275 patients, p = 0.004, χ² test). Median survival was longer after ¹⁷⁷Lu-PSMA RLT than after third-line treatment, but the difference was not statistically significant (mean 14 months versus 12 months, p = 0.32, t test). Adverse effects caused discontinuation of treatment more often for third-line treatment than for ¹⁷⁷Lu-PSMA RLT (22 of 66 patients versus 0 of 469 patients, p < 0.001, χ² test).

Conclusions

As for patients with mCRPC, treatment with ¹⁷⁷Lu-PSMA-617 RTL and ¹⁷⁷Lu-PSMA I&T gave better effects and caused fewer adverse effects than third-line treatment.

http://ift.tt/2DLvk2b

Founder of EJNM passed away

http://ift.tt/2GoYLVq

EANM/EARL FDG-PET/CT accreditation - summary results from the first 200 accredited imaging systems

Abstract

Purpose

From 2010 until July 2016, the EANM Research Ltd. (EARL) FDG-PET/CT accreditation program has collected over 2500 phantom datasets from approximately 200 systems and 150 imaging sites worldwide. The objective of this study is to report the findings and impact of the accreditation program on the participating PET/CT systems.

Methods

To obtain and maintain EARL accredited status, sites were required to complete and submit two phantom scans - calibration quality control (CalQC), using a uniform cylindrical phantom and image quality control (IQQC), using a NEMA NU2–2007 body phantom. Average volumetric SUV bias and SUV recovery coefficients (RC) were calculated and the data evaluated on the basis of quality control (QC) type, approval status, PET/CT system manufacturer and submission order.

Results

SUV bias in 5% (n = 96) of all CalQC submissions (n = 1816) exceeded 10%. After corrective actions following EARL feedback, sites achieved 100% compliance within EARL specifications. 30% (n = 1381) of SUVmean and 23% (n = 1095) of SUVmax sphere recoveries from IQQC submissions failed to meet EARL accreditation criteria while after accreditation, failure rate decreased to 12% (n = 360) and 9% (n = 254), respectively. Most systems demonstrated longitudinal SUV bias reproducibility within ±5%, while RC values remained stable and generally within ±10% for the four largest and ±20% for the two smallest spheres.

Conclusions

Regardless of manufacturer or model, all investigated systems are able to comply with the EARL specifications. Within the EARL accreditation program, gross PET/CT calibration errors are successfully identified and longitudinal variability in PET/CT performances reduced. The program demonstrates that a harmonising accreditation procedure is feasible and achievable.

http://ift.tt/2rFVjCs

Prospective evaluation of 18 F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial)

Abstract

Purpose

The purpose of this study was to evaluate ¹⁸F-FACBC PET/CT, PET/MRI, and multiparametric MRI (mpMRI) in detection of primary prostate cancer (PCa).

Methods

Twenty-six men with histologically confirmed PCa underwent PET/CT immediately after injection of 369 ± 10 MBq ¹⁸F-FACBC (fluciclovine) followed by PET/MRI started 55 ± 7 min from injection. Maximum standardized uptake values (SUV_max) were measured for both hybrid PET acquisitions. A separate mpMRI was acquired within a week of the PET scans. Logan plots were used to calculate volume of distribution (V_T). The presence of PCa was estimated in 12 regions with radical prostatectomy findings as ground truth. For each imaging modality, area under the curve (AUC) for detection of PCa was determined to predict diagnostic performance. The clinical trial registration number is NCT02002455.

Results

In the visual analysis, 164/312 (53%) regions contained PCa, and 41 tumor foci were identified. PET/CT demonstrated the highest sensitivity at 87% while its specificity was low at 56%. The AUC of both PET/MRI and mpMRI significantly (p < 0.01) outperformed that of PET/CT while no differences were detected between PET/MRI and mpMRI. SUV_max and V_T of Gleason score (GS) >3 + 4 tumors were significantly (p < 0.05) higher than those for GS 3 + 3 and benign hyperplasia. A total of 442 lymph nodes were evaluable for staging, and PET/CT and PET/MRI demonstrated true-positive findings in only 1/7 patients with metastatic lymph nodes.

Conclusions

Quantitative ¹⁸F-FACBC imaging significantly correlated with GS but failed to outperform MRI in lesion detection. ¹⁸F-FACBC may assist in targeted biopsies in the setting of hybrid imaging with MRI.

http://ift.tt/2GoyUNF

Photodegradation of 2,4-dichlorophenol by supported Pd(X 2 ) catalyst (X = Cl, Br, N 3 ): a HOMO manipulating point of view

Abstract

Three different palladium(II) complexes with ligands containing nitrogenized aromatic rings were investigated theoretically as model to obtain the computational band gap energies. The results demonstrated promising possibility for designing palladium(II) complexes with photocatalytic properties at visible light irradiation. Deliberated products were synthesized via grafting on the silica-coated Fe₃O₄ magnetic nanoparticles (Fe₃O₄@SiO₂). Formation of complexes on the surface of Fe₃O₄@SiO₂, as insoluble and reusable photocatalysts, was proved by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric (TGA), X-ray photoelectron spectroscopy (XPS), vibrating sample magnetometer (VSM), transmission electron microscope (TEM), and scanning electron microscopy (SEM) analyses. The trend of the band gap energies of prepared structures was calculated via experimental and theoretical methods. The photocatalytic capability of these nanoparticles was investigated in degradation of 2,4-dichlorophenol by means of HPLC analysis. A tentative reaction mechanism for the formation of intermediates was proposed.

Graphical abstract

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http://ift.tt/2ninySg

Air quality and acute myocardial infarction in adults during the 2016 Hangzhou G20 summit

Abstract

To fulfill its commitment to a successful Hangzhou G20 summit (4 to 5 September 2016), the Chinese government implemented a series of measures to improve the air quality in Hangzhou. We report findings on air quality and acute myocardial infarction (AMI) hospital admissions in adults during the Hangzhou G20 summit. Three study periods were defined. The first period was pre-G20 (28 July to 27 August: limited restrictions on industrial emissions). The second period was G20 (28 August to 6 September) when there were further restrictions on industrial emissions and increased transportation restrictions. The third period was post-G20 (7 September to 6 October) when restrictions were relaxed again. The mean number of AMI admissions per day was, respectively, 8.2 during G20, 13.3 during pre-G20, and 15.1 during post-G20. We used time-series Poisson regression models to estimate the relative risk (RR) for AMI associated with pollution levels. Our results suggest that the air quality improvement can reduce the number of hospital admissions for AMI.

http://ift.tt/2DHNuBY

Organic fertilizer application increases the soil respiration and net ecosystem carbon dioxide absorption of paddy fields under water-saving irrigation

Abstract

Quantifying carbon sequestration in paddy soil is necessary to understand the effect of agricultural practices on carbon cycles. The objective of this study was to assess the effect of organic fertilizer addition (MF) on the soil respiration and net ecosystem carbon dioxide (CO₂) absorption of paddy fields under water-saving irrigation (CI) in the Taihu Lake Region of China during the 2014 and 2015 rice-growing seasons. Compared with the traditional fertilizer and water management (FC), the joint regulation of CI and MF (CM) significantly increased the rice yields and irrigation water use efficiencies of paddy fields by 4.02~5.08 and 83.54~109.97% (p < 0.05). The effects of organic fertilizer addition on soil respiration and net ecosystem CO₂ absorption rates showed inter-annual differences. CM paddy fields showed a higher soil respiration and net CO₂ absorption rates during some periods of the rice growth stage in the first year and during most periods of the rice growth stage in the second year. These fields also had significantly higher total CO₂ emission through soil respiration (total R_soil) and total net CO₂ absorption compared with FC paddy fields (p < 0.05). The total R_soil and net ecosystem CO₂ absorption of CM paddy fields were 67.39~91.55 and 129.41~113.75 mol m⁻², which were 27.66~135.52 and 12.96~31.66% higher than those of FC paddy fields. The interaction between water and fertilizer management had significant effects on total net ecosystem CO₂ absorption. The frequent alternate wet–dry cycles of CI paddy fields increased the soil respiration and reduced the net CO₂ absorption. Organic fertilizer promoted the soil respiration of paddy soil but also increased its net CO₂ absorption and organic carbon content. Therefore, the joint regulation of water-saving irrigation and organic fertilizer is an effective measure for maintaining yield, increasing irrigation water use efficiency, mitigating CO₂ emission, and promoting paddy soil fertility.

http://ift.tt/2ninzFO