18 F-Fluorocholine PET/CT as a second line nuclear imaging technique before surgery for primary hyperparathyroidism

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Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair

Abstract

Purpose

The growth phases of medically treated abdominal aortic aneurysms (AAA) are frequently associated with an ¹⁸F–fluorodesoxyglucose positron emission tomography (FDG-PET) pattern involving low baseline and subsequent higher FDG uptake. However, the FDG-PET patterns associated with the endovascular aneurysm repair (EVAR) of larger AAA are presently unknown. This study aimed to investigate the relationship between serial AAA FDG uptake measurements, obtained before EVAR and 1 and 6 months post-intervention and subsequent sac shrinkage at 6 months, a well-recognized indicator of successful repair.

Methods

Thirty-three AAA patients referred for EVAR (maximal diameter: 55.4 ± 6.0 mm, total volume: 205.7 ± 63.0 mL) underwent FDG-PET/computed tomography (CT) before EVAR and at 1 and 6 months thereafter, with the monitoring of AAA volume and of a maximal standardized FDG uptake [SUVmax] averaged between the axial slices encompassing the AAA.

Results

Sac shrinkage was highly variable and could be stratified into three terciles: a first tercile in which shrinkage was absent or very limited (0–29 mL) and a third tercile with pronounced shrinkage (56–165 mL). SUVmax values were relatively low at baseline in the 1st tercile (SUVmax: 1.69 ± 0.33), but markedly increased at 6 months (2.42 ± 0.69, p = 0.02 vs. baseline). These SUV max values were by contrast much higher at baseline in the 3rd tercile (SUVmax: 2.53 ± 0.83 p = 0.009 vs. 1st tercile) and stable at 6 months (2.49 ± 0.80), while intermediate results were documented in the 2nd tercile. Lastly, the amount of sac shrinkage, expressed in absolute values or in percentages of baseline AAA volumes, was positively correlated with baseline SUVmax (p = 0.001 for both).

Conclusion

A low pre-EVAR FDG uptake and increased AAA FDG uptake at 6 months are associated with reduced sac shrinkage. This sequential FDG-PET pattern is similar to that already shown to accompany growth phases of medically treated AAA.

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Val M. Runge. Imaging of Cerebrovascular Disease. A Practical Guide

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[68Ga]Pentixafor-PET/MRI for the detection of Chemokine receptor 4 expression in atherosclerotic plaques

Abstract

Purpose

The expression of chemokine receptor type 4 (CXCR4) was found co-localized with macrophages on the atherosclerotic vessel wall and participated in the initial emigration of leukocytes. Gallium-68 [⁶⁸Ga]Pentixafor has recently been introduced for the imaging of atherosclerosis by targeting CXCR4. We sought to evaluate human atherosclerotic lesions using [⁶⁸Ga]Pentixafor PET/MRI.

Methods

Thirty-eight oncology patients underwent [⁶⁸Ga]Pentixafor PET/MR imaging at baseline. Maximum standardized uptake values (SUV_max) were derived from hot lesions in seven arterial segments and target-to-blood ratios (TBR) were calculated. ANOVA post-hoc and paired t test were performed for statistical comparison, Spearman's correlation coefficient between uptake ratios and cardiovascular risk factors were assessed. The reproducibility of [⁶⁸Ga]Pentixafor PET/MRI was assessed in seven patients with a follow-up exanimation by Pearson's regression and Bland–Altman plots analysis.

Results

Thirty-four of 38 patients showed 611 focal [⁶⁸Ga]Pentixafor uptake that followed the contours of the large arteries. Both prevalence and mean TBR_max were highest in the descending aorta. There were significantly higher TBR values found in men (1.9 ± 0.3) as compared to women (1.7 ± 0.2; p < 0.05). Patients with mean TBR_max > 1.7 showed a significantly higher incidence of diabetes, hypertension hypercholesterolemia and history of cardiovascular disease than patients with mean TBR_max ≤ 1.7. [⁶⁸Ga]Pentixafor uptake showed a good reproducibility (r = 0.6, p < 0.01), and there was no difference between the mean TBR_max values of plaque lesions (TBR_baseline1.8 ± 0.3 vs TBR_follow-up1.8 ± 0.3) (p = 0.9).

Conclusion

Patients with high arterial uptake showed increased incidence of cardiovascular risk factors, suggesting a potential role of [⁶⁸Ga]Pentixafor in characterization of atherosclerosis.

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Correction to: Diagnostic and prognostic value of baseline FDG PET/CT skeletal textural features in diffuse large B cell lymphoma

Abstract

The formulae for Dice and Jaccard indices used to assess volumes concordance should read as follows:

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11 C–MET PET/MRI for detection of recurrent glioma

Abstract

Introduction

Radiological assessment of brain tumors is widely based on the Radiology Assessment of Neuro-Oncology (RANO) criteria that consider non-specific T1 and T2 weighted images. Limitation of the RANO criteria is that they do not include metabolic imaging techniques that have been reported to be helpful to differentiate treatment related changes from true tumor progression. In the current study, we assessed if the combined use of MRI and PET with hybrid ¹¹C–MET PET/MRI can improve diagnostic accuracy and diagnostic confidence of the readers to differentiate treatment related changes from true progression in recurrent glioma.

Methods

Fifty consecutive patients with histopathologically proven glioma were prospectively enrolled for a hybrid ¹¹C–MET PET/MRI to differentiate recurrent glioma from treatment induced changes. Sole MRI data were analyzed based on RANO. Sole PET data and in a third evaluation hybrid ¹¹C–MET-PET/MRI data were assessed for metabolic respectively metabolic and morphologic glioma recurrence. Diagnostic performance and diagnostic confidence of the reader were calculated for the different modalities, and the McNemar test and Mann-Whitney U Test were applied for statistical analysis.

Results

Hybrid ¹¹C–MET PET/MRI was successfully performed in all 50 patients. Glioma recurrence was diagnosed in 35 of the 50 patients (70%). Sensitivity and specificity were calculated for MRI (86.11% and 71.43%), for ¹¹C–MET PET (96.77% and 73.68%), and for hybrid ¹¹C–MET-PET/MRI (97.14% and 93.33%). For diagnostic accuracy hybrid ¹¹C–MET-PET/MRI (96%) showed significantly higher values than MRI alone (82%), whereas no significant difference was found for 11C–MET PET (88%). Furthermore, by rating on a five-point Likert scale significantly higher scores were found for diagnostic confidence when comparing ¹¹C–MET PET/MRI (4.26 ± 0,777) to either PET alone (3.44 ± 0.705) or MRI alone (3.56 ± 0.733).

Conclusion

This feasibility study showed that hybrid PET/MRI might strengthen RANO classification by adding metabolic information to conventional MRI information. Future studies should evaluate the clinical utility of the combined use of ¹¹C–MET PET/MRI in larger patient cohorts.

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FDG PET-CT as a powerful tool for diagnosing and monitoring treatment outcomes of relapsing polychondritis

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Prediction of functional recovery after primary PCI using the estimate of myocardial salvage in gated SPECT early after acute myocardial infarction

Abstract

Purpose

Primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) aims to achieve myocardial salvage (MS). Because the reference method for measuring MS requires myocardial perfusion imaging (MPI) after tracer injection before PCI, alternative approaches have been proposed, but none has gained wide acceptance. Gated SPECT MPI can assess infarct size (IS), but can also show myocardial stunning. Thus, we compared functional and perfusion abnormalities early after AMI to estimate MS, and to predict left ventricular ejection fraction (LVEF) recovery at follow-up.

Methods

We studied 120 patients with AMI. Gated SPECT MPI was performed early (before hospital discharge) and at 6 months after AMI to measure IS, MS and functional outcome. MS was defined as the difference between the number of segments with abnormal thickening (i.e. the stunned area or area at risk) and the number of segments with abnormal perfusion (i.e. the final IS), expressed as a percentage of the total number of segments in the AHA model. LVEF was calculated using quantitative gated SPECT.

Results

The area at risk was 40 ± 25%, IS was 17.3 ± 16% and MS was 22 ± 19%. Early LVEF was 46.6 ± 11.6% and late LVEF was 51.4 ± 11.6%, with 54 patients showing at least an increase in LVEF of more than 5 units. ROC analysis showed that MS was able to predict LVEF recovery with an area under the curve (AUC) of 0.79 (p < 0.0001), and using a cut off >23% detected LVEF recovery with 74% sensitivity and 71% specificity. Conversely, IS was associated with an AUC 0.53 (not significant).

Conclusion

MS assessed by a single early gated SPECT MPI study can accurately predict LVEF evolution after primary PCI for AMI.

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Chun K. Kim and Katherine A. Zukotynski (editors): SPECT and SPECT/CT: a clinical guide

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Correction to: Dosimetry in clinical radionuclide therapy: the devil is in the detail

Abstract

The above article which was published in Volume 44/ Issue 12 has incorrect page numbers. Instead of 1-3, it should have been 2137-2139.

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Anaplastic thyroid carcinoma on 68 Ga-PSMA PET/CT: opening new frontiers

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Preclinical evaluation of an 18 F-trifluoroborate methionine derivative for glioma imaging

Abstract

Purpose

¹¹C–methionine (MET) is one of the most commonly used amino acid tracers for PET imaging of brain tumors. In this study, we report an ¹⁸F-labeled boron-derived methionine analogue, denoted as ¹⁸F-B-MET, as a potential substitute of ¹¹C–MET for glioma PET imaging.

Methods

¹⁹F-B-MET was synthesized from readily available chemicals according to our previous publication. For kit development, ¹⁹F-B-MET was aliquoted in quantities of 10 nmol for on-demand one-step labeling. The ¹⁸F-labeling was performed by ¹⁸F-¹⁹F isotope exchange, and quality control was performed by both HPLC and radio-TLC. Uptake of the tracer was determined in GL26, C6 and U87 tumor cells. PET imaging and the biodistribution assay were performed on mice bearing subcutaneous or orthotopic C6 and U87 tumor xenografts.

Results

Starting with 740–1110 MBq ¹⁸F-fluoride, >370 MBq of ¹⁸F-B-MET was obtained in 25 min (n = 5) with >99% purity and high specific activity (>37 GBq/μmol). ¹⁸F-B-MET demonstrated excellent in vitro stability with <1% decomposition after incubation with plasma for 2 h. In vitro cell uptake assay showed that ¹⁸F-B-MET accumulated in tumor cells in a time dependent manner and could be competitively inhibited by natural methionine and other L-type transporter transported amino acids. In vivo biodistribution and imaging studies showed high tumor accumulation (2.99 ± 0.23 %ID/g, n = 6) compared with low uptake of brain (0.262 ± 0.05 %ID/g, n = 6) at 60 min after injection in a subcutaneous C6 tumor model. Orthotropic C6 and U87 tumors were clearly visualized with high tumor to brain ratios at 60 min post-injection, corroborating with tumor L-type amino acid transporter 1 (LAT-1) expression levels.

Conclusion

¹⁸F-B-MET was radiolabeled with high yield in a one-step labeling process, showed excellent pharmacokinetic properties in vivo, with high tumor-to-brain contrast.

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Isam Alobid and Paolo Castelnuovo (editors): Nasoseptal Perforations: Endoscopic Repair Techniques

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Comparison of 18 F–FDG PET/MRI and MRI alone for whole-body staging and potential impact on therapeutic management of women with suspected recurrent pelvic cancer: a follow-up study

Abstract

Purpose

To evaluate the diagnostic performance of ¹⁸F–FDG PET/MRI for whole-body staging and potential changes in therapeutic management of women with suspected recurrent pelvic cancer in comparison with MRI alone.

Methods

Seventy-one consecutive women (54 ± 13 years, range: 25–80 years) with suspected recurrence of cervical (32), ovarian (26), endometrial (7), vulvar (4), and vaginal (2) cancer underwent PET/MRI including a diagnostic contrast-enhanced MRI protocol. PET/MRI and MRI datasets were separately evaluated regarding lesion count, localization, categorization (benign/malignant), and diagnostic confidence (3-point scale; 1–3) by two physicians. The reference standard was based on histopathology results and follow-up imaging. Diagnostic accuracy and proportions of malignant and benign lesions rated correctly were retrospectively compared using McNemar's chi² test. Differences in diagnostic confidence were assessed by Wilcoxon test.

Results

Fifty-five patients showed cancer recurrence. PET/MRI correctly identified more patients with cancer recurrence than MRI alone (100% vs. 83.6%, p < 0.01). In contrast to PET/MRI, MRI alone missed 4/15 patients with pelvic recurrence and miscategorized 8/40 patients with distant metastases as having local recurrence only. Based on the reference standard, 241 lesions were detected in the study cohort (181 malignant, 60 benign). While PET/MRI provided correct identification of 181/181 (100%) malignant lesions, MRI alone correctly identified 135/181 (74.6%) malignant lesions, which was significantly less compared to PET/MRI (p < 0.001). PET/MRI offered superior diagnostic accuracy (99.2% vs. 79.3%, p < 0.001) and diagnostic confidence in the categorization of malignant lesions compared with MRI alone (2.7 ± 0.5 vs. 2.4 ± 0.7, p < 0.001).

Conclusion

PET/MRI demonstrates excellent diagnostic performance and outperforms MRI alone for whole-body staging of women with suspected recurrent pelvic cancer, indicating potential changes in therapy management based on evaluation of local recurrence and distant metastatic spread.

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Up-front PET/CT changes treatment intent in patients with head and neck squamous cell carcinoma

Abstract

Purpose

In patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), we wanted to examine the differences in overall treatment decisions, i.e. curative versus palliative treatment intent, reached by a multidisciplinary team conference (MDTC) based on 18F–fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) or chest X-ray + MRI of the head and neck (CXR/MRI).

Patients and methods

This was a prospective blinded cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging was conducted as per standard practice. After at least 3 months (to eliminate recall bias in the team), the first project MDTC was conducted, based on either CXR/MRI or PET/CT, and the tumor board drew conclusions regarding treatment. After an additional 3 months, a second project MDTC was conducted using the complementary imaging modality.

Results

A total of 307 patients were included. Based on CXR/MRI, 303 patients (99%) were recommended for curative treatment and only four patients (1%) for palliative treatment. Based on PET/CT, the MDTC concluded that 278 (91%) patients were suitable for curative treatment and 29 (9%) patients for palliative treatment. The absolute difference of 8% was statistically significant (95% CI: 4.8%–11.5%, p < 0.001).

Conclusions

A PET/CT-based imaging strategy significantly changed the decisions regarding treatment intent made by a MDTC for patients diagnosed with HNSCC, when compared with the standard imaging strategy of CXR/MRI.

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Impact of initial myocardial perfusion imaging versus invasive coronary angiography on outcomes in coronary artery disease: a nationwide cohort study

Abstract

Purpose

In patients with stable coronary artery disease (CAD), two main options exist to guide management: initial invasive coronary angiography (CAG), or selective CAG after risk stratification using myocardial perfusion imaging (MPI). This study compared clinical outcomes between these two strategies in a large, real-world population.

Methods

The initial cohort comprised 1,000,000 randomly selected patients who had been entered in the National Health Insurance Research Database of Taiwan between 2000 and 2011. Patients with acute coronary syndromes, prior myocardial infarction (MI) or coronary revascularization, and prior treadmill testing or stress echocardiography were excluded. The remaining patients with suspected or known CAD were divided into those in whom initial CAG had been performed and those in whom initial MPI had been performed, and were followed until the end of 2011 for all-cause mortality, MI, and revascularization. A Cox proportional hazards model was used to estimate the risk of events after adjusting for covariates.

Results

The MPI and CAG groups each comprised 4,495 patients after frequency matching, with a similar Charlson comorbidity index (CCI). The MPI group had a significantly and dramatically lower incidence of revascularization (729 vs. 2,380, p < 0.001), MI (268 vs. 1,044, p < 0.001), and all-cause mortality (522 vs. 784, p < 0.001) than the CAG group. Multivariable analysis adjusting for age, gender, CCI, and comorbidities showed that in the MPI group fewer patients had revascularization (HR 0.24, 95% CI 0.22–0.26) and MI (HR 0.23, 95% CI 0.20–0.26), and the rate of all-cause mortality was lower (HR 0.58, 95% CI 0.52–0.64).

Conclusions

In patients with suspected stable CAD, compared with initial invasive CAG, a selective strategy guided by MPI was associated with lower rates of revascularization and MI and improved survival.

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Combined evaluation of regional coronary artery calcium and myocardial perfusion by 82 Rb PET/CT in the identification of obstructive coronary artery disease

Abstract

Purpose

Cardiac imaging with PET/CT allows measurement of coronary artery calcium (CAC), myocardial perfusion and coronary vascular function. We investigated whether the combined assessment of regional CAC score, ischemic total perfusion deficit (ITPD) and quantitative coronary vascular function would further improve the diagnostic accuracy of PET/CT in predicting obstructive coronary artery disease (CAD).

Methods

We analyzed 113 patients with suspected CAD referred to ⁸²Rb PET/CT myocardial perfusion imaging with available coronary angiographic data. Obstructive CAD was defined as ≥75% stenosis. The receiver operating characteristic area under curve (AUC) was applied to evaluate the ability of CAC score, ITPD, hyperemic myocardial blood flow (MBF) and coronary flow reserve (CFR) to identify CAD.

Results

Vessels with obstructive CAD (71 vessels) had higher ITPD (4.6 ± 6.2 vs. 0.6 ± 1.3) and lower hyperemic MBF (1.01 ± 0.5 vs. 1.75 ± 0.6 ml/min/g) and CFR (1.56 ± 0.6 vs. 2.38 ± 0.7; all p < 0.001) than those without. In prediction of per-vessel CAD, the AUCs for the models including CAC/ITPD/hyperemic MBF (0.869) and CAC/ITPD/CFR (0.875) were higher (both p < 0.01) than for the model including CAC/ITPD (0.790). Compared with CAC/ITPD, continuous net reclassification improvement was 0.69 (95% bootstrap confidence interval, CI, 0.365–1.088) for the CAC/ITPD/hyperemic MBF model and 0.99 (95% bootstrap CI 0.64–1.26) for the CAC/ITPD/CFR model.

Conclusion

Hyperemic MBF and CFR provide incremental information about the presence of CAD over CAC score and perfusion imaging parameters. The combined use of CAC, myocardial perfusion imaging and quantitative coronary vascular function in may help predict more accurately the presence of obstructive CAD.

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F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study

Abstract

Purpose

To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT.

Methods

We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up.

Results

Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0–98.9) and 90.5% (95%CI: 69.6–98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6–97.3) and 86.4% (95%CI: 65.1–97.1), respectively.

Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l.

Conclusions

Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary hyperparathyroidism and negative or inconclusive conventional imaging results. Bilateral cervical exploration could be avoided in the majority (75%) of patients.

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Effect of CRP value on 18 F–FDG PET vascular positivity in Takayasu arteritis: a systematic review and per-patient based meta-analysis

Abstract

Purpose

The aim of this study was to quantify the association between the CRP value and ¹⁸F–FDG PET vascular positivity in Takayasu arteritis (TAK) through a structured dedicated systematic review and meta-analysis.

Methods

From January 2000 to December 2016, the PubMed/MEDLINE database was searched for articles specifically dealing with the assessment of vascular inflammation using ¹⁸F–FDG PET and CRP biomarkers in TAK. Inclusion criteria for the qualitative analysis were (1) ¹⁸F–FDG PET used to assess the disease activity, (2) The use of the ACR criteria for the diagnosis of TAK, (3) No case mixed vasculitis (i.e., no giant cell arteritis), and (4) CRP concentration and clinical disease activity available. For the meta-analysis, PET-positive and PET-negative subgroups with the corresponding CRP concentrations were generated based on per patient data. The standard mean difference, which represents the effect of the CRP concentrations on the ¹⁸F–FDG PET vascular uptake, was computed for all studies, and then the results were pooled together.

Results

Among the 33 initial citations, nine complete articles including 210 patients fulfilled the inclusion criteria. Five studies found a significant correlation between the ¹⁸F–FDG PET and CRP concentration, one provided a trend towards association and three did not find any association between the two biomarkers. Six studies found a significant association between ¹⁸F–FDG PET and clinical disease activity, one found a trend towards association and the last two studies did not evaluate this correlation. The meta-analysis (121 patients) provided the following results: Standard Mean Deviation = 0.54 [0.15;0.92]; Chi² = 3.35; I² = 0%; Test for overall effect: Z = 2.70 (P = 0.007).

Conclusion

The CRP concentration only moderately reflects the ¹⁸F–FDG PET vascular positivity in TAK, suggesting dissociated information. Standardized longitudinal prospective studies are necessary to assess the value of ¹⁸F–FDG PET as an independent biomarker for subtle vascular wall inflammation detection.

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One-step synthesis of an 18 F-labeled boron-derived methionine analog: a substitute for 11 C-methionine?

Abstract

Amino acid-based tracers have been extensively investigated for positron emission tomography (PET) imaging of brain tumors, and ¹¹C-methionine (¹¹C-MET) is one of the most extensively investigated. However, widespread clinical use of ¹¹C-MET is challenging due to the short half-life of ¹¹C and low radiolabeling yield. In this issue of the European Journal of Nuclear Medicine and Molecular Imaging, Yang and colleagues report an ¹⁸F-labeled boron-derived methionine analog, ¹⁸F-B-MET, as a potential substitute for ¹¹C-MET in PET imaging of glioma. The push-button synthesis, highly efficient radiolabeling, and good imaging performance in glioma models make this tracer a promising candidate for future clinical translation.

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Airborne gamma-ray spectra processing: Extracting photopeaks

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): Eugene Druker
The acquisition of information from the airborne gamma-ray spectra is based on the ability to evaluate photopeak areas in regular spectra from natural and other sources. In airborne gamma-ray spectrometry, extraction of photopeaks of radionuclides from regular one-second spectra is a complex problem. In the region of higher energies, difficulties are associated with low signal level, i.e. low count rates, whereas at lower energies difficulties are associated with high noises due to a high signal level. In this article, a new procedure is proposed for processing the measured spectra up to and including the extraction of evident photopeaks. The procedure consists of reducing the noise in the energy channels along the flight lines, transforming the spectra into the spectra of equal resolution, removing the background from each spectrum, sharpening the details, and transforming the spectra back to the original energy scale. The resulting spectra are better suited for examining and using the photopeaks. No assumptions are required regarding the number, locations, and magnitudes of photopeaks. The procedure does not generate negative photopeaks. The resolution of the spectrometer is used for the purpose. The proposed methodology, apparently, will contribute also to study environmental problems, soil characterization, and other near-surface geophysical methods.



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ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer

Delineation of clinical target volumes (CTVs) remains a weak link in radiation therapy (RT), and large inter-observer variation is seen. Guidelines for target and organs at risk delineation for prostate cancer in the primary setting are scarce. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists.

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A model combining age, equivalent uniform dose and IL-8 may predict radiation esophagitis in patients with non-small cell lung cancer

To study whether cytokine markers may improve predictive accuracy of radiation esophagitis (RE) in non-small cell lung cancer (NSCLC) patients.

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Two decades of high dose rate brachytherapy with external beam radiotherapy for prostate cancer

High-dose-rate brachytherapy (HDR-BT) has optimal prerequisites in radiotherapy of prostate cancer (PC) with a conformal dose distribution and high doses per fraction giving a biological dose escalation. We report the outcome after HDR-BT and external beam radiotherapy (EBRT) after 20 years of experience.

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IJMS, Vol. 19, Pages 656: Expression Profiling of Regulatory and Biosynthetic Genes in Contrastingly Anthocyanin Rich Strawberry (Fragaria × ananassa) Cultivars Reveals Key Genetic Determinants of Fruit Color

IJMS, Vol. 19, Pages 656: Expression Profiling of Regulatory and Biosynthetic Genes in Contrastingly Anthocyanin Rich Strawberry (Fragaria × ananassa) Cultivars Reveals Key Genetic Determinants of Fruit Color

International Journal of Molecular Sciences doi: 10.3390/ijms19030656

Authors: Mohammad Hossain Hoy-Taek Kim Ashokraj Shanmugam Ujjal Nath Gayatri Goswami Jae-Young Song Jong-In Park Ill-Sup Nou

Anthocyanins are the resultant end-point metabolites of phenylapropanoid/flavonoid (F/P) pathway which is regulated at transcriptional level via a series of structural genes. Identifying the key genes and their potential interactions can provide us with the clue for novel points of intervention for improvement of the trait in strawberry. We profiled the expressions of putative regulatory and biosynthetic genes of cultivated strawberry in three developmental and characteristically colored stages of fruits of contrastingly anthocyanin rich cultivars: Tokun, Maehyang and Soelhyang. Besides FaMYB10, a well-characterized positive regulator, FaMYB5, FabHLH3 and FabHLH3-delta might also act as potential positive regulators, while FaMYB11, FaMYB9, FabHLH33 and FaWD44-1 as potential negative regulators of anthocyanin biosynthesis in these high-anthocyanin cultivars. Among the early BGs, Fa4CL7, FaF3H, FaCHI1, FaCHI3, and FaCHS, and among the late BGs, FaDFR4-3, FaLDOX, and FaUFGT2 showed significantly higher expression in ripe fruits of high anthocyanin cultivars Maehyang and Soelhyang. Multivariate analysis revealed the association of these genes with total anthocyanins. Increasingly higher expressions of the key genes along the pathway indicates the progressive intensification of pathway flux leading to final higher accumulation of anthocyanins. Identification of these key genetic determinants of anthocyanin regulation and biosynthesis in Korean cultivars will be helpful in designing crop improvement programs.

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The More We Know, the More Mystery There Is

Physicist Marcelo Gleiser Muses over the Paradoxes of Scientific Progress

-- Read more on ScientificAmerican.com

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Why the UK’s new opt-out organ donation plan probably won’t work

Plans for the whole of the UK to shift to a system where consent for organ donation is assumed may actually do very little to save lives

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New study - why patients with known metastatic gynae carcinomas presenting with nonspecific neurological symptoms s… https://t.co/0cgINF4084

New study - why patients with known metastatic gynae carcinomas presenting with nonspecific neurological symptoms s… https://t.co/0cgINF4084

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RT @ASHClinicalNews : Written in @BloodJournal : Brentuximab plus nivolumab could be an alternative to salvage chemotherapy in rel/ref Hodgki…

RT @ASHClinicalNews : Written in @BloodJournal : Brentuximab plus nivolumab could be an alternative to salvage chemotherapy in rel/ref Hodgki…

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IJERPH, Vol. 15, Pages 400: Does Electronic Cigarette Use Predict Abstinence from Conventional Cigarettes among Smokers in Hong Kong?

IJERPH, Vol. 15, Pages 400: Does Electronic Cigarette Use Predict Abstinence from Conventional Cigarettes among Smokers in Hong Kong?

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15030400

Authors: Socrates Wu Man Wang William Li Antonio Kwong Vienna Lai Tai Lam

Objectives: To investigate the effects of ever use of electronic cigarettes (ECs), many of which lack nicotine, on abstinence from convention cigarettes among Hong Kong adult smokers. Methods: We collected data from 956 daily smokers in 2014–2015 regarding ever EC use and smoking behaviors at baseline, any and past 30-day EC use at the 3-month follow-up. Outcomes measured at 6 months included past 7-day point prevalence abstinence (PPA), biochemically validated quitting, smoking reduction (≥50% from baseline) and cessation attempt. Logistic regression yielded adjusted odds ratios (AOR) for quitting in relation to EC use, adjusting for socio-demographic characteristics and smoking profile. Complete case, missing observation as smoking and propensity score analyses were conducted. Results: By complete case, ever EC use at baseline did not predict self-reported PPA (AOR 0.99, 95% CI 0.57–1.73), biochemically validated quitting (AOR 1.22, 95% CI 0.64–2.34), cessation attempt (AOR 0.74, 95% CI 0.48–1.14), or smoking reduction (AOR 0.89, 95% CI 0.54–1.47). EC use during the first 3 months did not predict quitting (AOR 1.02, 95% CI 0.22–4.71). Similar results were observed for missing observations as smoking and propensity score analyses. Conclusions: Any use of ECs, many of which lack nicotine, did not predict smoking abstinence among Hong Kong adult smokers.

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IJERPH, Vol. 15, Pages 401: Exploring Heat Stress Relief Measures among the Australian Labour Force

IJERPH, Vol. 15, Pages 401: Exploring Heat Stress Relief Measures among the Australian Labour Force

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15030401

Authors: Kerstin Zander Supriya Mathew Stephen Garnett

Australia experiences frequent heat waves and generally high average temperatures throughout the continent with substantial impacts on human health and the economy. People adapt to heat by adopting various relief measures in their daily lives including changing their behaviour. Many labour intensive outdoor industries implement standards for heat stress management for their workforce. However, little is known about how people cope with heat at their workplaces apart from studies targeting some specific industries where labourers are exposed to extreme heat. Here, we analysed responses from 1719 people in the Australian labour force to self-reported heat stress and associated coping mechanisms. Three quarters of respondents experienced heat stress at their workplace with fatigue and headache being the two most frequently stated symptoms. Almost all of those who were affected by heat would hydrate (88%), 67% would cool, and 44% would rest as a strategy for coping with heat. About 10% intended to change their jobs because of heat stress in the workplace. We found differences in heat relief measures across gender, education, health, level of physical intensity of job, and time spent working outside. People working in jobs that were not very demanding physically were more likely to choose cooling down as a relief measure, while those in labour intensive jobs and jobs that required considerable time outside were more likely to rest. This has potential consequences for their productivity and work schedules. Heat affects work in Australia in many types of industry with impact dependent on workforce acclimatisation, yet public awareness and work relief plans are often limited to outdoor and labour intensive industries. Industries and various levels of government in all sectors need to implement standards for heat management specific to climate zones to help people cope better with high temperatures as well as plan strategies in anticipation of projected temperature increases.

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Open Availability of Patient Medical Photographs in Google Images Search Results: Cross-Sectional Study of Transgender Research

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In the age of #bigdata, what can basket/umbrella trials do to guide drug development and biomarker selection?Dr El… https://t.co/KiQGCJo2GE

In the age of #bigdata, what can basket/umbrella trials do to guide drug development and biomarker selection? Dr El… https://t.co/KiQGCJo2GE

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What are the challenges in communicating the benefits and risks of aspirin to the wider population regarding cancer… https://t.co/jl2BNnG9S6

What are the challenges in communicating the benefits and risks of aspirin to the wider population regarding cancer… https://t.co/jl2BNnG9S6

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A Web-Based, Social Networking Beginners’ Running Intervention for Adults Aged 18 to 50 Years Delivered via a Facebook Group: Randomized Controlled Trial

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Urgent reversal of vitamin K antagonists

This Therapetics article by Beverley Hunt and Marcel Levi (BMJ 2018;360:j5424, doi:10.1136/bmj.j5424) contains a typographic error. In the description of vitamin K as a reversing agent wrongly listed...

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Diphencyclopropenone (DPCP) for alopecia areata: a UK survey

Abstract

Alopecia areata (AA) is a T-cell mediated autoimmune hair loss condition with an estimated lifetime risk of 1.7%. It is characterized clinically by sudden-onset non-inflammatory hair loss that may occur at any site. The disease course is unpredictable with many patients experiencing spontaneous re-growth along with episodes of further loss. Unfortunately, around a fifth of patients presenting with patchy alopecia will progress to complete scalp (alopecia totalis (AT)) or scalp & body (alopecia universalis (AU)) hair loss from which spontaneous regrowth is rare (<10%). The adverse psychological consequences of AA include high rates of anxiety and depression.

This article is protected by copyright. All rights reserved.

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Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report

Novel immune checkpoint inhibitors have been often utilized for different types of malignancies as salvage therapy with varying success. One obstacle to immune checkpoint inhibitor use is the higher incidence ...

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RT @TheLancetOncol : Article online: phase 3 trial of #adjuvant anastrozole vs exemestane vs letrozole, upfront or after 2 years of #tamoxif…

RT @TheLancetOncol : Article online: phase 3 trial of #adjuvant anastrozole vs exemestane vs letrozole, upfront or after 2 years of #tamoxif…

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Baclofen is largely ineffective for alcohol use disorders, finds study

Baclofen is largely ineffective for treating alcohol use disorders, a meta-analysis of randomised trials has found.“This new meta-analysis shows that baclofen is no more effective than placebo on a...

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Safety and efficacy of biologic therapies in psoriatic patientswith alcoholic cirrhosis: a French retrospective study of 23 cases

Abstract

There are few studies specifically addressing the safety and efficacy of biologic treatments, especially anti TNF-alpha agents, in psoriatic patients with cirrhosis as such patients are usually excluded from prospective interventional studies. However, one should be aware that biologics are often prescribed in this particular population for several reasons. This is probably due to the fact that physicians are usually reluctant to prescribe conventional systemic treatment such as methotrexate or acitretine in psoriatic patients with liver abnormalities because of their liver toxicity. In addition, there is a general agreement that biologics have very few pharmacologic interaction with liver function and are not contraindicated in case of liver insufficiency.

This article is protected by copyright. All rights reserved.

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Non-structural protein 1 from avian influenza virus H9N2 is an efficient RNA silencing suppressor with characteristics that differ from those of Tomato bushy stunt virus p19

Abstract

Non-structural protein 1 (NS1) of influenza A virus is a multifunctional dimeric protein that contains a conserved N-terminal RNA binding domain. Studies have shown that NS1 suppresses RNA silencing and the NS1 proteins encoded by different influenza A virus strains exhibit differential RNA silencing suppression activities. In this study, we showed that the NS1 protein from avian influenza virus (AIV) H9N2 suppressed systemic RNA silencing induced by sense RNA or dsRNA. It resulted in more severe Potato virus X symptom, but could not reverse established systemic green fluorescent protein silencing in Nicotiana benthamiana. In addition, its systemic silencing suppression activity was much weaker than that of p19. The local silencing suppression activity of AIV H9N2 NS1 was most powerful at 7 dpi and was even stronger than that of p19. And the inhibition ability to RNA silencing of NS1 is stronger than that of p19 in human cells. Collectively, these results indicate that AIV H9N2 NS1 is an effective RNA silencing suppressor that likely targets downstream step(s) of dsRNA formation at an early stage in RNA silencing. Although NS1 and p19 both bind siRNA, their suppression mechanisms seem to differ because of differences in their suppression activities at various times post-infiltration and because p19 can reverse established systemic RNA silencing, but NS1 cannot.

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Inflammatory myofibroblastic tumors—A retrospective analysis of the Cooperative Weichteilsarkom Studiengruppe

Abstract

Background

Inflammatory myofibroblastic tumors (IMTs) are a rare subgroup of soft tissue tumors. The outcome of patients with IMT has been reported as favorable when the tumor is completely resected. If surgical resection is not possible, systemic therapy has to be considered. However, the best systemic treatment and response rates are currently unclear.

Methods

Thirty-eight patients under the age of 21, who were registered between 2000 and 2014 with a primary diagnosis of IMT, were analyzed.

Results

IMT was typically localized intra-abdominally or in the pelvis. In 20 patients, the tumor was resected without further therapy; 17 patients were in complete remission at last evaluation and two patients were in partial remission. Eighteen patients received systemic therapy, 15 of whom had macroscopically incomplete resection. Systemic therapy most commonly consisted of regimens with dactinomycin, ifosfamide or cyclophosphamide, and vincristine, with or without doxorubicin, and it seemed to reduce tumor extension in individual cases. Five-year event-free survival was 74 ± 14% and 5-year overall survival was 91 ± 10% for all patients. The patients who died due to the disease were those with incomplete resection (n = 3).

Conclusions

Surgery without further systemic therapy was a feasible and acceptable therapeutic option for every second patient with IMT. Standard chemotherapy for pediatric soft tissue sarcoma produced favorable results in individual cases and was able to shrink the tumor enough to enable resection. Superior efficacy of new targeted therapies such as anaplastic lymphoma kinase-inhibitors compared to standard chemotherapy has to be proven in the future.

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Recurrence of Ewing sarcoma: Is detection by imaging follow-up protocol associated with survival advantage?

Abstract

Background

The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse.

Patients and methods

A retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan–Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death.

Results

In the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%).

Conclusion

FUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.

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Hopes for the research agenda about hope

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Highest billing US doctor sentenced to 17 years for Medicare fraud

A Florida ophthalmologist who for years billed Medicare more than any other doctor must repay $42.5m (£30.2m; €34.4m) to the government and has been sentenced to 17 years in a federal prison.Salomon...

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Localization of the cannabinoid type-1 receptor in subcellular astrocyte compartments of mutant mouse hippocampus

Abstract

Astroglial type-1 cannabinoid (CB₁) receptors are involved in synaptic transmission, plasticity and behavior by interfering with the so-called tripartite synapse formed by pre- and post-synaptic neuronal elements and surrounding astrocyte processes. However, little is known concerning the subcellular distribution of astroglial CB₁ receptors. In particular, brain CB₁ receptors are mostly localized at cells' plasmalemma, but recent evidence indicates their functional presence in mitochondrial membranes. Whether CB₁ receptors are present in astroglial mitochondria has remained unknown. To investigate this issue, we included conditional knock-out mice lacking astroglial CB₁ receptor expression specifically in glial fibrillary acidic protein (GFAP)-containing astrocytes (GFAP-CB₁-KO mice) and also generated genetic rescue mice to re-express CB₁ receptors exclusively in astrocytes (GFAP-CB₁-RS). To better identify astroglial structures by immunoelectron microscopy, global CB₁ knock-out (CB₁-KO) mice and wild-type (CB₁-WT) littermates were intra-hippocampally injected with an adeno-associated virus expressing humanized renilla green fluorescent protein (hrGFP) under the control of human GFAP promoter to generate GFAPhrGFP-CB₁-KO and -WT mice, respectively. Furthermore, double immunogold (for CB₁) and immunoperoxidase (for GFAP or hrGFP) revealed that CB₁ receptors are present in astroglial mitochondria from different hippocampal regions of CB₁-WT, GFAP-CB₁-RS and GFAPhrGFP-CB₁-WT mice. Only non-specific gold particles were detected in mouse hippocampi lacking CB₁ receptors. Altogether, we demonstrated the existence of a precise molecular architecture of the CB₁ receptor in astrocytes that will have to be taken into account in evaluating the functional activity of cannabinergic signaling at the tripartite synapse.

Main Points

• Intracellular CB₁ receptors are localized in astroglial mitochondria. About 12% of the mitochondria in the hippocampal astrocytes express the receptor.
• This novel finding extends the subcellular compartmentalization of the CB₁ receptor in the brain.

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New paclitaxel targeting technique delivers chemotherapy directly to cancer cells

A research team at the University of California, Riverside has discovered a way for chemotherapy drug paclitaxel to target migrating, or circulating, cancer cells, which are responsible for the development of tumour metastases. Until now, paclitaxel has...

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IJERPH, Vol. 15, Pages 399: Correlation between Changes in Local Earth’s Magnetic Field and Cases of Acute Myocardial Infarction

IJERPH, Vol. 15, Pages 399: Correlation between Changes in Local Earth’s Magnetic Field and Cases of Acute Myocardial Infarction

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15030399

Authors: Gediminas Jaruševičius Tautvydas Rugelis Rollin McCraty Mantas Landauskas Kristina Berškienė Alfonsas Vainoras

The impact of changes in the geomagnetic field on the human body remains the subject of studies across the world, yet there is no consensus. Current studies are observing effects that require further work by researchers in order to find out the mechanisms that would allow a proper assessment of the correlations between the Earth‘s magnetic field variations and changes in human organisms. The main purpose of this study was to investigate possible correlations between the strength of time-varying aspects of the local Earth’s magnetic field and incidence of myocardial infarctions. Study participants included 435 males and 268 females who had diagnosis of myocardial infarction during the period of 1 January 2016 to 31 December 2016 and attended the Department of Cardiology at the Hospital of Lithuanian University of Health Sciences (LUHS), Kauno klinikos. Time varying magnetic field data was collected at the magnetometer site located in Lithuania. After mathematical analysis, the results support the hypothesis that the Earth’s magnetic field has a relationship between the number of acute myocardial infarction with ST segment elevation (STEMI) cases per week and the average weekly geomagnetic field strength in different frequency ranges. Correlations varied in different age groups as well as in males and females, which may indicate diverse organism sensitivity to the Earth’s magnetic field.

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Wanted: a WhatsApp alternative for clinicians

In this article (BMJ 2018;360:k622, doi:10.1136/bmj.k622) we omitted an n from Helgi Johannsson's name. The implementation date of the General Data Protection Regulation was also incorrect. It comes...

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