Self-limiting Ibrutinib-Induced Neutrophilic Panniculitis

Abstract: Neutrophilic panniculitis is a relatively rare condition, characterized by predominantly neutrophilic inflammation in the subcutaneous fat. Rarely, neutrophilic panniculitis may be induced by chemotherapeutics or targeted molecular therapies, including the Bruton tyrosine kinase inhibitor ibrutinib. Previously reported cases of ibrutinib-induced panniculitis were suppressed with sustained low-dose steroid therapy while continuing ibrutinib therapy. To our knowledge, self-limiting panniculitis during ibrutinib therapy has not yet been described. We describe a case of self-limiting, neutrophilic panniculitis which developed during ibrutinib therapy. A 78-year-old woman presented to the dermatology clinic with a 3-week history of painful erythematous nodules on her lower extremities which occurred 1 month after initiating ibrutinib therapy for chronic lymphocytic leukemia. Physical examination revealed tender erythematous poorly demarcated subcutaneous nodules on the anterior and posterior aspects of both lower legs. A panniculitis was suspected clinically, and a punch biopsy was performed. Histological evaluation revealed a lobular panniculitis with fat necrosis and infiltrates consisting predominantly of neutrophils. A diagnosis of neutrophilic panniculitis was rendered, which the patient opted not to treat. The eruption waned before resolving spontaneously over the course of 6 months despite continued ibrutinib therapy. This case illustrates panniculitis as an emerging adverse drug reaction after treatment with ibrutinib and that not all cases will require ibrutinib dose adjustment or steroid therapy but rather may be subject to spontaneous resolution.

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Applicability of Kd for modelling dissolved 137Cs concentrations in Fukushima river water: Case study of the upstream Ota River

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Kazuyuki Sakuma, Hideki Tsuji, Seiji Hayashi, Hironori Funaki, Alex Malins, Kazuya Yoshimura, Hiroshi Kurikami, Akihiro Kitamura, Kazuki Iijima, Masaaki Hosomi
A study is presented on the applicability of the distribution coefficient (Kd) absorption/desorption model to simulate dissolved ¹³⁷Cs concentrations in Fukushima river water. The upstream Ota River basin was simulated using GEneral-purpose Terrestrial Fluid-flow Simulator (GETFLOWS) for the period 1 January 2014 to 31 December 2015. Good agreement was obtained between the simulations and observations on water and suspended sediment fluxes, and on particulate bound ¹³⁷Cs concentrations under both base and high flow conditions. By contrast the measured concentrations of dissolved ¹³⁷Cs in the river water were much harder to reproduce with the simulations. By tuning the Kd values for large particles, it was possible to reproduce the mean dissolved ¹³⁷Cs concentrations during base flow periods (observation: 0.32 Bq/L, simulation: 0.36 Bq/L). However neither the seasonal variability in the base flow dissolved ¹³⁷Cs concentrations (0.14–0.53 Bq/L), nor the peaks in concentration that occurred during storms (0.18–0.88 Bq/L, mean: 0.55 Bq/L), could be reproduced with realistic simulation parameters. These discrepancies may be explained by microbial action and leaching from organic matter in forest litter providing an additional input of dissolved ¹³⁷Cs to rivers, particularly over summer, and limitations of the Kd absorption/desorption model. It is recommended that future studies investigate these issues in order to improve simulations of dissolved ¹³⁷Cs concentrations in Fukushima rivers.



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Monitoring of soil radon by SSNTD in Eastern India in search of possible earthquake precursor

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Argha Deb, Mahasin Gazi, Jayita Ghosh, Saheli Chowdhury, Chiranjib Barman
The present paper deals with monitoring soil radon-222 concentration at two different locations, designated Site A and Site B, 200 m apart at Jadavpur University campus, Kolkata, India, with a view to find possible precursors for the earthquakes that occurred within a few hundred kilometers from the monitoring site. The solid state nuclear track detector CR-39 has been used for detection of radon gas coming out from soil. Radon-222 time series at both locations during the period August 2012–December 2013 have been analysed. Distinct anomalies in the soil radon time series have been observed for seven earthquakes of magnitude greater than 4.0 M that occurred during this time. Of these, radon anomalies for two earthquakes have been observed at both locations A and B. Absence of anomalies for some other earthquakes has been discussed, and the observations have been compared with some earthquake precursor models.



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Volumetric assessment of tumor size changes in pediatric low-grade gliomas: feasibility and comparison with linear measurements

Abstract

Purpose

We report a retrospective comparison between bi-dimensional RANO criteria and manual volumetric segmentation (MVS) in pediatric low-grade gliomas.

Methods

MRI FLAIR or T1 post contrast images were used for assessment of tumor response. Seventy patients were included in this single center study, for each patient two scans were assessed ("time 0" and "end of therapy") and response to therapy was evaluated for both methods. Inter-reader variability and average time for volumetric assessment were also calculated.

Results

Fourteen (20%) of the 70 patients had discordant results in terms of response assessment between the bi-dimensional measurements and MVS. All volumetric response assessments were in keeping with the subjective analysis of tumor (radiology report). Of the 14 patients, 6 had stable disease (SD) on MVS and progressive disease (PD) on 2D assessment, 5 patients had SD on MVS and partial response (PR) on 2D assessment, 2 patients had PD on MVS and SD on 2D assessment, and 1 patient had PR on MVS and SD on 2D analysis. The number of discordant results rises to 21(30%) if minor response is integrated in the response assessment. MVS was relatively fast and showed high inter-reader concordance.

Conclusion

Our analysis shows that therapeutic response classification may change in a significant number of children by performing a volumetric tumor assessment. Furthermore, MVS is not particularly time consuming and has very good inter-reader concordance.

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Age-related early/late variations of functional connectivity across the human lifespan

Abstract

Purpose

Many questions remain regarding how the brain develops, matures, and ages across the lifespan. The functional connectivity networks in the resting-state brain can reflect many of the characteristic changes in the brain that are associated with increasing age. Functional connectivity has been shown to be time-dependent over the course of a lifespan and even over the course of minutes. The lifespan strategies of all cognitive networks and how dynamic functional connectivity is associated with age are unclear.

Methods

In this paper, studies employing both linear and quadratic models to define new specific lifespan strategies, including early/late increase/decrease models, were conducted to explore the lifespan functional changes. A large data sample was retrieved from the publicly available data from the Nathan Kline Institute (N = 149 and ages 9–85). Both static and dynamic functional connectivity indexes were calculated including the static functional connectivity, the mean of the dynamic functional connectivity and variations in dynamic functional connectivity.

Results

The between-network connectivity results revealed early increases in the default-mode (DF) and cingulo-opercular network (CO)-associated network connectivities and a late increase in the fronto-parietal (FP)-associated network connectivity. These results depicted various lifespan strategies for different development stages and different cognitive networks across the lifespan. Additionally, the static FC and mean dynamic FC exhibited consistent results, and their variation exhibited a constant decrease with age across the entire age range.

Conclusion

These results (FDR-corrected p value < 0.05) suggest that the early/late variations in lifespan strategies could reflect an association between varied and complex circumstances and brain development.

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Thoracic Imaging of Solid Tumor Patients Treated with Immune Checkpoint Inhibitors

Abstract

Purpose of Review

Immune checkpoint inhibitors harness the patient's own immune system to fight cancer. They are now approved for treating a number of solid malignancies, with more agents and indications expected in the coming months and years. Because of their unique mechanism of action, these agents may lead to unusual imaging appearances.

Recent Findings

Rare patients may experience pseudoprogression, whereby tumors may initially increase in size or number despite response to therapy. Many patients will experience autoimmune side effects including pneumonitis, which may lead to respiratory compromise and will necessitate cessation of therapy. Occasionally pneumonitis or a sarcoid-like reaction can mimic metastatic disease.

Summary

It is imperative that radiologists be aware of these unusual imaging manifestations in patients on immunotherapy so that they are able to assist oncologists in appropriately treating these patients. In particular, we urge caution in interpreting new or enlarging lesions, since these may not always mean progression of disease. Additionally, radiologists should look out for potential immune-related side effects of these therapies.

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What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence.

What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence.

Radiology. 2018 Jan 29;:171665

Authors: Gao Y, Albert M, Young Lin LL, Lewin AA, Babb JS, Heller SL, Moy L

Abstract
Purpose To assess adherence with annual or biennial screening mammography after a diagnosis of high-risk lesion(s) at stereotactic biopsy with or without surgical excision and to identify clinical factors that may affect screening adherence after a high-risk diagnosis. Materials and Methods This institutional review board-approved HIPAA-compliant retrospective study included 208 patients who underwent stereotactic biopsy between January 2012 and December 2014 that revealed a high-risk lesion. Whether the patient underwent surgical excision and/or follow-up mammography was documented. Adherence of these women to a protocol of subsequent mammography within 1 year (9-18 months) or within 2 years (9-30 months) was compared with that of 45 508 women with normal screening mammograms who were imaged during the same time period at the same institution. Possible factors relevant to postdiagnosis management and screening adherence were assessed. Consultation with a breast surgeon was identified by reviewing clinical notes. Uptake of pharmacologic chemoprevention following diagnosis (patient decision to take chemopreventive medications) was assessed. The Fisher exact test was used to compare annual or biennial screening adherence rates. Binary logistic regression was used to identify factors predictive of whether women returned for screening within selected time frames. Results In total, 913 (1.3%) of 67 874 women were given a recommendation to undergo stereotactic biopsy, resulting in diagnosis of 208 (22.8%) of 913 high-risk lesions. Excluding those with a prior personal history of breast cancer or upgrade to cancer at surgery, 124 (66.7%) of 186 women underwent surgery and 62 (33.3%) did not. Overall post-high-risk diagnosis adherence to annual or biennial mammography was similar to that in control subjects (annual, 56.4% vs 50.8%, P = .160; biennial, 62.0% vs 60.1%, P = .630). Adherence was significantly better in the surgical group than in the nonsurgical group for annual mammography (70.0% vs 32.0%; odds ratio [OR] = 5.0; 95% confidence interval [CI]: 2.4, 10.1; P < .001) and for biennial mammography (74.3% vs 40.0%; OR = 4.3; 95% CI: 2.1, 8.8; P < .001). Among the patients in the nonsurgical group, those adherent to annual or biennial mammography were significantly more likely to have seen a breast surgeon than the nonadherent women (annual, 77.3% vs 35.7%, P = .005; biennial, 67.9% vs 36.4%, P = .045). All patients receiving chemopreventive agents underwent a surgical consultation (100%; n = 21). Conclusion Although diagnosis of a high-risk lesion at stereotactic breast biopsy did not compromise overall adherence to subsequent mammographic screening, patients without surgical excision, particularly those who did not undergo a surgical consultation, had significantly lower imaging adherence and chemoprevention uptake as compared with their counterparts who underwent surgery, suggesting that specialist care may be important in optimizing management. © RSNA, 2018.

PMID: 29378151 [PubMed - as supplied by publisher]

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