Theiler’s murine encephalomyelitis virus infection of astrocytes induces the expression of chemokines which attract activated but not resting T lymphocytes

Journal of NeuroVirology - In this article, we studied the production of the chemokine CXCL9, also termed Mig (monokine induced by gamma interferon) by cultured SJL/J mouse astrocytes infected with...     

Searching for Indicators of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms: The Value of 18FDG–PET Confirmed

Background

Malignancy in intraductal papillary mucinous neoplasms (IPMN) of the pancreas may be predicted on the basis of a number of clinical and radiologic features, which have raised sensitivity but result in a specificity as low as 20?C50%. We sought to confirm the additional value of ¹⁸F-18-fluorodeoxyglucose?Cpositron emission tomography (¹⁸FDG?CPET) in diagnostic accuracy of imaging-based IPMN malignancy assessment.

Methods

This prospective uncontrolled case series contained 44 patients with IPMN undergoing comprehensive diagnostic evaluation, including magnetic resonance cholangiopancreatography and ¹⁸FDG?CPET. Average follow-up time was 39.3?months (range 3?C97?months). Diagnostic performance regarding the diagnosis of malignancy was evaluated for the classic preoperative assessment, including clinical signs, CA 19-9, imaging (computed tomography and magnetic resonance cholangiopancreatography), and International Consensus Guidelines criteria, as well as ¹⁸FDG?CPET scan.

Results

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 22, 32, 100, and 43%, and 83, 100, 100, 94, and 96%, respectively, for comprehensive assessment without and with ¹⁸FDG?CPET [maximum standardized uptake value (SUV_max) cutoff of 2.5?MBq]. Elevated CA 19-9 values and positive PET scan were the only independent prognostic factors for malignancy (odds ratio 2.11, 95% confidence interval 1.15?C2.74 and 5.49, 95% confidence interval 3.98?C21.44, respectively).

Conclusions

¹⁸FDG?CPET is useful for detection of malignancy in IPMN, improving the differential diagnosis with benign cases by functional data. The choice of SUV_max cutoff should maximize specificity.     

Symptom-based approach to colorectal cancer: survey of primary care physicians in Italy

Background. Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms.

Aim. To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer.

Methods. A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema.

Results. Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P=ns). Cancer was found in 14.6% of patients. Age >50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively).

Conclusion. The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged >50 years with iron deficiency anaemia.