Prognostic meaning of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ration (LMR) in newly diagnosed Hodgkin lymphoma patients treated upfront with a PET-2 based strategy

Recent reports identify NLR (the ratio between absolute neutrophils counts, ANC, and absolute lymphocyte count, ALC), as predictor of progression-free survival (PFS) and overall survival (OS) in cancer patients. We retrospectively tested NLR and LMR (the ratio between absolute lymphocyte and monocyte counts) in newly diagnosed Hodgkin lymphoma (HL) patients treated upfront with a PET-2 risk-adapted strategy. NLR and LMR were calculated using records obtained from the complete blood count (CBC) from 180 newly diagnosed HL patients. PFS was evaluated accordingly to Kaplan-Meier method. Higher NLR was associated to advanced stage, increased absolute counts of neutrophils and reduced count of lymphocytes, and markers of systemic inflammation. After a median follow-up of 68 months, PFS at 60 months was 86.6% versus 70.1%, respectively, in patients with NLR?≥?6 or NLR?<?6. Predictors of PFS at 60 months were PET-2 scan (p?<?0.0001), NLR?≥?6.0 (p?=?0.02), LMR?<?2 (p?=?0.048), and ANC (p?=?0.0059) in univariate analysis, but only PET-2 was an independent predictor of PFS in multivariate analysis. Advanced-stage patients (N?=?119) were treated according to a PET-2 risk-adapted protocol, with an early switch to BEACOPP regimen in case of PET-2 positivity. Despite this strategy, patients with positive PET-2 still had an inferior outcome, with PFS at 60 months of 84.7% versus 40.1% (negative and positive PET-2 patients, respectively, p?<?0.0001). Independent predictors of PFS by multivariate analysis were PET-2 status and to a lesser extend NLR in advanced stage, while LMR maintained its significance in early stage. By focusing on PET-2 negative patients, we found that patients with NLR?≥?6.0 or LMR?<?2 had an inferior outcome compared to patients with both ratios above the cutoff (78.7 versus 91.9 months, p?=?0.01). We confirm NLR as predictor of PFS in HL patients independently from stage at diagnosis. Integration of PET-2 scan, NLR and LMR can result in a meaningful prognostic system that needs to be further validated in prospective series including patients treated upfront with PET-2 adapted-risk therapy.     

Pediatric astrocytic tumor grading: comparison between arterial spin labeling and dynamic susceptibility contrast MRI perfusion

Purpose

The aim of this study was to compare arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) MRI perfusion with respect to diagnostic performance in tumor grading in pediatric patients with low- and high-grade astrocytic tumors (AT).

Methods

We retrospectively analyzed 37 children with histologically proven treatment naive low- and high-grade AT who underwent concomitant pre-operative ASL and DSC MRI perfusion. Studies were performed on a 1.5 T scanner, and a pulsed technique was used for ASL. DSC data were post-processed with a leakage correction software. Normalization of tumor perfusion parameters was performed with contralateral normal appearing gray matter. Normalized cerebral blood volume (nCBV) values in the most perfused area of each neoplasm were compared with normalized DSC-derived cerebral blood flow (nDSC-CBF) and ASL-derived cerebral blood flow (nASL-CBF) data, and correlated with WHO tumor grade. Statistics included Pearson’s chi-square and Mann-Whitney U tests, Spearman’s rank correlation, and receiver operating characteristic (ROC) analysis.

Results

A significant correlation was demonstrated between DSC and ASL data (p?<?0.001). Significant differences in terms of DSC and ASL data were found between low- and high-grade AT (p?<?0.001). ROC analysis demonstrated similar performances between all parameters in predicting tumor grade (nCBV: AUC 0.96, p?<?0.001; nDSC-CBF: AUC 0.98, p?<?0.001; nASL-CBF: AUC 0.96, p?<?0.001).

Conclusions

Normalized pulsed ASL performed with a 1.5 T scanner provides comparable results to DSC MRI perfusion in pediatric AT and may allow distinction between high- and low-grade AT.

     

Frequency and characteristics of contralateral breast abnormalities following recall at screening mammography

Purpose

To determine the frequency and characteristics of contralateral, non-recalled breast abnormalities following recall at screening mammography.

Methods

We included a series of 130,338 screening mammograms performed between 1 January 2014 and 1 January 2016. During the 1-year follow-up, clinical data were collected for all recalls. Screening outcome was determined for recalled women with or without evaluation of contralateral breast abnormalities.

Results

Of 3,995 recalls (recall rate 3.1%), 129 women (3.2%) underwent assessment of a contralateral, non-recalled breast abnormality. Most lesions were detected at clinical mammography and/or breast tomosynthesis (101 women, 78.3%). The biopsy rate was similar for recalled lesions and contralateral, non-recalled lesions, but the positive predictive value of biopsy was higher for recalled lesions (p = 0.01). A comparable proportion of the recalled lesions and contralateral, non-recalled lesions were malignant (p = 0.1). The proportion of ductal carcinoma in situ was similar for both groups, as well as invasive cancer characteristics and type of surgical treatment.

Conclusions

About 3% of recalled women underwent evaluation of contralateral, non-recalled breast lesions. Evaluation of the contralateral breast after recall is important as we found that 15.5% of contralateral, non-recalled lesions were malignant. Contralateral cancers and screen-detected cancers show similar characteristics, stage and surgical treatment.

Key Points

? 3% of recalled women underwent evaluation of contralateral, non-recalled lesions ? One out of seven contralateral, non-recalled lesions was malignant ? A contralateral cancer was diagnosed in 0.5% of recalls ? Screen-detected cancers and non-recalled, contralateral cancers showed similar histological characteristics ? Tumour stage and surgical treatment were similar for both groups

     

Radiation exposure using the O-arm<Superscript>®</Superscript> surgical imaging system

Purpose

This study was conducted to characterise the O-arm^® surgical imaging system in terms of patient organ doses and medical staff occupational exposure during three-dimensional thoracic spine and pelvic examinations.

Methods

An anthropomorphic phantom was used to evaluate absorbed organ doses during a three-dimensional thoracic spine scan and a three-dimensional pelvic scan with the O-arm^®. Staff occupational exposure was evaluated by constructing an ambient dose cartography of the operating theatre during a three-dimensional pelvic scan as well as using an anthropomorphic phantom to simulate the O-arm^® operator.

Results

Patient organ doses ranged from 30 ± 4 μGy to 20.0 ± 3.0 mGy and 4 ± 1 μGy to 6.7 ± 1.0 mGy for a three-dimensional thoracic spine and pelvic examination, respectively. For a single three-dimensional acquisition, the maximum ambient equivalent dose at 2 m from the iso-centre was 11 ± 1 μSv.

Conclusion

Doses delivered to the patient during a three-dimensional thoracic spine image acquisition were found to be significant with the O-arm^®, but lower than those observed with a standard computed tomography examination. The detailed dose cartography allows for the optimisation of medical staff positioning within the operating theatre while imaging with the O-arm^®.

     

False-positive synovial fluid alpha-defensin test in a patient with acute gout affecting a prosthetic knee

The alpha-defensin test has demonstrated promising results in studies evaluating it for the diagnosis of prosthetic joint infection. There are limited data in the literature regarding its use in patients with other inflammatory joint conditions, but a high specificity for infection has been reported. We describe a patient with a prosthetic knee joint, who had a positive alpha-defensin lateral flow assay but in whom subsequent results confirmed a diagnosis of acute gout with no evidence of infection.     

The potential shortcomings of measuring hyperactivated motility by computer-aided sperm analysis when sperm motion is multiphasic

This paper was written from the standpoint that computer-aidedsperm analysis (CASA) instruments, which capture a 'snapshot'of sperm trajectories in order to generate their data, may providea poor measure of hyperactivated motility in a sperm populationwhere hyperactivation is multiphasic in nature. To illustratethis point, a series of theoretical sperm populations were constructedwhich varied subtly but significantly in the nature of the hyperactivatedbehaviour expressed by spermatozoa. The parameters which weremanipulated were: (I) the number of hyperactivated phases exhibitedwithin a given period of time; (ii) the duration of these phases;and (iii) proportion of spermatozoa within the population whichexhibited hyperactivated phase. Thee populations were then subjectto an analysis in which snapshots of sperm motion were examinedto determine the percentage of hyperactivated spermatozoa forthat population. The results indicated that whilst this snapshotapproach to quantifying hyperactivation could provide a figurefor the percentage of hyperactivated spermatozoa for that population.The results indicated that whilst this snapshot approach toquantifying hyperactivation could provide a figure for the percentageof hyperactivated spermatozoa within the sample window, thisoften inaccurately described the underlying behaviour of thepopulation. Since there is very likely to be a significant amountof biological information contained within the nature of multiphasicbehaviour, this paper has argued that this aspect of snapshotanalysis is one which requires serious consideration by CASAmanufacturers and medical researchers.     

sFlt-1/PlGF ratio for the prediction of the time of delivery

Purpose

The soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio has been shown to be a useful parameter for the diagnosis and prediction of preeclampsia (PE). An increased sFlt-1/PlGF ratio can be closely linked to the need to deliver. The aim of the study was to examine the mean time until delivery (MTUD) in pregnant women with a strongly increased sFlt-1/PlGF ratio.

Methods

From 2010 to 2018, the sFlt-1/PlGF ratio was determined in 995 singleton pregnancies with diagnosis or suspicion of PE/HELLP syndrome and/or intrauterine growth restriction (IUGR). MTUD of patients with a value above 655 in?<?34 weeks of gestation (group 1: n?=?13) and above 201 in?≥?34 weeks of gestation (group 2: n?=?15) was calculated. Patients with a value?>?85 but?<?655 in?<?34 weeks of gestation (group 3: n?=?70) and a value?>?110 but?<?201 (group 4: n?=?44) in?≥?34 weeks of gestation acted as controls.

Results

28 pregnant women with severely elevated sFlt-1/PlGF ratio and 114 controls were included. In group 1, MTUD was longer compared to group 2 without reaching statistical significance (96.7 h?±?132.2 vs. 47.7 h?±?44, p?=?0.222). In pregnancies?<?34 weeks of gestation (early onset), MTUD was significantly longer in group 3 compared to group 1 (361 h?±?317.3 vs. 96.7 h?±?132.2, p?<?0.001). In pregnancies?≥?34 weeks of gestation (late onset), MTUD was significantly longer in group 4 compared to group 2 (123.6 h?±?139.2 vs. 47.7 h?±?44, p?=?0.002).

Conclusions

The sFlt-1/PlGF ratio is suitable for decision-making regarding close monitoring of high-risk patients and need for lung maturation. However, for planning of delivery itself further prospective interventional studies are required to define its role as outcome predictor.

     

Identification Of Two New Pmp22 Mouse Mutants Using Large-Scale Mutagenesis And A Novel Rapid Mapping Strategy

In some alcohol-related pathologies of chronic alcoholism women are more vulnerable than men. A consecutive sample of 62 chronic alcoholics was studied, 18 females and 44 males, aged between 28 and 69 years to assess the incidence and distribution of peripheral neuropathy with regard to gender. All patients underwent clinical and neurological observations, laboratory tests, and electroneurography. Total lifetime dose of ethanol (TLDE) and other risk factors for neuropathy (disease duration, age, nutritional status) were calculated and correlated to sural nerve sensory-evoked potential (SEP) amplitude. In 42 patients (67.7%), we observed the presence of clinical and/or infraclinical neuropathy, mostly axonal, in 29 males (65.9%) and 13 females (72.2%). In women, compared to men, TLDE and disease duration were significantly inversely correlated to sural nerve SEP amplitude, i.e in women, SEP amplitude is significantly reduced in relation to TLDE and disease duration increase. These data indicate a higher sensitivity of females towards the toxic effects of ethanol, other than malnutrition, on peripheral nerve fibres.     

Pain in Parkinson disease: a cross-sectional survey of its prevalence,specifics, and therapy

We aimed to evaluate prevalence, phenotype, and therapeutic realities of pain in patients with Parkinson disease (PD). Therefore, we assessed 181 outpatients with PD using a cross-sectional approach applying the German Pain Questionaire (DSF), the PainDetect, and a self-developed Parkinson Disease Pain Questionaire (UPDPQ) covering detailed therapeutic aspects. Furthermore, we investigated the association between pain and PD-disease characteristics, quality of life (PDQ-39), depression, and anxiety (HADS-D, HADS-A). Overall, prevalence of pain was high (95.4%); 91.1% suffered from chronic pain, but in only 22.3% of them, pain disorder was diagnosed. Pain impaired everyday-life moderately to very severely in 48.4% of patients and was the most distressing symptom in 10.2% of all patients. Pain was localized mainly in the back (71.4%) or joints (52.4%), frequently occurred as pain attacks (79%) but appeared with neuropathic character in only 15.3% of patients. Most patients (74.2%) received some kind of pain treatment, mainly provided by orthopedists (62.0%) or general practitioners (50.0%). Physiotherapy (61.3%), pain killers (54.4%), or massage (35.5%) were the most frequent therapeutic measures. Rehabilitative therapy (96.3%) and physiotherapy (89.5%) were rated as most effective, but with vastly temporary effects. 53.3% of patients attributed PD as the main cause for their pain, but only 33.6% found relief from anti-parkinsonian drugs. High levels of pain were associated with higher scores of depression and anxiety, and lower quality of life. Results suggest that pain in PD is frequent, complex, and quality-of-life-impairing but under-diagnosed and unsystematically treated and indicate need to systematically investigate pathophysiology-based treatment strategies.