Diagnostic accuracy of 18F-FDG PET/CT for assessing response to radiofrequency ablation treatment in lung metastases: a multicentre prospective study

Purpose

To assess diagnostic accuracy of ¹⁸F-FDG PET/CT at 3 months for the detection of local recurrence after radiofrequency ablation (RFA) of lung metastases.

Methods

The PET/CT scan at 3 months was compared with a baseline PET/CT scan from a maximum of 2 months before RFA, with the reference standard as recurrence diagnosed by CT during a 12-month follow-up. Local recurrence was diagnosed on the PET/CT scan if lesional uptake was greater than the mediastinal background. Maximum standardized uptake values (SUVmax) were recorded. ROC curve analysis for SUVmax was performed. Overall survival (OS) and time to local relapse were computed from the date of RFA using the Kaplan-Meier method (www.clinicaltrials.gov: NCT 00382252).

Results

Between 2005 and 2009, 89 patients (mean age 65 years) underwent RFA for 115 lung metastases (mean size 16.2 ± 6.9 mm). The median SUVmax before RFA was 5.8?±?4. PET/CT at 3 months and the reference standard were available in 77 patients and 100 lesions. Accuracy was 66.00 % (95 % CI 55.85–75.18 %), sensitivity 90.91 % (95 % CI 58.72–99.77 %), specificity 62.92 % (95 % CI 52.03–72.93 %), PPV 23.26 % (95 % CI 11.76–38.63 %), and NPV 98.25 % (95 % CI 90.61–99.96 %). One-year OS was 94.2 % (95 % CI 86.6–97.5 %) and the probability of being free of local recurrence 1 year after RFA was 84.6 % (95 % CI 75.0–90.8 %).

Conclusion

The specificity of PET/CT at 3 months is low because of persistent inflammation, especially when the lesion is close to the pleura. This technique is useful for its negative predictive value, but positive findings need to be confirmed by histology before new treatment is planned.     

Prevalence of Metabolic Syndrome in Behçet Disease: A Case-Control Study in Turkey

Background

Chronic inflammatory diseases such as psoriasis, rheumatoid arthritis, and inflammatory bowel diseases have been reported to be associated with the development of metabolic syndrome (MetS), which is characterized by central obesity, elevated triglycerides (TG), reduced high-density lipoproteins (HDL), impaired fasting blood glucose (FBG), and hypertension. Behçet disease (BD) is a chronic, immuno-inflammatory disease with multisystemic involvement.

Objective

The aim of this study was to investigate the prevalence and risk factors for MetS in patients with BD.

Methods

All patients had BD according to the criteria of the International Study Group. Diagnosis of MetS was established according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Mean waist circumference, body mass index (BMI), FBG, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol, HDL, very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), TG, systolic BP, and diastolic BP were measured and analyzed.

Results

A total of 86 patients and 72 healthy controls were included. MetS was detected in 35.4 % of patients and 20 % of controls (p = 0.04). Patients with BD had a 2.67-fold higher risk for MetS than healthy controls (p < 0.05). Significant risk factors for developing MetS according to multivariate analyses were BD, age, and BMI. Age at onset of the disease, duration of disease, BMI, gastrointestinal system involvement, and neurological involvement were correlated with increased MetS risk (p < 0.05). MetS tended to increase with age and the duration of the disease and was higher in women under the age of 40 years compared with healthy controls in the same age group.

Conclusion

All BD patients should be closely monitored for hypertension, hyperlipidemia, and diabetes mellitus to avoid MetS development.     

Association between exercise and primary incidence of prostate cancer

BACKGROUND:

Exercise is a modifiable lifestyle risk factor associated with prostate cancer risk reduction. However, whether this association is different as a function of race is unclear. In the current study, the authors attempted to characterize the link between exercise and prostate cancer (CaP) in white and black American men.

METHODS:

Using a prospective design, 307 men (164 of whom were white and 143 of whom were black) who were undergoing prostate biopsy completed a self‐reported survey that assessed exercise behavior (metabolic equivalent [MET] hours per week). Crude and adjusted logistic regression analyses were used to estimate the risk of prostate cancer controlling for age, body mass index, digital rectal examination findings, previous biopsy, Charlson comorbidity score, and family history of CaP stratified by self‐reported race.

RESULTS:

There was no significant difference noted with regard to the amount of exercise between racial groups (P = .12). Higher amounts of MET hours per week were associated with a decreased risk of CaP for white men in both crude (P = .02) and adjusted (P = .04) regression models. Among whites, men who exercised ≥ 9 MET hours per week were less likely to have a positive biopsy result compared with men exercising < 9 MET hours per week (odds ratio, 0.47; 95% confidence interval, 0.22‐0.99 [P = .047]). There was no association noted between MET hours per week and risk of CaP among black men in both crude (P = .79) and adjusted (P = .76) regression models.

CONCLUSIONS:

In a prospective cohort of men undergoing biopsy, increased exercise, measured as MET hours per week, was found to be associated with CaP risk reduction among white but not black men. Investigating race‐specific mechanisms by which exercise modifies CaP risk and why these mechanisms disfavor black men in particular are warranted. Cancer 2013. © 2013 American Cancer Society.     

Relationship between antibiotic resistance,efflux pumps,and biofilm formation in extended-spectrum β-lactamase producing Klebsiella pneumoniae

Klebsiella pneumoniae is an important pathogen both in community and hospital environment. In this study, we aimed to determine the antibiotic susceptibilities, expression levels of AcrA, ketM, kdeA, kpnEF, and kexD genes related to efflux pump and biofilm formation in 100 extended-spectrum β-lactamase producing Klebsiella pneumoniae. The relative expression levels of AcrA, ketM, kdeA, kpnEF, and kexD were determined by quantitative real-time PCR and biofilm formation was screened by microtiter plate assay. Based on CLSI breakpoints, zone diameters showed that 72% of isolates were resistant to ceftazidime, 79% to aztreonam, 54% to ciprofloxacin, 32% to ertapenem, 74% to tobramycin, 65% to tetracycline and all isolates were resistant to ampicillin, ceftriaxone, and cefotaxime. The relative expression of AcrA was upregulated in ciprofloxacin susceptible isolates and also upregulation of newly described efflux pump, kexD, was correlated with tobramycin and aztreonam resistance. A significant correlation was observed between resistance-nodulation-division and single-type efflux pumps. On the other hand, ciprofloxacin susceptible isolates formed stronger biofilms than resistant isolates. The up or down regulation of efflux pumps didn’t enhance biofilm formation capacity.     

Therapeutic versus prophylactic plus therapeutic administration of omega-3 fatty acid on endotoxin-induced periodontitis in rats

BACKGROUND: The aim of the present study was 1) to evaluate the possible effects of therapeutic usage of omega-3 fatty acid on the gingival tissue levels of prostaglandin E2 (PGE2), prostaglandin F2alpha (PGF2alpha), platelet activating factor (PAF), and leukotriene B4 (LTB4) in endotoxin-induced periodontitis in rats and 2) to investigate whether prophylactic usage provides any additional benefits to therapeutic doses of omega-3 fatty acid. METHODS: Experimental periodontitis was induced by repeated injection of Escherichia coli lipopolysaccharide (LPS). Thirty-six adult male Sprague-Dawley rats were divided into four study groups: 1) saline controls; 2) LPS; 3) therapeutic omega-3 fatty acid (TO3); and 4) prophylactic plus therapeutic omega-3 fatty acid (P + TO3) groups. In TO3 group, omega-3 fatty acid was given for 15 days following induction of experimental periodontitis. In P + TO3 group, omega-3 fatty acid was started 15 days before baseline, and then periodontitis was induced at baseline and omega-3 fatty acid was continued for 15 days after baseline. On day 15 after baseline, all rats were anesthetized and sacrificed. PGE2, PGF2alpha, and LTB4 levels in gingival tissue samples were analyzed by enzyme immunoassay and PAF levels were analyzed by radioimmonoassay. Data were evaluated statistically by using parametric tests. RESULTS: LPS injection resulted in significant amount of bone loss (P<0.05). Neither therapeutic nor prophylactic plus therapeutic administration of omega-3 fatty acid with the doses and duration of therapy used in the present study was effective in preventing endotoxin-induced alveolar bone loss. TO3 group exhibited significant decreases in the gingival tissue levels of PGE2, PGF2alpha, LTB4, and PAF compared to the LPS group (P<0.05). PGE2 and PGF2alpha levels in TO3 group were similar to those of the saline group (P>0.05), while LTB4 and PAF levels were statistically higher than the saline group (P<0.05). Prophylactic plus therapeutic usage of omega-3 fatty acid provided similar levels of all these mediators to those of the saline controls (P>0.05). CONCLUSIONS: Therapeutic omega-3 fatty acid significantly reduced the gingival tissue levels of PGE2, PGF2alpha, LTB4, and PAF in experimental periodontitis. Furthermore, prophylactic usage of omega-3 fatty acid provided additional beneficial effects to the therapeutic administration by decreasing the gingival tissue levels of these mediators to levels of healthy tissue. These findings should be verified by longitudinal clinical trials investigating clinical and biochemical periodontal parameters to better define the possible role of omega-3 fatty acids in periodontal treatment.     

Nine-year change of mortality and discharge against medical advice among major trauma patients in a Chinese Intensive Care Unit

Background

The mortality/morbidity of patients can be used to evaluate the quality of a trauma care, which can be influenced by incidence of discharge against medical advice (DAMA).

Objective

This study was to investigate annual changes of mortality/morbidity and DAMA of trauma patients in one Chinese Intensive Care Unit (ICU) in 9 years.

Methods

A retrospective analysis of data [age, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), mortality rate, and DAMA] was performed with trauma patients admitted in the emergency ICU of the Second Affiliated Hospital of Zhejiang University from 2003 to 2011.

Results

The rate of total mortality (in-hospital death and dying at discharge) was 6.9 % and the rate of DAMA (deterioration at discharge and improvement at discharge) was 6.6 %. The mortality rate was significantly decreased from 11.1 to 4.6 %, and the rate of deterioration at discharge was increased from 2.8 to 6.4 %. Among the three periods (2003–2005, 2006–2008, and 2009–2011), the age and APACHE II score of patients in total death, deterioration at discharge, and death plus deterioration at discharge groups were highest in the period 2009–2011, whereas the GCS was statistically lower in all groups except in the deterioration at discharge group.

Conclusion

The medical quality of trauma care has been improved through gradual improvement of instruments and trained medical staffs. The rate of deterioration at discharge was increased, especially in elder patient group. The DAMA had a significant impact on the accurate assessment of trauma care, which should be paid more attention on its potential roles in the future.

     

Prognostic role of E-cadherin in patients with advanced serous ovarian cancer

Purpose

To analyse correlation between expression of E-cadherin and clinical and pathological features and overall survival in advanced-stage serous ovarian carcinoma.

Methods

The expression of E-cadherin was analysed immunohistochemically in formalin-fixed, paraffin-embedded samples from 54 patients with advanced-stage serous ovarian cancer and related to clinicopathological characteristics and patients survival. The clinicopathological characteristics included the stage according to the International Federation of Gynecology and Obstetrics (FIGO), tumour differentiation, number of mitoses per 10 high-power fields (HPF), residual tumour size, and vascular invasion. Only patients with serous ovarian cancer FIGO stages III–IV were included. Overall survival (OS) was defined as time from surgery to the last follow-up date on 01.10.2010. OS was evaluated using Kaplan–Meier method, and log-rank test was used to asses the differences between the positive and E-cadherin negative group. Multivariate analysis was completed using the Cox proportional hazard regression model.

Results

E-cadherin immunoreactivity was not associated with FIGO stage, tumour grade, number of mitotic figures per 10 HPF, residual tumour volume or vascular invasion. Negative E-cadherin expression significantly predicted shorter OS (p < 0.001). The multivariate analyses showed that negative E-cadherin (p < 0.001), FIGO stage (p = 0.012) and residual tumour size >1 cm after the initial cytoreductive surgery (p < 0.001) were predictors of shorter OS.

Conclusion

Negative E-cadherin expression like presence of residual tumour after primary cytoreductive surgery and higher FIGO stage seem to predict unfavourable clinical outcome in patients with advanced-stage serous ovarian cancer. Negative expression of E-cadherin was shown to be a significant independent predictor of poorer OS. E-cadherin as marker has prognostic value.