Ga-68-DOTA-TATE PET/CT for Discrimination of Tumors of the Optic Pathway

Purpose: Symptomatic tumors of the optic nerve pathway may endanger vision. They are difficult to classify by imaging alone and biopsy may damage visual function. Tumor pathology influences treatment decision and a diagnostic tool with a high sensitivity and specificity would therefore be invaluable. We hypothesized that Ga-68-DOTA-TATE PET/CT may help in discriminating optic nerve tumors as uptake of somatostatin is elevated in meningiomas.

Material and Methods: Ga-68-DOTA-TATE PET/CT was used to examine 13 patients with ambiguous, symptomatic lesions of the optic pathway for treatment planning. The presence or absence of meningioma was validated by histopathology or supplementary diagnostic work-up.

Results: Ga-68-DOTA-TATE PET/CT identified 10 meningiomas (en plaque?=?1, optic nerve sheath?=?4, sphenoidal?=?5) correctly via increased SSTR (somatostatin receptor) expression (mean SUV_max (maximum standardized uptake value)?=?14.3?±?15.4). 3 tumors did not show elevated Ga-68-DOTA-TATE uptake (SUV_max?=?2.1?±?1.0). Subsumizing all clinical-radiological follow-up tools available, these lesions were classified as an intracerebral metastasis of an advanced gastric carcinoma, histologically proven inflammatory collagenous connective tissue and presumed leukemic infiltration of a newly diagnosed chronic lymphocytic leukemia. In this case series, Ga-68-DOTA-TATE PET/CT demonstrated both a sensitivity and specificity of 100%. Yet, the golden standard of histopathology was only available in a subset of patients included.

Conclusion: Ga-68-DOTA-TATE PET/CT proved to be a valuable diagnostic tool for the correct classification of equivocal, symptomatic tumors of the anterior optic pathway requiring therapy. PET/CT results influenced therapy decision essentially in all cases.     

Forensic aspects of gene expression signatures for age determination in bruises as evaluated in an experimental porcine model

Determining the age of bruises and the force used to inflict the trauma is of crucial importance in both human and veterinary forensic pathology. In the present study, the expression of more than 50 different genes in subcutaneous fat and muscle tissue from experimental bruises in pigs was investigated. The aim was to evaluate if expression signatures of selected genes were capable of determining bruises according to age and the force of impact. Eighteen experimental pigs were anesthetized, and on each animal four blunt traumas were inflicted on the back with a low, moderate or high force. The pigs were euthanized from 1 to 10 h after infliction of the trauma and subcutaneous fat and muscle tissues were sampled. As control, subcutaneous fat and muscle tissues were sampled from two un-injured pigs. Quantitative real-time polymerase chain reaction was performed to evaluate mRNA expression of genes involved in inflammation, tissue damage and repair. Expression signatures of thirteen selected genes in subcutaneous fat but not in muscle tissue reflected the age of bruises with a precision of approximately ±2 h. Moreover, the gene expression signature in the subcutaneous fat was to some extend able to separate bruises inflicted with different forces. Expression signatures of selected genes in the subcutaneous fat will increase the precision of the age determination of bruises in pigs. Further, due to the similarity of porcine and human skin physiology and immunity, these results might also provide valuable information in human forensic science.     

Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer

Patients with duodenal ulcer or functional dyspepsia do not differ on dyspeptic symptoms. The aim of the present study was to test the hypothesis that functional dyspepsia and duodenal ulcer are two different diagnostic entities by examining the discriminating power of several anamnestic, biological, and psychosocial variables. Ninety-four patients with duodenal ulcer and 86 patients with functional dyspepsia were included. Anamnestic data, global assessment,Helicobacter pylori status, blood group, Lewis^a+ phenotype, and several measures of psychological distress and somatic complaints were registered. Compared to patients with functional dyspepsia, the duodenal ulcer patients were more often infected byHelicobacter pylori and had their stomach discomfort more often relieved by eating. Compared to patients with duodenal ulcer, patients with functional dyspepsia had higher scores of depression, trait anxiety, general psychopathology and different somatic complaints (called somatization). They were also less satisfied with the health care system, their disorder had a greater negative impact on their quality of life, and their global assessment of own health was poorer. Discriminant analysis including age, smoking,Helicobacter pylori status, global assessment, and somatic complaint classified 86.1% of the patients correctly (77.9% of the patients with functional dyspepsia and 93.6% of the patients with duodenal ulcer). It is concluded that duodenal ulcer and functional dyspepsia are two separate diagnostic entities. Patients with duodenal ulcer are older, smoke more often, and almost all are infected withHelicobacter pylori, while patients with functional dyspepsia are characterized by somatization and a negative assessment of their own health.     

Survey on Neonatal End-of-Life Comfort Care Guidelines Across America

Context

Infants of age less than one year have the highest mortality rate in pediatrics. The American Academy of Pediatrics published guidelines for palliative care in 2013; however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL).