Role of radiologic imaging at the time of initial diagnosis of stage T1b-T3b melanoma

BACKGROUND: In patients with T1b-T3b cutaneous melanoma the utility of radiologic imaging at the time of diagnosis is unclear. Whether initial imaging led to a change in stage or treatment plan was investigated. METHODS: The melanoma database was searched for patients with T1b-T3b primary lesions, clinically N0, and asymptomatic for metastatic disease. Radiologic studies conducted before wide local excision +/- sentinel lymph node biopsy as well as all further imaging and investigations were analyzed. Outcome measures included upstaging, change in initial surgical management, true-positive, false-positive, true-negative, and false-negative rates of each imaging modality. RESULTS: In all, 344 preoperative imaging studies (chest x-ray [CXR], computed tomography [CT], positron emission tomography [PET]/CT) were performed on 158 patients, resulting in 49 findings suspicious for metastatic melanoma and 134 findings suggestive of nonmelanoma pathology. Only 1 of 344 (0.3%) studies, a PET/CT, correlated with confirmed metastatic melanoma. The false-positive rates were CXR 5 of 7 (71.4%), chest CT 21 of 24 (87.5%), abdomen/pelvis CT 10 of 11 (90.9%), head CT 2 of 2 (100.0%), PET/CT 3 of 5 (60.0%). No patient was upstaged or had a change in initial surgical management based on preoperative imaging. The cost of all initial imaging and imaging to follow-up abnormal findings was estimated as $555,308 for the 158 patients studied. CONCLUSIONS: Imaging at the time of initial diagnosis of T1b-T3b, clinically N0, M0 melanoma was of low yield with a high false-positive rate, and did not lead to upstaging or change in initial surgical management. These findings suggest that imaging of asymptomatic patients at the time of diagnosis may not be warranted.     

Correlates of insider and outsider conceptualizations of recovery

OBJECTIVE: The concept of recovery can be based on the self report of the individual experiencing the phenomenon ("insider" perspective) or objectively measured by clinicians and researchers ("outsider perspective"). The purpose of this study was to examine the relations among insider (hope and empowerment) and outsider (symptoms and cognition) variables of recovery. METHODS: 66 individuals with schizophrenia, bipolar disorder or major depression were administered the Brief Psychiatric Rating Scale, a battery of cognitive measures, The Hope Scale and The Empowerment Scale. RESULTS: For symptoms, depression and anxiety had the strongest relationships with hope and empowerment. Cognition was associated with a subset of activist oriented empowerment subscales. There were strong relationships among the hope and empowerment measures but few relationships among symptoms and cognition. CONCLUSIONS: Relationships exist between insider and outsider conceptualizations of recovery in that symptoms and cognition are associated with some aspects of hope and empowerment.     

The salivary exosomal microRNA as a potential biomarker in patients with periodontitis and oral cancers

Periodontitis and oral cancers are the most common oral diseases in the human population. The early diagnosis of oral diseases allows the efficient therapy of the patient. During oral diseases, resident cells in the affected tissue secrete exosomal microRNAs (miRNAs) into saliva. As these miRNAs have a crucial role in the pathogenesis of oral diseases, they have been suggested as non-invasive and validated biomarkers in predicting periodontitis severity and cancer progression. Several attempts have been performed to evaluate the expression of salivary exosomal miRNAs in patients with periodontitis and oral cancers. Some miRNAs are differentially expressed in the saliva of the affected patients when compared to healthy individuals. These miRNAs are reviewed in this narrative review. Collectively, it seems that salivary exosomal microRNAs could be used as a diagnostic biomarker in oral diseases. However, further studies are required to validate them.