Targeted biopsy based on ADC map in the detection and localization of prostate cancer: A feasibility study

Purpose:

To investigate the feasibility of targeted biopsy based on an apparent diffusion coefficient (ADC) map in the detection and localization of prostate cancer.

Materials and Methods:

This study included 288 consecutive patients with high or increasing serum prostate‐specific antigen (PSA) levels who underwent prostatic magnetic resonance imaging (MRI) examination with an ADC map. Four core‐targeted biopsies of low ADC lesions were performed under transrectal‐ultrasound guidance with reference to ADC map. The positive predictive values (PPVs) of low ADC lesions were calculated and compared for the peripheral zone (PZ), transition zone (TZ), and anterior portion, respectively. Comparisons of ADC values and sizes between malignant and nonmalignant lesions were also performed.

Results:

A total of 313 low ADC lesions were detected in 195 patients and sampled by targeted biopsies. The PPVs were 55.3% (95% confidence interval [CI]: 50–61) in total, 61.0% (95% CI: 53–69) for PZ, 50.6% (95% CI: 43–58) for TZ, and 90.9% (95% CI: 81–100) for the anterior portion. The most common nonmalignant pathology of low ADC lesions was hyperplasia, followed by chronic prostatitis. There were significant differences in ADC values and sizes between malignant and nonmalignant low ADC lesions.

Conclusion:

Targeted biopsies could be capable of detecting cancers well wherever they may be in the prostate, although the PPVs varied depending on the location of low ADC lesions. J. Magn. Reson. Imaging 2013;37:1168–1177. © 2012 Wiley Periodicals, Inc.     

Grisel syndrome as a complication of Kawasaki disease: a case report and review of the literature

Grisel syndrome is a non-traumatic atlantoaxial subluxation and a rare complication of any inflammatory condition of the upper neck and otolaryngological procedures. Delayed diagnosis causes neurological impairment, ranging from radiculopathy to paralysis and death. Kawasaki disease is a very frequent and important acute febrile vasculitis of childhood that is seen worldwide, and upper neck involvement (cervical lymphadenopathy) is one of the common symptoms of Kawasaki disease. A case of Grisel syndrome that occurred as a complication of Kawasaki disease is reported. This is the first case report, in English, of Grisel syndrome as a complication of Kawasaki disease. Conclusion: Pediatricians should be aware of Grisel syndrome as a possible complication of Kawasaki disease.     

A novel PET scanner with semiconductor detectors may improve diagnostic accuracy in the metastatic survey of head and neck cancer patients

Objectives

Our research group developed new PET scanner with semiconductor detectors for high spatial resolution with low scatter noise. On head and neck cancer (HNC) surgery, FDG-PET may often provide false-positive findings in cervical node involvements. Accordingly, we assessed diagnostic accuracy using this new scanner in the HNC patients as compared with the conventional lutetium oxyorthosilicate (LSO) PET.

Methods

We prospectively studied FDG imaging in 35 HNC patients by both semiconductor PET and LSO-PET. At 60 min after ¹⁸F-FDG injection, two PET scans were obtained using both scanners consecutively and in random order. Two nuclear medicine specialists scored FDG abnormalities using 5 point scale system for receiver operating characteristic (ROC) curve analysis.

Results

63 suspected of metastatic or recurrent lesions were evaluated and correlated by the final confirmation by pathological findings or clinical courses (malignant 26/benign 37). Semiconductor PET showed sensitivity of 92.3 % (24/26), specificity of 51.4 % (19/37), and accuracy of 68.2 % (43/63), while LSO-PET showed sensitivity of 84.6 % (22/26), specificity of 16.2 %(6/37), and accuracy of 44.4 % (28/63), respectively. Especially, semiconductor PET accurately diagnosed as true negative in the 13 of 14 lesions only detected by LSO-PET. ROC analyses revealed the diagnostic superiority of semiconductor PET from location of- and area under curve particularly in the study of small (≤10 mm) lesions.

Conclusion

A new novel semiconductor PET scanner can increase diagnostic accuracy with reduction in false positive findings in the HNC patients mainly due to higher spatial resolution and lower noise than the LSO-PET. This new technology can lead to more accurate diagnosis and the more optimal therapeutic tactics in head and neck surgery.     

Feasibility and toxicity of docetaxel before or after fluorouracil, epirubicin and cyclophosphamide as adjuvant chemotherapy for early breast cancer

Background

The tolerance and safety associated with the administration order of the anthracycline and taxane drugs have not been evaluated.

Patients and methods

Breast cancer patients with node-positive or high-risk patients with node-negative were eligible. The feasibility and toxicity were evaluated in the following regimens—arm A, 3 courses of fluorouracil 500 mg/m², epirubicin 100 mg/m² and cyclophosphamide 500 mg/m² (FEC) followed by 3 courses of docetaxel 100 mg/m² (DOC); arm B, 3 courses of DOC followed by 3 courses of FEC.

Results

Forty-two patients were registered. The relative dose intensity was 94.2 % for FEC and 97.8 % for DOC in arm A, and 98.9 % for DOC and 95.2 % for FEC in arm B. In arm A, grade 3 or higher hematological toxicity was observed in nine patients, and febrile neutropenia developed in three patients with FEC. In arm B, grade 3 or higher hematological toxicity was observed in seven patients, but febrile neutropenia was not noted in any patient.

Conclusion

The regimens in both arms A and B were safe regarding adjuvant chemotherapy for early breast cancer. However, DOC followed by FEC might be more tolerable. Further studies will maximize the results obtained with DOC followed by FEC.     

Artemis‐dependent DNA double‐strand break formation at stalled replication forks

Stalled replication forks undergo DNA double‐strand breaks (DSBs) under certain conditions. However, the precise mechanism underlying DSB induction and the cellular response to persistent replication fork stalling are not fully understood. Here we show that, in response to hydroxyurea exposure, DSBs are generated in an Artemis nuclease‐dependent manner following prolonged stalling with subsequent activation of the ataxia–telangiectasia mutated (ATM) signaling pathway. The kinase activity of the catalytic subunit of the DNA‐dependent protein kinase, a prerequisite for stimulation of the endonuclease activity of Artemis, is also required for DSB generation and subsequent ATM activation. Our findings indicate a novel function of Artemis as a molecular switch that converts stalled replication forks harboring single‐stranded gap DNA lesions into DSBs, thereby activating the ATM signaling pathway following prolonged replication fork stalling.     

Potential application of high-resolution microfocus X-ray techniques for observation of bone structure and bone-implant interface

PURPOSE: The aim of the present study was to evaluate the potential application of 2 types of microfocus x-ray units to study the bone structure around dental implants and at the bone-implant interface. MATERIALS AND METHODS: IMZ titanium implants were placed in the maxilla and mandible of a beagle dog. After implantation periods of 1, 2, and 3 months, the bone-implant interface was evaluated with microfocus x-ray computed tomography (CT) and microfocus x-ray fluoroscopy. RESULTS: Microfocus x-ray CT images of the bone-implant specimen at 3 months after implant placement revealed a clear distinction between the implant and the bone. The implant surface was partially covered with bone, and direct contact between the implant and bone could be clearly seen. Differences in degrees of calcification were identified by the differences in relative black and white intensity. Microfocus x-ray fluoroscopy also showed clear features of the bone and titanium implant The original drill hole and new bone formation could be recognized. These findings corresponded with traditional histologic observations by light microscopy. DISCUSSION AND CONCLUSION: Microfocus x-ray techniques are non-destructive and require a very short examination time. They are considered useful to observe details of the bone structure and bone-implant interface. Microfocus x-ray fluoroscope and microfocus x-ray CT techniques can provide a clear and distinguishable image of the bone-implant interface because of their high spatial resolution.     

Connective tissue growth factor expressed in rat alveolar bone regeneration sites after tooth extraction

OBJECTIVE: To understand bone regeneration process after tooth extraction could be a clue to develop a new strategy for alveolar bone reconstruction. Recently, accumulated evidences support that connective tissue growth factor (CTGF) is implicated in tissue repair of many tissues. In this study, we investigated the spatial and temporal expression of CTGF in the rat tooth extraction sockets. DESIGN: Five weeks old wild type male rats (weighing 120 g) were used for this experiment. Expression of CTGF was determined by immunohistochemistry and in situ hybridization in the rat upper molar tooth extraction sockets at 2, 4, 7, 10 and 14 days after tooth extraction. RESULTS: CTGF was expressed strongly in the endothelial cells migrating into the granulation tissue at the bottom of the sockets during 4 days after tooth extraction. During the reparative process, no apparent chondrocyte-like cell appeared in the sockets, while osteoblast-like cells proliferated in the sockets with low CTGF expression at 7, 10, 14 days after extraction. As expected, no staining was observed with the preimmune rabbit IgG and CTGF sense probe. CTGF may play an important role in angiogenesis and granulation tissue formation specifically at early healing stage after tooth extraction to initiate alveolar bone repair. CONCLUSION: CTGF was expressed at early healing stage of the rat tooth extraction wound.     

Assessing the performance of a methyl methacrylate-based resin cement with self-etching primer for bonding orthodontic brackets

Questions over the usefulness of a self-etching primer with resin adhesive in the bonding of orthodontic brackets remain unsolved. The purpose of this study was to determine the effects of using Multibond, a new methyl methacrylate (MMA)-based resin cement with self-etching primer, on the shear bond strength of orthodontic brackets compared with Superbond C&B, which is a well-known MMA-based resin cement containing phosphoric acid etching. Metal or plastic brackets were bonded to etched or self-etching primed bovine teeth using Superbond C&B or Multibond. The shear bond strengths were measured after immersion in water at 37 degrees C for 24 hours. Data were analyzed by two-way analysis of variance and Scheffe's test. The surface appearances of the teeth after phosphoric acid etching or self-etching priming were observed by field-emission scanning electron microscopy (FE-SEM). Metal brackets bonded with Multibond had a significantly lower shear bond strength than metal brackets bonded with Superbond C&B. No significant differences in shear bond strength were observed between Multibond and Superbond C&B when plastic brackets were bonded to the enamel. The shear bond strength of metal brackets bonded with Multibond was comparable with that of plastic brackets bonded with Superbond C&B. Adhesive remnant index score showed a tendency of more residual resin cement remaining on the teeth when metal brackets were bonded with Multibond. FE-SEM observation revealed less dissolution of the enamel surface resulting from treatment with Multibond self-etching primer as compared with phosphoric acid. Thus, the Multibond system may be a candidate for bonding orthodontic brackets with the advantage of minimizing enamel loss.     

Usefulness of CT images for diagnosis of odontogenic maxillary sinusitis

To assess the usefulness of CT images for the diagnosis of suspected odontogenic maxillary sinusitis, 52 patients with maxillary sinusitis who had received CT examination were retrospectively analyzed. maxillary sinus ostium was established on coronal CT image in 20 out of 55 lesions in those 52 patients. However, a considerable number of patients who had inflammatory disease not only in the maxillary sinus but also in other paranasal sinuses (38/55) or in the nasal meatus (34/55) were included in those 52 patients. Concerning the opening of the ostium, the clinical diagnosis is frequently different from the diagnosis made using CT. The CT findings of the maxillary sinus ostium, nasal meatus and other paranasal sinuses were thus important in planning the treatment for patients with maxillary sinusitis in dentistry, as in otorhinolaryngology.