Diagnostic performance of contrast enhanced CT and 18F-FDG PET/CT in suspicious recurrence of biliary tract cancer after curative resection

<p>Abstract</p> <p>Background</p> <p>Because of the late clinical presentation of biliary tract cancer (BTC), only 10% of patients are eligible for curative surgery. Even among those patients who have undergone curative surgery, most patients develop recurrent cancer. This study is to determine the clinical role of ¹⁸F-FDG PET/CT during post-operative surveillance of suspected recurrent BTC based on symptoms, laboratory findings and contrast-enhanced CT (ceCT) findings.</p> <p>Methods</p> <p>We consecutively enrolled 50 patients with BTC who underwent curative surgery. An ¹⁸F-FDG PET/CT was obtained for assessment of recurrence based on clinical suspicion during post-operative surveillance. The final confirmation of recurrence was determined pathologically or clinically. When a pathologic confirmation was impossible or inconclusive, a clinical confirmation was used by radiologic correlation with subsequent follow-up ceCT at a minimum of 3-month intervals. Diagnostic efficacy was evaluated by comparing the results of ceCT and ¹⁸F-FDG PET/CT with the final diagnosis.</p> <p>Results</p> <p>Among the 50 patients, 34(68%) were confirmed to have a recurrence. PET/CT showed higher sensitivity (88% <it>vs</it>. 76%, <it>p </it>= 0.16) and accuracy (82% <it>vs</it>. 66%, <it>p </it>= 0.11) for recurrence compared to ceCT, even though the difference was not significant. The positive (86% <it>vs</it>. 74%, <it>p </it>= 0.72) and negative predictive values for recurrence (73% <it>vs</it>. 47%, <it>p </it>= 0.55) were not significantly different between PET/CT and ceCT. However, an additional PET/CT on ceCT significantly improved the sensitivity than did a ceCT alone (94% [32/34] for PET/CT on ceCT <it>vs</it>. 76% [26/34] for ceCT alone, <it>p </it>= 0.03) without increasing the specificity, positive predictive value, and negative predictive value.</p> <p>Conclusions</p> <p>¹⁸F-FDG PET/CT alone is not more sensitive or specific than ceCT in the detection of recurrent BTC after curative surgery. These results do not reach statistical significance, probably due to the low number of patients. However, an additional ¹⁸F-FDG PET/CT on ceCT significantly improves the sensitivity of detecting recurrences.</p

Neuroprotection of Tanshinone IIA against Cerebral Ischemia/Reperfusion Injury through Inhibition of Macrophage Migration Inhibitory Factor in Rats

. Recent studies have demonstrated that TSA has protective effects against focal cerebral I/R injury. However, little is known about the underlying mechanisms. Here we put forward the hypothesis that TSA acts through inhibition of MIF expression during focal cerebral I/R injury in rats.Rats were subjected to middle cerebral artery occlusion (MCAO) for 2 hours. This was followed by reperfusion. We measured neurological deficits, brain water content, and infarct volume, and found that neurological dysfunction, brain edema, and brain infarction were significantly attenuated by TSA 6 hours after reperfusion. We also measured myeloperoxidase (MPO) activity at 6 and 24 hours, and found that neutrophil infiltration was significantly higher in the vehicle+I/R group than in the TSA+I/R group. ELISA demonstrated that TSA could inhibit MIF expression and the release of TNF-α and IL-6 induced by I/R injury. Western blot analysis and immunofluorescence staining showed that MIF expression was significantly lower in the TSA+I/R group than in the vehicle+I/R group. MIF was found almost all located in neurons and hardly any located in astrocytes in the cerebral cortex. Western blot analysis and EMSA demonstrated that NF-κB expression and activity were significantly increased in the vehicle+I/R group. However, these changes were attenuated by TSA.Our results suggest that TSA helps alleviate the proinflammatory responses associated with I/R-induced injury and that this neuroprotective effect may occur through down-regulation of MIF expression in neurons

Appropriate age range for introduction of complementary feeding into an infant’s diet

Peer reviewedPublisher PD

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

Autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients as measured by sympathetic skin response

AbstractObjectivesThe purpose of this study was to evaluate the prevalence of autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients and to investigate its risk factors using the sympathetic skin response.MethodsWe performed a cross-sectional study on 113 non-diabetic continuous ambulatory peritoneal dialysis patients using the sympathetic skin response, a non-invasive test to detect sympathetic sudomotor deficit.ResultsSixty-six patients (58.4%) showed an abnormal sympathetic skin response suggesting a sympathetic sudomotor deficit. Patients were then categorized into two groups according to their sympathetic skin response result. The baseline clinical data, nutritional and dialysis adequacy indices of the two groups were compared. Patients with an abnormal sympathetic skin response are significantly older (54.9 ± 12.52 vs 61.79 ± 12.16 years, p=0.004), more malnourished with a lower albumin (35.79 ± 2.41 vs 33.98 ± 4.92 g/L, p=0.012) and normalized protein nitrogen appearance values (0.99 ± 0.17 vs 0.93 ± 0.16 g/kg/day, p=0.046). Further, they have a lower residual renal function as calculated by weekly renal Kt/V (0.63 ± 0.61 vs 0.29 ± 0.35, p=0.001) or renal creatinine clearance (41.35 ± 40.2 vs 21.96 ± 27.22 L/wk/1.73 m2, p=0.006). Patients with an abnormal sympathetic skin response are also receiving a smaller dialysis dose as calculated by the total weekly Kt/V (2.13 ± 0.6 vs 1.83 ± 0.41, p=0.004) or the total creatinine clearance (82. 42 ± 37.34 vs 66.81 ± 25.38 L/wk/1.73 m2, p=0.017).ConclusionBased on sympathetic skin response, autonomic dysfunction is common among non-diabetic continuous ambulatory peritoneal dialysis patients. Patients with autonomic dysfunction are significantly older, more malnourished, have low residual renal function and are receiving a smaller dialysis dose. A prospective study is warranted to investigate the reversibility of autonomic dysfunction after an increment in dialysis dose

Usefulness of ultrasound-guided placement of acute hemodialysis catheter

AbstractFailure of central vein cannulation may occur in as high as 10% of cases using anatomical landmark (ALM) as guidance for the direction of needle puncture. In addition, significant time and patient discomfort may be required besides possibility of adverse complications such as hematoma, pneumothorax and arteriovenous fistula formation. Use of ultrasound-guided cannulation of central veins has been studied previously with good results by using dedicated ultrasound probes and needle holder/guides. We tested the results by using dedicated ultrasound probes without the needle holder/guide. Data were analyzed retrospectively over an 8-month period, in attempt to compare, the ultrasound guidance without the needle guide method and the ALM guidance for the placement of central venous catheters in internal jugular and femoral veins. Central vein was located with a 7.5 MHz transducer which is connected to a portable, battery powered, 2-dimentional (2D) echo device. There were total of 48 episodes of central venous cannulation (37 internal jugular and 11 femoral veins). Of these, 25 were done under ultrasound guidance. The number of skin punctures and passes under the skin were lower in the ultrasound-guided group. The vein was entered (passed) during the first attempt in 72% of the ultrasound-guided group, as compared with only 26% of the ALM group. The time needed was under 5 minutes in most ultrasound-guided cases. There were no immediate or late major complications in both groups. We conclude that ultrasound guidance without the need of the dedicated needle guide produces comparable results of fewer venous puncture attempts, increases success rate, and low complications rate. Routine use of ultrasound guided central vein cannulation is encouraged