Predictive and prognostic value of 18F-DOPA PET/CT in patients affected by recurrent medullary carcinoma of the thyroid

Abstract

Introduction

Medullary thyroid carcinoma (MTC) is a malignancy accounting for about 5–8% of thyroid cancers. Serum calcitonin and carcinoembryonic antigen (CEA) levels are widely used to monitor disease progression. However, prognostic factors able to predict outcomes are highly desirable. We, therefore, aimed to assess the prognostic role of ¹⁸F-DOPA PET/CT in patients with recurrent MTC.

Materials and methods

60 patients (mean age 64 ± 13 years, range 44–82) with recurrent MTC were eligible from a multicenter database. All patients underwent a restaging ¹⁸F-DOPA PET/CT, performed at least 6 months after surgery. CEA/calcitonin levels, local recurrences, nodal involvement and metastases at PET/CT were recorded. SUVmax, SUVmean (also normalized to mediastinal uptake) and metabolic tumor volume were automatically calculated for each lesion, by placing a volume of interest around the lesion with 40% of peak activity as threshold for the automatic contouring. The patients were clinically and radiologically followed up for 21 ± 11 months. Rate of progression-free survival (PFS), disease-specific survival (DSS) and incremental prognostic value of ¹⁸F-DOPA PET/CT over conventional imaging modalities were assessed by Kaplan–Meier curves and Log-Rank test. Cox regression univariate and multivariate analyses were performed for assessing predictors of prognosis.

Results

¹⁸F-DOPA PET/CT showed abnormal findings in 27 patients (45%) and resulted unremarkable in 33 (55%). PFS was significantly longer in patients with an unremarkable PET/CT scan (p = 0.018). Similarly, an unremarkable PET/CT study was associated with a significantly longer DSS (p = 0.04). ¹⁸F-DOPA PET/CT added prognostic value over other imaging modalities both for PFS and for DSS (p < 0.001 and p = 0.012, respectively). Neither semiquantitative PET parameters nor clinical or laboratory data were predictive of a worse PFS and DSS in patients with recurrent MTC.

Conclusion

¹⁸F-DOPA PET/CT scan has an important prognostic value in predicting disease progression and mortality rate.

Modern Approaches to the Surgical Management of Malignant Breast Disease

The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with postoperative radiation, but has evolved to include several options that produce excellent oncologic endpoints and improved cosmesis. These options include skin- and nipple-sparing mastectomies with immediate reconstruction as well as oncoplastic procedures that allow larger excisions and better postoperative breast shape. This article provides an overview of these modern surgical approaches for breast cancer treatment.

Outline of guidelines for the management of vasculitis and vascular disorders in Japan, 2016 revised edition

Abstract

The proposal by the 1994 International Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitides (CHCC1994) and by the CHCC2012 markedly influenced the classification and way of considering cutaneous vasculitis. In the proposal by the CHCC1994, hypersensitivity angiitis was defined as an equivalent pathological condition to microscopic polyangiitis or cutaneous leukocytoclastic angiitis (CLA), and it was not adopted as a disease name. However, CLA which was positioned as a type of small-vessel vasculitis is only a pathological name. In the proposal by the CHCC2012, a new category of single-organ vasculitis included CLA and cutaneous arteritis. Vasculitis allergica cutis (Ruiter) corresponded to CLA and cutaneous polyarteritis nodosa corresponded to cutaneous arteritis. The Japanese Dermatological Association (JDA) prepared guidelines for the management of vasculitis and vascular disorders in 2008 based on the proposal by the CHCC1994 and their original viewpoint of dermatology. The JDA subsequently revised the 2008 edition guidelines in 2016 following publication of the proposal of the CHCC2012 in Japanese. We presented the outline of the 2016 edition guidelines and propose a treatment algorithm for primary vasculitides based on the evaluation of the cutaneous symptoms for cases suspected as primary cutaneous vasculitides, which integrates the 2008 JDA guideline and CHCC2012 classification. This is the secondary English version of the original Japanese manuscript for the guideline for management of vasculitis and vascular disorders published in the Japanese Journal of Dermatology 127(3); 299–415, 2017.

Epidemiology and comorbidities of patients with chronic urticaria in Korea: A nationwide population-based study

Abstract

Few population-based studies have focused on the epidemiology and comorbidities of chronic urticaria (CU) or chronic spontaneous urticaria (CSU). The objective of this study was to obtain information on the epidemiology and comorbidities associated with CU and CSU in Korea. We conducted a cross-sectional analysis using a national health insurance database. An algorithm based on the International Classification of Diseases, 10th revision, was used for the identification of patients with CU and CSU, and an age–sex adjusted logistic regression model was used to assess the risk of comorbidities in these patients. The average annual prevalence rates of CU and CSU during the 4-year period between 2010 and 2013 were 3.08% and 1.40%, respectively. The prevalence rates of CU and CSU were higher in women than men (1:1.39 and 1:1.34, respectively) and peaked at 0–9 and 70–79 years, respectively. After adjustment for age and sex, the patients with CU and CSU were found to have a significantly higher prevalence rate of CU/CSU-related diseases, compared with those without CU (mean adjusted odds ratio, 8.46; 95% confidence interval, 8.10–8.83). Allergic rhinitis, drug allergies, asthma, thyroid diseases and cancers were the most common comorbidities. Stomach, thyroid, liver and prostate cancers were the most prevalent cancers. This study provides large epidemiological data on the prevalence rates of CU and CSU, and their comorbidities, in Korea. Patients with CU and CSU impose a higher burden, in terms of specific comorbidities, than those without CU.

Efficacy of the combined use of a mild foaming cleanser and moisturizer for the care of infant skin

Reduced GABA levels correlate with cognitive impairment in patients with relapsing-remitting multiple sclerosis

Abstract

Objectives

To investigate if brain gamma-aminobutyric acid (GABA) levels in patients with relapsing-remitting multiple sclerosis (RRMS) are abnormal compared with healthy controls, and their relationship to cognitive function in RRMS.

Methods

Twenty-eight RRMS patients and twenty-six healthy controls underwent magnetic resonance spectroscopy (MRS) at 3-T to detect GABA signals from posterior cingulate cortex (PCC), medial prefrontal cortex (mPFC) and left hippocampus using the 'MEGAPoint Resolved Spectroscopy Sequence' (MEGA-PRESS) technique. All subjects also underwent a cognitive assessment.

Results

In RRMS patients, GABA+ were lower in the PCC (p = 0.036) and left hippocampus (p = 0.039) compared with controls, decreased GABA+ in the PCC and left hippocampus were associated with specific cognitive functions (r = -0.452, p = 0.016 and r = 0.451, p = 0.016 respectively); GABA+ in the mPFC were not significantly decreased or related to any cognitive scores (p > 0.05).

Conclusions

This study demonstrates that abnormalities of the GABAergic system may be present in the pathogenesis of RRMS and suggests a potential link between regional GABA levels and cognitive impairment in patients with RRMS.

Key points

• GABA levels may decrease in patients with RRMS.

• Lower GABA levels correlated with worse cognitive performance in patients with RRMS.

• Dysfunctional GABAergic neurotransmission may have a role in cognitive impairment in RRMS.

Responses to Snow, Miller, and Seok

Van den Stock, Ady, The Horizon of Modernity: Subjectivity and Social Structure in New Confucian Philosophy

Zhang, Zhaoyang 張朝陽, Reconstruction of Early Chinese Civil Law 中國早期民法的建構

Novel uses of bilateral advancement flaps for tip defects on the nose part II

Comparison of Cyclic and Continuous 308-nm Excimer Laser Treatments for Vitiligo: A Randomized Controlled Non-Inferiority Trial

Azathioprine and risk of multiple keratinocyte cancers

Machine Learning and Melanoma: The Future of Screening

Epidemiology of Malignant Cutaneous Granular Cell Tumors: A United States Population-Based Cohort Analysis using the Surveillance, Epidemiology, and End Results (SEER) Database

Malignant cutaneous granular cell tumors (mcGCT) are rare and associated with substantial morbidity and mortality. The literature includes single-institution studies.

Efficacy and tolerance profile of thalidomide in cutaneous lupus erythematosus: a systematic review and meta-analysis

Thalidomide has shown excellent results for severe cutaneous lupus Erythematosus (CLE) but its prescription is limited by potentially severe adverse events.

Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: a retrospective cohort study

Antimalarials are effective for rheumatic skin diseases, but have been associated with retinopathy.We investigated the toxicity risk of antimalarials alone and in combination.Antimalarials were generally well tolerated and had similar risk profiles. Risk of retinopathy seems to be lowest for quinacrine, then hydroxychloroquine, and highest for chloroquine.

Novel uses of bilateral advancement flaps for tip defects on the nose part I

A comparison of apremilast monotherapy and combination therapy for plaque psoriasis in clinical practice: a Canadian multicenter retrospective study

Demographic and Healthcare Service Utilization by 4,417 Patients with Hidradenitis Suppurativa

What is already known on this topic?Hidradenitis suppurativa (HS) is associated with increased burden of healthcare utilization.What does this article add to our knowledge?Patients with HS impose an increased burden on the healthcare system compared to patients with psoriasis and to the general population.How does this information affect clinical practice and/or change patient care?These results should encourage policy-makers and healthcare providers to explore more cost-effective treatments for HS patients.

Utilization patterns and survival outcomes after wide local excision or Mohs micrographic surgery for Merkel cell carcinoma in the United States, 2004-2009