Diagnostic test accuracy of 18F-FDG PET/CT for prediction of programmed death ligand 1 (PD-L1) expression in solid tumours: a meta-analysis.

AIM: To investigate the predictive value of integrated 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) for the prediction of programmed death ligand 1 (PD-L1) expression in solid tumours via a systematic review and meta-analysis. MATERIALS AND METHODS: The PubMed, Cochrane, and EMBASE databases, from the earliest available date of indexing through 31 October 2020, were searched for studies evaluating the diagnostic performance of 18F-FDG PET/CT for prediction of PD-L1 expression in solid tumours other than lung cancer. RESULTS: Across seven studies (473 patients), the pooled sensitivity for 18F-FDG PET/CT was 0.75 (95% confidence interval [CI]: 0.65-0.82) without heterogeneity (I2 = 47.2, p=0.08) and a pooled specificity of 0.73 (95% CI: 0.64-0.81) with heterogeneity (I2 = 53.8, p=0.04). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 2.8 (95% CI: 2.1-3.7) and negative likelihood ratio (LR-) of 0.35 (95% CI: 0.26-0.47). The pooled diagnostic odds ratio (DOR) was 8 (95% CI: 5-13). Hierarchical summary receiver operating characteristic (ROC) curve and indicates that the area under the curve was 0.80 (95% CI: 0.77-0.84). CONCLUSION: The current meta-analysis showed a moderate sensitivity and specificity of 18F-FDG PET/CT for the prediction of PD-L1 expression in solid tumours. At present, the literature regarding the use of 18F-FDG PET/CT for the prediction of PD-L1 expression in solid tumours still limited; thus, further large multicentre studies would be necessary to substantiate the diagnostic accuracy of 18F-FDG PET/CT for prediction of PD-L1 expression in solid tumours.

Psychoacoustics and neurophysiological auditory processing in patients with Charcot-Marie-Tooth disease types 1A and 2A.

BACKGROUND AND PURPOSE: Hidden hearing loss has been reported in patients with Charcot-Marie-Tooth (CMT) disease; however, the auditory-processing deficits have not been widely explored. We investigated the psychoacoustic and neurophysiological aspects of auditory processing in patients with CMT disease type 1A (CMT1A) and type 2A (CMT2A). METHODS: A total of 43 patients with CMT1A and 15 patients with CMT2A were prospectively enrolled. All patients with CMT disease had normal sound-detection ability by using pure-tone audiometry. Spectral-ripple discrimination, temporal modulation detection and auditory frequency-following response were compared between CMT1A, CMT2A and control groups. RESULTS: Although all participants had normal audiograms, patients with CMT disease had difficulty understanding speech in noise. The psychoacoustic auditory processing was somewhat different depending on the underlying pathophysiology of CMT disease. Patients with CMT1A had degraded auditory temporal and spectral processing. Patients with CMT2A had no reduced spectral resolution, but they showed further reduced temporal resolution than the patients with CMT1A. The amplitudes of the frequency-following response were reduced in patients with CMT1A and CMT2A, but the neural timing remained relatively intact. CONCLUSIONS: When we first assessed the neural representation to speech at the brainstem level, the grand average brainstem responses were reduced in both patients with CMT1A and CMT2A compared with healthy controls. As the psychoacoustic aspects of auditory dysfunctions in CMT1A and CMT2A were somewhat different, it is necessary to consider future auditory rehabilitation methods based on their pathophysiology.

More accurate than MRI measurement of tumor size in breast cancer by using the peri-tumoral halo uptake layer method of the 18F-FDG PET/CT scan.

OBJECTIVE: To evaluate the reliability of a method using the peri-tumoral halo layer (PHL) for assessing tumor size in breast cancer patients on the fluorine-18-fluorodeoxy glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan compared to MRI and pathology. SUBJECTS AND METHODS: Among 121 patients with breast cancer who underwent both 18F-FDG PET/CT and MRI between March 2013 and June 2016, 59 patients were included in this study. Exclusion criteria were as follows: history of neoadjuvant therapy, history of pre-operative mammotome, insufficient pathologic/radiologic size report, clustered tumor, positive tumor resection margin, 18F-FDG non-avid tumor. The PHL was examined by two nuclear medicine physicians. Tumor sizes (longest diameters) on 18F-FDG PET/CT were estimated using margins defined as the inner line of the PHL. Pathologic tumor sizes were utilized as reference standards. RESULTS: The PHL of each tumor was most commonly designated as the 20%-30% band of the maximum standardized uptake value (SUVmax) it exhibited an inverse correlation with tumor SUVmax. Tumor size on 18F-FDG PET/CT showed a more linear correlation with pathology than that on MRI (r2=0.91 vs 0.65). In Bland-Altman analysis, 18F-FDG PET/CT showed significantly lower bias in size difference relative to pathology, compared with MRI (0.6±9.6cm vs. -1.9±17.3cm). Fluorine-18-FDG PET/CT showed more accurate T staging with pathology, especially in T3 cases, than MRI. CONCLUSION: A method of tumor size determination, using PHL on 18F-FDG PET/CT, showed more linear relationship and smaller size differences with pathology than MRI (average 0.6 vs. 1.9cm). It provides sufficient reliability and reproducibility for measuring tumor size in breast cancer.

Surveillance of the Middle East respiratory syndrome (MERS) coronavirus (CoV) infection in healthcare workers after contact with confirmed MERS patients: incidence and risk factors of MERS-CoV seropositivity.

Given the mode of transmission of Middle East respiratory syndrome (MERS), healthcare workers (HCWs) in contact with MERS patients are expected to be at risk of MERS infections. We evaluated the prevalence of MERS coronavirus (CoV) immunoglobulin (Ig) G in HCWs exposed to MERS patients and calculated the incidence of MERS-affected cases in HCWs. We enrolled HCWs from hospitals where confirmed MERS patients had visited. Serum was collected 4 to 6 weeks after the last contact with a confirmed MERS patient. We performed an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of MERS-CoV IgG and an indirect immunofluorescence test (IIFT) to confirm MERS-CoV IgG. We used a questionnaire to collect information regarding the exposure. We calculated the incidence of MERS-affected cases by dividing the sum of PCR-confirmed and serology-confirmed cases by the number of exposed HCWs in participating hospitals. In total, 1169 HCWs in 31 hospitals had contact with 114 MERS patients, and among the HCWs, 15 were PCR-confirmed MERS cases in study hospitals. Serologic analysis was performed for 737 participants. ELISA was positive in five participants and borderline for seven. IIFT was positive for two (0.3%) of these 12 participants. Among the participants who did not use appropriate personal protective equipment (PPE), seropositivity was 0.7% (2/294) compared to 0% (0/443) in cases with appropriate PPE use. The incidence of MERS infection in HCWs was 1.5% (17/1169). The seroprevalence of MERS-CoV IgG among HCWs was higher among participants who did not use appropriate PPE.

Isolated brain metastasis from uterine cervical cancer: a case report and review of literature.

The metastasis of cervical cancer to the brain is usually associated with systemic involvement such as lungs, liver and bones, and isolated brain metastasis is very rare because the primary mechanism of spread is by hematogenous dissemination of tumor cells. Although a few cases of isolated brain metastasis from cervical cancer have been reported, isolated brain metastasis from neuroendocrine cell carcinoma, which is characterized with aggressive and early metastatic features, has never been reported. A 44-year-old woman with cervical cancer composed of large neuroendocrine cell carcinoma was diagnosed with isolated brain metastasis at eight months after the definitive treatment with surgery followed by adjuvant chemotherapy. Careful evaluation would be needed during follow-up for the patients with cervical cancer with aggressive histologic type.

Rupture of uterine serosal hematoma: delayed complication of uterine perforation.

Uterine perforation, a major complication of dilatation and curettage (D&C), is typically recognized at the time of the procedure. Large defects in the uterine wall or injury to other intraabdominal organs can result in an acute abdomen requiring immediate surgical treatment. On the other hand, small perforations usually resolve on their own without any long-term consequences. Here, the authors report a case of delayed hemoperitoneum, ten days after the D&C evacuation of an early pregnancy. Initially, intramural pregnancy was the suspected etiology. However, histopathology suggested that the inciting event was the rupture of a serosal uterine hematoma, which likely resulted from an incomplete uterine perforation during D&C. The patient did well after undergoing an uneventful laparoscopy.

Prenatal diagnosis of congenital syphilis presenting with transient pleural effusion in the fetus: a case report and rising incidence of congenital syphilis in South Korea.

Congenital syphilis is preventable and curable if maternal infection is detected early, and pregnant women in Korea are screened routinely for this disease. Nevertheless, the incidence of congenital syphilis is not decreasing. Prenatal diagnosis of congenital syphilis is difficult and treatment is usually based on maternal syphilis serology. Prenatal ultrasonographic examination may sometimes reveal abnormal features suggesting congenital infection. The authors report a case of congenital syphilis that was diagnosed in both fetus and asymptomatic mother following detection on prenatal ultrasonography of transient fetal pleural effusion. The case is noteworthy for its sonographic presentation as fetal pleural effusion rapidly resolved spontaneously.

Effects of sFlt-1 and alpha 2-macroglobulin on vascular endothelial growth factor-induced endothelin-1 upregulation in human microvascular endothelial cells.

INTRODUCTION: Soluble fms-like tyrosine kinase-1 (sFlt-1) is a vascular endothelial growth factor (VEGF) binding protein and potent antagonist of VEGF. Alpha 2 macroglobulin (α2M) is another major binding protein for circulating VEGF, which is present in human plasma at higher concentration (2-4 mg/mL) than sFlt-1. This study investigated the effects of sFlt-1 and α2M on VEGF-induced endothelin-1 (ET-1) upregulation in human microvascular endothelial cell-1 (HMEC-1). METHODS: HMEC-1 was cultured and incubated with varying concentrations of sFlt-1 and α2M in combination with VEGF. ET-1 mRNA expression in the cells was measured by real time RT-PCR and ET-1 protein by western blot analysis. RESULTS: ET-1 expression in HMEC-1 incubated with VEGF significantly increased in time- and dose-dependent manners. Next, HMEC-1 was treated with the sFlt-1 (10-1000 ng/mL) or α2M (10-10000 ng/mL) in the presence of VEGF (10 ng/mL). We found that sFlt-1 induced a significant decrease of ET-1 expression upregulated by VEGF, while α2M did not affect the VEGF-induced ET-1 expression. CONCLUSIONS: sFLT-1 suppressed the VEGF-induced the ET-1 expression of HMEC-1. However, α2M did not show a significant effect on the ET-1 expression that was induced by VEGF. The results suggest that a certain proportion of the bound form α2M-VEGF have a biological action involved in the pathophysiology of preeclampsia.

Role of multiparametric 3.0-Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance.

OBJECTIVE: To evaluate predictors of more aggressive disease and the role of multiparametric 3.0-T magnetic resonance imaging (MRI) in selecting patients with prostate cancer for active surveillance (AS). PATIENTS AND METHODS: We retrospectively assessed 298 patients with prostate cancer who met the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, defined as T1c/T2, PSA level of ≤10 ng/mL, PSA density (PSAD) of <0.2 ng/mL(2) , Gleason score <7, and one or two positive biopsy cores. All patients underwent preoperative MRI, including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging, as well as radical prostatectomy (RP) between June 2005 and December 2011. Imaging results were correlated with pathological findings to evaluate the ability of MRI to select patients for AS. RESULTS: In 35 (11.7%) patients, no discrete cancer was visible on MRI, while in the remaining 263 (88.3%) patients, a discrete cancer was visible. Pathological examination of RP specimens resulted in upstaging (>T2) in 21 (7%) patients, upgrading (Gleason score >6) in 136 (45.6%), and a diagnosis of unfavourable disease in 142 (47.7%) patients. The 263 patients (88.3%) with visible cancer on imaging were more likely to have their cancer status upgraded (49.8% vs 14.3%) and be diagnosed with unfavourable disease (52.1% vs 14.3%) than the 35 patients (11.7%) with no cancer visible upon imaging, and these differences were statistically significant (P < 0.001 for all). A visible cancer lesion on MRI, PSAD, and patient age were found to be predictors of unfavourable disease in multivariate analysis. CONCLUSION: MRI can predict adverse pathological features and be used to assess the eligibility of patients with prostate cancer for AS.

Secondary missed abdominal pregnancy due to iatrogenic uterine perforation: a case report.

Abdominal pregnancy is extremely rare and can result from the reimplantation of an intrauterine pregnancy after spontaneous uterine rupture. In this report, we present the case of a secondary missed abdominal pregnancy resulting from iatrogenic uterine perforation during dilatation and curettage in an early intrauterine pregnancy and subsequently misdiagnosed as intrauterine trophoblastic disease. Transvaginal ultrasound missed the diagnosis, which was finally confirmed by computed tomography. We discuss the particulars of the case along with a review of the relevant literature.

Primary anaplastic lymphoma kinase-negative anaplastic large-cell lymphoma of the breast in a male patient.

Anaplastic large-cell lymphoma is an extremely rare lymphoma subtype. We describe the mammographic and ultrasonographic findings in a 51-year-old male patient who suffered from a palpable lump caused by this rare disease.

The usefulness of the story recall test in patients with mild cognitive impairment and Alzheimer's disease.

BACKGROUND: The story recall test (SRT) is one of the most reliable neuropsychological assessments for evaluating verbal memory function in order to distinguish between individuals with normal aging, mild cognitive impairment (MCI), and Alzheimer's disease (AD). The SRT is analogous to the logical memory test in Wechsler Memory Scale-III, which has recently been developed and standardized to apply to older adults in Korea. The purpose of this study was to examine the usefulness of the SRT and its ability to discriminate between normal cognitive aging and patients with MCI or AD. METHODS: One hundred and twelve patients with MCI, 97 patients with AD, and 53 healthy elderly adults participated in this study. The SRT was compared with the Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), Korean version of the Mini Mental State Examination (K-MMSE), and the Korean version of the Hopkins Verbal Learning Test (K-HVLT). RESULTS: The SRT was well-correlated with the dementia rating scales and the K-HVLT. However, the sensitivity and specificity of the SRT was greatly influenced by the level of education of the subjects. CONCLUSIONS: The SRT is a sensitive measurement of verbal memory function that can be used in clinical settings to discriminate between normal memory functioning and the very early and moderate stages of AD in a Korean population. Moreover, it is important to recognize that the SRT is more appropriate for subjects with a high level of education rather than a low level of education to differentiate normal cognitive aging from MCI or AD.

The role of surgery in the management of intracranial gliomas: current concepts.

The role of surgery in the management of human gliomas has been controversial. The results from numerous neurosurgical series are inconsistent. The current adjuvant therapies have facilitated treatment of patients, and have rendered neurosurgical removal without morbidity or mortality more commonplace than ever before. Here, we investigated the role of surgery in the management of adults with low- and high-grade gliomas. Even though there is substantial evidence which claims that surgery per se has a role to play in extending patient survival, there is a paucity of randomized clinical trials on this subject, and little in the way of Class II data to support these claims. However, this should not divert patients away from surgery, because there may be additional benefits from a concerted effort to remove a tumor completely. At the present time, it seems best that clinicians continue to individualize patient treatment based on a myriad of factors that relate to the patient, the patient's tumor, and the known biology of the disease.

Regional grey matter changes in patients with migraine: a voxel-based morphometry study.

We used voxel-based morphometry (VBM) to compare grey matter volume (GMV) between 20 migraine patients (five with aura and 15 without aura) with normal conventional magnetic resonance imaging findings and 33 healthy controls matched for age and sex. A separate analysis was also performed to delineate a possible correlation between the GMV changes and the headache duration or lifetime headache frequency. When compared with controls, migraine patients had significant GMV reductions in the bilateral insula, motor/premotor, prefrontal, cingulate cortex, right posterior parietal cortex, and orbitofrontal cortex (P < 0.001, uncorrected for multiple comparisons at a voxel level; corrected P < 0.05 after small volume corrections). All regions of the GMV changes were negatively correlated with headache duration and lifetime headache frequency (P < 0.05, Pearson's correlation test). We found evidence for structural grey matter changes in patients with migraine. Our findings of progressive GMV reductions in relation to increasing headache duration and increasing headache frequency suggest that repeated migraine attacks over time result in selective damage to several brain regions involved in central pain processing.

Evaluation of polymerization in fluoride-containing composite resins.

Fluoride-containing restorative materials are frequently utilized to delay or inhibit caries. The quality of the fluoride-containing composite resins was evaluated by testing their microhardness, polymerization shrinkage, thermal expansion coefficient, and surface morphology. Some of them were evaluated in conjunction with the thermocycling process. The microhardness values of the thermocycled specimens were similar to those of the specimens immersed only in distilled water. Among the specimens, Surefil showed the highest (68.6 +/- 1.2 Hv) value. A linear correlation was found between microhardness and the filler content (vol%) of the specimens regardless of their states. Polymerization shrinkage rapidly increased during the light curing, and then it reached a plateau. The shrinkage values increased as the specimens became thicker. In a temperature range of 30 approximately 80 degrees C, the coefficients of thermal expansion of the control specimens ranged between 43 x 10(-6)/ degrees C and 77 x 10(-6)/ degrees C. An inverse correlations were observed between the filler content (vol%) and the coefficient of thermal expansion and between microhardness and the coefficient of thermal expansion of the control specimens. Tetric Ceram showed a perforated or "Swiss-cheese" morphology after thermocycling. It was unique and occurred only in this product.

Mechanically-induced proximal arterial occlusion and stent-within-a-stent technique for the treatment of bilateral vertebral artery dissecting aneurysms.

Several endovascular approaches have been used in the treatment of dissecting aneurysms of the vertebrobasilar system. We present a case of a bilateral spontaneous vertebral artery (VA) dissecting aneurysms presenting with a subarachnoid haemorrhage. The dominant left VA aneurysm was treated with a stent-within-a-stent construct and the contralateral VA aneurysm was proximally occluded, with no complications, by an unintentional mechanically-induced arterial occlusion.

CD14 receptor gene promoter polymorphism: awakening maternal immunity during pregnancy.

We investigated whether monocyte CD14 receptor gene promoter polymorphisms were associated with the development and severity of pre-eclampsia. We genotyped the CD14 -260 C/T polymorphism in 36 pre-eclamptic patients and 52 healthy pregnant controls. A total of 30.6% and 69.4% of pre-eclamptic patients had the C and T alleles, respectively, and 48.0% and 52.0% of the controls, respectively. More pre-eclamptic patients were TT homozygotes compared with controls (50.0% versus 13.5%). In pre-eclamptic patients, the TT homozygotes exhibited a significantly higher mean systolic blood pressure compared with the non-TT homozygotes (173 +/- 28 mmHg versus 153 +/- 22 mmHg). We also noted a tendency towards increased proteinuria and placental abruption in the TT homozygotes compared with the non-TT homozygotes. We conclude that CD14 gene promoter polymorphisms appear to be a risk factor for pre-eclampsia. With further research, these findings might form the basis of a prognostic tool for pre-eclampsia.

Changes in gene expression involved in energy utilization during chicken follicle development.

Ovarian follicle development in egg-laying species is characterized by rapid growth in 7 days prior to ovulation when DNA and protein synthesis is markedly increased in the granulosa and theca cells. However, energy and substrate sources to facilitate the extensive DNA and protein synthesis necessary for folliculogenesis have not been identified in avian species. The current study was undertaken to investigate the expression profiles of regulatory genes involved in glucose transport, glycolysis and fatty acid oxidation in the follicle membranes from the small white follicle (SWF) to follicle 1 (F1) stages of follicle development. In our analysis of glucose transporter (GLUT) isoform expression, the level of GLUT1 mRNA increased with follicle development while GLUT2, GLUT3 and GLUT8 mRNA levels were unaffected by follicle development. In contrast, the expression patterns of proteins involved in metabolism down-stream of glucose transport, including hexokinase (HK), pyruvate dehydrogenase E1alpha (PDH E1alpha) and citrate synthase (CS), did not vary with the developmental stage of the follicle, even during rapid follicle growth. Expression of genes related to beta-oxidation of fatty acids (carnitine palmityl CoA transferase I and II, l-3-hydroxyacyl CoA dehydrogenase and long-chain acyl-CoA dehydrogenase), for which expression in the ovarian follicles of mammalian species has not previously been studied, was not changed consistently with the follicle development. These results suggest that both glucose and fatty acids might work as energy sources to ensure rapid follicle development in the chicken ovary, even though glycolysis and beta-oxidation are not modulated by follicle development.

Unusual renal cell carcinomas: a pictorial essay.

Renal cell carcinoma (RCC) is the most common solid renal neoplasm. Clear cell (conventional) carcinoma is the most common pathologic subtype of RCC. Usually RCC is a hypervascular, solid, solitary mass with contour bulging. However, RCC can manifest different features according to the pathologic tumor subtypes. Preoperative diagnosis of cyst-associated RCC is very difficult, especially in cases of RCC originating in a cyst. Multiple or bilateral presentation of RCC occurs in fewer than 5% of cases. In addition, RCCs may demonstrate unusual findings such as infiltrative growth mimicking transitional cell carcinoma, fatty component mimicking angiomyolipoma, severe perinephric infiltration, and extensive calcifications mimicking inflammation or other tumor. RCCs can be associated with hereditary diseases such as von Hippel-Lindau disease. Familiarity with these radiologic features of unusual RCCs can help ensure correct diagnosis and proper management.