Aberrant patterns of PET response during treatment for DLBCL patients with MYC gene rearrangements.

PURPOSE: MYC gene rearrangements in diffuse large B-cell lymphoma (DLBCL) patients are associated with poor prognosis. Our aim was to compare patterns of 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET/CT) response in MYC + and MYC- DLBCL patients. METHODS: Interim PET/CT (I-PET) and end of treatment PET/CT (EoT-PET) scans of 81 MYC + and 129 MYC- DLBCL patients from 2 HOVON trials were reviewed using the Deauville 5-point scale (DS). DS1-3 was regarded as negative and DS4-5 as positive. Standardized uptake values (SUV) and metabolic tumor volume (MTV) were quantified at baseline, I-PET, and EoT-PET. Negative (NPV) and positive predictive values (PPV) were calculated using 2-year overall survival. RESULTS: MYC + DLBCL patients had significantly more positive EoT-PET scans than MYC- patients (32.5 vs 15.7%, p = 0.004). I-PET positivity rates were comparable (28.8 vs 23.8%). In MYC + patients 23.2% of the I-PET negative patients converted to positive at EoT-PET, vs only 2% for the MYC- patients (p = 0.002). Nine (34.6%) MYC + DLBCL showed initially uninvolved localizations at EoT-PET, compared to one (5.3%) MYC- patient. A total of 80.8% of EoT-PET positive MYC + patients showed both increased lesional SUV and MTV compared to I-PET. In MYC- patients, 31.6% showed increased SUV and 42.1% showed increased MTV. NPV of I-PET and EoT-PET was high for both MYC subgroups (81.8-94.1%). PPV was highest at EoT-PET for MYC + patients (61.5%). CONCLUSION: MYC + DLBCL patients demonstrate aberrant PET response patterns compared to MYC- patients with more frequent progression during treatment after I-PET negative assessment and new lesions at sites that were not initially involved. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: HOVON-84: EudraCT: 2006-005,174-42, retrospectively registered 01-08-2008. HOVON-130: EudraCT: 2014-002,654-39, registered 26-01-2015.

Sulawesi Onthophagus: seven new species in select groups (Coleoptera: Scarabaeidae: Scarabaeinae).

Eleven species in five small operational groups of the scarab genus Onthophagus Latreille, 1802 (Coleoptera: Scarabaeidae: Scarabaeinae) are treated, all from the Indonesian island of Sulawesi and nearby smaller islands. These groups are defined, and their species are keyed, described, and illustrated, including the following seven new species: Onthophagus bisscrutator (O. scrutator group); O. bongkudai (O. holosericus group); O. sopu (O. manguliensis group); O. hollowayi, O. seseba, and O. annulopunctatus (O. seseba group); and O. begoniophilus (O. deflexicollis group). Lectotypes are designated for Onthophagus scrutator Harold, 1877 and O. holosericus Harold, 1877.

Added value of FDG-PET imaging in the diagnostic workup for yttrium-90 radioembolisation in patients with colorectal cancer liver metastases.

OBJECTIVE: Yttrium-90 radioembolisation (Y90-RE) is recommended for unresectable, chemorefractory liver-dominant disease; however, the incidence of extrahepatic disease (EHD) is high. FDG-PET may have additional value to CT in demonstrating EHD. Our aim was to evaluate the added diagnostic value of FDG-PET to abdominal CT and study the influence of FDG-PET findings on treatment decisions. METHODS: All consecutive patients with colorectal cancer liver metastases (CRCLM) referred for Y90-RE were included. Patients who underwent both CT and FDG-PET in the diagnostic workup were selected. Imaging reports were scrutinised for documented sites of EHD, and changes of management due to FDG-PET findings were determined. RESULTS: A total of 42 patients were included. Findings on CT and FDG-PET matched in 20 patients (no EHD, n = 15; identical EHD, n = 5). In 4 patients, lesions detected on CT were not FDG-avid, and in 18 patients, FDG-PET showed more lesions than CT (P < 0.05). In 7/42 patients (17 %) a change of management was made based on the additional FDG-PET findings, i.e. exclusion from Y90-RE treatment (n = 6) and change in treatment plan (whole liver rather than segmental treatment, n = 1). CONCLUSIONS: In patients with CRCLM referred for Y90-RE, FDG-PET showed significantly more EHD and led to a considerable change of management.

New Guinea Onthophagus: taxonomy of ten small, unicolored new species (Coleoptera: Scarabaeidae: Scarabaeinae).

The taxonomy of small, unicolor brown to black Papuasian species of the genus Onthophagus Latreille, 1802 is discussed. Two multi-species groups are defined in the nominotypical subgenus Onthophagus, one with broad and one with narrow dorsal eye foramina (O. acerus and O. kokodentatus groups, respectively). Twelve species are listed, keyed, and diagnosed. Ten of these are new species from Papua New Guinea (PNG) and West New Guinea (WNG, Indonesia), here described in the Onthophagus acerus group: O. aceroides (WNG), O. baiyericus (PNG), O. bituberoculus (WNG), O. daymanus (PNG), O. kokocellosus (PNG), O. kokopygus (PNG); in the Onthophagus kokodentatus group: O. dissidentatus (PNG), O. kokodentatus (PNG), O. kukali (PNG); and an ungrouped new species: Onthophagus ofianus (PNG). Two previously named species, O. acer Gillet, 1930 and O. mimikanus Balthasar, 1969, are briefly diagnosed and discussed.

[Fracture of the femoral neck in bed caused by an epileptic seizure]. / Collumfractuur in bed door een epileptische aanval.

An 82-year-old man was brought into the emergency department after an epileptic seizure. Although the seizure took place in his bed and was not followed by a fall, his right hip was broken. No underlying bone abnormalities were found. The patient received a femoral head & neck prosthesis and recovered fully. Fractures are more common in patients with epilepsy than in the general population, due to both seizure-related trauma and a relatively high prevalence of osteoporosis, which is due partly to the use of anti-epileptic drugs. However, even after a seizure without trauma in a patient without underlying abnormalities of bone structure, a fracture may arise as a result of the force of the muscle contractions during the seizure.

Entrapment of the external iliac vein in a both-column acetabular fracture.

We present a patient with an associated both-column acetabular fracture with entrapment of the external iliac vein in the fracture. This complication was not recognized until fracture manipulation during open reduction and fixation. This case report demonstrates that an acetabular fracture can have an associated vascular injury without any obvious clinical signs. This can be especially dangerous during percutaneous manipulation and fixation of these fractures as an obstruction or injury to the external iliac vein may occur and remain unrecognized. We feel that any surgeon involved in treating patients with acetabular or pelvic fractures should be aware of this potentially serious complication.

The absence of MyoD in regenerating skeletal muscle affects the expression pattern of basement membrane, interstitial matrix and integrin molecules that is consistent with delayed myotube formation.

MyoD is a member of a skeletal muscle specific family of transcription factors which directs the events of myogenesis during development and regeneration. Muscle cells that lack MyoD show delayed fusion in vivo and in vitro and defects have been observed in vitro in the attachment of MyoD(-/-) myoblasts to complex substrates such as Matrigel. Since interactions with the extracellular matrix (ECM) are important during myoblast fusion (i. e. myotube formation), it was hypothesised that expression of ECM molecules or their receptors may be altered in MyoD(-/-) muscle. The production of basement membrane molecules such as collagen type IV and several laminins, the interstitial molecules fibronectin and tenascin-C, and the cell surface molecules integrin alpha5 and alpha6 were quantitated in vitro using ELISA on cultured cells from MyoD(-/-) and wild type mice. Differences were observed in the production of fibronectin, tenascin-C, collagen type IV, laminin-1 and integrin alpha5 between control and MyoD(-/-) myotubes in vitro. This corresponded with delayed fusion of myoblasts in MyoD(-/-) cultures. On the basis of these findings with respect to matrix expression in vitro, fluorescent immunohistochemistry was carried out on adult whole muscle autografts to examine whether the expression of these molecules, as well as integrin alpha7, was altered in the complex in vivo environment. Some minor differences in expression patterns were observed in MyoD(-/-) as compared to normal BALB/c autografts. The overall expression of matrix components was consistent with the delayed onset of myotube formation. These results suggest that the delay in myotube formation in MyoD(-/-) muscle is not a direct result of altered expression of the matrix molecules collagen type IV, laminins, fibronectin, tenascin-C, and integrins alpha5, alpha6 or alpha7.