Selective use of Peptide Receptor Radionuclide Therapy following comparative imaging of Ga-68 DOTATATE PET/CT against I-131 MIBG scintigraphy in a small Asian cohort of Adult Neuroblastoma

Adult neuroblastoma (AN) is rare with an extremely poor prognosis. No standard therapy exists for this entity and treatment options are limited in recurrent or refractory disease. ¹³¹I-MIBG has been used in combination with myeloablative therapy before autologous bone marrow transplantation or in a salvage therapy setting. However, myelotoxicity is a dose-limiting factor in heavily pre-treated patients and response is not always sustained. Somatostatin receptor scintigraphy and theranostics with radiolabelled somatostatin receptor analogues are becoming more commonplace with the recognition of these receptors in over 90% of neuroblastoma cells. We describe three AN patients assessed for somatostatin receptor status and the novel use of ¹⁷⁷Lu-based peptide recep-tor radionuclide therapy (PRRT) in two of them and a literature review.

High Thyroid Stimulating Receptor Antibody Titre and Large Goitre Size at First-Time Radioactive Iodine Treatment are Associated with Treatment Failure in Graves' Disease

INTRODUCTION

Our study aimed to identify the factors associated with successful first-time radioactive iodine (RAI) treatment in patients with Graves' disease (GD).

MATERIALS AND METHODS

This is a restrospective study of patients with GD who were treated with RAI. Treatment success was defined as onset of permanent hypothyroidism or euthyroidism after 1 dose of RAI at 1-year follow-up.

RESULTS

There were 388 GD patients who underwent RAI treatment between January 2014 and December 2015. Of these, 74% achieved treatment success. Median time to achieve permanent hypothyroidism was 2 months. Male gender, smoking, higher antithyroid drug dosage, lower thyroid stimulating hormone (TSH) level, large goitre size and TSH receptor antibody (TRAb) titre at time of RAI were significantly associated with treatment failure. Multivariate analysis showed that larger goitre size and higher TRAb titre were associated with lower first-time RAI success.

CONCLUSION

Larger goitre size and higher TRAb titre predict lower success of RAI therapy in GD patients. Treatment decisions and strategies should be customised for patients who present with these characteristics.

Congenital pulmonary arteriovenous malformations

We report the rare case of an 11-year-old boy who presented with intractable hypoxaemia and a pulmonary mass. Investigations revealed this to be a pulmonary arteriovenous malformation. It was entirely confined to the right middle lobe and was successfully treated via a right middle lobectomy. The relevant literature with respect to both diagnosis and treatment is reviewed.

Combinatorial fluorescence energy transfer tags for multiplex biological assays

We report an approach for developing combinatorial fluorescence energy transfer (CFET) tags by tuning the tags' fluorescence emission signatures. The tags can all be excited at a single wavelength and analyzed by a simple optical system. We constructed eight CFET tags with unique fluorescence signatures, detected by a three-color capillary array electrophoresis (CAE) system with 488 nm excitation, using only three fluorescent dyes. A 1',2'-dideoxyribose phosphate spacer was used to separate the donor and acceptor to tune the energy transfer efficiency, generating unique fluorescence signatures. The spacer also served as an electrophoretic mobility tag to tune the mobility of CFET-labeled DNA for multiplex detection of single-nucleotide polymorphisms (SNPs). Six nucleotide variations were identified simultaneously using six CFET tags on synthetic DNA templates and on a PCR product from the retinoblastoma tumor suppressor gene.

Tufted hair folliculitis

A case of scarring alopecia presenting as two circumscribed, tender and inflamed areas in the occiput with residual tufted follicles is reported. Each tuft comprised 10 to 15 normal-appearing hairs arising from individual hair follicles in the reticular dermis or subcutaneous fat, converging toward a single orifice in the epidermis. The initial pathologic finding was inflammation and scarring of the papillary and mid dermis with almost total sparing of the hair follicles in the subcutaneous fat. Successful treatment was achieved by surgical excision of the two areas. It is suggested that the areas of tufting represented nevoid lesions that underwent inflammation and scarring.

Comparison of acral nevomelanocytic proliferations in Japanese and whites

The preponderance of malignant melanomas that occur in the Japanese population affect the palmar and plantar areas, in contrast to those of whites, which occur predominantly on the head, neck, and trunk. Furthermore, a precursor lesion, the dysplastic nevus, has been well defined in nonacral white skin but not in the Japanese. In this paper, a similarity between benign and atypical acral nevomelanocytic proliferations in Japanese and whites is described. However, it appears that in the Japanese group the melanocytes in benign and atypical proliferations are less dendritic than those noted in whites, and, in both groups, extensive pigmentation was noted in both the epidermal and dermal components of benign and malignant lesions in this limited review. A practical approach to classifications of atypism is, likewise, offered.

Reference values of blood parameters in beef cattle of different ages and stages of lactation

Reference (normal) values for 12 blood serum components were determined for 48 Shorthorn cows (2-10 years old) and their 48 calves, 357 crossbred cows (12-14 years old), 36 feedlot bulls and 36 feedlot steers. In addition, hemoglobin, hematocrit, triiodothyronine, thyroxine and cortisol levels were determined for the crossbred cows, and feedlot bulls and steers. Reference values were tabulated according to sex, age and stage of lactation. Serum concentrations of urea, total protein and bilirubin, and serum activity of aspartate aminotransferase and lactate dehydrogenase increased with age (P less than 0.05), while calcium, phosphorus and alkaline phosphatase decreased with age (P less than 0.05) from birth to the age of ten years. The Shorthorn cows had the highest levels of glucose at parturition (P less than 0.05) with decreasing levels during lactation. Creatinine concentration decreased during lactation and increased during postweaning. Both lactate dehydrogenase and aspartate aminotransferase levels increased (P less than 0.05) during lactation. Urea and uric acid were present at higher concentrations in lactating than nonlactating cows (P less than 0.05). The values reported, based on a wide age range and large number of cattle, could serve as clinical guides and a basis for further research.

Ultrastructure: effects of melanin pigment on target specificity using a pulsed dye laser (577 nm)

It has been shown recently that brief pulses of 577 nm radiation from the tunable dye laser are absorbed selectively by oxyhemoglobin. This absorption is associated with highly specific damage to superficial vascular plexus blood vessels in those with lightly pigmented (type I-II) skin. To determine whether pigmentary differences in the overlying epidermis influence this target specificity, we exposed both type I (fair) and type V (dark) normal human skin to varying radiant exposure doses over 1.5-microsecond pulse durations from the tunable dye laser at a wavelength of 577 nm. Using ultrastructural techniques, we found in type I skin that even clinical subthreshold laser exposures caused reproducible alterations of erythrocytes and adjacent dermal vascular endothelium without comparable damage to the overlying epidermis. In contrast, degenerated epidermal basal cells represented the predominant form of cellular damage after laser exposure of type V skin at comparable doses. We conclude that epidermal melanin and vascular hemoglobin are competing sites for 577 nm laser absorption and damage, and that the target specificity of the 577 nm tunable dye laser is therefore influenced by variations in epidermal pigmentation. This finding is relevant to the clinical application of the tunable dye laser in the ablative treatment of vascular lesions. We also found on ultrastructure that the presence of electron-lucent circular structures of approximately 800 A in diameter were observed only at and above clinical threshold doses in those with type I skin and at the highest dose of 2.75 J/cm2 in type V skin. It has been proposed that these structures might be heat-fixed molds of water vapor. Both this and ultrastructural changes of epidermal basal cells demonstrate mechanisms responsible for alteration of tissue after exposure to 577 nm, which are discussed.

Blood and serum components and organ weights in steers, bulls and zeranol-implanted bulls

To investigate certain physiological aspects of the mode of action of zeranol or Ralgro on growth, behavior and carcass quality of young bulls, concentrations of 19 blood components and weights of eight organs were determined. Experimental animals consisted of 36 untreated steers, 36 untreated bulls, 36 bulls implanted with zeranol at 3 mo of age and subsequently at 5, 8 and 10 mo and 36 bulls implanted with zeranol at 6 mo of age and subsequently at 9 and 11 mo. In addition, half of the animals in each group were subjected to moderate pre-slaughter stress (mixing and trucking 160 km); the other half was subjected to minimum pre-slaughter stress (no mixing and 4 km transport). Concentrations of cortisol, urea nitrogen and albumin in serum were higher (P less than .01) and those of glutamic oxaloacetic transaminase (GOT), lactate dehydrogenase (LDH), alkaline phosphatase (AP) and creatinine were lower (P less than .05) in steers than in intact males. Concentrations of GOT, LDH, and creatinine were higher (P less than .05) in implanted than those in control males. Pre-slaughter stress had a significant effect on several traits measured in blood or serum. Thyroid glands were smaller (P less than .01) in steers than in control and implanted males. Testes were smaller (P less than .01) in the zeranol-implanted than in untreated males. Results indicate that zeranol had only a minor effect on the 19 blood components studied, but it did reduce testicle size. Castration had a major impact on several of the blood components. Pre-slaughter management had a significant effect on several blood components.

The effects of two shipping treatments on the carcass characteristics of bulls implanted with zeranol and unimplanted steers

A total of 144 male crossbred calves were allocated to four management treatments (bulls; steers; bulls implanted with zeranol at 100 d of age and re-implanted at 69, 93 and 56 d thereafter; bulls implanted with zeranol at 168 d of age and re-implanted at 93 and 56 d thereafter), and two pre-slaughter shipping treatments (minimum pre-slaughter stress with cattle shipped and slaughtered within 4 h of leaving the feedlot pen; moderate pre-slaughter stress with cattle mixed, trucked 160 km and slaughtered up to 24 h of leaving the feedlot pen) in a 4 X 2 factorial arrangement. Management treatment had no significant effect on carcass pH (45 min), carcass muscle temperature (45 min), or peak shear-force of cooked longissimus muscle. Steers had significantly lower dressing percentage, warm-carcass weight, hide weight and carcass-lean content, but higher marbling score, fat thickness and intramuscular-fat content than all treatments with bulls. Minimum pre-slaughter stress resulted in significantly lower dressing percentage, warm-carcass weight, and carcass pH (45 min), but generally had no effect on carcass tissue-yield measurements compared with the moderate stress treatment. Implanted bulls produced carcasses with significantly darker meat, higher 24-h pH and lower meat expressible juice than bulls and castrates for the moderate pre-slaughter stress treatment. These results provide evidence that zeranol implantation in bulls had a minor influence on carcass characteristics, and did not reduce the incidence of dark-cutting carcasses in young bulls subjected to moderate pre-slaughter shipping stress.

Relationships among serum characteristics and performance and carcass traits in growing pigs

Twelve blood serum components were determined on 78 barrows and 66 gilts, serially slaughtered at six age groups, starting at 69 d, at 2-wk intervals. One-half of the animals were fed ad libitum and one-half were fed "time restricted". Partial correlations between production and carcass traits and serum components were calculated from the residuals of the least-squares analysis. Calcium, serum protein and albumin were highly (P less than .01) correlated with several production and carcass traits. Creatinine was positively correlated (P less than .05) with backfat, loin fat, and percent dissected muscle and bone. Alkaline phosphatase showed a positive relationship with average daily gain (P less than .05) and percent dissected bone (P less than .01). A stepwise regression analysis was used to examine simultaneously the relative predictive value of the blood serum components. The nitrogenous compounds, which included albumin, total protein, urea and creatinine, were the most important predictors of performance (avg daily gain, feed conversion) and carcass composition. However, most of the serum components were not related to the performance and carcass composition traits.

Exercise-induced anaphylaxis: a serious form of physical allergy associated with mast cell degranulation

Exercise-induced anaphylaxis (EIA) is a unique and an increasingly recognized syndrome consisting of premonitory symptoms and signs of generalized body warmth, pruritus, and erythema, which progresses on continued exertion to confluent urticaria, laryngeal edema with stridor or hoarseness, and gastrointestinal colic and frequently culminates in vascular collapse. Previous studies of five individuals with this condition have demonstrated significant elevations of serum histamine concurrent with the early clinical manifestations after experimental exercise. To assess relevant morphologic alterations in the skin of these patients, cutaneous mast cells were examined by light and transmission electron microscopy before and during the initial erythema elicited by exertion. The marked alterations observed in mast cells immediately after exercise consisted of (1) loss of electron density and internal substructure of granules, (2) fusion of granule membranes with those of adjacent granules and with mast cell membranes creating conduits to the extracellular space, and (3) an apparent decrease in the number of intact granules per cell. Biopsy specimens obtained before exercise from patients with EIA and from two normal individuals who served as control subjects were identical, and the control subjects had normal mast cell morphology after exercise. Serum histamine levels were significantly elevated in patients with EIA after exercise at the time of biopsy, whereas control subjects had normal levels. These observations provide evidence that EIA is a distinct form of physical allergy associated with mast cell degranulation similar in morphology to that of human pulmonary mast cell IgE-Fc-dependent activation secretion. Characterization of this disorder is important because its prevalence may be underestimated, and its clinical consequences, which may include some morbidity, are not fully known.

Depletion and repopulation of epidermal dendritic cells after allogeneic bone marrow transplantation in humans

We have observed marked depletion of epidermal dendritic cells, defined by monoclonal antibodies directed against HLA-DR (Ia-like) and T6 antigens, after allogeneic bone marrow transplantation. To more precisely characterize this observation, we examined a total of 39 sequential biopsies from 15 patients both before and after allogeneic bone marrow transplantation. Profound depletion of HLA-DR and T6-positive epidermal dendritic cells was observed early after transplantation (1-4 weeks), followed by gradual and variable repopulation. Transmission electron microscopy confirmed absence of dendritic cells in selected biopsies. Depletion of dendritic cells did not appear to be related to development of clinical or histologic evidence of graft-versus-host disease, suggesting that depletion may relate to pretransplant conditioning regimens. The rate of return of these cells, however, may be influenced by the presence or persistence of clinical disease. Repopulation of epidermal dendritic cells after initial depletion in bone marrow transplantation represents a human model relevant to studies concerned with the origin and kinetics of Langerhans cells.