Radiological Patterns of Drug-induced Interstitial Lung Disease (DILD) in Early-phase Oncology Clinical Trials

PURPOSE

Drug-induced interstitial lung disease (DILD) is a rare, but potentially fatal toxicity. Clinical and radiological features of DILD in the early experimental setting are poorly described.

PATIENTS AND METHODS

A total of 2,499 consecutive patients with advanced cancer on phase I clinical trials were included. DILD was identified by a dedicated radiologist and investigators, categorized per internationally recognized radiological patterns, and graded per Common Terminology Criteria for Adverse Events (CTCAE) and the Royal Marsden Hospital (RMH) DILD score. Clinical and radiological features of DILD were analyzed.

RESULTS

Sixty patients overall (2.4%) developed DILD. Median time to onset of DILD was 63 days (range, 14-336 days). A total of 45% of patients who developed DILD were clinically asymptomatic. Incidence was highest in patients receiving drug conjugates (7.4%), followed by inhibitors of the PI3K/AKT/mTOR pathway (3.9%). The most common pattern seen was hypersensitivity pneumonitis (33.3%), followed by nonspecific interstitial pneumonia (30%), and cryptogenic organizing pneumonia (26.7%). A higher DILD score [OR, 1.47, 95% confidence interval (CI), 1.19-1.81; P < 0.001] and the pattern of DILD (OR, 5.83 for acute interstitial pneumonia; 95% CI, 0.38-90.26; P = 0.002) were significantly associated with a higher CTCAE grading. The only predictive factor for an improvement in DILD was an interruption of treatment (OR, 0.05; 95% CI, 0.01-0.35; P = 0.01).

CONCLUSIONS

DILD in early-phase clinical trials is a toxicity of variable onset, with diverse clinical and radiological findings. Radiological findings precede clinical symptoms. The extent of the affected lung parenchyma, scored by the RMH DILD score, correlates with clinical presentation. Most events are low grade, and improve with treatment interruption, which should be considered early.

Quantitative discrimination between oil and water in drilled bore cores via Fast-Neutron Resonance Transmission Radiography

A novel method utilizing the Fast Neutron Resonance Transmission Radiography is proposed for non-destructive, quantitative determination of the weight percentages of oil and water in cores taken from subterranean or underwater geological formations. The ability of the method to distinguish water from oil stems from the unambiguously-specific energy dependence of the neutron cross-sections for the principal elemental constituents. Monte-Carlo simulations and initial results of experimental investigations indicate that the technique may provide a rapid, accurate and non-destructive method for quantitative evaluation of core fluids in thick intact cores, including those of tight shales for which the use of conventional core analytical approaches appears to be questionable.

The effect of recurrent episodes of clinical mastitis caused by gram-positive and gram-negative bacteria and other organisms on mortality and culling in Holstein dairy cows

The objective of this study was to estimate the effects of recurrent episodes of different types of clinical mastitis (CM) caused by gram-positive (Streptococcus spp., Staphylococcus aureus, Staphylococcus spp.) and gram-negative (Escherichia coli, Klebsiella, Citrobacter, Enterobacter, Pseudomonas) bacteria, and other organisms (Arcanobacterium pyogenes, Mycoplasma, Corynebacterium bovis, yeast, miscellaneous) on the probability of mortality and culling in Holstein dairy cows. Data from 30,233 lactations in cows of 7 dairy farms in New York State were analyzed. Cows were followed for the first 10 mo in lactation, or until death or culling occurred, or until the end of our study period. Generalized linear mixed models with a Poisson error distribution were used to study the effects of recurrent cases of the different types of CM and several other factors (herd, parity, month of lactation, current year and season, profitability, net replacement cost, other diseases) on cows' probability of death (model 1) or being culled (model 2). Primiparous and multiparous cows were modeled separately because they had different risks of mortality and culling and potentially different CM effects on mortality and culling. Approximately 30% of multiparous cows had at least one case of CM in lactation compared with 16.6% of primiparous cows. Multipara also had higher lactational incidence risks of second (10.7%) and third (4.4%) cases than primipara (3.7% and 1.1%, respectively). For primipara, CM increased the probability of death, with each successive case occurring in a month being increasingly lethal. In multipara, gram-negative CM increased the probability of death, especially when the gram-negative case was the first or second CM case in lactation. Primiparous cows with CM were more likely to be culled after CM than if they did not have CM, particularly after a second or third case. In multipara, any type of CM increased the probability of being culled. Gram-negative CM cases were associated with the numerically highest risk of culling.

The cost and management of different types of clinical mastitis in dairy cows estimated by dynamic programming

The objective of this study was to estimate the cost of 3 different types of clinical mastitis (CM) (caused by gram-positive bacteria, gram-negative bacteria, and other organisms) at the individual cow level and thereby identify the economically optimal management decision for each type of mastitis. We made modifications to an existing dynamic optimization and simulation model, studying the effects of various factors (incidence of CM, milk loss, pregnancy rate, and treatment cost) on the cost of different types of CM. The average costs per case (US$) of gram-positive, gram-negative, and other CM were $133.73, $211.03, and $95.31, respectively. This model provided a more informed decision-making process in CM management for optimal economic profitability and determined that 93.1% of gram-positive CM cases, 93.1% of gram-negative CM cases, and 94.6% of other CM cases should be treated. The main contributor to the total cost per case was treatment cost for gram-positive CM (51.5% of the total cost per case), milk loss for gram-negative CM (72.4%), and treatment cost for other CM (49.2%). The model affords versatility as it allows for parameters such as production costs, economic values, and disease frequencies to be altered. Therefore, cost estimates are the direct outcome of the farm-specific parameters entered into the model. Thus, this model can provide farmers economically optimal guidelines specific to their individual cows suffering from different types of CM.

Effects of repeated gram-positive and gram-negative clinical mastitis episodes on milk yield loss in Holstein dairy cows

The objective of this study was to estimate the effects of recurrent episodes of gram-positive and gram-negative cases of clinical mastitis (CM) on milk production in Holstein dairy cows. We were interested in the severity of repeated cases in general, but also in the severity of the host response as judged by milk production loss when a previous case was caused by a similar or different microorganism. The results were based on data from 7,721 primiparous lactations and 13,566 multiparous lactations in 7 large dairy herds in New York State. The distribution of organisms in the CM cases showed 28.5% gram-positive cases, 31.8% gram-negative cases, 15.0% others, and 24.8% with no organism identified. Mixed models, with a random herd effect and an autoregressive covariance structure to account for repeated measurements, were used to quantify the effect of repeated CM and several other control variables (parity, week of lactation, other diseases) on milk yield. Our data indicated that repeated CM cases showed a very similar milk loss compared with the first case. No reduction of severity was present with increasing count of the CM case. Gram-negative cases had more severe milk loss compared with gram-positive and other cases irrespective of the count of the case in lactation. Milk loss in multipara (primipara) due to gram-negative CM was approximately 304 kg (228 kg) in the 50 d following CM. This loss was approximately 128 kg (133 kg) for gram-positive cases and 92 kg (112 kg) for other cases. The severity of a second case of gram-negative CM was not reduced by previous cases of gram-negative CM in multipara and only slightly less severe in a similar scenario in primipara cows. Similarly, a previous gram-positive case did not reduce severity of a second or third gram-positive case. Hence, our data do not support that immunological memory of previous exposure to an organism in the same generic class provides protection for a next case of CM with an organism in the same class.

Age related maculopathy and diabetes

PURPOSE

To compare the prevalence of age-related maculopathy (ARM) in a sample of diabetic patients with the general population.

METHODS

Binocular indirect ophthalmoscopy, biomicroscopy, and fluorescein angiography. Retrospective prevalence study; descriptive-observational case-control type. Two different groups were analyzed from a sample of 1000 consecutive files of diabetic patients: 1) 65 to 74 years old (n = 263) and 2) 75 years and older (n = 199). Prevalence was compared to that of the general population in a control group and the following epidemiologic studies: Beaver Dam Eye Study, Framingham Eye Study, Blue Mountains Study, and Rotterdam Eye Study.

RESULTS

In diabetic patients aged 75 or older, prevalence of ARM was as follows: early lesions 2.51% (5/199), late lesions (ARMD) 2.51% (5/199). In comparison, the risk in patients 75 or older is as follows: control group (ARMD): OR 4.79, 95% CI 1.778-12.033, p (Fisher) 0.0005; Beaver Dam Eye Study (ARMD): OR 2.93, 95% CI 1.152-7.450, p (Fisher): 0; Blue Mountains Eye Study (ARMD): OR 3.06, 95% CI 1.208-7.754, p (Fisher): 0; Framingham Eye Study (ARM): OR 6.73, 95% CI 3.041-14.880, p (Fisher): 0; Rotterdam Eye Study: p (Fisher) 0.133.

CONCLUSIONS

1) A lower prevalence of ARM was found in the sample of diabetic patients aged 75 or older than in the general population (with the exception of the Rotterdam study). 2) Prevalence of ARM was even lower in diabetic patients presenting diabetic retinopathy, whether or not they had been treated with photocoagulation. 3) In diabetic patients, the exudative form was more frequent than the atrophic form, in an inverse ratio to that of the general population.

Effect of repeated episodes of generic clinical mastitis on milk yield in dairy cows

Our objective was to estimate the milk losses associated with multiple occurrences of generic bovine clinical mastitis (CM) within and across lactations. We studied 10,380 lactations from 5 large, high-producing dairy herds that used automatic recording of daily milk yields. Mixed models, with a random herd effect and an autoregressive covariance structure to account for repeated measurements, were used to quantify the effect of CM and other control variables (parity, week of lactation, other diseases) on milk yield. Many cows that developed CM were higher producers than their non-mastitic herdmates before CM occurred. Milk yield began to drop after diagnosis; the greatest loss occurred in the first weeks (up to 126 kg) and then gradually tapered to a constant value approximately 2 mo after CM. Mastitic cows often never recovered their potential yield. First-lactation cows lost 164 kg of milk for the first episode and 198 kg for the second in the 2 mo after CM diagnosis, compared with their potential yield. Among older cows, this estimate was 253 kg for the first, 238 kg for the second, and 216 kg for the third CM case. A cow that had 1 or more CM episodes in her previous lactation produced 1.2 kg/d less milk over the whole current lactation (95% confidence interval: 0.6, 1.7) than a cow without CM in her previous lactation. These findings provide dairy producers with information on the average milk loss associated with CM cases without considering the causative agent, and can be used for economic analysis.

Identification of double mandibular canals: literature review and three case reports with CT scans and cone beam CT

OBJECTIVES

The aim of this study is to describe three rare cases of double mandibular canals identified using three-dimensional imaging techniques and to discuss how frequently this variation occurs.

METHODS

A review of the current literature is presented and the study methods are discussed. Three hitherto unpublished cases of double mandibular canals are presented and described, two of them observed by CT scans and the third by cone beam CT (CBCT). They were identified from a pool of more than 6000 mandibular CT scans and CBCT images. These examinations were carried out in the context of pre-implant analyses in the mandible area.

RESULTS

Mandibular canals can be detected on panoramic radiographs. However, as confusion is possible when using two-dimensional images, it is only with tomographic imaging that some of these distinctive features can be identified. The case revealed by CBCT is the only one reported in the literature to date using this means of identification.

CONCLUSIONS

The presence of bifid mandibular canals is very rare, yet it is important to recognize this anatomical variation in any surgical procedures involving the lower jaw and its presence can only be confirmed by volumetric imaging.

La tomographie volumétrique numérisée par le système NewTom : intérêt de ce nouvel examen d'imagerie médicale chez l'enfant

In some cases, after preliminary clinical examination, medical imaging can provide indispensable complementary information for the care of young patients. Volume imaging using two- and three-dimensional reconstructions provides the most complete information possible. Problems involving the superposition of anatomical structures, which can occur with conventional X-rays, are a thing of the past, and this technique represents the future in this field. In high-density tissue such as bone or teeth, tomodensitometry is the preferred examination as it can give a three-dimensional approach to the study. However, because of the high radiation dose required, scanner is still a second intention examination. Development of digital volume tomography using NewTom system, designed for maxillofacial exploration, produces the same type of image for a very much reduced X-ray dose, and at low cost. Although the use of this new examining technique is developing rapidly in Europe and throughout the world since its recent introduction, France is lagging behind as to date there are only seven machines in the entire country. The main uses in children, illustrated by original clinical cases, relate to preoperative surgery planning, post-trauma diagnostic workups, orthodontic checkups, postoperative follow-up and TMJ examinations. The purpose of this article is to inform dental surgeons, paediatricians and doctors about this new medical imaging examination, which will most definitely have a place in the battery of diagnostic tools available to us. After weighing the advantages/risks involved, it should be possible to reduce the number of tomodensitometry exams in favour of this new examination technique in children according to the clinical examination data and diagnostic information required.

Phase transition in the bounded one-dimensional multitrap system

We have previously discussed the diffusion limited problem of the bounded one-dimensional multitrap system where no external field is present, and pay special attention to the transmission of the diffusing particles through the imperfect traps. We discuss here the case in which an external field is included to each trap and find not only the transmission but also the energy associated with the diffusing particles in the presence and absence of such a field. From the energy we find the specific heat C(h) and show that for certain values of the parameters associated with the multitrap system it behaves in a manner which is suggestive of phase transition. Moreover, this phase transition is demonstrated not only through the conventional single peak at which the specific heat function is undifferentiable but also through the less frequent phenomenon of double peaks.

Diffusion-limited reaction for the one-dimensional trap system

We have previously discussed the one-dimensional multitrap system of finite range and found somewhat unexpected result that the larger is the number of imperfect traps the higher is the transmission through them. We discuss in this work the effect of a small number of such traps arrayed along either a constant or a variable finite spatial section. It is shown that under specific conditions, to be described in the following, the remarked high transmission may be obtained for this case also. Thus, compared to the theoretical large number of traps case these results may be experimentally applied to real phenomena.

Diffusion-limited reaction in the presence of n traps

We solve the problem of a one-dimensional array of n imperfect traps. These traps are physically represented by small regions of space (in the one-dimensional version we discuss here these traps are represented by small sections of the x axis) with a smaller diffusion constant than that outside them. Small physical particles of one kind diffuse outside and through these small sections. In this work we investigate the changes of the particles density incurred by the presence of these traps. We also check how this density behaves when the density of traps becomes very large.

Gamma ray nuclear resonance absorption: an alternative method for in vivo body composition studies

We have evaluated gamma ray nuclear resonance absorption (gamma-NRA) on nitrogen, a mature technology proposed and developed by Soreq NRC for detecting explosives, as an alternative to neutron activation for in vivo assaying of body nitrogen. The principles of the gamma-NRA method are outlined, and a test facility constructed at McMaster University's Accelerator Laboratory is described. The results of a feasibility study recently performed there on phantoms and animal tissue are presented and discussed. gamma-NRA is a full imaging technique that essentially constitutes element-specific absorptiometry--i.e., it can generate projections of the mass distribution for a specific element, along with a conventional radiograph of the patient. From the transmission profile of an individual scanned by 9.17 MeV gamma rays, local or whole body nitrogen content can be determined via the resonant attenuation undergone when the beam encounters regions of nitrogen concentration. The advantages of gamma-NRA over neutron activation are (a) radiation doses delivered to the body are at least one order of magnitude lower, thus allowing repeated measurements on individual patients and also rendering the method ethically acceptable for application to children; (b) gamma-NRA is inherently free from uncertainties related to nonuniform distributions of the element in question within the body; (c) it is applicable to patients of varying size and shape; and (d) it yields both nitrogen images and conventional radiographic images of the body.

The premaxilla in Neandertal and early modern children: ontogeny and morphology

This comparative study of maxillae in Neandertals, Qafzeh, and extant children examines two specific traits: the premaxillary suture (sutura incisiva) and the interincisive sinuses, proposing a new hypothesis about some features of the Neandertal mid-face. Morphologic study of the premaxillary suture at its different borders (i.e. the nasal aspect of the frontal process, nasal and palatal aspects of the palatal process of the maxilla) indicates a persistence of the suture among very young Neandertal children in comparison to the condition in extant ones. This suggests a longer independence of some parts of the premaxilla in Neandertals. To further examine this possibility, CT scans of two Neandertal children were analyzed: Roc de Marsal, estimated to be about 3 years, and Engis 2, estimated to be about 5-6 years. The results are quite different between the fossils. In the older, the premaxillary suture is represented only by a deep groove. In the younger it extends deep to the surface of the nasal process reaching the Parinaud's canal. Synostosis of the premaxillary suture was found to occur later in Neandertal children than in modern ones. Moreover, we observed the existence of two interincisive sinuses in the fossil children, whereas this is rare in modern children (present on only 2% of our sample of 0-6 year-old infants, n = 247). Persistence of an open premaxillary suture represents the potential for an extended period of growth of the Neandertal mid-face. Although no trace of the premaxillary suture remains in adult Neandertals, Neandertals present many features classically considered as consequences of this persistence. The two interincisive sinuses could be a consequence of the labio-lingual diameter of the incisors. The results presented here can be further investigated by additional studies on the cranial sutural system and by precise morphologic observations and CT scans of the mid-face of a larger sample of fossil children.

Anomaly of the facial canal in a Mondini malformation with recurrent meningitis

A patient with recurrent meningitis and congenital hearing loss was evaluated with tomography and metrizamide cisternography. Tomography showed an aberrant first portion of the facial nerve canal, while on cisternography, communication between the internal auditory canal and the dilated labyrinthine remnant was evident. The authors describe the radiographic findings and their significance and propose a mechanism for the formation of the anomalous facial nerve canal.

Computed tomography in 75 clinical cases of syringomyelia

Seventy-five patients with a clinical diagnosis of syringomyelia were examined by computed tomography after intrathecal injection of metrizamide. A central cavity was demonstrated in 67 patients. Tilting the patient head down did not increase the rate of cavity opacification. This evidence favors transneural migration of metrizamide into the cavity. The spinal cord was measurably enlarged in only a minority of the patients. In some, the cavity appeared to have clefts or wall defects. These results are discussed according to the etiopathogenic theories advanced by Gardner, Aboulker, and Williams.

Jugular venous reflux in cerebral radionuclide angiography: an explanation

A case of isotopic jugular venous reflux, reaching the opposite jugular vein, is described. Phlebography and aortography were simultaneously performed in this patient and showed the innominate vein narrowed and pinched between the sternal notch and the aortic arch. This narrowing depends on the position of the left arm.