[18F]FDG-PET/CT-based risk stratification in women with locally advanced uterine cervical cancer

BACKGROUND

[18F]FDG-PET/CT is used for staging and treatment planning in patients with locally advanced cervical cancer (LACC). We studied if a PET-based prediction model could provide additional risk stratification beyond International Federation of Gynaecology and Obstetrics (FIGO) staging in our population with LACC to aid treatment decision making.

METHODS

In total, 183 patients with LACC treated with chemoradiation between 2013 and 2018 were included. Patients were treated according to FIGO 2009 and retrospectively reclassified according to FIGO 2018 staging system. After validation of an existing PET-based prediction model, the predicted recurrent free survival (RFS), disease specific survival (DSS) and overall survival (OS) at 1, 3, and 5 years, based on metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax) and highest level of [18F]FDG-positive node was calculated. Then the observed survival was compared to the predicted survival. An area under the curve (AUC) close to or higher than 0.7 was considered adequate for accurate prediction. The Youden (J) index defined survival chance cutoff values for low and high risk groups.

RESULTS

All AUC values for the comparison between predicted and observed outcomes were > 0.7 except for 5-year RFS and for 5-year OS which were close to 0.7 (0.684 and 0.650 respectively). Cutoff values for low and high risk survival chance were 0.44 for the 3-year RFS and 0.47 for the 5-year OS. The FIGO 2009 system could not differentiate between the risk profiles. After reclassification according to FIGO 2018, all patients with stage IIIC2 and IVB fell in the high risk and almost all patients with stages IB2-IIIB and IVA in the low risk group. In patients with stage IIIC1 disease the FIGO stage cannot discriminate between the risk profiles.

CONCLUSIONS

Low and high risk patients with LACC can be identified with the PET-based prediction model. In particular patients with stage IIIC1 need additional risk stratification besides the FIGO 2018 staging. The Kidd model could be a useful tool to aid treatment decision making in these patients. Our results also support the choice of [18F]FDG-PET/CT imaging in patients with LACC.

Effects of Shear Rate and Protein Concentration on Amyloidogenesis via Interfacial Shear

The influence of hydrodynamics on protein fibrillization kinetics is relevant to biophysics, biochemical reactors, medicine, and disease. This investigation focused on the effects of interfacial shear on the fibrillization kinetics of insulin. Human insulin served as a model protein for studying shear-induced fibrillization with relevance to amyloid diseases such as Alzheimer's, Parkinson's, prions, and type 2 diabetes. Insulin solutions at different protein concentrations were subjected to shear flows with prescribed interfacial angular velocities using a knife-edge (surface) viscometer (KEV) operating in a laminar axisymmetric flow regime where inertia is significant. Fibrillization kinetics were quantified using intrinsic fibrillization rate and times (onset, half, and end) determined through spectroscopic measurement of monomer extinction curves and fitting to a sigmoidal function. Additionally, the occurrence of gelation was determined through macroscopic imaging and transient fibril microstructure was captured using fluorescence microscopy. The results showed that increasing interfacial shear rate produced a monotonic increase in intrinsic fibrillization rate and a monotonic decrease in fibrillization time. Protein concentration did not significantly impact the intrinsic fibrillization rate or times; however, a minimum fibril concentration for gelation was found. Protein microstructure showed increasing aggregation and plaque/cluster formation with time.

Growth of microorganisms in an interfacially driven space bioreactor analog

Fluid bioreactors in microgravity environments may utilize alternative methods of containment and mixing. The ring-sheared drop (RSD) is a containerless mixing device which functions in microgravity using surface tension for containment and mixes through interfacially-driven flow. To assess the feasibility of using interfacially driven flow devices, such as the RSD, as bioreactors, Escherichia coli growth and recombinant protein expression were analyzed in a ground-based analog of the RSD called the knife edge surface viscometer (KEV). Results demonstrated that the KEV can facilitate the growth of E. coli and that growth rate increases logarithmically with increasing knife edge rotation rate, similar to the standard growth method on Earth (orbital shaker). Furthermore, the KEV was shown to be viable for supporting recombinant protein expression in E. coli at levels comparable to those achieved using standard growth methods.

Patient decision aids in joint replacement surgery: a literature review and an opinion survey of consultant orthopaedic surgeons

INTRODUCTION

Patient decision aids could facilitate shared decision-making in joint replacement surgery. However, patient decision aids are not routinely used in this setting.

METHODS

With a view to developing a patient decision aid for UK hip/knee joint replacement practice, we undertook a systematic search of the literature for evidence on the use of shared decision-making and patient decision aids in orthopaedics, and a national survey of consultant orthopaedic surgeons on the potential acceptability and feasibility of patient decision aids.

RESULTS

We found little published evidence regarding shared decision-making or patient decision aids in orthopaedics. In the survey, 362 of 639 (57%) randomly selected consultant orthopaedic surgeons responded. Respondents appear representative of consultant orthopaedic surgeons in the UK. Of 272 valid responses, 79% (95% CI, 73-85%) thought patient decision aids a good or excellent idea. There was consensus on the potential helpfulness of patient decision aids and core content. A booklet to take home was the preferred medium/practice model.

CONCLUSIONS

Despite the increased emphasis on patient involvement in decision-making, there is little evidence in the medical literature relating to shared decision-making or the use of patient decision aids in orthopaedic surgery. Further research in this area of clinical practice is required. Our survey shows that consultant orthopaedic surgeons in the UK are generally positive about the use of patient decision aids for joint replacement surgery. Survey results could inform future development of patient decision aids for joint replacement practice in the UK.

Decreased plasma orexin-A levels in obese individuals

Orexin-A and -B stimulate appetite and food intake in rats. Orexins and orexin receptors are present in the hypothalamus as well as the enteric nervous system, the pancreas and the gut. The presence of orexins in peripheral blood, however, has not yet been reported. To determine whether orexin-A is present in human plasma and is related to body weight, we measured plasma orexin-A and leptin levels in a population with a body mass index (BMI) range from 19.8 to 59 kg/m(2). Plasma orexin-A levels correlated negatively and plasma leptin levels correlated positively with BMI. In obese and morbidly obese individuals, orexin-A levels were significantly lower and leptin levels were significantly higher when compared to normal. Our results support previous data suggesting that orexin-A acts also in a peripheral manner. The fact that lower levels of plasma orexin-A are present in obese individuals suggests that it is involved in the regulation of human energy metabolism.

Postprandial refilling and turnover: specific gallbladder motor function defects in patients with gallstone recurrence

BACKGROUND AND AIMS

Impaired gallbladder motor functions are important in the pathogenesis of primary cholesterol gallstones, and possibly in the pathogenesis of recurrent gallstones. By using ultrasonography and cholescintigraphy simultaneously, we recently defined new parameters of gallbladder motor function (postprandial refilling and turnover in addition to emptying), which were markedly impaired in gallstone patients. The aim of this study was to assess the value of these new parameters in distinguishing patients with from those without gallstone recurrence.

METHODS

We studied 11 patients with gallstone recurrence, 11 without gallstone recurrence (at least 40 months after complete dissolution by oral bile acids) and 11 healthy controls. Simultaneous measurements of gallbladder volume (ultrasound) and gallbladder counts (gamma-camera scintigraphy) were carried out in the fasting state and at 10 min intervals following meal ingestion, for a period of 90 min. Gallbladder refilling, turnover of bile and turnover index were calculated, as well as gallbladder emptying by both cholescintigraphy and ultrasound.

RESULTS

Patients with gallstone recurrence had reductions in gallbladder emptying, postprandial refilling and gallbladder bile turnover. They also had a significant reduction in the turnover index (1.7 +/- 1.4) compared to controls (3.5 +/- 0.3, P < 0.01) and to patients without gallstone recurrence (3.1 +/- 1.5, P < 0.05). Patients without gallstone recurrence had only a small reduction in emptying and no reduction in postprandial refilling or turnover compared to controls.

CONCLUSIONS

We conclude that impairment of gallbladder emptying persists in all patients after gallstone dissolution, albeit to a more pronounced extent in patients with recurrence; but that impairment of postprandial refilling and turnover are specific defects in patients with recurrence.

Mathematical models of prevascular spheroid development and catastrophe-theoretic description of rapid metastatic growth/tumor remission

A brief survey is provided of deterministic models of tumor growth and development over the last three decades. The evolution of these models has proceeded from basic phenomenological and empirical descriptions, through both time-dependent and time-independent diffusion models (largely within the diffusive equilibrium approximation). This includes a study of the diffusion of growth inhibitors. The stability of spheroid models to small perturbations is discussed, and also recent applications of nonlinear elasticity theory and differential geometry to possible staging and grading of cancers. Finally, an excursion is made into catastrophe theory, wherein it is suggested that the cusp catastrophe (in particular) may provide a qualitative description of rapid, almost spontaneous (i) growth of metastases, or (ii) tumor remission (both occurring under certain restrictive conditions).

Postprandial gallbladder motor function: refilling and turnover of bile in health and in cholelithiasis

BACKGROUND & AIMS

Impaired gallbladder emptying is implicated in gallstone disease. Ultrasonography and scintigraphy have shown conflicting results because the former is influenced by postprandial refilling, whereas the latter is not influenced by refilling. The aim of this study was to measure postprandial refilling and turnover of bile by combining the two techniques.

METHODS

Simultaneous scintigraphy and ultrasonography were used in 14 patients with gallstones and 11 healthy controls. Measurements were performed while the patients were fasting and at 10-minute intervals after a standard meal for 90 minutes, and the measurements were used to calculate postprandial refilling, turnover of bile (in milliliters), and turnover index.

RESULTS

Ultrasonography and scintigraphy provided different gallbladder emptying patterns. Compared with controls, patients with gallstones had impaired emptying by both scintigraphy (P < 0.0001) and ultrasonography (P < 0.01). Postprandial refilling and turnover were both reduced between 60 and 90 minutes (P < 0.05), and the turnover index was markedly reduced (1.8 vs. 3.5; P < 0.001).

CONCLUSIONS

Simultaneous scintigraphy and ultrasonography provide a new model of gallbladder motor function showing that refilling begins immediately postprandially. In healthy controls, the gallbladder postprandially handles up to six times its basal volume within a period of 90 minutes, but this turnover of bile is markedly reduced in cholelithiasis causing a reduced washout effect of the gallbladder contents, including cholesterol crystals.

Equilibrium model of a vascularized spherical carcinoma with central necrosis--some properties of the solution

Properties of the solutions of a nonlinear time-independent diffusion equation are studied. The equation arises in a model of a spherically symmetric vascularized carcinoma with a central necrotic core. The boundary value problem as posed possesses a constant solution when the nutrient consumption rate and deposition rate (from the vascular network) are equal. This solution can lose uniqueness at a critical tumor dimension which corresponds to the onset of instability with respect to deviations from that uniform equilibrium state.

Diffusion regulated growth characteristics of a spherical prevascular carcinoma

Recently a mathematical model of the prevascular phases of tumor growth by diffusion has been investigated (S.A. Maggelakis and J.A. Adam, Math. Comput. Modeling, in press). In this paper we examine in detail the results and implications of that mathematical model, particularly in the light of recent experimental work carried out on multicellular spheroids. The overall growth characteristics are determined in the present model by four parameters: Q, gamma, b, and delta, which depend on information about inhibitor production rates, oxygen consumption rates, volume loss and cell proliferation rates, and measures of the degree of non-uniformity of the various diffusion processes that take place. The integro-differential growth equation is solved for the outer spheroid radius R0(t) and three related inner radii subject to the solution of the governing time-independent diffusion equations (under conditions of diffusive equilibrium) and the appropriate boundary conditions. Hopefully, future experimental work will enable reasonable bounds to be placed on parameter values referred to in this model: meanwhile, specific experimentally-provided initial data can be used to predict subsequent growth characteristics of in vitro multicellular spheroids. This will be one objective of future studies.

Mathematical models of tumor growth. IV. Effects of a necrotic core

Two mathematical models for the control of the growth of a tumor by diffusion of mitotic inhibitor are presented. The inhibitor production rate is taken to be uniform in a necrotic core for the first model and in the nonnecrotic region for the second model. Regions of stable and unstable growth are determined, and conclusions are drawn about the limiting peripheral widths of stable tissue growth for both models. Comparisons of the results from the two models indicate that the models are sensitive to the source distributions of inhibitor production.

Interpretation of d' values obtained from a multi-target confidence-rating procedure

Two Os made identifications and certainty ratings for five Canadian traffic signs under a theory of signal detectability confidence-rating paradigm. The data showed a strategy from the theory of signal detection for the task as a whole but not for each separate target. Rather than referring to five separate signal and noise distributions, Os apparently used a single-decision axis for their judgments. This outcome suggests the need for clarification of the meaning of individual d' values obtained by a multi-target confidence-rating procedure, based on theory of signal detectability.