Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection?

AIM To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). PATIENTS, METHODS In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. RESULTS Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). CONCLUSION PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.

Coronary collateral function long after drug-eluting stent implantation

OBJECTIVES: This study was designed to compare coronary collateral function in patients after bare-metal stent (BMS) or drug-eluting stent (DES) implantation. BACKGROUND: Drug-eluting stents have an inhibitory effect on the production of cytokines, chemotactic proteins, and growth factors, and may therefore negatively affect coronary collateral growth. METHODS: A total of 120 patients with long-term stable coronary artery disease (CAD) after stent implantation were included. Both the BMS group and the DES group comprised 60 patients matched for in-stent stenosis severity of the vessel undergoing collateral flow index (CFI) measurement at follow-up and for the duration of follow-up. The primary end point of the investigation was invasively determined coronary collateral function 6 months after stent implantation. Collateral function was assessed by simultaneous aortic, coronary wedge, and central venous pressure measurements (yielding CFI) and by intracoronary electrocardiogram during balloon occlusion. RESULTS: There were no differences between the groups regarding age, gender, body mass index, frequency of cardiovascular risk factors, use of cardiovascular drugs, severity of CAD, or site of coronary artery stenoses. Despite equal in-stent stenosis severity (46 +/- 34% and 45 +/- 36%) and equal follow-up duration (6.2 +/- 10 months and 6.5 +/- 5.4 months), CFI was diminished in the DES versus BMS group (0.154 +/- 0.097 vs. 0.224 +/- 0.142; p = 0.0049), and the rate of collaterals insufficient to prevent ischemia during occlusion (intracoronary electrocardiographic ST-segment elevation > or =0.1 mV) was higher with 50 of 60 patients in the DES group and 33 of 60 patients in the BMS group (p = 0.001). CONCLUSIONS: Collateral function long after coronary stenting is impaired with DES (sirolimus and paclitaxel) when compared with BMS. Considering the protective nature of collateral vessels, this could lead to more serious cardiac events in the presence of an abrupt coronary occlusion.

Vitamin E inhibits CD36 scavenger receptor expression in hypercholesterolemic rabbits

A numerous studies suggest that Vitamin E has a preventive role in atherosclerosis, although the mechanism of action still remains unclear. CD36, a member of the scavenger receptor family is centrally involved in the uptake of oxidized low density proteins (oxLDLs) from bloodstream. During the atherosclerotic process, the lipid cargo of oxLDL accumulates in macrophages and smooth muscle cells, inducing their pathological conversion to foam cells. In the present study, we investigate the role of Vitamin E on CD36 expression in an in vivo model. Atherosclerosis was induced by a 2% cholesterol containing Vitamin E poor diet. Three groups of six rabbits each were studied. The first group (control) was fed on Vitamin E poor diet. The second group was fed with Vitamin E poor diet containing 2% cholesterol and the rabbits in the third group were fed with Vitamin E poor diet containing 2% cholesterol and received injections of 50 mg/kg of Vitamin E i.m. After 4 weeks, aortas were removed and analysed by light microscopy for atherosclerotic lesions. Aortic samples were analysed for CD36 mRNA expression. The aortas of cholesterol-fed rabbits showed typical atherosclerotic lesions, detected by macroscopic and microscopic examination, and exhibited an increase in CD36 mRNA expression. Vitamin E fully prevented cholesterol induced atherosclerotic lesions and the induction of CD36 mRNA expression. The effects observed at the level of CD36 scavenger receptor expression in vivo suggest an involvement of reduced foam cell formation in the protective effect of Vitamin E against atherosclerosis.

Expression patterns of Bmi-1 and p16 significantly correlate with overall, disease-specific, and recurrence-free survival in oropharyngeal squamous cell carcinoma

BACKGROUND: The objective of this study was to link expression patterns of B-cell-specific Moloney murine leukemia virus integration site 1 (Bmi-1) and p16 to patient outcome (recurrence and survival) in a cohort of 252 patients with oral and oropharyngeal squamous cell cancer (OSCC). METHODS: Expression levels of Bmi-1 and p16 in samples from 252 patients with OSCC were evaluated immunohistochemically using the tissue microarray method. Staining intensity was determined by calculating an intensity reactivity score (IRS). Staining intensity and the localization of expression within tumor cells (nuclear or cytoplasmic) were correlated with overall, disease-specific, and recurrence-free survival. RESULTS: The majority of cancers were localized in the oropharynx (61.1%). In univariate analysis, patients who had OSCC and strong Bmi-1 expression (IRS >10) had worse outcomes compared with patients who had low and moderate Bmi-1 expression (P = .008; hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.167-2.838); this correlation was also observed for atypical cytoplasmic Bmi-1 expression (P = .001; HR, 2.164; 95% CI, 1.389-3.371) and for negative p16 expression (P < .001; HR, 0.292; 95% CI, 0.178-0.477). The combination of both markers, as anticipated, had an even stronger correlation with overall survival (P < .001; HR, 8.485; 95% CI, 4.237-16.994). Multivariate analysis demonstrated significant results for patients with oropharyngeal cancers, but not for patients with oral cavity tumors: Tumor classification (P = .011; HR, 1.838; 95%CI, 1.146-2.947) and the combined marker expression patterns (P < .001; HR, 6.254; 95% CI, 2.869-13.635) were correlated with overall survival, disease-specific survival (tumor classification: P = .002; HR, 2.807; 95% CI, 1.477-5.334; combined markers: P = .002; HR, 5.386; 95% CI, 1.850-15.679), and the combined markers also were correlated with recurrence-free survival (P = .001; HR, 8.943; 95% CI, 2.562-31.220). CONCLUSIONS: Cytoplasmic Bmi-1 expression, an absence of p16 expression, and especially the combination of those 2 predictive markers were correlated negatively with disease-specific and recurrence-free survival in patients with oropharyngeal cancer. Therefore, the current results indicate that these may be applicable as predictive markers in combination with other factors to select patients for more aggressive treatment and follow-up. Cancer 2011;. © 2011 American Cancer Society.

Macrocephaly in neurofibromatosis type 1: a sign post for optic pathway gliomas?

Optic pathway gliomas, which occur in 15-20% of paediatric patients with neurofibromatosis type 1, are the most common central nervous system tumour associated with this neurocutaneous disorder. The detection of optic pathway gliomas is essential for further management but is often delayed in infancy due to oligosymptomatic progression and difficulties in clinical detection. Therefore, the aim of our study was to find a clinical indicator for the presence of optic pathway gliomas in children with neurofibromatosis type 1 in order to facilitate early diagnosis and initiate further ophthalmological and neuroimaging investigations.

Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications

OBJECTIVES To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strategy.

Funktionalität peripherer Wahrnehmung bei Trackingaufgaben

Introduction: Beim Multiple-Object-Tracking müssen mehrere, sich bewegende Zielobjekte visuell verfolgt werden. Dabei scheint es vorteilhaft zu sein, den Blick zwischen den Zielobjekten zu verankern, um Bewegungsinformationen peripher wahrzunehmen (Fehd & Seiffert, 2010). Nach Prüfung dieser Annahme (Experiment 1) wurde getestet, wie gut und schnell auf Bewegungs- und Formveränderungen der Zielobjekte reagiert werden kann (Experiment 2), um die Funktionalität der peripheren Wahrnehmung zu überprüfen. Methods: 14 Teilnehmer hatten die Aufgabe, zum Ende eines Einzelversuchs 4 aus 10 Vierecken wiederzuerkennen, die sich linear für 6 s in einem projizierten Quadrat bewegten. Dabei wurden 3 Geschwindigkeiten (6, 9 und 12°/s) in 9 Blöcken à 15 Versuchen präsentiert, um die Ergebnisse von Fehd und Seiffert (2010) zu replizieren. In Experiment 2 sollten Teilnehmer auf das Anhalten eines Targets oder dessen Formveränderung zur Raute (Manipulation: 0.5 s) mit Knopfdruck reagieren, bei ausbleibender Veränderung hingegen die 4 Zielobjekte wiedererkennen (3 Bedingungen in 10 Blöcken à 12 Versuchen). Durch die Bestimmung von Sakkadenlatenzen (definiert als Zeitraum zwischen Beginn der Objektveränderung und Sakkadenbeginn auf das Objekt) kann bestimmt werden, ob die Veränderung bereits peripher wahrgenommen wurde. Unter anderem aufgrund der Sensitivität der Netzhaut gegenüber Bewegungen wurde erwartet, dass Bewegungsveränderungen häufiger und schneller erkannt werden und dass häufiger bereits reagiert werden kann, bevor der Blick auf dem veränderten Zielobjekt ist. Results: Experiment 1 ergab einen signifikanten Haupteffekt für Geschwindigkeit, F(2,26) = 62.66, p < .01, ηp2 = .83, mit höchsten Richtigkeiten bei 6°/s (58%). Ein Haupteffekt für Blickort, F(2,26) = 76.40, p < .01, ηp2 = .85, zeigt, dass der Blick unabhängig von der Geschwindigkeit länger auf dem Centroid war als auf Targets und Distraktoren. Aufgrund der höchsten Richtigkeiten bei 6°/s wurde diese Geschwindigkeit in Experiment 2 eingesetzt und festgestellt, dass Bewegungsveränderungen häufiger erkannt werden (83 %) als Formveränderungen (59 %), F(1,10) = 17.20, p < .01, ηp2 = .63. Unterschiede in Sakkadenlatenzen, F(1,10) = 6.73, p = .03, ηp2 = .40, deuten auf eine periphere Wahrnehmung der Bewegungsveränderungen hin. Experiment 3 wird zeigen, ob Sakkaden das Monitoring stören. Discussion/Conclusion: Die periphere Wahrnehmung scheint immer dann funktional zu sein, wenn mehrere, für eine Aufgabe relevante Objekte gleichzeitig verfolgt werden müssen und wenn Veränderungen, besonders der Bewegung, schnell erkannt werden müssen. Weitere Untersuchungen sollen zeigen, ob diese Funktionalität der peripheren Wahrnehmung auch im Sport (z.B. beim gleichzeitigen Verfolgen mehrerer Gegenspieler) erkannt werden kann. References: Fehd, H. M. & Seiffert, A. E. (2010). Looking at the center of the targets helps multiple object tracking. Journal of Vision, 10, 1–13.

Funktionalität peripherer Wahrnehmung bei Trackingaufgaben

Schlüsselwörter: Multiple-Object-Tracking, Sakkadenlatenz, Erkennungsleistung Einleitung Beim Multiple-Object-Tracking müssen mehrere, sich bewegende Zielobjekte visuell ver-folgt werden. Dabei scheint es vorteilhaft zu sein, den Blick zwischen den Zielobjekten zu verankern, um Bewegungsinformationen peripher wahrzunehmen (Fehd & Seiffert, 2010). Nach Prüfung dieser Annahme (Experiment 1) wurde getestet, wie gut und schnell auf Bewegungs- und Formveränderungen der Zielobjekte reagiert werden kann (Experiment 2), um die Funktionalität der peripheren Wahrnehmung zu überprüfen Methode 14 Teilnehmer hatten die Aufgabe, zum Ende eines Einzelversuchs 4 aus 10 Vierecken wiederzuerkennen, die sich linear für 6 s in einem projizierten Quadrat bewegten. Dabei wurden 3 Geschwindigkeiten (6, 9 und 12°/s) in 9 Blöcken à 15 Versuchen präsentiert, um die Ergebnisse von Fehd und Seiffert (2010) zu replizieren. In Experiment 2 sollten Teilnehmer auf das Anhalten eines Targets oder dessen Formveränderung zur Raute (Manipulation: 0.5 s) mit Knopfdruck reagieren, bei ausbleibender Veränderung hinge-gen die 4 Zielobjekte wiedererkennen (3 Bedingungen in 10 Blöcken à 12 Versuchen). Erwartet wurde, dass Bewegungsveränderungen häufiger und schneller erkannt werden. Ergebnisse Experiment 1 ergab einen signifikanten Haupteffekt für Geschwindigkeit, F(2,26) = 62.66, p < .01, ηp2 = .83, mit höchsten Richtigkeiten bei 6°/s (58%). Ein Haupteffekt für Blickort, F(2,26) = 76.40, p < .01, ηp2 = .85, zeigt, dass der Blick unabhängig von der Geschwindig-keit länger auf dem Centroid war als auf Targets und Distraktoren. Aufgrund der höchs-ten Richtigkeiten bei 6°/s wurde diese Geschwindigkeit in Experiment 2 eingesetzt und festgestellt, dass Bewegungsveränderungen häufiger erkannt werden (83 %) als Form-veränderungen (59 %), F(1,10) = 17.20, p < .01, ηp2 = .63. Unterschiede in Sakkadenla-tenzen, F(1,10) = 6.73, p = .03, ηp2 = .40, deuten auf eine periphere Wahrnehmung der Bewegungsveränderungen hin. Experiment 3 wird zeigen, ob Sakkaden das Monitoring stören. Diskussion Die periphere Wahrnehmung scheint immer dann funktional zu sein, wenn mehrere, für eine Aufgabe relevante Objekte gleichzeitig verfolgt werden müssen und wenn Verände-rungen, besonders der Bewegung, schnell erkannt werden müssen. Weitere Untersu-chungen sollen zeigen, ob diese Funktionalität der peripheren Wahrnehmung auch im Sport (z.B. beim gleichzeitigen Verfolgen mehrerer Gegenspieler) erkannt werden kann. Literatur Fehd, H. M. & Seiffert, A. E. (2010). Looking at the center of the targets helps multiple object tracking. Journal of Vision, 10, 1–13.