64 research outputs found
The Value of Positron Emission Tomography for Differentiating Brain Tumor Progression and Treatment-Induced Changes
Full text linkThe application of fluorescence techniques in meningioma surgery-a review
Full text linkSurgical resections of meningiomas, the most common intracranial tumor in adults, can only be curative if radical resection is achieved. Potentially, the extent of resection could be improved, especially in complex and/or high-grade meningiomas by fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA), indocyanine green (ICG), or fluorescein. This review aims to summarize and evaluate these fluorescence-guided meningioma surgery techniques. PubMed and Embase were searched for relevant articles. Additionally, we checked reference lists for further studies. Forty-eight articles were included in the final analysis. 5-ALA fluoresced with varying sensitivity and selectivity in meningiomas and in invaded bone and dura mater. Although ICG was mainly applied for video angiography, one report shows tumor fluorescence 18-28 h post-ICG injection. Lastly, the use of fluorescein could aid in the identification of tumor remnants; however, detection of dural tail is highly questionable. Fluorescence-guided meningioma surgery should be a reliable, highly specific, and sensitive technique. Despite numerous studies reporting the use of fluorescent dyes, currently, there is no evidence that these tools improve the radical resection rate and long-term recurrence-free outcome in meningioma surgery without neurological deficits. Evidence regarding the effectiveness and increased safety of resection after the application of these fluorophores is currently lacking. Future research should focus on the development of a meningioma-targeted, highly sensitive, and specific fluorophore.</p
Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis
Full text linkMultiple sclerosis is a common disease of the central nervous system in which the interplay between inflammatory and neurodegenerative processes typically results in intermittent neurological disturbance followed by progressive accumulation of disability. Epidemiological studies have shown that genetic factors are primarily responsible for the substantially increased frequency of the disease seen in the relatives of affected individuals, and systematic attempts to identify linkage in multiplex families have confirmed that variation within the major histocompatibility complex (MHC) exerts the greatest individual effect on risk. Modestly powered genome-wide association studies (GWAS) have enabled more than 20 additional risk loci to be identified and have shown that multiple variants exerting modest individual effects have a key role in disease susceptibility. Most of the genetic architecture underlying susceptibility to the disease remains to be defined and is anticipated to require the analysis of sample sizes that are beyond the numbers currently available to individual research groups. In a collaborative GWAS involving 9,772 cases of European descent collected by 23 research groups working in 15 different countries, we have replicated almost all of the previously suggested associations and identified at least a further 29 novel susceptibility loci. Within the MHC we have refined the identity of the HLA-DRB1 risk alleles and confirmed that variation in the HLA-A gene underlies the independent protective effect attributable to the class I region. Immunologically relevant genes are significantly overrepresented among those mapping close to the identified loci and particularly implicate T-helper-cell differentiation in the pathogenesis of multiple sclerosis
Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma:Is Less More?
Full text linkMRI is the gold standard for treatment response assessments for glioblastoma. However, there is no consensus regarding the optimal interval for MRI follow-up during standard treatment. Moreover, a reliable assessment of treatment response is hindered by the occurrence of pseudoprogression. It is unknown if a radiological follow-up strategy at 2-3 month intervals actually benefits patients and how it influences clinical decision making about the continuation or discontinuation of treatment. This study assessed the consequences of scheduled follow-up scans post-chemoradiotherapy (post-CCRT), after three cycles of adjuvant chemotherapy [TMZ3/6], and after the completion of treatment [TMZ6/6]), and of unscheduled scans on treatment decisions during standard concomitant and adjuvant treatment in glioblastoma patients. Additionally, we evaluated how often follow-up scans resulted in diagnostic uncertainty (tumor progression versus pseudoprogression), and whether perfusion MRI improved clinical decision making. Scheduled follow-up scans during standard treatment in glioblastoma patients rarely resulted in an early termination of treatment (2.3% post-CCRT, 3.2% TMZ3/6, and 7.8% TMZ6/6), but introduced diagnostic uncertainty in 27.7% of cases. Unscheduled scans resulted in more major treatment consequences (30%; p < 0.001). Perfusion MRI caused less diagnostic uncertainty ( p = 0.021) but did not influence treatment consequences ( p = 0.871). This study does not support the current pragmatic follow-up strategy and suggests a more tailored follow-up approach. </p
Protocol for the United Kingdom Rotator Cuff Study (UKUFF) : a randomised controlled trial of open and arthroscopic rotator cuff repair
Full text linkThis project was funded by the NIHR Health Technology Assessment programme (project number 05/47/02). J. L. Rees has received a grant from Oxford University which is related to this paper. J. Dawson reports that Oxford University has received a grant from HTA which is related to this paper, as well as a study grant.Peer reviewe
Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis
Full text linkUsing the ImmunoChip custom genotyping array, we analyzed 14,498 subjects with multiple sclerosis and 24,091 healthy controls for 161,311 autosomal variants and identified 135 potentially associated regions (P < 1.0 × 10−4). In a replication phase, we combined these data with previous genome-wide association study (GWAS) data from an independent 14,802 subjects with multiple sclerosis and 26,703 healthy controls. In these 80,094 individuals of European ancestry, we identified 48 new susceptibility variants (P < 5.0 × 10−8), 3 of which we found after conditioning on previously identified variants. Thus, there are now 110 established multiple sclerosis risk variants at 103 discrete loci outside of the major histocompatibility complex. With high-resolution Bayesian fine mapping, we identified five regions where one variant accounted for more than 50% of the posterior probability of association. This study enhances the catalog of multiple sclerosis risk variants and illustrates the value of fine mapping in the resolution of GWAS signals
Beyond ‘Needy’ Individuals: Conceptualizing Information Behavior
Full text linkUnderstanding information users and their behavior is a question of central importance for information
research and practice. The paper challenges several aspects of existing approaches to understanding information behavior, including: the focus on individual cognition at the expense of social and affective factors; the construction of information users as defined by their areas of ignorance and uncertainty, rather than their expertise; and the focus on purposive rather than non-purposive information behavior. It argues that only by addressing these weaknesses and developing new research strategies and theoretical frameworks which focus attention on the social processes and relationships which underpin users’ information behavior can we hope to develop a truly holistic understanding of the relationship between people and information. The paper uses the author’s study of information behavior researcher’s constructions of an author (Brenda Dervin) to illustrate how a social constructivist approach can both build on existing approaches to information behavior research and address some of their weaknesses. It argues that social constructivist approaches provide a theoretical lens through which information researchers can gain a clearer picture of information users not as ‘needy’ individuals to be ‘helped’, but as social beings, experts in their own life-worlds
Opposing effects of aspirin and anticoagulants on morbidity and mortality in patients with upper gastrointestinal bleeding
No full textObjective: We aimed to determine the effect of antithrombotics on in-hospital mortality and morbidity in patients with peptic ulcer disease-related upper gastrointestinal bleeding (PUD-related UGIB). Methods: The study cohort was retrospectively selected from a tertiary center database of patients with PUD-related UGIB, defined as bleeding due to gastric or duodenal ulcers, or erosive duodenitis, gastritis or esophagitis. Outcomes were compared among patient groups based on their antithrombotic medications before admission. Patients on no antithrombotics served as controls. The composite adverse outcomes, in-hospital mortality, rebleeding and-or need for surgery were measured. Severe bleeding and in-hospital complications were also recorded. Results: Of 398 patients with PUD-related UGIB, 44.5percent were on aspirin or anticoagulants only. The composite adverse outcome was most common in patients taking anticoagulants only (40.5percent), intermediate in controls (23.1percent) and least in those taking aspirin only (12.1percent). On multivariate analysis, patients taking aspirin alone had a significantly lower risk of adverse outcome events (odds ratio [OR] 0.4, 95percent CI 0.2-0.8) and a shorter length of hospital stay (regression coefficient=-3.4, 95percent CI [-6.6, -0.6]). In contrast, taking anticoagulants was associated with a greater risk of adverse outcome events (OR2.3, 95percent CI 1.0-5.3), severe bleeding (OR2.6, 95percent CI 1.2-5.8) and in-hospital complications (OR2.9, 95percent CI 1.3-6.6). Conclusions: Patients with PUB-related UGIB while taking aspirin had fewer adverse outcomes compared with those taking anticoagulants. Aspirin may have beneficial effects in this population. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.Barada K, 2009, J CLIN GASTROENTEROL, V43, P5, DOI 10.1097-MCG.0b013e31811edd13; Chiu PWY, 2009, CLIN GASTROENTEROL H, V7, P311, DOI 10.1016-j.cgh.2008.08.044; CHOUDARI CP, 1994, GUT, V35, P464, DOI 10.1136-gut.35.4.464; Cooper GS, 1997, J GEN INTERN MED, V12, P485, DOI 10.1046-j.1525-1497.1997.00087.x; Hallas J, 2006, BRIT MED J, V333, P726, DOI 10.1136-bmj.38947.697558.AE; Hearnshaw SA, 2011, GUT, V60, P1327, DOI 10.1136-gut.2010.228437; hsberg K, 2010, ALIMENT PHARM THER, V32, P801; Lanas A, 2011, ALIMENT PHARM THER, V33, P1225, DOI 10.1111-j.1365-2036.2011.04651.x; Marmo R, 2010, AM J GASTROENTEROL, V105, P1284, DOI 10.1038-ajg.2009.687; Marmo R, 2012, GASTROINTEST ENDOSC, V75, P263, DOI 10.1016-j.gie.2011.07.066; Marmo R, 2008, AM J GASTROENTEROL, V103, P1639, DOI 10.1111-j.1572-0241.2008.01865.x; Mose Hanne, 2006, Am J Geriatr Pharmacother, V4, P244, DOI 10.1016-j.amjopharm.2006.09.006; Ortiz V, 2009, DIGESTION, V80, P89, DOI 10.1159-000219345; Pirmohamed M, 2004, BRIT MED J, V329, P15, DOI 10.1136-bmj.329.7456.15; Rodriguez LAG, 2011, CIRCULATION, V123, P1108, DOI 10.1161-CIRCULATIONAHA.110.973008; Rubin TA, 2003, GASTROINTEST ENDOSC, V58, P369; Sostres C, 2011, DRUGS, V71, P1, DOI 10.2165-11585320-000000000-00000; Sung JJY, 2010, AM J GASTROENTEROL, V105, P84, DOI 10.1038-ajg.2009.507; Sung JJY, 2010, ANN INTERN MED, V152, P1, DOI 10.7326-0003-4819-152-1-201001050-00179; Taha AS, 2006, ALIMENT PHARM THERAP, V24, P633, DOI 10.1111-j.1365-2036.2006.03017.x; Theocharis GJ, 2008, J CLIN GASTROENTEROL, V42, P128, DOI 10.1097-01.mcg.0000248004.73075.ad; Thomopoulos KC, 2005, WORLD J GASTROENTERO, V11, P1365; van Leerdam ME, 2003, AM J GASTROENTEROL, V98, P1494, DOI 10.1016-S0002-9270(03)00299-5; Wang YR, 2010, ANN SURG, V251, P51, DOI 10.1097-SLA.0b013e3181b975b8; Wolf AT, 2007, AM J GASTROENTEROL, V102, P290, DOI 10.1111-j.1572-0241.2006.00969.x; Wong GLH, 2009, GASTROENTEROLOGY, V137, P525, DOI 10.1053-j.gastro.2009.05.00610
11C-Methionine uptake in meningiomas after stereotactic radiotherapy.
Full text linkOBJECTIVE: 11C-Methionine positron emission tomography (MET-PET) is used for stereotactic radiotherapy planning in meningioma patients. The role of MET-PET during subsequent follow-up (FU) is unclear. We analyzed the uptake of 11C-Methionine before and after stereotactic radiotherapy (SRT) in patients with a complex meningioma and investigated if there was a difference between patients with progressive disease (PD) and stable disease (SD) during FU. METHODS: This retrospective study investigates 62 MET-PETs in 29 complex meningioma patients. Standardized uptake value (SUV) max and SUV peak tumor-to-normal ratios (T/N-ratios) were calculated, comparing the tumor region with both the mirroring intracranial area and the right frontal gray matter. The difference in 11C-Methionine uptake pre- and post-SRT was analyzed, as well as the change in uptake between PD or SD. RESULTS: Median (IQR) FU duration was 67 months (50.5-91.0). The uptake of 11C-Methionine in meningiomas remained increased after SRT. Neither a statistically significant difference between MET-PETs before and after SRT was encountered, nor a significant difference in one of the four T/N-ratios between patients with SD versus PD with median (IQR) SUV max T/N R front 2.65 (2.13-3.68) vs 2.97 (1.55-3.54) [p = 0.66]; SUV max T/N mirror 2.92 (2.19-3.71) vs 2.95 (1.74-3.60) [p = 0.61]; SUV peak T/N R front 2.35 (1.64-3.40) vs 2.25 (1.44-3.74) [p = 0.80]; SUV peak T/N mirror 2.38 (1.91-3.36) vs 2.35 (1.56-3.72) [p = 0.95]. CONCLUSIONS: Our data do not support use of MET-PET during FU of complex intracranial meningiomas after SRT. MET-PET could not differentiate between progressive or stable disease.</p
The Value of Positron Emission Tomography for Differentiating Brain Tumor Progression and Treatment-Induced Changes
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