Role of hepatic colour duplex ultrasound in assessment of non alcoholic fatty liver disease-nafld

Abstract Background Gray-scale ultrasonography (US) is an initial, easy to use and widely available imaging modality for NAFLD, the presence of fat infiltration in the liver in the absence of excessive alcohol consumption and other causes of liver disease, is the most common cause of fatty liver, with a prevalence as high as 15-25% in many populations. Objective to determine the effect of obesity and NAFLD on the Doppler waveform pattern of the liver vascularity. Methods A case control study, conducted at Ain Shams University in the period between july and December 2018 . In both groups, liver span & subcutaneous fat was measured by ultrasonographic examination. Hepatic vein waveform pattern & portal vein mean flow velocity were assessed & hepatic artery resistance index was measured by duplex Doppler ultrasonography examination. Results Our study included 50 patients , 20 were control & 30 were cases.. The mean age of cases was 45.30 ± 10.15 SD & the mean age of control was 32.70 ± 10.95 SD rendering the mean age of cases & control of high statistical significance (p value=0.000). The Subcutaneous fat showed high significant statistical difference between cases & control groups with mean subcutaneous fat in control =0.75 ± 0.14 SD & mean subcutaneous fat in cases= 1.23 ± 0.42 SD with p –value = 0.000. The liver span showed high significant statistical difference between cases & control groups with mean in control =15.11 ± 0.85 SD & mean liver span in cases= 17.46 ± 1.67SD ( p value = 0.000). Hepatic vein wave pattern was normal in all 20 control (100%). In the 30 cases,the Hepatic vein wave pattern was triphasic in 12 patients (40%) & biphasic or monophasic In 18 patients (60%) with high statistical significance (p-value =0.000). There was negative correlation between the hepatic vein velocity & BMI with ( p value=0.0032). There was no statistically significant difference between cases & control as regards all Doppler indices including the Hepatic artery RI(resistive index), Hepatic artery PSV(peak systolic velocity), Portal vein velocity(maximum & minimum)& hepatic vein velocity (maximum velocity) where the p value was more than 0.05. Conclusion Patients with NAFLD have a high rate of abnormal hepatic vein Doppler waveform patterns ,which can be biphasic or monophasic rather than alterations in hepatic artery resistance index values by duplex Doppler ultrasonography. Also the fatty infiltration of hepatocytes can increase liver span & the subcutaneous fat.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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Evaluation of volume change in oral cavity proper before and after mandibular advancement:

The Angle Orthodontist ◽

10.2319/052420-474.1 ◽

2020 ◽

Vol 91 (1) ◽

pp. 81-87

Author(s):

Balaji Rajkumar ◽

Ratna Parameswaran ◽

Anantanarayanan Parameswaran ◽

Devaki Vijayalakshmi

Keyword(s):

Oral Cavity ◽

Statistical Significance ◽

Mean Difference ◽

Mandibular Advancement ◽

Strong Positive Correlation ◽

Positive Correlation ◽

High Statistical Significance ◽

Proper Volume ◽

The Mean ◽

Tongue Volume

ABSTRACT Objectives To evaluate the tongue and oral cavity proper volume in pre- and post-bilateral sagittal split osteotomy (BSSO) patients, and to establish whether there was a correlation between them. Materials and Methods A retrospective study that evaluated 12 patients' pre- and post-surgical computed tomography records satisfying the inclusion criteria. Borders were defined for measurement of tongue and oral cavity proper volume. The volume assessment was carried out using 3D slice software. Results The mean difference of tongue volume was 5.7 ± 1.7 cm3, which showed high statistical significance. The mean difference of oral cavity proper volume (OCVP) was 6.9 ± 3.4 cm3 and indicated high statistical significance. A very strong positive correlation existed between pre- and post-surgical tongue volume. Positive correlation was also evident between pre and post - surgical OCVP. Medium positive correlation was noted when the difference between pre- and post-surgical tongue and OCVP were assessed. Conclusions There was a significant change in volume of tongue and oral cavity proper after BSSO advancement surgery. The space around the tongue, position of tongue, and maxillary and mandibular relationship influence the volume of tongue and oral cavity proper.

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Pie Crust Technique of the Deep Medial Collateral Ligament in Knee Arthroscopy: Ultrasound and Anatomic Study

The Journal of Knee Surgery ◽

10.1055/s-0038-1668125 ◽

2018 ◽

Vol 32 (08) ◽

pp. 764-769

Author(s):

Guillem Claret-Garcia ◽

Jordi Montañana-Burillo ◽

Eduard Tornero-Dacasa ◽

Manel Llusá-Pérez ◽

Dragos Popescu ◽

...

Keyword(s):

Medial Collateral Ligament ◽

Statistical Significance ◽

Mean Value ◽

Saphenous Nerve ◽

Medial Compartment ◽

P Value ◽

Collateral Ligament ◽

Anatomical Dissection ◽

Ultrasound Measurements ◽

The Mean

AbstractThis article determines compartment opening of the medial articular space of the knee after pie crust (PC) technique of the medial collateral ligament (MCL) by ultrasound measurements and anatomic dissection. This is a cadaveric study of 12 specimens. Four anatomic references were marked on the skin. Distances between the femur and tibia in the internal compartment at 30 degrees of flexion were obtained with ultrasound measurements in four situations: with and without applying valgus force both prior and after the PC technique. Ultrasound measurements of the medial articular compartment were made twice and mean value was calculated. An anatomical dissection was performed and distances between the puncture marks and the infrapatellar branch of the saphenous nerve was measured. Lilliefors test of normality was applied and variables were expressed as mean and standard deviation (SD). Qualitative variables were expressed by absolute frequencies and percentages. Statistical significance was a two-tailed p-value of < 0.05. Prior to the PC technique, mean (SD) distance between the femur and tibia in the medial compartment were 14.2 (4.0) mm in basal conditions and 17.1 (3.7) mm when applying valgus force (p = 0.003). PC technique increased the mean (SD) distance by 1.9 (1.9) mm under basal conditions (p < 0.01) and 2.9 (1.6) mm when applying valgus force (p < 0.01). The infrapatellar branches of the saphenous nerve were not damaged and the mean (SD) distance between the punctures and the nerve was 9.0 (3.3) mm. The PC is a reproducible, safe, and measurable surgical technique that opens controllably the medial compartment. PC as described avoided damage to the nerve branches.

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Unravelling the mystery of the ‘minimum important difference’ using practical outcome measures in chronic respiratory disease

Chronic Respiratory Disease ◽

10.1177/1479973118816491 ◽

2019 ◽

Vol 16 ◽

pp. 147997311881649 ◽

Cited By ~ 3

Author(s):

Linzy Houchen-Wolloff ◽

Rachael A Evans

Keyword(s):

Outcome Measures ◽

Outcome Measure ◽

Statistical Significance ◽

Minimum Clinically Important Difference ◽

Chronic Respiratory Disease ◽

Important Change ◽

P Value ◽

Minimum Important Difference ◽

The Mean ◽

Functional Outcome Measures

It is important for clinicians and researchers to understand the effects of treatments on their patients, both at an individual and group level. In clinical studies, treatment effects are often reported as a change in the outcome measure supported by a measure of variability; for example, the mean change with 95% confidence intervals and a probability ( p) value to indicate the level of statistical significance. However, a statistically significant change may not indicate a clinically meaningful or important change for clinicians or patients to interpret. The minimum clinically important difference (MCID) or minimally important difference (MID) has therefore been developed to add clinical relevance or patient experience to the reporting of an outcome measure. In this article, we consider the concept of the MID using the example of practical outcome measures in patients with CRD. We describe the various ways in which an MID can be calculated via anchor- and distribution-based methods, looking at practical examples and considering the importance of understanding how an MID was derived when seeking to apply it to a particular situation. The terms MID and MCID are challenging and often used interchangeably. However, we propose all MIDs are described as such, but they could be qualified by a suffix: MIDS (MID – Statistical), MID-C (MID – Clinical outcome), MID-P (MID – Patient determined). However, this type of classification would only work if accepted and adopted. In the meantime, we advise clinicians and researchers to use an MID where possible to aid their interpretation of functional outcome measures and effects of interventions, to add meaning above statistical significance alone.

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The behavior of Mean Platelet Volume in Sepsis in critical patients with and without sepsis

Bionatura ◽

10.21931/rb/2021.06.02.22 ◽

2021 ◽

Vol 6 (2) ◽

pp. 1812-1817

Author(s):

Pablo Andrés Vélez ◽

Lucy Baldeón R ◽

Jorge Luis Vélez-Paez

Keyword(s):

Mean Platelet Volume ◽

Statistical Significance ◽

Area Under The Curve ◽

Biological Behavior ◽

P Value ◽

Platelet Volume ◽

Significant Area ◽

The Mean ◽

Critical Patients ◽

Elevated Lactate

The mean platelet volume is an anatomical biomarker that has shown its usefulness in various cardiovascular and metabolic pathologies; in sepsis, it has been positioning itself as an indicator of mortality, easily accessible and immediately applicable when reported in the routine blood count. This study demonstrates the mean platelet volume's biological behavior in critical patients with sepsis compared with non-septic patients. An observational, longitudinal, prospective, monocentric cohort study was conducted in 250 patients treated at the intensive care unit of the Pablo Arturo Suárez Hospital, Quito- Ecuador, from January 2019 January 2020. A group of patients with sepsis (n = 125) and without infectious pathologies (n = 125) were studied. The inclusion criteria were patients over 18 years of age of both genders, diagnosed with sepsis or septic shock using SEPSIS 3 criteria, and patients without septic pathology. The mean platelet volume (MPV) of days 1, 2, and 3 were studied. Septic patients had a mean APACHE (18.74 SD 9.52) higher than the non-septic ones (11.93 SD 7.01) (p = < 0.000). The MPV was consistently higher in patients with sepsis than non-septic patients, but it reached statistical significance on day 3 (9.13 SD 1.55 vs. 8.66 SD 1.34, p=0.042). The MPV on day 3 presented a significant area under the curve (AUC =0.580) (CI. 0.500-0.661), where the cut-off point according to Youden's index was positive for sepsis if MPV≥ 9.85 femtoliter (fL) with OR=3.30 and p-value= 0.005. Likewise, lactate on admission showed an AUC of 0.625 (CI. 0.555-0.694), with a cut-off point ≥of 1.15 mmol / L, OR=2.51, and p=0.007. Age and hypertension did not show a multivariate relationship with the presence of sepsis. It was shown that MPV is higher in patients with sepsis compared to non-septic ones. This observation reaches significance on day 3. Additionally, elevated lactate at admission was also associated with a septic state. On the other hand, platelet count did not show the expected behavior.

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Job Satisfaction among Hemodialysis and Labour Ward Nurses: A Comparative Descriptive Study

TEXILA INTERNATIONAL JOURNAL OF NURSING ◽

10.21522/tijnr.2015.se.21.01.art004 ◽

2021 ◽

pp. 48-56

Author(s):

Monisayo Olayemi Komolafe

Keyword(s):

Job Satisfaction ◽

Work Environment ◽

Statistical Significance ◽

Descriptive Study ◽

P Value ◽

Satisfaction Scale ◽

Cross Sectional ◽

Dialysis Unit ◽

The Mean ◽

Labour Ward

Introduction: Increasing CKD cases means higher demands for haemodialysis nurses. Haemodialysis nurses are required to fulfil many demanding roles such as advocate, caregiver, educator, mentor and technician while patients attend a dialysis unit. The complexities of the role that are performed by these nurses along with organization factors within the work environment have led to haemodialysis nurses experiencing high levels of burnout thus impacting on satisfaction derived from job done. Objectives: To compare job satisfaction among haemodialysis nurses with that of labour ward nurses and determine if the type of patient managed affects job satisfaction of nurses. Methodology: The multidimensional Job satisfaction scale designed and validated by Murat Ozpehlivan and Zafer Acar was used to determine job satisfaction among sixty-six hemodialysis nurses and sixty-four labour ward nurses in a cross sectional comparative descriptive study. Statistical significance difference between the two group of nurses attributed to events with a p-value lower than 5% (p < 0.05). Results: The overall mean job satisfaction score was higher among the labour ward nurses 67.95 ± 13.39 compared to the mean score among renal nurses 65.07 ± 14.24 (T= 1.81, p = 0.240). The mean score of labour ward nurses regarding satisfaction based on patient managed 74.51 ± 14.96 is higher than the mean score among renal participants of 71.21 ± 14.70 (T= 1.27, p = 0.201). Conclusion: Hemodialysis nurses in Nigeria are satisfied with the job they do and this is comparable to that of nurses in labour ward.

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227 CALRETICULIN, A 60-kDa PROTEIN, PREVENTS POLYSPERMY IN ZONA PELLUCIDA-FREE PIG OCYTES

Reproduction Fertility and Development ◽

10.1071/rdv25n1ab227 ◽

2013 ◽

Vol 25 (1) ◽

pp. 261

Author(s):

R. Romar ◽

C. Soriano-Úbeda ◽

M. D. Saavedra ◽

J. Gadea ◽

M. Avilés ◽

...

Keyword(s):

Zona Pellucida ◽

Calcium Binding ◽

Statistical Significance ◽

P Value ◽

Oocyte Activation ◽

Cortical Granules ◽

Chaperone Protein ◽

The Mean

After gamete membrane fusion or artificial oocyte activation, cortical granules undergo exocytosis and the released content modifies the zona pellucida (ZP), preventing polyspermy. Calreticulin (CRT), a calcium-binding highly conserved protein of 60 kDa, is contained in cortical granules from hamster eggs (Muñoz-Gotera et al. 2001 Mol. Reprod. Dev. 60), and we recently showed it is exocytosed from chemically activated ZP-free pig oocytes (Romar et al. 2012 Reprod. Fertil. Dev. 24). When pig ZP-enclosed oocytes were incubated with CRT, monospermy was not improved (Romar et al. 2011, Maternal communication with gametes and embryo, p. 72), suggesting that the likely role of CRT in preventing polyspermy might be carried out at the oolemma level. Our objective was to evaluate whether CRT prevents polyspermy in pig ZP-free oocytes by treating the cells with this protein before being inseminated. In vitro-matured cumulus–oocyte complexes (44 h, NCSU-37 medium) were decumulated and ZP was digested with Tyrode’s acid. The ZP-free oocytes were incubated for 30 min in TALP medium supplemented with 0, 100, 1000, and 5000 pg of CRT (ab91577, Abcam, Cambridge, MA, USA) per oocyte. After washing, ZP-free oocytes were inseminated (25 000 sperm mL–1) and gametes were co-cultured for 18 h. Putative zygotes were fixed and stained with Hoechst 33342 to analyse the fertilization results. Four replicates with 30 to 35 oocytes per group were done, and results were analysed by one-way ANOVA. A P-value ≤0.05 was taken to denote statistical significance. Incubation with CRT did not affect penetration rates that were similar among groups (77.12 ± 3.88 and 72.73 ± 4.07, respectively, for the 0- and 5000-pg CRT groups). However, the mean number of sperm per penetrated oocyte decreased from 3.01 ± 0.28 (0-pg group) to 2.07 ± 0.16 (5000-pg group), and monospermy rate increased from 30.77 ± 4.87 (0-pg group) to 52.27 ± 5.36 (5000-pg group; P ≤ 0.05). Incubation with CRT did not affect the number of sperm attached to oolemma, which was similar among all groups (11.45 ± 1.16 v. 10.75 ± 1.17, respectively, for 0 and 5000 pg of CRT). These preliminary data suggest that CRT, a protein exocytosed after oocyte activation, participates in the membrane block to polyspermy in pigs. Future studies to describe the exact mechanism of action of this chaperone protein are necessary. Supported by MEC and FEDER (AGL2009-12512-C02-01).

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Activation of Clotting Factors in Thrombocytopenia Due to Platelets Destruction: A Possible Compensated Mechanism for Hemostasis.

Blood ◽

10.1182/blood.v106.11.3999.3999 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3999-3999

Author(s):

Vincenzo Fontana ◽

Wenche Jy ◽

Eugene Ahn ◽

Pamela Dudkiewicz ◽

Lawrence L. Horstman ◽

...

Keyword(s):

Bone Marrow Failure ◽

Statistical Significance ◽

Mean Value ◽

P Value ◽

Clotting Factors ◽

Platelet Destruction ◽

Excessive Bleeding ◽

Giant Platelets ◽

Fatal Bleeding ◽

The Mean

Abstract INTRODUCTION. Thrombocytopenia (TP) due to bone marrow failure, as in aplastic anemia (AA), is often associated with frequent and fatal bleeding, whereas fatal bleeding in TP due to platelet destruction, as in ITP, is rare. It has been suggested that giant platelets or increased cell-derived microparticles (MP) act to limit bleeding in ITP. We investigated clotting factors and MP from 3 cell types, platelets (PMP), leukocytes (LMP), and endothelial (EMP), in patients with different causes of their TP. METHODS. Group 1 (platelet destruction) consisted of 2 subgroups, Grp 1a having n=35 pts with active ITP (ITP-A) and Grp 1b having n=15 pts with platelet destruction (PD) by other disorders (TTP, PNH, others). Group 2 (impaired production (IP)) consisted of n=19 pts with AA, MDS/MPD, and others. Group 3 comprised n=28 pts with ITP in remission (ITP-R). Laboratory measures included CBC, platelets, FVIII, FIX, FXI, and 3 kinds of MP: PMP, LMP, EMP. Signs and symptoms of bleeding were graded and recorded. RESULTS. Key data is summarized in Table 1. The percentage of patients with elevated activity of FVIII was significantly more prevalent in Grp 1a vs. Grp 3 (53% vs. 15%, p=0.002) or Grp 1b vs. Grp 2 (73% vs. 11%, p=0.0002). The mean value of FVIII titer was also significantly higher in Grp 1a vs. Grp 3 (1.92 vs. 1.33 U/mL, p=0.0036) or Grp 1b vs. Grp 2 (2.44 vs. 1.18 U/mL, p=0.00007). The mean percentage of patients with elevated FIX or FXI, or the mean value of FIX or FXI titer were also higher in Grp 1a vs. Grp 3 or Grp 1b vs. Grp 2, but the difference did not reach statistical significance. PMP counts were found to correlate with platelet counts in all groups, and were significantly higher in Grp 3 than Grp 1a (p=0.0004). Grp 3 also had higher EMP than Grp 1a (p=0.04). LMP showed no significant differences. REPRESENTATIVE CASE. A patient with chronic ITP who relapsed with severe acute ITP was monitored sequentially. In acute phase of TP, activities of FVIII, FIX, and FXI surged, in parallel with shortening of aPTT, and patient had minimal signs of bleeding. Serial assays revealed gradual fall of factor activities, reaching normal levels after 5 months. A similar pattern was observed in another patient, with acute TTP: clotting factors returned to normal after 2 months. CONCLUSION. TP due to platelet destruction appears to trigger activation of intrinsic clotting pathway which may protect from excessive bleeding. Surge in FVIII was most notable. This compensation effect appears to be absent in TP due to depressed platelet production, and likewise for ITP in remission. The mechanism underlying this phenomenon remains to be elucidated. Further study is in progress to delineate the mechanism. Table 1 Grp1a (ITP-A) Grp1b (PD) Grp2 (IP) Grp3 (ITP-R) p value p value Number 35 15 19 28 1a vs 3 1b vs 2 FVIII (%) 53 73 11 15 0.002 0.0002 FIX (%) 19 27 6 13 NS NS FXI (%) 16 14 0 8 NS NS PMP 8315 15531 9768 17085 0.0004 NS EMP 328 325 393 578 0.04 NS LMP 1388 1230 1255 1486 NS NS

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Profile of Cell-Derived Microparticles (C-MP) in ITP: Red Cell Microparticles (RMP) Correlate with Severity of ITP.

Blood ◽

10.1182/blood.v108.11.1087.1087 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1087-1087

Author(s):

Vincenzo Fontana ◽

Pamela Dudkiewicz ◽

Eugene Ahn ◽

Wenche Jy ◽

Lawrence L. Horstman ◽

...

Keyword(s):

Statistical Significance ◽

Annexin V ◽

Inverse Correlation ◽

Intravenous Immunoglobulins ◽

Mean Value ◽

P Value ◽

Clotting Factors ◽

Anionic Phospholipids ◽

The Mean ◽

Sensitive Marker

Abstract BACKGROUND: The roles of cell-derived microparticles (C-MP) released from platelets (PMP), endothelial cells (EMP), leukocytes (LMP) and red cells (RMP) in hemostasis, thrombosis and inflammation have been appreciated in recent years. Although PMP were shown to be hemostatically active, the roles of other C-MP, especially RMP, have not been studied in ITP. We investigated C-MP in patients with ITP. MATERIAL AND METHODS: One-hundred-six patients with ITP were studied. They consisted of 73 pts with active ITP (ITP-A, 30M/43F, mean age 53.8 yr) and 33 pts in remission (ITP-R, 4M/29F, mean age 53.4 yr). ITP-A was defined by plt count <140,000 for >3 months; ITP-R was defined by plt count >140,000 for >3 months. Mean plt counts was 78,000 for ITP-A and 224,000 for ITP-R. The two groups were similar in ages. CBC with plt count, aPTT and activities of FVIII, FIX, FXI, were measured. Using flow cytometry, PMP were identified by CD41+, EMP by CD31+/CD41−, LMP by CD45+, and RMP by glycophorin+. Effects of intravenous immunoglobulins (IVIG) on C-MP were also evaluated. RESULTS: There was a strong inverse correlation between plt counts and RMP (p=0.002). RMP were higher when plt counts were lower. A significant correlation was found between platelet counts and PMP (p<0.0001) and EMP (p<0.0001), but not LMP (p>0.05). The mean value of RMP was higher in ITP-A than ITP-R (p= 0.009). Conversely, PMP and EMP were higher in ITP-R (P<0.0001). No difference was found in LMP. FVIII and IX were higher in ITP-A than ITP-R (p=0.006, p=0.001, respectively).The aPTT was shorter and FXI higher in ITP-A but they did not reach statistical significance. Only RMP (not PMP, EMP or LMP) correlated with elevated factors VIII, IX and XI (P=0.005, 0.001 and 0.005 respectively) and inversely correlated with aPTT (p=0.009). Infusion of IVIG reduced RMP (RMP pre/post=1519/1018), not the other C-MP, in 9 pts DISCUSSION/CONCLUSIONS: (i) RMP inversely correlated with plt counts and appear to be a sensitive marker of severity of ITP. However mechanisms of RMP generation, their reduction following IVIG and their roles remain to be elucidated. (ii) Among C-MP, only RMP, not other C-MP, were associated with shortening aPTT and elevated FVIII, IX, XI. (iii) RMP are positive for annexin V, providing anionic phospholipids for clotting factors and generating thrombin (data not shown). These findings suggest that RMP associated with these factors are involved in hemostasis to prevent bleeding in severe ITP. Table 1. ITP-A ITP-R p-value No. Patients 73 33 Plt count 78,000 224,000 <0.0001 C-MP: PMP 8074 16403 <0.0001 EMP 292 667 <0.0001 LMP 1718 1705 n. s. RMP 2292 1505 <0.01 Coag: aPTT 24.9 25.7 n. s. FVIII 1.95 1.50 0.006 FIX 1.53 1.28 0.001 FXI 1.29 1.12 n.s.

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Very Early Post-Treatment PET/CT Scan Performed One Week after First Chemotherapy Course Compared Against the Standard PET after Third Course in Histologically Aggressive Lymphoma (NHL).

Blood ◽

10.1182/blood.v108.11.2433.2433 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2433-2433

Author(s):

Fernando Cabanillas ◽

Jorge Toro ◽

Jorge W. Perdomo ◽

Idalia Liboy ◽

Orestes Pavia ◽

...

Keyword(s):

Ct Scan ◽

Statistical Significance ◽

Independent Set ◽

Post Treatment ◽

Pet Scan ◽

Aggressive Lymphoma ◽

P Value ◽

Pet Ct ◽

The Mean ◽

Pet Ct Scan

Abstract The FDG-PET/CT scan has become a standard tool in the management of NHL. Failure to achieve an early metabolic CR (mCR) is associated with a poor outcome and this information can be used to modify subsequent management. However, several issues still need to be resolved, including: 1-What is the best time to perform a post-treatment PET scan? Is very early (i.e. 1 week) after the first chemotherapy superior to the traditional 3rd course PET scan? 2-What criteria can we use to define mCR? Is there an SUV threshold on the very early PET scan that best defines mCR? In order to answer these questions we designed a study in which patients with histologically aggressive NHLs had 3 sequential PET scans: 1st one at baseline, a 2nd one on week 1 after the 1st course of chemotherapy (W1 PET) and the 3rd one after course 3 of chemotherapy (C3 PET). We have entered 32 patients of which 30 are currently assessable. Histologies were: DLCL=26, FLCL=4. IPI was ≥2 in 69%. At baseline, median SUVmax=17.14 (range 5.6–47.1). In the 30 cases who had a W1 PET, the mean SUVmax dropped to 4.4 (0.7–21.3, corrected for background). In the 24 who have completed their C3 PET the mean SUVmax was 1.55 (0–15.2) and only 6 patients had an SUV >0: 0.9, 3.7, 3.9, 5.1, 8.3, 15.2. We then examined the correlation between the SUVmax of W1 PET with SUVmax of C3 PET. 24 cases have already had both a W1 PET and a C3 PET. Table 1 shows that the W1 PET correlated well with 17 (71%) of the 24 C3 PETs. All 14 who achieved SUVmax <4.0 on W1 PET had an SUVmax <4.0 on C3 PET (all of the latter achieved SUVs <1.0). However, of 10 cases who failed to attain SUVmax <4.0 on W1 PET, 7 went on to achieve SUVmax <4.0 on C3 PET, and 2 of these 7 relapsed. For the purpose of determining the best SUV cut-off that can be used to define mCR, we examined the failure free survival (FFS) at various cut-offs ranging from 0 to 8.0 for both W1 PETs and C3 PETs. The best cut-off for both W1 PET and C3 PET was observed at 4.0 (table 2). We thus defined mCR as a post-treatment SUVmax <4.0. Those who achieved mCR on the W1 PET had a significantly superior FFS (Kaplan-Meier method) than those who didn’t reach mCR (table 2). The results for the C3 PET didn’t reach statistical significance (table 2). Conclusions: 1- Striking improvements in the PET scan are seen as early as 1 week after the first chemotherapy course. 2-The results of the W1 PET anticipated correctly 71% of C3 PET results. 3- Patients who attained an SUVmax <4.0 on the W1 PET had a remarkably superior outcome than those with SUV max ≥4.0 and was associated with a 91% FFS. Thus an SUV cut-off of <4.0 at W1 PET can be used to define mCR. This finding should be confirmed in an independent set of patients. 4- The W1 PET is more sensitive and specific than the C3 PET and is preferable to the C3 PET in predicting clinical outcome. Correlation of W1PET SUVmax With C3PET SUVmax W1PET SUVmax N C3PET SUVmax<4.0 C3PET SUVmax≥4.0 <4.0 14 14 0 ≥4.0 10 7 3 Correlation of W1PET SUVmax and C3PET SUVmax With Outcome W1PET SUVmax N %FFS 8 mos. P value <4.0 18 91% ≥4.0 12 0% .01 C3PET SUVmax <4.0 21 73% ≥4.0 3 67% .19

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