Optimised method for normal range estimation of standardized uptake values (SUVmax, SUVmean) in liver SPECT/CT images with somatostatin analogue 99mTc-HYNIC-TOC (Tektrotyd).

Abstract Background99mTc-HYNIC-TOC (Tektrotyd) is a radiopharmaceutical used for the diagnosis of lesions with overexpression of somatostatin receptors. The purpose of this study was to optimise the method and estimate normal ranges for standardized uptake values of Tektrotyd in healthy livers. MethodsAn analysis of SUVs normal ranges was performed for images acquired in a selected “healthy group” of 42 patients evaluated for NET tumours. The “pathological group” comprised 20 patients with liver lesions detected by scintigraphic imaging. Normal ranges for radiopharmaceutical uptake values were estimated based on the quantitative analysis of images acquired with a GE Healthcare NM/CT 850 gamma camera.ResultsThe method for healthy liver segmentation in SPECT/CT was optimized. The normal range of SUVs for the liver was: SUVbw max [5.2-14.0] g/ml and SUVlbm max [3.5-9.5] g/ml. The relative standard error (relative SE) of activity concentration estimated in the phantom study for the largest hot spheres was: ϕ=37mm- 5.9%, ϕ=28mm- 7.1%, ϕ=22mm- 11.4%, and ϕ=17mm- 22%.Conclusions· Segmentation in the mid-coronal CT image, at one-fourth of the height of the liver measured from the top, with a medium-sized VOI outlined on a given transverse SPECT slice was regarded as the optimal method for estimating normal ranges for standardized uptake values.· It is necessary to standardise quantification methods in the SPECT/CT studies. Our work is a step forward in obtaining standardisation of SPECT/CT SUV calculation methods.· Calculations for radiopharmaceutical uptake in tumours with volumes smaller than 5 ml are biased with a significant measurement error.

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Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0031-1287792 ◽

2011 ◽

Vol 120 (02) ◽

pp. 68-72 ◽

Cited By ~ 10

Author(s):

A. Jawiarczyk ◽

M. Bolanowski ◽

J. Syrycka ◽

G. Bednarek-Tupikowska ◽

M. Kałużny ◽

...

Keyword(s):

Adrenal Gland ◽

Somatostatin Receptors ◽

Subcutaneous Administration ◽

Pancreatic Neuroendocrine Tumor ◽

Somatostatin Analogue ◽

Left Adrenal Gland ◽

Glucose Levels ◽

Long Acting ◽

The Right

AbstractWe are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

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Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children

PEDIATRICS ◽

10.1542/peds.93.4.622 ◽

1994 ◽

Vol 93 (4) ◽

pp. 622-623

Author(s):

Robert Ellis

Keyword(s):

Cerebrospinal Fluid ◽

Intrathecal Chemotherapy ◽

Lateral Decubitus Position ◽

Normal Range ◽

Opening Pressure ◽

Csf Pressure ◽

Normal Ranges ◽

Extended Position ◽

Lateral Decubitus ◽

Lumbar Cerebrospinal Fluid

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children. Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded. Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure. Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.

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Lung and chest wall impedances in the dog in normal range of breathing: effects of pulmonary edema

Journal of Applied Physiology ◽

10.1152/jappl.1992.73.3.1040 ◽

1992 ◽

Vol 73 (3) ◽

pp. 1040-1046 ◽

Cited By ~ 45

Author(s):

G. M. Barnas ◽

D. Stamenovic ◽

K. R. Lutchen

Keyword(s):

Oleic Acid ◽

Pulmonary Edema ◽

Chest Wall ◽

Mean Airway Pressure ◽

Normal Range ◽

Normal Ranges ◽

Before And After ◽

Measured Resistance ◽

The Right ◽

Severe Pulmonary Edema

We evaluated the effect of pulmonary edema on the frequency (f) and tidal volume (VT) dependences of respiratory system mechanical properties in the normal ranges of breathing. We measured resistance and elastance of the lungs (RL and EL) and chest wall of four anesthetized-paralyzed dogs during sinusoidal volume oscillations at the trachea (50–300 ml, 0.2–2 Hz), delivered at a constant mean airway pressure. Measurements were made before and after severe pulmonary edema was produced by injection of 0.06 ml/kg oleic acid into the right atrium. Chest wall properties were not changed by the injection. Before oleic acid, EL increased slightly with increasing f in each dog but was independent of VT. RL decreased slightly and was independent of VT from 0.2 to 0.4 Hz, but above 0.4 Hz it tended to increase with increasing flow, presumably due to the airway contribution. After oleic acid injection, EL and RL increased greatly. Large negative dependences of EL on VT and of RL on f were also evident, so that EL and RL after oleic acid changed two- and fivefold, respectively, within the ranges of f and VT studied. We conclude that severe pulmonary edema changes lung properties so as to make behavior VT dependent (i.e., nonlinear) and very frequency dependent in the normal range of breathing.

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Lidar arc scan uncertainty reduction through scanning geometry optimization

Atmospheric Measurement Techniques ◽

10.5194/amt-9-1653-2016 ◽

2016 ◽

Vol 9 (4) ◽

pp. 1653-1669 ◽

Cited By ~ 7

Author(s):

Hui Wang ◽

Rebecca J. Barthelmie ◽

Sara C. Pryor ◽

Gareth. Brown

Keyword(s):

Theoretical Model ◽

Wind Speed ◽

Wind Energy ◽

Turbulence Intensity ◽

Wind Direction ◽

Energy Production ◽

Elevation Angle ◽

Relative Standard Error ◽

Power Performance ◽

Relative Standard

Abstract. Doppler lidars are frequently operated in a mode referred to as arc scans, wherein the lidar beam scans across a sector with a fixed elevation angle and the resulting measurements are used to derive an estimate of the n minute horizontal mean wind velocity (speed and direction). Previous studies have shown that the uncertainty in the measured wind speed originates from turbulent wind fluctuations and depends on the scan geometry (the arc span and the arc orientation). This paper is designed to provide guidance on optimal scan geometries for two key applications in the wind energy industry: wind turbine power performance analysis and annual energy production prediction. We present a quantitative analysis of the retrieved wind speed uncertainty derived using a theoretical model with the assumption of isotropic and frozen turbulence, and observations from three sites that are onshore with flat terrain, onshore with complex terrain and offshore, respectively. The results from both the theoretical model and observations show that the uncertainty is scaled with the turbulence intensity such that the relative standard error on the 10 min mean wind speed is about 30 % of the turbulence intensity. The uncertainty in both retrieved wind speeds and derived wind energy production estimates can be reduced by aligning lidar beams with the dominant wind direction, increasing the arc span and lowering the number of beams per arc scan. Large arc spans should be used at sites with high turbulence intensity and/or large wind direction variation.

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Primary hyperfibrinolysis as the presenting sign of prostate cancer: A case report

Vojnosanitetski pregled ◽

10.2298/vsp150525076k ◽

2016 ◽

Vol 73 (9) ◽

pp. 877-880 ◽

Cited By ~ 2

Author(s):

Andrijana Kulic ◽

Zorica Cvetkovic ◽

Vesna Libek

Keyword(s):

Prostate Cancer ◽

Case Report ◽

Fibrinogen Level ◽

Laboratory Diagnosis ◽

Cancer Case ◽

Normal Range ◽

Normal Ranges ◽

Assay Result ◽

The Right ◽

D Dimer

Introduction. A bleeding syndrome in the setting of primary hyperfibrinolysis in a prostate cancer patient is only 0.40? 1.65% of cases. The laboratory diagnosis of primary hyperfibrinolysis is based on the increase of biomarkers like D-dimer, fibrinogen split products, plasminogen, and euglobulin lysis test. These tests are not specific for primary hyperfibrinolysis. We reported a rare case of hemorrhagic syndrome caused by primary hyperfibrinolysis as the first clinical symptom of metastatic prostate cancer. Case report. A 64-year-old male was admitted to our hospital with large hematomas in the right pectoral and axillary areas (20 x 7 cm), right hemiabdomen (30 x 30 cm) and the left lumbal area, (25 x 5 cm). The patient had no subjective symptoms nor used any medication. Initial coagulation testing, prothrombin time (PT), and activated partial thromboplastin time (APTT) were within the normal range, while fibrinogen level was extremely low (1.068 g/L) (normal range 2.0?5.0) and the D-dimer assay result was high 1.122 mg/L (normal range < 0.23). The results obtained by rotation thrombelastometry pointed to primary fibrinolysis. Further clinical and laboratory examination indicated progressive malignant prostate disease. First line treatment for the patient was a combined administration of tranexamic acid (3 x 500 mg iv) and transfusion of ten units of cryoprecipitate (400 mL). Next day, fibrinolytic function measurements by rotation thrombelastometry were within the normal ranges. Fibrinogen level was normalized within two days (2.4 g/L). There were no newly developed hematomas. Conclusion. This case report shows primary hyperfibrinolysis with bleeding symptoms, which is an uncommon paraneoplastic phenomenon within expanded prostate malignancy. Rotation thrombelastometry in this severe complication helped to achieve the prompt and proper diagnosis and treatment.

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Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

Acta Endocrinologica ◽

10.1530/eje-18-0688 ◽

2019 ◽

Vol 180 (4) ◽

pp. K21-K29 ◽

Cited By ~ 4

Author(s):

Anne Marie Hannon ◽

Triona O’Shea ◽

Claire A Thompson ◽

Mark J Hannon ◽

Rosemary Dineen ◽

...

Keyword(s):

Case Series ◽

Later Life ◽

Reference Level ◽

Somatostatin Analogue ◽

Biochemical Control ◽

Normal Range ◽

Normal Limits ◽

Age Related ◽

Plasma Gh ◽

Pituitary Macroadenomas

Pregnancy is rarely reported in acromegaly. Many patients are diagnosed in later life and younger patients may have subfertility due to hypopituitarism. We present a case series of 17 pregnancies in 12 women with acromegaly. Twelve women with acromegaly who completed pregnancy were identified from centres involved in the Irish Pituitary Study. Eleven women had pituitary macroadenomas and one woman had a microadenoma. Only 5/17 pregnancies had optimal biochemical control of acromegaly preconception, as defined by IGF-1 concentration in the age-related reference level and plasma GH concentration of <2 μg/L. In 6/17 pregnancies, dopamine agonist treatment was continued during pregnancy; all other acromegaly treatments were discontinued during pregnancy. Effect of pregnancy on acromegaly: No patient developed new visual field abnormalities, or symptoms suggestive of tumour expansion during pregnancy. In 9/12 patients, plasma IGF-1 concentrations that were elevated preconception normalised during pregnancy. There was a reduction in plasma IGF-1 concentrations, though not into the normal range, in a further two pregnancies. Effect of acromegaly on pregnancy: 15 healthy babies were born at term; one patient underwent emergency C-section at 32 weeks for pre-eclampsia, and one twin pregnancy had an elective C-section at 35 weeks’ gestation. Blood pressure remained within normal limits in the remainder of the pregnancies. Gestational diabetes did not develop in any pregnancy. Our data suggests that pregnancy in women with acromegaly is generally safe, from a maternal and foetal perspective. Furthermore, biochemical control tends to improve despite the withdrawal of somatostatin analogue therapy during pregnancy.

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Population Pharmacokinetics of Fluconazole in Young Infants

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00569-08 ◽

2008 ◽

Vol 52 (11) ◽

pp. 4043-4049 ◽

Cited By ~ 120

Author(s):

K. C. Wade ◽

D. Wu ◽

D. A. Kaufman ◽

R. M. Ward ◽

D. K. Benjamin ◽

...

Keyword(s):

Fixed Effects ◽

Compartment Model ◽

Volume Of Distribution ◽

Relative Standard Error ◽

Data Set ◽

Mixed Effect ◽

Young Infants ◽

Relative Standard ◽

Population Pk ◽

The Impact

ABSTRACT Fluconazole is being increasingly used to prevent and treat invasive candidiasis in neonates, yet dosing is largely empirical due to the lack of adequate pharmacokinetic (PK) data. We performed a multicenter population PK study of fluconazole in 23- to 40-week-gestation infants less than 120 days of age. We developed a population PK model using nonlinear mixed effect modeling (NONMEM) with the NONMEM algorithm. Covariate effects were predefined and evaluated based on estimation precision and clinical significance. We studied fluconazole PK in 55 infants who at enrollment had a median (range) weight of 1.02 (0.440 to 7.125) kg, a gestational age at birth (BGA) of 26 (23 to 40) weeks, and a postnatal age (PNA) of 2.3 (0.14 to 12.6) weeks. The final data set contained 357 samples; 217/357 (61%) were collected prospectively at prespecified time intervals, and 140/357 (39%) were scavenged from discarded clinical specimens. Fluconazole population PK was best described by a one-compartment model with covariates normalized to median values. The population mean clearance (CL) can be derived for this population by the equation CL (liter/h) equals 0.015 · (weight/1)0.75 · (BGA/26)1.739 · (PNA/2)0.237 · serum creatinine (SCRT)−4.896 (when SCRT is >1.0 mg/dl), and using a volume of distribution (V) (liter) of 1.024 · (weight/1). The relative standard error around the fixed effects point estimates ranged from 3 to 24%. CL doubles between birth and 28 days of age from 0.008 to 0.016 and from 0.010 to 0.022 liter/kg/h for typical 24- and 32-week-gestation infants, respectively. This population PK model of fluconazole discriminated the impact of BGA, PNA, and creatinine on drug CL. Our data suggest that dosing in young infants will require adjustment for BGA and PNA to achieve targeted systemic drug exposures.

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Determination of total antioxidant capacity of milk by CUPRAC and ABTS methods with separate characterisation of milk protein fractions

Journal of Dairy Research ◽

10.1017/s0022029915000114 ◽

2015 ◽

Vol 82 (2) ◽

pp. 177-184 ◽

Cited By ~ 6

Author(s):

Sema Demirci Çekiç ◽

Aslı Demir ◽

Kevser Sözgen Başkan ◽

Esma Tütem ◽

Reşat Apak

Keyword(s):

Antioxidant Capacity ◽

Total Antioxidant Capacity ◽

Milk Protein ◽

Skim Milk ◽

Protein Fractions ◽

Relative Standard Error ◽

Antioxidant Power ◽

Antioxidant Capacities ◽

Relative Standard ◽

Total Antioxidant

Most milk-applied antioxidant assays in literature are based on the isolation and quantification of individual antioxidative compounds, whereas total antioxidant capacity (TAC) gives a more holistic picture due to cooperative action of antioxidants. Recently, the cupric reducing antioxidant capacity (CUPRAC) method has been modified to measure the antioxidant capacities of thiol-containing proteins, where the classical ammonium acetate buffer – that may otherwise precipitate proteins– was replaced with concentrated urea buffer (able to expose embedded thiol groups of proteins to oxidative attack) adjusted to pH 7.0. Thus, antioxidant capacity of milk was investigated with two competing TAC assays, namely CUPRAC and ABTS (2,2′-azinobis(3-ethylbenzothiazoline-6-sulphonic acid))/persulphate, because only these assays were capable of evaluating protein contribution to the observed TAC value. As milk fat caused turbidity, experiments were carried out with skim milk or defatted milk samples. To determine TAC, modified CUPRAC method was applied to whole milk, separated and redissolved protein fractions, and the remaining liquid phase after necessary operations. Both TAC methods were investigated for their dilution sensitivity and antioxidant power assessment of separate milk fractions such as casein and whey. Proteins like β-lactoglobulin and casein (but not simple thiols) exhibited enhanced CUPRAC reactivity with surfactant (SDS) addition. Addition of milk protein fractions to whole skim milk produced significant ‘negative-biased’ deviations (up to −26% relative standard error) from TAC absorbance additivity in the application of the ABTS method, as opposed to that of the CUPRAC method less affected by chemical deviations from Beer's law thereby producing much smaller deviations from additivity (i.e. the property of additivity is valid when the measured TAC of a mixture is equal to the sum of individual antioxidant capacities of its constituents).

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Effects of Intra-and Interindividual Variation on the Appropriate Use of Normal Ranges

Clinical Chemistry ◽

10.1093/clinchem/20.12.1535 ◽

1974 ◽

Vol 20 (12) ◽

pp. 1535-1542 ◽

Cited By ~ 207

Author(s):

Eugene K Harris

Keyword(s):

Blood Chemistry ◽

Interindividual Variation ◽

Normal Range ◽

Average Ratio ◽

Normal Ranges ◽

Distribution Of Values ◽

Laboratory Test Results ◽

Sources Of Variation ◽

Time Systems ◽

Number Of Individuals

Abstract Normal ranges based on the distribution of single samples from a large number of individuals reflect both intra- and interindividual variation. If the average ratio of these two sources of variation is small, then, assuming gaussian distributions, the conventional normal range will usually include a larger than expected proportion of an individual's distribution of values. When the average ratio exceeds 1.4, the normal range will include a proportion either larger or smaller than expected, depending on whether the individual's variability is less than or greater than average intra-individual variation. Investigation of multivariate normal regions in certain cases where calculations are feasible produced similar results. With these numerical guidelines, data from recent blood-chemistry studies indicate that conventional normal ranges are likely to be less sensitive than desired to significant changes in an individual's biochemical state. This analysis supports the continued development and use of cumulative (in time) systems for reporting laboratory test results for individuals.

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