scholarly journals Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

2021 ◽  
Vol 10 (21) ◽  
pp. 5160
Author(s):  
Egesta Lopci
Keyword(s):  
Large Scale ◽  
Clinical Laboratory ◽  
Scale Validation ◽  
Checkpoint Inhibitors ◽  
Laboratory Data ◽  
Major Change ◽  
New Drugs ◽  
Response Criteria ◽  
Clinical Implementation ◽  
Pet Ct

Immunotherapy with checkpoint inhibitors has prompted a major change not only in cancer treatment but also in medical imaging. In parallel with the implementation of new drugs modulating the immune system, new response criteria have been developed, aiming to overcome clinical drawbacks related to the new, unusual, patterns of response characterizing both solid tumors and lymphoma during the course of immunotherapy. The acknowledgement of pseudo-progression, hyper-progression, immune-dissociated response and so forth, has become mandatory for all imagers dealing with this clinical scenario. A long list of acronyms, i.e., irRC, iRECIST, irRECIST, imRECIST, PECRIT, PERCIMT, imPERCIST, iPERCIST, depicts the enormous effort made by radiology and nuclear medicine physicians in the last decade to optimize imaging parameters for better prediction of clinical benefit in immunotherapy regimens. Quite frequently, a combination of clinical-laboratory data with imaging findings has been tested, proving the ability to stratify patients into various risk groups. The next steps necessarily require a large scale validation of the most robust criteria, as well as the clinical implementation of immune-targeting tracers for immuno-PET or the exploitation of radiomics and artificial intelligence as complementary tools during the course of immunotherapy administration. For the present review article, a summary of PET/CT role for immunotherapy monitoring will be provided. By scrolling into various cancer types and applied response criteria, the reader will obtain necessary information for better understanding the potentials and limitations of the modality in the clinical setting.

The Role of PET/CT in the Era of Immune Checkpoint Inhibitors: State of Art

2020 ◽  
Vol 13 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Angelo Castello ◽  
Egesta Lopci
Keyword(s):  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Advanced Melanoma ◽  
Response Criteria ◽  
Response Evaluation ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Background: Immune checkpoint inhibitors (ICI) have achieved astonishing results and improved overall survival (OS) in several types of malignancies, including advanced melanoma. However, due to a peculiar type of anti-cancer activity provided by these drugs, the response patterns during ICI treatment are completely different from that with “old” chemotherapeutic agents. Objective: To provide an overview of the available literature and potentials of 18F-FDG PET/CT in advanced melanoma during the course of therapy with ICI in the context of treatment response evaluation. Methods: Morphologic criteria, expressed by Response Evaluation Criteria in Solid Tumors (RECIST), immune-related response criteria (irRC), irRECIST, and, more recently, immune-RECIST (iRECIST), along with response criteria based on the metabolic parameters with 18F-Fluorodeoxyglucose (18FFDG), have been explored. Results: To overcome the limits of traditional response criteria, new metabolic response criteria have been introduced on time and are being continuously updated, such as the PET/CT Criteria for the early prediction of Response to Immune checkpoint inhibitor Therapy (PECRIT), the PET Response Evaluation Criteria for Immunotherapy (PERCIMT), and “immunotherapy-modified” PET Response Criteria in Solid Tumors (imPERCIST). The introduction of new PET radiotracers, based on monoclonal antibodies combined with radioactive elements (“immune-PET”), are of great interest. Conclusion: Although the role of 18F-FDG PET/CT in malignant melanoma has been widely validated for detecting distant metastases and recurrences, evidences in course of ICI are still scarce and larger multicenter clinical trials are needed.

A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results

2008 ◽  
Vol 61 (4) ◽  
pp. 514-518 ◽  
Author(s):  
N Hatanaka ◽  
Y Yamamoto ◽  
K Ichihara ◽  
S Mastuo ◽  
Y Nakamura ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Pressure Ulcers ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Clinical Implementation ◽  
Clinical Tool ◽  
Braden Scale ◽  
Hospitalised Patients

Background:Various scales have been devised to predict development of pressure ulcers on the basis of clinical and laboratory data, such as the Braden Scale (Braden score), which is used to monitor activity and skin conditions of bedridden patients. However, none of these scales facilitates clinically reliable prediction.Aims:To develop a clinical laboratory data-based predictive equation for the development of pressure ulcers.Methods:Subjects were 149 hospitalised patients with respiratory disorders who were monitored for the development of pressure ulcers over a 3-month period. The proportional hazards model (Cox regression) was used to analyse the results of 12 basic laboratory tests on the day of hospitalisation in comparison with Braden score.Results:Pressure ulcers developed in 38 patients within the study period. A Cox regression model consisting solely of Braden scale items showed that none of these items contributed to significantly predicting pressure ulcers. Rather, a combination of haemoglobin (Hb), C-reactive protein (CRP), albumin (Alb), age, and gender produced the best model for prediction. Using the set of explanatory variables, we created a new indicator based on a multiple logistic regression equation. The new indicator showed high sensitivity (0.73) and specificity (0.70), and its diagnostic power was higher than that of Alb, Hb, CRP, or the Braden score alone.Conclusions:The new indicator may become a more useful clinical tool for predicting presser ulcers than Braden score. The new indicator warrants verification studies to facilitate its clinical implementation in the future.

scholarly journals Blood-Based Biomarkers for Glioma in the Context of Gliomagenesis: A Systematic Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Hamza Ali ◽  
Romée Harting ◽  
Ralph de Vries ◽  
Meedie Ali ◽  
Thomas Wurdinger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Scale Validation ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Clinical Implementation ◽  
Glial Tumor ◽  
Multiple Biomarkers ◽  
Degree Of Malignancy ◽  
New Research

BackgroundGliomas are the most common and aggressive tumors of the central nervous system. A robust and widely used blood-based biomarker for glioma has not yet been identified. In recent years, a plethora of new research on blood-based biomarkers for glial tumors has been published. In this review, we question which molecules, including proteins, nucleic acids, circulating cells, and metabolomics, are most promising blood-based biomarkers for glioma diagnosis, prognosis, monitoring and other purposes, and align them to the seminal processes of cancer.MethodsThe Pubmed and Embase databases were systematically searched. Biomarkers were categorized in the identified biomolecules and biosources. Biomarker characteristics were assessed using the area under the curve (AUC), accuracy, sensitivity and/or specificity values and the degree of statistical significance among the assessed clinical groups was reported.Results7,919 references were identified: 3,596 in PubMed and 4,323 in Embase. Following screening of titles, abstracts and availability of full-text, 262 articles were included in the final systematic review. Panels of multiple biomarkers together consistently reached AUCs >0.8 and accuracies >80% for various purposes but especially for diagnostics. The accuracy of single biomarkers, consisting of only one measurement, was far more variable, but single microRNAs and proteins are generally more promising as compared to other biomarker types.ConclusionPanels of microRNAs and proteins are most promising biomarkers, while single biomarkers such as GFAP, IL-10 and individual miRNAs also hold promise. It is possible that panels are more accurate once these are involved in different, complementary cancer-related molecular pathways, because not all pathways may be dysregulated in cancer patients. As biomarkers seem to be increasingly dysregulated in patients with short survival, higher tumor grades and more pathological tumor types, it can be hypothesized that more pathways are dysregulated as the degree of malignancy of the glial tumor increases. Despite, none of the biomarkers found in the literature search seem to be currently ready for clinical implementation, and most of the studies report only preliminary application of the identified biomarkers. Hence, large-scale validation of currently identified and potential novel biomarkers to show clinical utility is warranted.

scholarly journals Electronic tools in clinical laboratory diagnostics: key examples, limitations, and value in laboratory medicine

2021 ◽  
Vol 45 (6) ◽  
pp. 319-324
Author(s):  
Mary Kathryn Bohn ◽  
Giulia F. Fabiano ◽  
Khosrow Adeli
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Reference Intervals ◽  
Medical Laboratory ◽  
Laboratory Diagnostics ◽  
Evidence Based ◽  
Complex Data ◽  
Clinical Implementation ◽  
Patient Centered ◽  
Diagnostic Management

Abstract Electronic tools in clinical laboratory diagnostics can assist laboratory professionals, clinicians, and patients in medical diagnostic management and laboratory test interpretation. With increasing implementation of electronic health records (EHRs) and laboratory information systems worldwide, there is increasing demand for well-designed and evidence-based electronic resources. Both complex data-driven and simple interpretative electronic healthcare tools are currently available to improve the integration of clinical and laboratory information towards a more patient-centered approach to medicine. Several studies have reported positive clinical impact of electronic healthcare tool implementation in clinical laboratory diagnostics, including in the management of neonatal bilirubinemia, cardiac disease, and nutritional status. As patients have increasing access to their medical laboratory data, it is essential that accessible electronic healthcare tools are evidence-based and user-friendly for individuals of varying digital and medical literacy. Indeed, studies suggest electronic healthcare tool development processes significantly lack the involvement of relevant healthcare professionals and often present misinformation, including erroneous calculation algorithms or inappropriate interpretative recommendations. The current review provides an overview of the utility of available electronic healthcare tools in clinical laboratory diagnostics and critically reviews potential limitations and benefits of their clinical implementation. The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) online database is also detailed as an example of a pediatric diagnostic tool with widespread global impact.

scholarly journals Characteristics of patients infected with SARS COVID-19 admitted at COVID health facilities in one of the aspirational district of India: a retrospective study

2020 ◽  
Vol 7 (11) ◽  
pp. 4435
Author(s):  
Ekta Sharma ◽  
Gurmeet Katoch ◽  
Rajesh Guleri ◽  
Jalam Bhardwaj
Keyword(s):  
Large Scale ◽  
Clinical Laboratory ◽  
Descriptive Analysis ◽  
Laboratory Data ◽  
Age Groups ◽  
The Elderly ◽  
Categorical Variables ◽  
Close Monitoring ◽  
Continuous Variables ◽  
Wide Range

Background: COVID-19 is the third corona virus that has emerged among the human population in the last two decades. The main aim of this study was to describe the epidemiologic features, clinical presentation of first 52 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection admitted at COVID health facilities.Methods: A retrospective descriptive study was conducted over a period of three months from 1st April 2020 to 30th June 2020. We obtained demographic, epidemiological, clinical, laboratory data from the medical records of patients infected with SARS-Cov-2. The categorical variables were expressed in terms of frequency and percentages and the continuous variables were expressed as mean and standard deviation. In addition to descriptive analysis, Pearson’s chi- square test was applied to ascertain the associations between certain variables.Results: The mean age of participants was 29±11.67 years with a male preponderance. Forty three (83%) patients had travel history within India in the previous 30 days i.e. from Delhi (35%), Haryana (15%), Tamilnadu (11%), Himachal Pradesh (8%), Maharashtra (1.9%), Punjab (8%), and Uttar Pradesh (4%). Majority of the patients (90%) were asymptomatic. The age group of 21-30 years was the most affected group (44%) as comparison to the other age groups. No mortality was reported and 100% recovery rate was found.Conclusions: In conclusion, COVID-19 affects a wide-range of patients, from youth to the elderly.  In this study, all the COVID-19 infected patients were classified as mild as most were asymptomatic. Close monitoring and large-scale control strategies will be needed to prevent widespread transmission within the community.

scholarly journals Evaluation of the metabolism properties of choline kinase alpha in neoplasms of the parathyroid glands. A pilot study

2019 ◽  
Vol 16 (3) ◽  
pp. 94-103
Author(s):  
Natalia G. Mokrysheva ◽  
Iya A. Voronkova ◽  
Julia A. Krupinova ◽  
Mikhail B. Dolgushin ◽  
Larisa E. Gurevch ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Clinical Laboratory ◽  
Activity Index ◽  
Laboratory Data ◽  
Choline Kinase ◽  
Tissue Samples ◽  
Endocrine Disease ◽  
Chief Cells ◽  
Positron Emission ◽  
Pet Ct

BACKGROUND: Primary hyperparathyroidism (PHPT) is a widespread endocrine disease characterized by excessive production of parathyroid hormone (PTH) due to parathyroid gland hyperplasia (PGH) or tumor lesions (adenoma or cancer of the parathyroid gland (PG) in 80% and 15% of cases respectively). Choline kinase alpha (XK) overexpression is described in tumors of different localization, but there is no data on its expression in PG tumors. AIMS: To study the character of XK expression in PG neoplasms and its relationship with clinical, laboratory, and visualization characteristics (positron emission tomography combined with computed tomography (PET/CT) with 18Ffluorocholine (18FFC)). MATERIALS AND METHODS: The material for the study was based on tissue samples from 10 patients of 3470 years old (Me = 61.5; [48; 66]), with a laboratoryconfirmed diagnosis of PHT. An immunohistochemical study (IHC) was carried out on materials from 2 patients with hyperplasia of the main cells, from 5 patients with adenoma of PG, from 1 patient with atypical adenoma and 1 with carcinoma of PG; in 1 case the metastasis of cancer of the neck with lymph node was examined. RESULTS: The expression of XK is spotted in all types of PG cells (chief cells: active and inactive forms), transitional forms between the chief cells and oxyphil; oxyphil cells, but it was most intense in active chief cells. The expression of XK was observed in neoplasms of PG of various degrees of malignancy. In the most numerous group of PG formations with a favorable prognosis (11 samples from 7 patients), no statistically significant correlation (p 0.05) was obtained between the intensity expression of the XK, of the PTH and the proliferative activity index Ki67, the level of radiopharmaceutical accumulation in PET/CT with 18FFC (SUVmax) and laboratory data (PTH, Ca, Ca++). CONCLUSIONS: In the majority of investigated cases, moderate and intensive expression of the XK was detected in PG cells. A small amount of studied cases does not allow us to identify the connection between the intensity of XK expression and the malignant potential for the formation of PG.

scholarly journals Renal Cell Tumors: Uncovering the Biomarker Potential of ncRNAs

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2214
Author(s):  
Gonçalo Outeiro-Pinho ◽  
Daniela Barros-Silva ◽  
Margareta P. Correia ◽  
Rui Henrique ◽  
Carmen Jerónimo
Keyword(s):  
Renal Cell ◽  
Large Scale ◽  
Patient Management ◽  
Scale Validation ◽  
Clinical Importance ◽  
Limited Information ◽  
Clinical Implementation ◽  
Renal Cell Tumors ◽  
Patient Responsiveness ◽  
Improve Patient Management

Renal cell tumors (RCT) remain as one of the most common and lethal urological tumors worldwide. Discrimination between (1) benign and malignant disease, (2) indolent and aggressive tumors, and (3) patient responsiveness to a specific therapy is of major clinical importance, allowing for a more efficient patient management. Nonetheless, currently available tools provide limited information and novel strategies are needed. Over the years, a putative role of non-coding RNAs (ncRNAs) as disease biomarkers has gained relevance and is now one of the most prolific fields in biological sciences. Herein, we extensively sought the most significant reports on ncRNAs as potential RCTs’ diagnostic, prognostic, predictive, and monitoring biomarkers. We could conclude that ncRNAs, either alone or in combination with currently used clinical and pathological parameters, might represent key elements to improve patient management, potentiating the implementation of precision medicine. Nevertheless, most ncRNA biomarkers require large-scale validation studies, prior to clinical implementation.

scholarly journals Generalizable EHR-R-REDCap pipeline for a national multi-institutional rare tumor patient registry

JAMIA Open ◽  
2022 ◽  
Vol 5 (1) ◽  
Author(s):  
Sophia Z Shalhout ◽  
Farees Saqlain ◽  
Kayla Wright ◽  
Oladayo Akinyemi ◽  
David M Miller
Keyword(s):  
Large Scale ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
National Registry ◽  
Clinical Informatics ◽  
Patient Registry ◽  
Real World Data ◽  
Tumor Patient ◽  
Data Quality Assessment ◽  
National Patient

Abstract Objective To develop a clinical informatics pipeline designed to capture large-scale structured Electronic Health Record (EHR) data for a national patient registry. Materials and Methods The EHR-R-REDCap pipeline is implemented using R statistical software to remap and import structured EHR data into the Research Electronic Data Capture (REDCap)-based multi-institutional Merkel Cell Carcinoma (MCC) Patient Registry using an adaptable data dictionary. Results Clinical laboratory data were extracted from EPIC Clarity across several participating institutions. Laboratory values (Labs) were transformed, remapped, and imported into the MCC registry using the EHR labs abstraction (eLAB) pipeline. Forty-nine clinical tests encompassing 482 450 results were imported into the registry for 1109 enrolled MCC patients. Data-quality assessment revealed highly accurate, valid labs. Univariate modeling was performed for labs at baseline on overall survival (N = 176) using this clinical informatics pipeline. Conclusion We demonstrate feasibility of the facile eLAB workflow. EHR data are successfully transformed and bulk-loaded/imported into a REDCap-based national registry to execute real-world data analysis and interoperability.

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