Imaging Evaluation of Thymoma and Thymic Carcinoma

Imaging is integral in the management of patients with thymoma and thymic carcinoma. At initial diagnosis and staging, imaging provides the clinical extent of local invasion as well as distant metastases to stratify patients for therapy and to determine prognosis. Following various modalities of therapy, imaging serves to assess treatment response and detect recurrent disease. While imaging findings overlap, a variety of CT, MRI, and PET/CT characteristics can help differentiate thymoma and thymic carcinoma, with new CT and MRI techniques currently under evaluation showing potential.

Minimal important change and responsiveness of the Migraine Disability Assessment Score (MIDAS) questionnaire

Background The MIDAS is the most used questionnaire to evaluate migraine-related disability, but its utility to assess treatment response remains unclear. Our aim was to estimate the MIDAS’ minimal important change (MIC) value and its responsiveness. Methods A total of 103 patients were enrolled in a non-pharmacological, preference-based clinical trial. MIDAS and global rating of self-perceived change (GRoC) scores were collected at baseline, after 5 weeks of treatment, 4-weeks and 3-months follow-up after treatment. Anchor-based approaches were used to establish MIC values and responsiveness. Findings In all 3 timepoint comparisons, MIDAS presented a MIC of 4.5 points. A moderate positive correlation was identified between the MIDAS change and GRoC scores. The area under the curve ranged from 0.63 to 0.68. Conclusions This study showed that MIDAS has a limited responsiveness to change. A change of 4.5 points or more represents a clinically important change for patients with high frequent migraine and chronic migraine receiving non-pharmacological treatment.

A comparative Study Between Needling and Homologous Autoimplantation Techniques in Treatment of Multiple Plantar Warts

Background Warts are a common dermatologic complaint resulting from infection with HPV which spread by direct skin-to-skin contact or by autoinoculation. The clinical appearance of warts is variable depends on the type of HPV involved and the site of infection. There are various types of viral warts including common warts, plantar warts, plane warts and genital warts, usually diagnosis of warts is made through clinical examination of the lesions and no laboratory investigations are required. Objective To compare between the therapeutic efficacy and safety of needling versus homologous autoimplantation techniques in treatment of multiple plantar warts and assess their recurrence rate. Patients and Methods Our study included 40 patients with multiple de novo planter warts(3 -10 warts) of (>1 and <3 years duration) divided into 2 groups, 20 patients per group, one group subjected to autoimplantation of wart tissue and the other subjected to needling procedure. Follow up of studied patients was assessed by physician after 2,8 and 12 weeks of procedure through clinical and dermoscopic examination to assess treatment response and after 16 weeks to assess recurrence Results Results of our study reported that there was high statistically significant difference between the 2 studied groups as regard response to treatment after 12 weeks being higher among autoimplantation group (p = 0.001). Moreover, there were no significant relations between treatment response of both patient groups and each of gender, age of patients, number of warts and duration of lesions. Conclusion Autoimplantation technique is more effective and less painful than needling procedure in treatment of multiple plantar warts (both manipulated and remote warts). No significant relations were found between treatment response of either techniques and demographic or clinical characteristics of studied patients.

Radiation Therapy for Chemotherapy Refractory Gingival Myeloid Sarcoma

Gingival myeloid sarcoma (MS) refractory to induction chemotherapy is a rare clinical entity and can be treated with palliative radiation therapy (RT). However, there are few previously published reports of RT approaches for the treatment of gingival MS. We present a single institution retrospective observational study of adult patients treated with palliative RT for chemotherapy refractory gingival MS. A total of six patients diagnosed with gingival MS in the setting of relapsed or refractory acute myeloid leukemia treated with palliative RT were identified, with a median age of 66 (range 52–77). Patients were treated with radiation doses ranging from 5 to 20 Gy in 2–10 fractions. Two patients had adequate follow-up time to assess treatment response. One patient who was simulated with PET/CT experienced a local complete response, while the other patient required retreatment 2 months after initial treatment and experienced an eventual local partial response. Three patients experienced radiation mucositis, with one patient experiencing grade 5 toxicity attributed to concomitant treatment with the radiosensitizer hydroxyurea. We believe that this study can provide a practical reference point for other clinicians given the rarity of gingival MS requiring palliative radiation therapy as a clinical entity.

Alternative Devices for Heart Rate Variability Measures: A Comparative Test–Retest Reliability Study

Using healthy adult participants, seven measures of heart rate variability were obtained simultaneously from four devices in five behavioral conditions. Two devices were ECG-based and two utilized photoplethysmography. The 140 numerical values (measure, condition, device) are presented. The comparative operational reliability of the four devices was assessed, and it was found that the two ECG-base devices were more reliable than the photoplethysmographic devices. The interchangeability of devices was assessed by determining the between-device Limits of Agreement. Intraclass correlation coefficients were determined and used to calculate the standard error of measurement and the Minimal Detectable Difference. The Minimal Detectable Difference, MDD, quantifies the smallest statistically significant change in a measure and is therefore critical when HRV measures are used longitudinally to assess treatment response or disease progression.

Investigation of abbreviated 4 and 8 item versions of the PTSD Checklist 5

Posttraumatic stress disorder (PTSD) is a significant public health concern associated with marked impairment across the lifespan. Exposure to traumatic events alone, however, is insufficient to determine if an individual has PTSD. PTSD is a heterogeneous diagnosis such that assessment of all 20 symptoms is problematic in time-limited treatment settings. Brief assessment tools that identify those at risk for PTSD and measure symptom severity are needed to improve access to care and assess treatment response. The present study evaluated abbreviated measures of PTSD symptoms derived from the PTSD Checklist for DSM-5 (PCL-5) – a 20-item validated measure of PTSD symptoms – across two studies. In the first, using a community sample of adults exposed to a traumatic event, 4-and 8-item versions of the PCL-5 were identified that were highly correlated with the full PCL-5. In the second, using a sample of combat veterans, the 4-and 8-item measures had comparable diagnostic utility to the total-scale PCL-5. These results provide support for an abbreviated measure of the PCL-5 as an alternative to the 20-item total scale.

MR Spectroscopic Imaging Predicts Early Response to Anti-Angiogenic Therapy in Recurrent Glioblastoma

Background Determining failure to anti-angiogenic therapy in recurrent GBM (rGBM) remains a challenge. The purpose of the study was to assess treatment response to bevacizumab-based therapy in patients with rGBM using MR spectroscopy (MRS). Methods We performed longitudinal MRI/MRS in 33 patients with rGBM to investigate whether changes in N-acetylaspartate (NAA)/Choline (Cho) and Lactate (Lac)/NAA from baseline to subsequent time points after treatment can predict early failures to bevacizumab-based therapies. Results After stratifying based on 9 month survival, longer-term survivors had increased NAA/Cho and decreased Lac/NAA levels compared to shorter-term survivors. ROC analyses for intratumoral NAA/Cho correlated with survival at 1 day, 2 weeks, 8 weeks, and 16 weeks. Intratumoral Lac/NAA ROC analyses were predictive of survival at all time points tested. At the 8 week time point, 88% of patients with decreased NAA/Cho did not survive 9 months; furthermore, 90% of individuals with an increased Lac/NAA from baseline did not survive at 9 months. No other metabolic ratios tested significantly predicted survival. Conclusions Changes in metabolic levels of tumoral NAA/Cho and Lac/NAA can serve as early biomarkers for predicting treatment failure to anti-angiogenic therapy as soon as 1 day after bevacizumab-based therapy. The addition of MRS to conventional MR methods can provide better insight into how anti-angiogenic therapy affects tumor microenvironment and predict patient outcomes.

Automated Oxygen Gradient Ektacytometry: A Novel Biomarker in Sickle Cell Anemia

Sickle cell anemia (SCA) is a hereditary hemoglobinopathy with a variable phenotype. There is no single biomarker that adequately predicts disease severity and can be used to monitor treatment response in patients in clinical trials and clinical care. The use of clinical outcomes, such as vaso-occlusive crises (VOC), requires long and expensive studies, sometimes with inconclusive results. To address these limitations, there are several biomarkers under study to improve the ability to predict complications and assess treatment response in both clinical and research settings. Oxygen gradient ektacytometry, also called as oxygenscan, is an assay that measures the effects of deoxygenation and reoxygenation on red blood cell (RBC) deformability and is gaining popularity in SCA research, because it captures the dynamic sickling capacity of a patient’s RBCs as they are subjected to an oxygen gradient under steady shear stress. We describe here the oxygenscan methodology and evaluate the correlation between oxygenscan parameters and more well-known biomarkers of SCA such as fetal hemoglobin (HbF), F-cells, and dense red blood cells (DRBCs). Our data indicate that the oxygenscan curve is affected by all these parameters and the result incorporates the effects of %HbF, %F-cells, RBC hydration, and RBC membrane deformability.