Taguchi's analysis to optimize descending aortography for patent ductus arteriosus, with clinical verification.

OBJECTIVE: Taguchi's analysis was adopted to optimize the various factors referring to cardiac angiographic examination used to delineating ductus arteriosus in pediatric patients. SUBJECTS AND METHODS: Thirty-six pediatric patients, 9 male and 27 female, mean age of 6.5±4.7yrs, range 0.6 to 16.6 years were included in the study from January 2004 to April 2005. All patients had patent ductus arteriosus (PDA). Taguchi's L9 orthogonal array was used to generate nine different designs of angiographic levels. Four control factors were selected: a) body surface area (BSA), b) projection angle, c) catheter location, and d) the volume of contrast medium. Each factor was set to three different levels. Statistical analysis, signal-to-noise (S/N) ratio, and analysis of variance (ANOVA) were used to estimate the optimum level of each control factor and to analyze the effect of each factor. RESULTS AND CONCLUSION: The optimal combinations that obtained the highest image quality for PDA were: a) at <0.65m(2) of BSA, b) right anterior oblique (RAO) position at 30(o) plus cranial position (Cr) at 15(o) and lateral view, c) catheter location at T2-3 and d) contrast medium volume: 1.0cc/kg. The projection angle was found to be the most significant factor to delineate ductus arteriosus using the ANOVA test and was not influenced by other factors. The setting of RAO at 30(o) plus Cr at 15(o) and the LAT view obtained the optimal image quality for PDA during descending aortography.

Correlation of Tc-99 m ethyl cysteinate dimer single-photon emission computed tomography and clinical presentations in patients with low cobalamin status.

BACKGROUND: Cobalamin (Cbl) deficiency has been associated with various neuropsychiatric symptoms of different severities. While some studies dedicated in structural neuroimaging credibly address negative impact of low Cbl status, functional imaging reports are limited. We herein retrospectively review the correlation of Tc-99 m ethyl cysteinate dimer single-photon emission computed tomography (Tc-99 m-ECD SPECT) and clinical presentations among patients with low serum cobalamin (Cbl) status (<250 pg/ml). METHODS: Twelve symptomatic patients with low serum Cbl status were enrolled. Clinical presentations, Tc-99 m-ECD SPECT, and neuropsychological tests were reviewed. RESULTS: Dysexecutive syndrome (67 %), forgetfulness (50 %), attention deficits (42 %), and sleep disorders (33 %) constituted the major clinical presentations. All patients (100 %) had temporal hypoperfusion on the Tc-99 m-ECD SPECT. Five patients (42 %) had hypoperfusion restricted within temporal regions and deep nuclei; seven patients (58 %) had additional frontal hypoperfusion. In patients with hypoperfusion restricted within temporal regions and deep nuclei, psychiatric symptoms with spared cognition were their main presentations. Among patients with additional frontal hypoperfusion, six of seven patients (86 %) showed impaired cognitive performances (two of them were diagnosed as having dementia). Among ten patients who finished neuropsychological tests, abstract thinking (70 %) was the most commonly affected, followed by verbal fluency (60 %), short-term memory (50 %), and attention (50 %). Anxiety and sleep problems were the major clinically remarkable psychiatric features (33 % both). Four Tc-99 m-ECD SPECT follow-up studies were available; the degree and extent of signal reversal correlated with cognitive changes after Cbl replacement therapy. CONCLUSIONS: Our TC-99 m-ECD SPECT observations provide pivotal information of neurobiological changes within basal ganglia and fronto-temporal regions in conjunction with disease severity among patients with Cbl deficiency. Hypoperfusion within thalamus/basal ganglia and temporal regions may be seen in the earlier state of Cbl deficiency, when psychiatric symptoms predominate. Hypoperfusion beyond thalamus/basal ganglia and involving frontal regions appears when cognitive problems, mostly dysexecutive syndrome, are manifested. Symmetric hypofrontality of SPECT in the context of dysexcutive syndrome serves as a distinguishing feature of non-amnestic mild cognitive impairment attributed to Cbl deficiency. Concordant with TC-99 m-ECD SPECT findings, the psychiatric symptoms and dysexcutive syndrome undergird impaired limbic and dorsolateral prefrontal circuits originating from basal ganglia respectively.

Traditional Chinese medicine treatment for benign thyroid nodules: Literature review.

Thyroid nodules (TNs) are pathological changes characterized by abnormal proliferation of thyroid gland tissue. Approximately 19% to 67% of asymptomatic individuals are diagnosed with TNs, with the majority being benign nodules and 4% to 6.5% being thyroid cancer nodules. Western medicine recommends regular examinations and surgery, while traditional Chinese medicine (TCM) provides an alternative choice to maintain thyroid function and reduce the need for surgery. However, in Taiwan, research on TCM treatment for benign TNs is primarily limited to case reports, lacking large-scale and systematic clinical studies. We conducted a search of electronic databases including PubMed, Google Scholar, Wanfang Data, and China National Knowledge Infrastructure to collect clinical trials related to TCM treatment for TNs. Our goal is to provide new treatment options, further validate the value of TCM in the treatment of TNs, and lay a foundation for future clinical research.

Dietary nitrate intake and net nitrite-generating capacity of the oral microbiome interact to enhance cardiometabolic health: Results from the Oral Infections Glucose Intolerance and Insulin Resistance Study (ORIGINS).

Background: We investigated the association between dietary nitrate intake and early clinical cardiometabolic risk biomarkers, and explored whether the oral microbiome modifies the association between dietary nitrate intake and cardiometabolic biomarkers. Methods: Cross-sectional data from 668 (mean [SD] age 31 [9] years, 73% women) participants was analyzed. Dietary nitrate intakes and alternative healthy eating index (AHEI) scores were calculated from food frequency questionnaire responses and a validated US food database. Subgingival 16S rRNA microbial genes (Illumina, MiSeq) were sequenced, and PICRUSt2 estimated metagenomic content. The Microbiome Induced Nitric oxide Enrichment Score (MINES) was calculated as a microbial gene abundance ratio representing enhanced net capacity for NO generation. Cardiometabolic risk biomarkers included systolic and diastolic blood pressure, HbA1c, glucose, insulin, and insulin resistance (HOMA-IR), and were regressed on nitrate intake tertiles in adjusted multivariable linear models. Results: Mean nitrate intake was 190[171] mg/day. Higher nitrate intake was associated with lower insulin, and HOMA-IR but particularly among participants with low abundance of oral nitrite enriching bacteria. For example, among participants with a low MINES, mean insulin[95%CI] levels in high vs. low dietary nitrate consumers were 5.8[5.3,6.5] vs. 6.8[6.2,7.5] (p=0.004) while respective insulin levels were 6.0[5.4,6.6] vs. 5.9[5.3,6.5] (p=0.76) among partcipants with high MINES (interaction p=0.02). Conclusion: Higher dietary nitrate intake was only associated with lower insulin and insulin resistance among individuals with reduced capacity for oral microbe-induced nitrite enrichment. These findings have implications for future precision medicine-oriented approaches that might consider assessing the oral microbiome prior to enrollment into dietary interventions or making dietary recommendations.

Nitrite Generating and Depleting Capacity of the Oral Microbiome and Cardiometabolic Risk: Results from ORIGINS.

Background The enterosalivary nitrate-nitrite-nitric oxide (NO3-NO2-NO) pathway generates NO following oral microbiota-mediated production of salivary nitrite, potentially linking the oral microbiota to reduced cardiometabolic risk. Nitrite depletion by oral bacteria may also be important for determining the net nitrite available systemically. We examine if higher abundance of oral microbial genes favoring increased oral nitrite generation and decreased nitrite depletion is associated with a better cardiometabolic profile cross-sectionally. Methods and Results This study includes 764 adults (mean [SD] age 32 [9] years, 71% women) enrolled in ORIGINS (Oral Infections, Glucose Intolerance, and Insulin Resistance Study). Microbial DNA from subgingival dental plaques underwent 16S rRNA gene sequencing; PICRUSt2 was used to estimate functional gene profiles. To represent the different components and pathways of nitrogen metabolism in bacteria, predicted gene abundances were operationalized to create summary scores by (1) bacterial nitrogen metabolic pathway or (2) biochemical product (NO2, NO, or ammonia [NH3]) formed by the action of the bacterial reductases encoded. Finally, nitrite generation-to-depletion ratios of gene abundances were created from the above summary scores. A composite cardiometabolic Z score was created from cardiometabolic risk variables, with higher scores associated with worse cardiometabolic health. We performed multivariable linear regression analysis with cardiometabolic Z score as the outcome and the gene abundance summary scores and ratios as predictor variables, adjusting for sex, age, race, and ethnicity in the simple adjusted model. A 1 SD higher NO versus NH3 summary ratio was inversely associated with a -0.10 (false discovery rate q=0.003) lower composite cardiometabolic Z score in simple adjusted models. Higher NH3 summary score (suggestive of nitrite depletion) was associated with higher cardiometabolic risk, with a 0.06 (false discovery rate q=0.04) higher composite cardiometabolic Z score. Conclusions Increased net capacity for nitrite generation versus depletion by oral bacteria, assessed through a metagenome estimation approach, is associated with lower levels of cardiometabolic risk.

Nitrate-dependent degradation of acetone by Alicycliphilus and Paracoccus strains and comparison of acetone carboxylase enzymes.

A novel acetone-degrading, nitrate-reducing bacterium, strain KN Bun08, was isolated from an enrichment culture with butanone and nitrate as the sole sources of carbon and energy. The cells were motile short rods, 0.5 to 1 by 1 to 2 µm in size, which gave Gram-positive staining results in the exponential growth phase and Gram-negative staining results in the stationary-growth phase. Based on 16S rRNA gene sequence analysis, the isolate was assigned to the genus Alicycliphilus. Besides butanone and acetone, the strain used numerous fatty acids as substrates. An ATP-dependent acetone-carboxylating enzyme was enriched from cell extracts of this bacterium and of Alicycliphilus denitrificans K601(T) by two subsequent DEAE Sepharose column procedures. For comparison, acetone carboxylases were enriched from two additional nitrate-reducing bacterial species, Paracoccus denitrificans and P. pantotrophus. The products of the carboxylase reaction were acetoacetate and AMP rather than ADP. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis of cell extracts and of the various enzyme preparations revealed bands corresponding to molecular masses of 85, 78, and 20 kDa, suggesting similarities to the acetone carboxylase enzymes described in detail for the aerobic bacterium Xanthobacter autotrophicus strain Py2 (85.3, 78.3, and 19.6 kDa) and the phototrophic bacterium Rhodobacter capsulatus. Protein bands were excised and compared by mass spectrometry with those of acetone carboxylases of aerobic bacteria. The results document the finding that the nitrate-reducing bacteria studied here use acetone-carboxylating enzymes similar to those of aerobic and phototrophic bacteria.

Esophageal fish bone migration induced thyroid abscess: case report and review of the literature.

A thyroid abscess is a rare condition, and it is so infrequently encountered. A migrated fish bone is a rare otolaryngologic emergency indicated when the foreign body penetrates through the esophageal mucosa into the thyroid gland space of the neck after several weeks of swallowing. We present the case of a 50-year-old woman who had fever and anterior neck painful mass. An intrathyroid abscess was diagnosed; and she underwent thyrotomy with transcervical approach. A foreign body, which proved to be a fish bone and which fortunately did not cause any adverse effects, was removed.

Soluble Forms of the Receptor for Advanced Glycation Endproducts (RAGE) in Periodontitis.

The receptor for advanced glycation endproducts (RAGE) is critically involved in the pathobiology of chronic inflammatory diseases. Soluble forms of RAGE have been proposed as biomarkers of severity in inflammatory and metabolic conditions, and in monitoring therapeutic responses. The aim of the present study was to determine circulating levels of the soluble forms of RAGE in periodontitis and to evaluate the expression of cell-bound, full-length RAGE and its antagonist AGER1 locally, in gingival tissues. Periodontitis patients and periodontally healthy, sex- and age-matched controls (50 per group) were included. Serum levels of total soluble RAGE and cleaved RAGE (cRAGE) were significantly lower in periodontitis patients. Levels of the endogenous secretory esRAGE were similar in the two groups. cRAGE remained significantly lower in the periodontitis group following multiple adjustments, and had a statistically significant inverse correlation with body mass index and all periodontal parameters. In periodontitis patients, gene expression of full-length RAGE and of AGER1 were significantly higher in periodontitis-affected gingival tissues compared to healthy gingiva. Soluble forms of RAGE, particularly cRAGE, may serve as biomarkers for the presence and severity/extent of periodontitis, and may be implicated in its pathogenesis and its role as a systemic inflammatory stressor.

The semiquantitative bone scintigraphy index correlates with serum tartrate-resistant acid phosphatase activity in breast cancer patients with bone metastasis.

OBJECTIVE: To determine if a correlation exists between the semiquantitative bone scintigraphy index (SQBSI) and serum tartrateresistant acid phosphatase 5b (TRACP5b) activity, a novel osteoclast marker that has been shown to be useful for monitoring bone metastasis in breast cancer (BC) patients. PARTICIPANTS AND METHODS: Among patients enrolled in 2 prospective studies conducted at Tri-Service General Hospital, Taipei, Taiwan, between December 2000 and July 2002, we identified post hoc 52 patients with both BC and bone metastasis who had detailed records of clinical condition, bone scintigraphy, and concordant serum TRACP5b levels. Between January 1, 2003, and December 31, 2005, we performed bone scintigraphy and serum TRACP5b activity assays to monitor these patients, while they were treated according to clinical need. To assess clinical condition, we obtained information from patient records, such as performance status and visual analogue pain score, as well as from selected laboratory tests for tumor markers and serum TRACP5b activity. Those patients with BC and bone metastasis who had undergone whole-body bone scintigraphy and serum TRACP5b activity determination before any therapeutic intervention were designated the pretreated group (n=30). We developed our own formula for calculating SQBSI on the basis of bone scintigraphy findings. RESULTS: A significant correlation was observed between SQBSI and serum TRACP5b activity in pretreated BC patients with bone metastasis, but the strength of the correlation lessened after treatment. No significant correlation was noted between the change in serum TRACP5b activity and the change in SQBSI in treated patients. Compared with the change in SQBSI, the change in TRACP5b activity had higher sensitivity, specificity, and positive predictive value as well as a greater likelihood ratio for reflecting the clinical scenarios of bone morbidity over time. CONCLUSION: As monitors of the response of bone metastasis in BC to treatment, serial determinations of serum TRACP5b activity and SQBSI were both shown to be useful by our preliminary findings. However, serum TRACP5b activity proved the better monitoring tool. If follow-up studies were conducted within 6 months, the combined use of SQBSI and TRACP5b would allow distinction of genuine disease progression from the "flare" phenomenon, in which bone metastasis can appear to progress in bone scintigraphic images although clinical symptoms improve. Larger prospective studies are needed to confirm these findings.

Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection.

Enterogastric reflux (EGR) is regarded as an unavoidable consequence of distal gastrectomy. We evaluated the efficacy of Roux-en-Y (RY) gastrojejunostomy and Braun enteroenterostomy (BEE) for preventing EGR. Between January 2002 and January 2005, 60 patients who underwent distal gastrectomy for gastric cancer or peptic ulcers were divided into RY, Billroth II reconstruction (BII) without or with BEE (BII+B) according to reconstructive method. After 12 months, EGR and mucosal alterations of the remnant stomach were evaluated using biliary scintigraphy, endoscopy, and histology. Scintigraphy showed fasting and postprandial EGR into the remnant stomach occurred in 5.3% and 21.1% of the RY group, 62.1% and 93.1% of the BII group, and 50.0% and 91.7% of the BII+B group, respectively. Endoscopy showed bile reflux occurred in 15.8% of the RY group, 75.9% of the BII group, and 83.3% of the BII+B group. In addition, the prevalence of Helicobacter pylori (HP) infection in the RY group was less than in the other groups (P<0.02). Therefore, RY after distal gastrectomy was effective in reducing EGR and HP infection. BEE was ineffective in diverting bile flow away from the gastric remnant.

A quantitative evaluation of multiple biokinetic models using an assembled water phantom: A feasibility study.

This study examined the feasibility of quantitatively evaluating multiple biokinetic models and established the validity of the different compartment models using an assembled water phantom. Most commercialized phantoms are made to survey the imaging system since this is essential to increase the diagnostic accuracy for quality assurance. In contrast, few customized phantoms are specifically made to represent multi-compartment biokinetic models. This is because the complicated calculations as defined to solve the biokinetic models and the time-consuming verifications of the obtained solutions are impeded greatly the progress over the past decade. Nevertheless, in this work, five biokinetic models were separately defined by five groups of simultaneous differential equations to obtain the time-dependent radioactive concentration changes inside the water phantom. The water phantom was assembled by seven acrylic boxes in four different sizes, and the boxes were linked to varying combinations of hoses to signify the multiple biokinetic models from the biomedical perspective. The boxes that were connected by hoses were then regarded as a closed water loop with only one infusion and drain. 129.1±24.2 MBq of Tc-99m labeled methylene diphosphonate (MDP) solution was thoroughly infused into the water boxes before gamma scanning; then the water was replaced with de-ionized water to simulate the biological removal rate among the boxes. The water was driven by an automatic infusion pump at 6.7 c.c./min, while the biological half-life of the four different-sized boxes (64, 144, 252, and 612 c.c.) was 4.8, 10.7, 18.8, and 45.5 min, respectively. The five models of derived time-dependent concentrations for the boxes were estimated either by a self-developed program run in MATLAB or by scanning via a gamma camera facility. Either agreement or disagreement between the practical scanning and the theoretical prediction in five models was thoroughly discussed. The derived biokinetic model represented the metabolic mechanism in the human body and helped to solidify the internal circulatory system into concert with numerical verification.

Implication for second primary cancer from visible oral and oropharyngeal premalignant lesions in betel-nut chewing related oral cancer.

BACKGROUND: Visible oral and oropharyngeal premalignant lesions may be used to monitor for a second primary oral cancer. To control for bias, we focused on the visible oral and oropharyngeal premalignant lesions of patients with oral cancer with a positive betel-nut chewing habit. Visible oral and oropharyngeal premalignant lesions that can predict second primary oral cancers were studied. METHODS: Nine hundred ninety-seven patients with positive betel-nut chewing habits and oral cancer were enrolled in this retrospective cohort study. We analyzed the relevance of their visible oral and oropharyngeal premalignant lesion incidence and relative clinicopathological variables to the development of a second primary oral cancer. RESULTS: Second primary oral cancer risk was significantly higher in patients with positive visible oral and oropharyngeal premalignant lesions (P < .0001), especially in younger patients (P = .0023; ≤40 years: adjusted odds ratio [OR] 2.66; 40-60 years: adjusted OR 2.61). The heterogeneous leukoplakia was (adjusted OR 2.17) higher than homogeneous leukoplakia. CONCLUSION: The predictive value and practicality of visible oral and oropharyngeal premalignant lesions make it a potentially valuable marker in follow-ups of patients with a positive betel-nut chewing habit with oral cancer, especially young patients with heterogeneous leukoplakia.

Tc-99m-ECD SPECT as the measure for therapeutic response in patients with cobalamin deficiency: Two case reports.

BACKGROUND: Cobalamin (Cbl) is an essential vitamin for human health. While an increasing body of evidence supports the negative impact of Cbl deficiency on cognition, the causality has yet to be determined, and the reported therapeutic responses after Cbl supplement therapy have been inconsistent. Besides, few reports have described neuroimaging characteristics associated with the therapeutic response. METHODS: To describe and compare technetium-99m ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) findings in 2 patients with Cbl deficiency with distinct therapeutic responses. RESULTS: Case 1 scored 12/30 in the mini-mental state examination (MMSE) and 34/100 in the cognitive abilities screening instrument (CASI). Profound deficits in mental manipulation, drawing, short-term/long-term memory, and verbal fluency were noted. Case 2 scored 24/30 in the MMSE and 78/100 in the CASI, mainly due to impaired mental manipulation, abstract thinking, and borderline performance in short-term memory and verbal fluency. While both cases showed widespread hypoperfusion within bilateral frontotemporal regions and thalamus on Tc-99m-ECD SPECT, Case 2 demonstrated relatively preserved radio-uptake in the frontal regions, especially the anterior cingulate cortex (ACC) and prefrontal cortex (PFC), consistent with the better therapeutic response (Case 1: 12/30 to 11/30 in the MMSE; Case 2: 24/30 to 28/30 in the MMSE). CONCLUSION: Given that the ACC integrates the limbic system and frontosubcortical circuits and the PFC governs executive function, the extent and severity of hypofrontality may be responsible for the worse prognosis. Our Tc-99m-ECD SPECT observations revealed that the negative impact on cerebral metabolic tone is relevant to the severity of Cbl deficiency, and the functional integrity of the ACC and PFC is highly associated with the preservation of global cognitive function in our cases with Cbl deficiency.

Optimizing quality of digital mammographic imaging using Taguchi analysis with an ACR accreditation phantom.

This work demonstrated the improvement of the visualization of lesions by modulating the factors of an X-ray mammography imaging system using Taguchi analysis. Optimal combinations of X-ray operating factors in each group of level combination were determined using the Taguchi method, in which all factors were organized into only 18 groups, yielding analytical results with the same confidence as if each factor had been examined independently. The 4 considered operating factors of the X-ray machine were (1) anode material (target), (2) kVp, (3) mAs and (4) field of view (FOV). Each of these factors had 2 or 3 levels. Therefore, 54 (2×3×3×3 = 54) combinations were generated. The optimal settings were Rh as the target, 28 kVp, 80 mAs and 19×23 cm(2) FOV. The grade of exposed mammographic phantom image increased from the automatic exposure control (AEC) setting 70.92 to 72.00 under the optimal setting, meeting the minimum standard (70.00) set by Taiwan's Department of Health. The average glandular dose (AGD) of the exposed phantom, 0.182 cGy, was lower than that, 0.203 cGy, under the AEC setting. The Taguchi method was extremely promising for the design of imaging protocols in clinical diagnosis.

Fluorodeoxyglucose Uptake in Advanced Non-small Cell Lung Cancer With and Without Pulmonary Lymphangitic Carcinomatosis.

AIM: To assess the correlation between advanced non-small cell lung cancer (NSCLC) with or without pulmonary lymphangitic carcinomatosis (PLC) and fluorodeoxyglucose (FDG) uptake and its effect on survival outcomes. PATIENTS AND METHODS: We retrospectively reviewed 157 patients with NSCLC. The mean and maximum standardized uptake values (SUVmean and SUVmax, respectively), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were evaluated for their effect on overall survival (OS) and progression-free survival (PFS). RESULTS: The PLC group included 55 patients and the non-PLC group included 102 patients. The SUVmean, SUVmax, MTV and TLG values were lower in the non-PLC group. In the PLC group, primary lung tumor TLG was a significant predictor of PFS, while whole-body TLG was found to be a significant predictor in non-PLC patients. CONCLUSION: Primary lung tumor TLG was a good predictor in PLC patients. Whole-body TLG could be a useful predictor only in patients without PLC.

Metastatic pulmonary calcification in renal failure mimicking pulmonary embolism on lung scan.

Metastatic pulmonary calcification (MPC) characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. However, MPC with pulmonary artery calcification is uncommon and has only been detected in a few patients with severe disorders. A 48-year-old man with chronic renal failure had cough and progressive dyspnea. Ventilation-perfusion (V/Q) lung scans showed multiple large-sized mismatched V/Q defects in the left middle and lower zones of lungs, which was consistent with a high probability of pulmonary embolism (PE). The findings of pulmonary scintigraphy resulted from MPC with pulmonary artery calcification, revealed by simultaneous technetium-99m MDP scintigraphy, low-dose computed tomography, and high-resolution computed tomography (HRCT) of the chest.

Influence of thyroid transcription factor-1 on fluorodeoxyglucose uptake and prognosis of non-small cell lung cancer.

AIM: To assess the correlation between thyroid transcription factor-1 (TTF1) protein expression in primary tumors from patients with non-small cell lung cancer (NSCLC) and fluorodeoxyglucose (FDG) uptake, and to determine its effect on survival outcomes. PATIENTS AND METHODS: We categorized 112 patients with NSCLC according to TTF1 expression (TTF1(+): n=59, TTF1(-): n=53), and retrospectively determined whether positron-emission topography measurements, including standardized uptake values [mean (SUVm) and maximum (SUVmax)], metabolic tumor volume (MTV), total lesion glycolysis (TLG), and other clinical factors could predict progression-free (PFS) or overall (OS) survival of these patients. RESULTS: The SUVm, SUVmax, MTV, and TLG values were lower in the TTF1(+) group; their survival outcomes were also better. The SUVm, SUVmax, and TLG values were good prognostic indicators for OS and PFS in this group. CONCLUSION: Primary NSCLC tumors expressing TTF1 had lower FDG uptake than those that did not and this was a good prognostic indicator.

Reliability and effectiveness of GEWF solution in the identification of lymph nodes in specimens of colorectal carcinoma.

Lymph node status is pivotal in the staging process of cancer. With regards to colorectal cancer, lymph node retrieval is always laborious. Sometimes, it is also a challenge to recover a minimum of 12 lymph nodes from the pericolorectal tissue. Among many proposed adjunctive solutions, GEWF solution (glacial acetic acid, ethanol, distilled water, and formaldehyde) has been introduced recently and suggested to be superior. To further evaluate its efficiency, the pericolorectal tissue, which has been reexamined extensively in the conventional condition, was refixed into GEWF solution in this study. More lymph nodes were found in 75% (n = 6) of the 8 experimental cases, and 50% (n = 4) of them had 12 or more yielded lymph nodes eventually. In addition, no adverse influences on the expressions of immunohistochemical and special stains were seen. These data support the reliability and effectiveness of GEWF solution in improvement of lymph node yield.

Indicators associated with coronary atherosclerosis in metabolic syndrome.

BACKGROUND: Metabolic factors associated with coronary atherosclerosis (CA) in metabolic syndrome (MetS) remain unclear. METHODS: A total of 550 consecutive subjects without documented coronary artery disease who received contrast-enhanced coronary computed tomography angiography were analyzed. CA was defined as coronary artery calcification (CAC) scores >0 or, zero CAC score combining noncalcified plaques within the proximal third segment of major coronary arteries. Metabolic factors and novel atherosclerotic biomarkers including high-sensitive C-reactive protein (hs-CRP) and adiponectin were measured. MetS was recognized according to the ethnicity-specific National Cholesterol Educational Program Adult Treatment Panel III, 2001. RESULTS: After adjusted with novel atherosclerotic biomarkers, MetS was significantly associated with CA Odds ratio [OR], 2.88; 95% confidence interval [CI], 1.88 to 4.42; p<0.001). Subgroup analysis revealed that fasting blood glucose ≥ 110 mg/dl/diabetes mellitus in non-MetS subjects (OR, 1.40; 95%CI, 1.08 to 1.82; p<0.05) and total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) ≥ 4.2 in MetS subjects (OR, 4.44; 95%CI, 1.93 to 10.20; p<0.001) were independently associated with CA. Both indicators were significantly associated with increased serum hs-CRP and reduced adiponectin levels in all subjects. CONCLUSIONS: MetS is independently associated with CA after adjustment of atherosclerotic biomarkers. TC/HDL-C ≥ 4.2 in MetS and fasting blood glucose ≥ 110 mg/dl/diabetes mellitus in non-MetS subjects are independent indicators of CA, suggesting the potential difference in pathophysiology of CA.

Conversion from FDG-negative to -positive during follow-up in a rare case of pulmonary lymphoepithelioma-like carcinoma.

A female patient aged 75 years presented with an incidental pulmonary nodule without FDG uptake when undergoing FDG PET/CT. Without obtaining histologic diagnosis, the follow-up FDG PET/CT 2 years later demonstrated intense FDG avidity within previously FDG-negative tumor. After surgery, the pathologic diagnosis is pulmonary lymphoepithelioma-like carcinoma (LELC). LELCs are unique because of histologic similarities with undifferentiated nasopharyngeal lymphoepithelioma and with a better prognosis as compared with other lung malignancies. However, the expression of FDG uptake in LELC has never been discussed. Herein, we describe a pulmonary LELC manifesting as a slowly growing tumor displaying conversion from FDG-negative to -positive avidity.