Task reformulation and data-centric approach for Twitter medication name extraction.

Automatically extracting medication names from tweets is challenging in the real world. There are many tweets; however, only a small proportion mentions medications. Thus, datasets are usually highly imbalanced. Moreover, the length of tweets is very short, which makes it hard to recognize medication names from the limited context. This paper proposes a data-centric approach for extracting medications in the BioCreative VII Track 3 (Automatic Extraction of Medication Names in Tweets). Our approach formulates the sequence labeling problem as text entailment and question-answer tasks. As a result, without using the dictionary and ensemble method, our single model achieved a Strict F1 of 0.77 (the official baseline system is 0.758, and the average performance of participants is 0.696). Moreover, combining the dictionary filtering and ensemble method achieved a Strict F1 of 0.804 and had the highest performance for all participants. Furthermore, domain-specific and task-specific pretrained language models, as well as data-centric approaches, are proposed for further improvements. Database URL https://competitions.codalab.org/competitions/23925 and https://biocreative.bioinformatics.udel.edu/tasks/biocreative-vii/track-3/.

Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation.

BACKGROUND: The objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy. METHODS: Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events). RESULTS: The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014). CONCLUSIONS: After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.

Diffusion magnetic resonance imaging as an evaluation of the response of brain metastases treated by stereotactic radiosurgery.

BACKGROUND: Loss of tumor cell results in a relative increase in extracellular space that may lead to alteration of ADC. Our purpose was to see if the ADC could be used, rather than methods depending on changes in tumor size, to predict treatment success after treatment of brain metastases with SRS. METHODS: In a prospective study, the ADCs of 21 patients with 32 solid or solid-dominated brain metastases were taken before and 1 week, 1 month, and at 3-month intervals after SRS. Mean ADC values at the various time intervals were compared with each other to see whether or not the ADC might be used as an early indicator of treatment success or failure. RESULTS: The mean pretreatment value of the ADC in the metastatic tumors was 1.05 +/- 0.12 x 10(-3) mm2/s (mean +/- SD). This value for the tumors rose significantly (P = .009) 7 days after SRS and continued to rise with time. Magnetic resonance imaging showed that 91% of these tumors had been controlled by the SRS. The ADC values in cystic/necrotic tumor tissue (2.13 +/- 0.18 x 10(-3) mm2/s) were significantly (P < .001) higher than those in noncentral necrotic tumor tissue (1.61 +/- 0.14 x 10(-3) mm2/s). CONCLUSIONS: The ADC values might eventually be useful to evaluate treatment success-and in some patients, detected even at early time points-and to distinguish radiation-induced central necrosis from tumor regrowth in cases where other imagery is not definitive.

A positron emission tomography/computed tomography (PET/CT) acquisition protocol for CT radiation dose optimization.

BACKGROUND: In current combined positron emission tomography/computed tomography (PET/CT) systems, high-quality CT images not only increase diagnostic value by providing anatomic delineation of hyper- and hypometabolic tissues, but also shorten the acquisition time for attenuation correction compared with standard PET imaging. However, this technique potentially introduces more radiation burden to patients as a result of the higher radiation exposure from CT. METHODS: In this study, the radiation doses delivered from typical germanium-based and CT-based transmission scans were measured and compared using an anthropomorphic Rando Alderson phantom with insertions of thermoluminescent dosimeters. Image geometric distortion and quantified uptake values in PET images with different manipulating CT acquisition protocols for attenuation correction were also evaluated. RESULTS: It was found that radiation doses during germanium-based transmission scans were almost negligible, while doses from CT-based transmission scans were significantly higher. Using a lower radiation dose, the CT acquisition protocol did not significantly affect attenuation correction and anatomic delineation in PET. CONCLUSIONS: This study revealed the relation between image information and dose. The current PET/CT imaging acquisition protocol was improved by decreasing the radiation risks without sacrificing the diagnostic values.

FDG PET/CT images demonstrating Fournier gangrene with bilateral pelvic muscle extension in a patient with recurrent rectosigmoid cancer.

A 71-year-old male patient with Parkinsonism was referred for an F-FDG PET/CT scan for suspicious recurrence of rectosigmoid adenocarcinoma. The FDG PET/CT scan revealed increased FDG uptakes in the lower pelvic region around the wall of the rectal stump, with extension to the bilateral pelvic sidewalls and the right gluteous minimus muscle. In addition, multiple small air bubbles were noted in the lesions on the attenuation CT images. Fournier gangrene was diagnosed. After treatment with intravenous antibiotics and debridement with sigmoidoscopic irrigation, the patient was discharged and remained uneventful during clinical follow-up for 50 days.

FDG PET/CT repeatedly demonstrated hepatic cyst infection in a patient with autosomal dominant polycystic kidney disease.

A 70-year-old man with a history of autosomal dominant polycystic kidney disease was referred for F-FDG PET/CT scans twice at 6-month intervals due to repeated fever with negative conventional imaging studies. The FDG PET/CT scans revealed different hepatic cyst lesions in the 2 scans, with a large infected cyst in the second study. After aspiration and intravenous antibiotics treatment, the patient was discharged and remained uneventful thereafter for 6 months.

Dynamic FDG PET/CT imaging with diuresis demonstrates an enterovesical fistula in a lymphoma patient with repeated colon diverticulitis.

A 43-year-old male patient with follicular B-cell lymphoma was referred for a FDG PET/CT scan due to severe left lower abdominal pain to rule out recurrent cancer. These FDG PET/CT images and previous FDG PET/CT images 5 months ago both revealed an air bubble in the urinary bladder on the CT images. He had a recurrent urinary tract infection history for 6 months. A list-mode dynamic data acquisition with diuresis intravenous injection revealed linear FDG activity extending from the upper-left portion of the bladder to a soft tissue mass in the lower-left pelvic region. An enterovesical fistula was confirmed by surgery.

Vesicovaginorectal fistula on a FDG PET/CT of a patient with recurrent cervical cancer and end-stage renal disease.

A 59-year-old woman with recurrent cervical cancer and end-stage renal disease was referred for FDG PET/CT for restaging. The patient had hemodialysis for 4 years and radiotherapy 3 years ago and 1 year ago. The PET/CT scan showed recurrent cervical cancer and intense FDG radioactivity in the urinary bladder, with a small air bubble in both the urinary bladder and the vagina. After supine positioning without voiding, the delayed images showed more air bubbles with less FDG activity in the urinary bladder. The vesicovaginorectal fistula was confirmed by surgery.

The role of pretreatment FDG-PET in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

PURPOSE: Pretreatment with 2- [(18)F] fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) was evaluated as a predictor of local failure-free survival (LFFS), disease-free survival (DFS), and overall survival (OS) in patients with nonkeratinizing nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) alone or concurrently with chemotherapy (CCRT). PATIENTS AND METHODS: Seventy-five M0 NPC patients who received FDG-PET before treatment were analyzed. The primary tumor FDG uptake was measured as the maximum standardized uptake value (SUVmax). The LFFS, DFS, and OS were calculated by the Kaplan-Meier method, and the differences were evaluated on log-rank test. The prognostic significance was assessed by univariate and multivariate analyses. RESULTS: Eighteen patients received IMRT alone and 57 received CCRT. The mean SUVmax was significantly higher in 12 patients with locoregional or distant failure than in those without failure (p <0.001). On multivariate analysis, the SUVmax was the only significant variable for 5-year LFFS (p = 0.017) and DFS (p = 0.000) but not for OS (p = 0.065). CONCLUSION: SUVmax is a potential independent prognostic predictor of clinical outcomes in patients with nasopharyngeal carcinoma treated with IMRT alone or with CCRT. A high (18)F-FDG uptake (SUVmax >5) indicates poor outcome in patients with NPC.

Diuresis makes vesicocolic fistula visible on FDG PET/CT.

A 71-year-old man with rectal cancer history was referred for FDG PET/CT due to serum carcinoembryonic antigen level elevation. In addition to rectal cancer recurrent lesion, the FDG PET/CT scan also showed homogeneous intense FDG accumulation in the whole segment of descending colon and a small air bubble in the urinary bladder. After furosemide injection, the vesicocolic fistula was confirmed by typical air pattern in the urinary bladder on attenuation CT images and the decrease FDG activity in the descending colon. The patient has had the clinical manifestations of pneumaturia and watery diarrhea which support the diagnosis of vesicocolic fistula.

Pituitary FDG uptake in a patient of lung cancer with bilateral adrenal metastases causing adrenal cortical insufficiency.

A 64-year-old woman with history of lung cancer and left adrenal gland metastasis was referred for FDG PET/CT to assess the response to target therapy and local radiotherapy treatment. In addition to bilateral adrenal gland FDG uptake lesions, the PET/CT also showed focal FDG uptake in pituitary gland with standardized uptake value of 3.9. Adrenocorticotropic hormone serum level was 439 pg/mL (normal <46 pg/mL), and serum cortisol level was 6 µg/dL (normal range, 5-25 µg/dL). The image and serum test results suggested the diagnosis of lung cancer, with bilateral adrenal metastases causing adrenal cortical insufficiency with secondary pituitary gland hyperplasia.

Incremental value of integrated FDG-PET/CT in evaluating indeterminate solitary pulmonary nodule for malignancy.

OBJECTIVES: The objective of this study was to evaluate the increased diagnostic benefit of integrated positron emission tomography/computed tomography (PET/CT) interpretation in evaluating solitary pulmonary nodules for malignancy. METHODS: One hundred seventeen patients (67 men and 50 women; mean age +/- SD, 61.7 +/- 13.6 years, range, 31-86 years) with indeterminate solitary pulmonary nodules and no previous history of malignancy were analyzed. PET/CT was performed with an integrated PET/CT scanner (Siemens Biograph BGO duo) 1 h after an intravenous injection of 370 MBq (10 mCi) (18)F-fluorodeoxyglucose. Patients fasted for 6 h before imaging. PET was interpreted alone or combined with CT and was graded according to a five-point scale. A malignant diagnosis was based on histological findings or a clinical and radiological follow-up after at least 24 months. The diagnostic performances of PET alone and integrated PET/CT interpretation were evaluated using discriminant analysis. RESULTS: PET alone correctly classified 85% of nodules and integrated PET/CT interpretation increased the correct classification to 89%, with similar sensitivity and specificity of 88% and 89%, respectively. False-positive PET results mainly resulted from granulomatous disorders. Four (50%) of the eight cases deemed indeterminate on PET alone were resolved with combined PET/CT interpretation. CONCLUSIONS: Although the benefit attributable to the CT component was limited when integrated PET/CT was used, PET and CT acted synergistically to significantly increase the diagnostic veracity for PET-indeterminate nodules.

Neuromodulation on cervical spinal cord combined with hyperbaric oxygen in comatose patients--a preliminary report.

BACKGROUND: Because both SCS and HBO therapy have shown some promise in treating patients with states of reduced consciousness, we evaluated the combination of therapies in a prospective trial in comatose patients. METHODS: Twelve patients who had received median nerve stimulation for 3 months without improvement in consciousness received cSCS for 1 year combined with simultaneous HBO therapy for the first 3 months. Another group enrolled 12 patients who received median nerve stimulation only were served as control. RESULTS: Six patients emerged from coma at 1 year (after conclusion of treatment). Glasgow Coma Scale score, SPECT imaging, and PVS scores (state and reaction subscores) of the 12 patients were all significantly increased at 1 year compared with enrollment (P < .05). Neither respirator nor tracheostomy was needed to assist respiration in any patient. Only 1 of 12 patients still needed nasogastric tube feeding at 1 year. By contrast, control patients (without cSCS and HBO therapy) showed no apparent improvement. CONCLUSION: Increase of GCS score, cerebral blood perfusion, and PVS scores were observed in comatose patients treated with combined cSCS and HBO therapy.

Simultaneous [99mTc]TRODAT-1 and [123I]ADAM brain SPECT in nonhuman primates.

PURPOSE: This study examined the feasibility of simultaneous dopamine and serotonin transporter imaging using [(123)I]ADAM and [(99m)Tc]TRODAT-1 single photon emission computed tomography (SPECT). PROCEDURES: Simultaneous [(123)I]ADAM (185 MBq) and [(99m)Tc]TRODAT-1 (740 MBq) SPECT was performed in three age-matched female Formosan rock monkeys. An asymmetric energy window was used for dual, and symmetric energy windows were used for single-isotope imaging. Oral fluoxetine (20 mg) and intravenous methylphenidate HCl (1 mg/kg) were given 24 h and 10 min, respectively, before dual-isotope SPECT to test imaging specificities of [(123)I]ADAM and [(99m)Tc]TRODAT-1. RESULTS: Comparable image quality and uptake ratios between dual- and single-isotope SPECT scans were found. Dual-isotope SPECT in fluoxetine-pretreated monkeys showed decreased uptake of [(123)I]-ADAM, but not of [(99m)Tc]TRODAT-1. Dual-isotope SPECT in methylphenidate-pretreated monkeys showed decreased [(99m)Tc]TRODAT-1 uptake without affecting [(123)I]-ADAM uptake. CONCLUSION: Simultaneous [(123)I]-ADAM and [(99m)Tc]TRODAT-1 SPECT appears promising in nonhuman primates and may provide a suitable preclinical model with further clinical implications.

Duodenal metastasis from hepatocelluar carcinoma demonstrated on FDG PET/CT imaging.

It is rare for patients with hepatocellular carcinoma (HCC) to have gastrointestinal metastasis. We report on a 67-year-old man with HCC who was first treated with liver transplantation and then received transcatheter arterial embolization for recurrence in the right hepatic lobe. He underwent whole-body FDG PET/CT imaging for survey, and a FDG-avid lesion was localized in the duodenum. Endoscopic examination revealed an ulcerative tumor in the first portion of the duodenum. Histologic examination determined metastatic HCC.