Axillary lymph-node metabolic activity assessment on 18F-FDG-PET/CT in rheumatoid arthritis patients treated with biologic therapies.

Objective: Recent studies have provided new insights into the role of lymph nodes (LNs) in rheumatoid arthritis (RA). The aim of this study was to evaluate the metabolic activity of the axillary LNs in relation to that of the upper limb joints and the clinical assessment of disease activity in RA patients treated with biologic therapies.Method: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) scans were acquired for 64 patients with RA at baseline and after 6 months of biologic therapy, and the patients' clinical status was evaluated. The maximum standardized uptake value (SUVmax), metabolic active volume, and total lesion glycolysis (TLG) were used to assess glucose metabolism in the LNs and 12 joints. Clinical evaluations included serum markers and the Disease Activity Score based on 28-joint count-erythrocyte sedimentation rate (DAS28-ESR).Results: Changes in the SUVmax and TLG for the axillary LNs correlated significantly with those of the ipsilateral wrist joints. There was a positive correlation between the changes in the three metabolic parameters of the axillary LNs and the changes in disease activity after treatment. After 6 months of biologic therapy, all metabolic parameters for the axillary LNs in patients with a DAS28-ESR < 3.2 were significantly lower than those of patients with a DAS28-ESR ≥ 3.2.Conclusion: A relationship between the glucose metabolism of the axillary LNs and the ipsilateral wrist joints was demonstrated by the 18F-FDG-PET/CT parameters. The metabolic activity and active volume of axillary LNs may reflect the therapeutic response to the biologic treatment of RA.

GOLEM--multimedia simulator for medical education.

We created multimedia medical training simulator "GOLEM" for learning diagnostics and therapy of the critical clinical disorders. The theoretical basis of the simulator is the mathematical formulation of the relationship of homeostasis of the internal environment (acid/base and electrolyte equilibrium, of transport of blood gases, of osmotic and volume homeostasis), respiration, circulation and kidneys including regulatory influence of relevant hormones and the influence of some therapeutic procedures. Mathematical description consists of 39 non-linear differential equations and containing 89 input and 179 output variables. For the development of the simulation models developer's tools from MathWorks (Matlab and Simulink) has been used. The integration of the multimedia components, hypertext and simulation models interface was achieved by using Control Web, developed by Moravian Instruments, originally designed for long distance controls using PC and Internet. We have used our simulator as an efficient educational tool to help medical students learn circulatory, respiratory, acid-base, electrolyte, osmotic and volume disorders and train the diagnostic and therapeutic decisions by executing simulated interventions on virtual "patients".