Efficacy of radioactive iodine treatment of graves’ hyperthyroidism using a single calculated 131I dose

Abstract Objective To evaluate the success rate of therapeutic administration of a single calculated 131I activity for eliminating hyperthyroidism due to Graves’ disease. Methods and materials Patients with Graves’ hyperthyroidism underwent pinhole thyroid imaging, 24-h radioactive iodine uptake (RAIU) measurements and clinical examination and received a calculated 131I activity of 0.2 mCi per estimated gram of thyroid tissue, adjusted for the 24-h RAIU. The goal of RAI treatment was to achieve hypothyroidism within 3–6 months of 131I administration. Response to RAI therapy was assessed at 7 weeks and 3 months by clinical and biochemical follow-up. Results The study included 316 hyperthyroid patients with Graves’ disease (F238:M78, mean age 42.1 ± 16 y, 4–94). 179 patients (56.6%) had no prior therapeutic intervention (treatment-naive patients), whereas 6 patients had prior thyroid surgery, and 131 (41.5%) had been treated with anti-thyroid medications. The mean estimated thyroid gland size was 50.2 g ± 18, range 15–100. Mean RAIU was 0.57 ± 0.17 (normal 0.07–0.30). RAI doses ranged from 5 to 70 mCi (mean dose = 18.1 mCi). Successful treatment of hyperthyroidism at our institution was obtained after a single therapeutic 131-I activity administration in 295 of 316 (93.3%) patients. Multivariate logistic regression analysis demonstrated that failure of 131I therapy was associated with previous PTU therapy (p <  0.001). The mean response time after successful RAI therapy was 110.2 days, with cumulative response of 25% at 61 days, 50% by 84 days and 75% by 118 days after radioiodine administration. The mean time to respond for those on prior PTU medications was 297 days compared to 116 days for those on MMI and 109 days for those not previously treated with antithyroid medications. In patients with persistent hyperthyroidism, failure of RAI therapy was documented in 16 patients (76.2%) within (less than) one year after 131I administration and in 5 patients (23.8%) more than one year after initial therapy, considered late failure. Conclusion Successful 131I therapy for Graves’ hyperthyroidism with a single calculated dose can be achieved in the majority (> 90%) of patients, adjusting for the thyroid size and 24 h uptake measurement.https://deepblue.lib.umich.edu/bitstream/2027.42/146543/1/40842_2018_Article_71.pd

The smart home: how consumers craft new service networks by combining heterogeneous smart domestic products

Service research suggests homes are becoming increasingly connected as consumers automate and personalize new forms of service provision. Yet large-scale empirical evidence on how and why consumers automate smart domestic products is lacking. To address this knowledge gap we analyze 13,905 consumer-crafted, automated combinations of smart domestic products, totaling 1,144,094 installations, across 253 separate service providers on the Web service IFTTT.com. An exploratory network analysis examines the topology of the network and an interpretive coding exercise reveals how consumers craft different styles of human-computer interaction to co-create value. The results reveal the smart domestic product network is disassortative, imbalanced, has a long-tailed degree distribution, and that popular services have high centrality across all product category combinations. We show that popular combinations of smart domestic products are primarily motivated by utilitarian value seeking enacted through a preference for automated tasks outside of conscious attention, though more individualistic combinations are slightly more likely to be hedonistically inclined. We conclude by showing how these consumer-crafted forms of service provision within domestic environments reveal design redundancy and opportunities for service innovation

Prediction of Therapy Tumor-Absorbed Dose Estimates in I-131 Radioimmunotherapy Using Tracer Data Via a Mixed-Model Fit to Time Activity

Abstract Background: For individualized treatment planning in radioimmunotherapy (RIT), correlations must be established between tracer-predicted and therapy-delivered absorbed doses. The focus of this work was to investigate this correlation for tumors. Methods: The study analyzed 57 tumors in 19 follicular lymphoma patients treated with I-131 tositumomab and imaged with SPECT/CT multiple times after tracer and therapy administrations. Instead of the typical least-squares fit to a single tumor's measured time-activity data, estimation was accomplished via a biexponential mixed model in which the curves from multiple subjects were jointly estimated. The tumor-absorbed dose estimates were determined by patient-specific Monte Carlo calculation. Results: The mixed model gave realistic tumor time-activity fits that showed the expected uptake and clearance phases even with noisy data or missing time points. Correlation between tracer and therapy tumor-residence times (r=0.98; p<0.0001) and correlation between tracer-predicted and therapy-delivered mean tumor-absorbed doses (r=0.86; p<0.0001) were very high. The predicted and delivered absorbed doses were within±25% (or within±75 cGy) for 80% of tumors. Conclusions: The mixed-model approach is feasible for fitting tumor time-activity data in RIT treatment planning when individual least-squares fitting is not possible due to inadequate sampling points. The good correlation between predicted and delivered tumor doses demonstrates the potential of using a pretherapy tracer study for tumor dosimetry-based treatment planning in RIT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98438/1/cbr%2E2011%2E1053.pd

Identifying Patient Candidates for IL-1 Inhibition: Lessons From Real-World Cases

A subgroup of patients with gouty arthritis have a chronic recurring form that is particularly difficult to treat. Such patients experience repeated flares and often have abundant tophi. Many also have underlying comorbidities, such as renal impairment, cardiovascular disease, gastrointestinal disorders, obesity, and hypertension, which contraindicate the use of standard anti-inflammatory medications. Five patients with difficult to treat gouty arthritis who were either candidates and/or treated with anti-IL therapy are described.info:eu-repo/semantics/publishedVersio

Biological-Effect Modeling of Radioimmunotherapy for Non-Hodgkins Lymphoma: Determination of Model Parameters

Treatment with Tositumomab and 131I tositumomab anti-CD20 radioimmunotherapy (Bexxar) yields a nonradioactive antibody antitumor response (the so-called cold effect) and a radiation response. Numerical parameter determination by least-squares (LS) fitting was implemented for more accurate parameter estimates in equivalent biological-effect calculations. Methods: One hundred thirty-two tumors in 37 patients were followed using five or six SPECT/CT studies per patient, three each (typical) post-tracer (0.2 GBq) and post-therapy (?3 GBq) injections. The SPECT/CT data were used to calculate position- and time-dependent dose rates and antibody concentrations for each tumor. CT-defined tumor volumes were used to track tumor volume changes. Combined biological-effect and cell-clearance models were fit to tumor volume changes. Optimized parameter values determined using LS fitting were compared to previous fitted values that were determined by matching calculated to measured tumor volume changes using visual assessment. Absorbed dose sensitivity (α) and cold-effect sensitivity (?p) parameters were the primary fitted parameters, yielding equivalent biological-effect (E) values. Results: Individual parameter uncertainties were approximately 10% and 30% for α and ?p, respectively. LS versus previously fit parameter values were highly correlated, although the averaged α value decreased and the averaged ?p value increased for the LS fits compared to the previous fits. Correlation of E with 2-month tumor shrinkage data was similar for the two fitting techniques. The LS fitting yielded improved fit quality and likely improved parameter estimation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140326/1/cbr.2012.1467.pd

Inducing Partner Preference in Mice by Chemogenetic Stimulation of CA2 Hippocampal Subfield

Social recognition is fundamental for social decision making and the establishment of long-lasting affiliative behaviors in behaviorally complex social groups. It is a critical step in establishing a selective preference for a social partner or group member. C57BL/6J lab mice do not form monogamous relationships, and typically do not show prolonged social preferences for familiar mice. The CA2 hippocampal subfield plays a crucial role in social memory and optogenetic stimulation of inputs to the dorsal CA2 field during a short memory acquisition period can enhance and extend social memories in mice. Here, we show that partner preference in mice can be induced by chemogenetic selective stimulation of the monosynaptic projections from the hypothalamic paraventricular nucleus (PVN) to the CA2 during the cohabitation period. Specifically, male mice spend more time in social contact, grooming and huddling with the partner compared to a novel female. Preference was not induced by prolonging the cohabitation period and allowing more time for social interactions and males to sire pups with the familiar female. These results suggest that PVN-to-CA2 projections are part of an evolutionarily conserved neural circuitry underlying the formation of social preference and may promote behavioral changes with appropriate stimulation

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Accelerated surgery; Hip fracture; Randomised control trialCirurgia accelerada; Fractura de maluc; Prova controlada aleatòriaCirugía acelerada; Fractura de cadera; Prueba controlada aleatorizadaINTRODUCTION: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. METHODS AND ANALYSIS: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. ETHICS AND DISSEMINATION: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources. TRIAL REGISTRATION NUMBER: NCT02027896; Pre-results

Rationale and design of the hip fracture accelerated surgical treatment and care track (hip attack) trial: A protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Introduction: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. Methods and Analysis: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. Ethics and Dissemination: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources