Clinical application of SPECT-CT with 99mTc-Tektrotyd in bronchial and thymic neuroendocrine tumors (NETs)

Neuroendocrine tumors (NETs) of the thorax including bronchial and thymic tumors belong to foregut NETs. Limited loco-regional thoracic NETs can be resected with surgery, but in extensive metastatic disease the treatment is mainly palliative. A high incidence and density of somatostatin receptors (SSTR2, SSTR3, and SSTR5) are found in thoracic NETs. The purpose of this study was to evaluate the role of SPECT-CT somatostatin receptor scintigraphy (SRS) with 99mTc-Tektrotyd for imaging, staging and follow up of patients with bronchial and thymic neuroendocrine tumors. Forty-one patients with thoracic tumors with neuroendocrine differentiation were studied. Sixty-eight examinations including SPECT-CT studies of the neck and chest and/or abdomen and pelvis were carried out 2–4 hrs. post i.v. administration of aver­age 740 MBq activity dose of 99mTc-EDDA/HYNIC-TOC (Tektrotyd, Polatom). In all 41 investigated patients we obtained 81.25% (13/16), 88% (22/25) and 85.36% (35/41) of sensitivity, specificity and accuracy of this diagnostic approach, respectively. Somatostatin-receptor scintigraphy correctly identified all primary NETs located in the lungs and thymus. SPECT-CT studies with 99mTc-EDDA/HYNIC-TOC resulted in exact pre-surgical and pre-treatment N/M staging of bronchial and thymic NETs, except 2 cases with multiple hepatic metastases and 1 with massive suprarenal metastasis. It can be concluded that SPECT-CT with 99mTc-EDDA/HYNIC-TOC is a valuable tool for staging and follow-up of patients with thoracic NETs

First record of Psorergatoides Fain, 1959 (Acari, Cheyletoidea, Psorergatidae) for the Balkan Peninsula with description of the cutaneous lesions on the wing membrane of its hosts Myotis myotis (Borkhausen, 1797) and Myotis blythii (Tomes, 1857) (Chiroptera, Vespertilionidae)

Healthy wing membranes are essential for bats. They are critical for maintaining the water balance and, during hibernation, they protect the bat’s body from dehydration. Assessing the state of the membrane visually is an easy and effective way to monitor a bat’s health and discover abnormal structures and infections in wild bat populations. During pre- and post-hibernation surveys of bats’ wings, we identified the presence of skin mites, Psorergatoides kerivoulae (Fain, 1959). The parasite causes cutaneous lesions on the wing membranes of the greater moused-eared bat, Myotis myotis (Borkhausen, 1797) and the lesser moused-eared bat, Myotis blythii (Tomes, 1857). The lesser mouse-eared bat is a new host for this parasite. Our study is the first to describe the histopathology of the infection on the wings of the greater and lesser mouse-eared bats. To our knowledge, this is the southernmost record of this parasite and the first mention of the genus Psorergatoides for the Balkans

Cosmopolitan conservation: the multi-scalar contributions of urban green infrastructure to biodiversity protection [Letter]

Urbanization is a leading cause of biodiversity loss globally. Expanding cities alter regional ecological processes by consuming habitat and modifying biogeochemical and energetic flows. Densifying cities often lose valuable intra-urban green spaces. Despite these negative impacts, novel urban ecosystems can harbor high biodiversity and provide vital ecosystem services for urban residents. Recognizing the benefits of urban ecosystems, cities across the globe are increasingly planning for urban green infrastructure (UGI). UGI as a planning concept can transform how cities integrate biodiversity into urbanized landscapes at multiple scales and contribute to conservation goals. Full operationalization of UGI concepts can also reduce urban energy and resource demands via substituting polluting technologies by UGI, further contributing to the global conservation agenda. Realizing the potential contributions of UGI to local, regional, and global conservation goals requires addressing four inter-dependent challenges: (1) expanding social-ecological-systems thinking to include connections between complex social, ecological, and technological systems (SETS), (2) explicitly addressing multi-level governance challenges, (3) adapting SETS approaches to understand the contextual and biocultural factors shaping relationships between UGI and other causal processes in cities that shape biodiversity, and (4) operationalizing UGI systems through robust modeling and design approaches. By transforming UGI policy and research through SETS approaches to explicitly integrate biodiversity we can support global conservation challenges while improving human wellbeing in cities and beyond

Fulminate anaerobic bacteremia after chemotherapy for metastatic breast cancer despite the prophylactic use of GCSF

Mila Petrova1, Zhasmina Mihaylova1, Albena Fakirova21Clinic of Hematology and Oncology, Department of Medical Oncology; 2Department of Pathology, Medical Military Academy, Sofia, BulgariaAbstract: Chemotherapy-induced neutropenia often occurs in our routine work and presents an obstacle for adequate (dose and continuance) treatment, which may affect patients’ outcome. Granulocyte colony-stimulating factors (GCSFs) effectively prevent myelosuppression and thus improve the standard treatment. Through their application cases of chemotherapyinduced neutropenia have been reduced. Still these factors cannot remove entirely the danger of encountering neutropenia, which can cause dangerous complications. We present a case of a fulminate anaerobic infection with unknown origin in a patient with metastatic breast cancer after standard treatment with chemotherapy supported by GCSFs.Keywords: neutropenia, granulocyte colony-stimulating factors, anaerobic infection, phlegmo

Sorafenib in metastatic MTC – a case report and minireview of the literature

Mila Petrova1, Zhasmina Mihaylova1, Albena Fakirova21Hematology and Oncology Department, 2Pathology Department, Medical Military Academy, Sofia, BulgariaAbstract: Medullary thyroid cancer (MTC) is a rare and only surgically treatable disease with early development of metastases and bad prognosis. Due to the lack of efficient systemic treatment, new strategies and approaches are needed to better the patients’ outcome. One of the most promising treatment options is the use of tyrosine multikinase inhibitors, which appear to have some effect on the disease progression with tolerable toxicity. Most of them affect many key pathways in the cancer genesis and have proven their effect in different malignancies. We report a case of a young patient with metastatic MTC treated successfully for two months with sorafenib.Keywords: medullary thyroid cancer, tumor response, cardiotoxicity, TKI

Macromycetes in the Pirin Mts (SW Bulgaria)

This paper attempts to compile available and unpublished data on the macromycetes of the Pirin Mts. The total number of currently known species is 350, including 34 ascomycetes and 316 basidiomycetes. Among them, 60 species are reported for the first time for the Pirin Mts, including Inocybe pisciodora which is a new record for Bulgaria.The species composition, ecological-trophic structure, and economically important edible fungi are briefly discussed. A list of 25 macroscopic fungi of conservation significance for the mycota of this mountain, evaluated with the recent IUCN criteria, is given, including 4 Critically Endangered, 9 Endangered, 7 Vulnerable, and 5 Near Threatened species

LEIOMYOSARCOMA OF INFERIOR VENA CAVA

Sarcomas are very rare tumors and in 10-30% of the cases are located in the retroperitoneum. Leiomyosarcomas of inferior vena cava accounts for less than 1% of all sarcomas. Despite the poor prognosis as a whole, some cases with R0 resection might have excellent outcome. So, all attempts for R0 resection should be undertaken. Herein we present a case with tumor located at the border of lower and middle third of the IVC managed by excision, primary suture and preservation of both renal veins. A short review of the basic surgical options and risk factors is given

Climate Change Adaption between Governance and Government—Collaborative Arrangements in the City of Munich

Growing cities face severe land use conflicts. Urban expansion and the densification of existing built areas are increasing the pressure on green spaces, which are key for climate change adaptation. Planning procedures embroiled in these land use conflicts are often complicated and slow. This is due to the increasing complexity in planning processes, which involve a multitude of stakeholders and decision-makers, whose responsibilities are not always entirely clear. Governance-oriented forms of decision making with horizontal structures are often required, but these also entail challenges. In our study, we ask how climate adaptation through urban green spaces can be integrated into planning processes. The study is based on a methodological combination, including document analysis and qualitative interviews with administrative staff. The City of Munich, a rapidly growing German city, serves as a case study. The results show different collaborative arrangements in four planning arenas and demonstrate how these structures support or hinder climate change adaptation mainstreaming. We conclude that hierarchical structures impede horizontal collaborative arrangements and shed lights on mechanisms reinforcing these structures. For large administrations, informal meetings and coordinating units are effective in fostering interdepartmental cooperation