Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (¹⁸F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients.</p> <p>Methods</p> <p>Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31–78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9). Preoperative FDG-PET scan and intraoperative GP study were performed in all patients. Mean time interval between preoperative FDG-PET scan and surgery was 16 days (range 1–41 days) in 19 patients. For intraoperative GP studies, 19 patients were injected with a dose of 10–15 mCi ¹⁸F FDG at approximately 30 minutes before the planned surgery time. In two patients, the intraoperative GP study was performed immediately after preoperative FDG-PET scan.</p> <p>Results</p> <p>Preoperative FDG-PET and intraoperative GP detected 48 and 45 lesions, respectively. A total of 50 presumed site of recurrent disease from 20 patients were resected. Thirty-seven of 50 presumed sites of recurrent disease were histological-proven tumor positive and 13 of 50 presumed sites of recurrent disease were histological-proven tumor negative. When correlated with final histopathology, the number of true positive lesions and false positive lesions by preoperative FDG-PET and intraoperative GP were 31/9 and 35/8, respectively. Both preoperative FDG-PET and intraoperative GP were true positive in 29 lesions. Intraoperative GP detected additional small lesions in the omentum and pelvis which were not seen on preoperative FDG-PET scan. FDG-PET scan demonstrated additional liver metastases which were not detected by intraoperative GP. Preoperative FDG-PET detected distant metastasis in the lung in one patient. The estimated radiation dose received by a surgeon during a single 18F FDG GP surgery was below the occupational limit.</p> <p>Conclusion</p> <p>The combined use of preoperative FDG-PET and intraoperative GP is potentially helpful to the surgeon as a roadmap for accurately locating and determining the extent of tumor recurrence in patients with CRC. While intraoperative GP appears to be more sensitive in detecting the extent of abdominal and pelvic recurrence, preoperative FDG-PET appears to be more sensitive in detecting liver metastases. FDG-PET is also a valuable method in detecting distant metastases.</p

"Belonging” in the gentrified Golden Horn/Halic neighbourhoods of Istanbul

Mainstream gentrification research predominantly examines experiences and motivations of the middle-class gentrifier groups, while overlooking experiences of non-gentrifying groups including the impact of in situ local processes on gentrification itself. In this paper, I discuss gentrification, neighbourhood belonging and spatial distribution of class in Istanbul by examining patterns of belonging both of gentrifiers and non-gentrifying groups in historic neighbourhoods of the Golden Horn/Halic. I use multiple correspondence analysis (MCA), a methodology rarely used in gentrification research, to explore social and symbolic borders between these two groups. I show how gentrification leads to spatial clustering by creating exclusionary practices and eroding social cohesion, and illuminate divisions that are inscribed into the physical space of the neighbourhood

The Therapeutic Management of Back Pain With and Without Sciatica in the Emergency department: A Systematic review

Introduction An increasing number of patients are attending the Emergency Department (ED) with back pain with or without sciatica. There is evidence to suggest that medical management is varied and inconsistent. Objective The purpose of this study was to review the literature to determine the evidence base for the therapeutic management of adults presenting with back pain with or without sciatica in the ED. Methods A systematic review of the literature included the therapeutic management of patients presenting in the ED. Articles published in peer review journals in English language up to August 2018 were searched for in the following data-bases: MEDLINE, EMBASE, SCOPUS, CINAHL, ZETOC, PubMed, The Cochrane Library (Cochrane Database of Systematic Reviews), Web of Science, Open Grey and ETHOS. A narrative synthesis approach was followed. Results Twenty two studies, including 17 randomised control trials, one randomised control pilot study, two cohort studies, one cohort pilot study and one retrospective audit were included. The Downs and Black methodological quality scores ranged from 16 to 31 with a mean score of 24 out of a possible 32. Conclusion Evidence suggests that Naproxen alone should be considered as first line management in cases of back pain without sciatica. Intra-venous corticosteroids should be considered in the management of cases of severe sciatica. More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED, specifically focusing on non-pharmacological management and the first line management of patients presenting with LBP with sciatica

Prevalencija, enterotoksigena svojstva i antimikrobna osjetljivost bakterije Staphylococcus aureus izolirane iz različitih vrsta hrane životinjskog podrijetla

This study aimed to determine the prevalence, enterotoxigenic properties and antimicrobial resistance profile of Staphylococcus aureus isolated from 850 food samples, including bulk tank milk, Tulum cheese, chicken meat and beef carcasses, in Türkiye. S. aureus contamination rates and the mean contamination levels of 86 positive samples from bulk tank milk, Tulum cheese, chicken meat and beef carcasses were 10.8% (n:49) and 3.01±0.48 log cfu/ml, 17% (n:17) and 3.08±0.42 log cfu/g, 12% (n:12) and 2.89±0.27 log cfu/g, and 4% (n:8) and 1.28±0.54 log cfu/cm2 , respectively. 39 out of 86 isolates (45.3%) had one or more enterotoxin genes (sea-see, seg-selj, sep). sed was the most common classical enterotoxin gene, whereas sei was the most common new enterotoxin gene. Antimicrobial susceptibility testing against 16 antibiotics performed by VITEK 2 showed that 61 isolates (70.9%) were resistant to various antibiotics. 32.8% of the resistant isolates were multidrug resistant (MDR) and the mean multiple antimicrobial resistance (MAR) index was 0.301. The isolates were mostly resistant to penicillin (63.9%), followed by oxacillin (24.4%), clindamycin (19.7%) and erythromycin (12.7%). mecA was detected in 13 isolates (15.1%), but no mecC was found. It was concluded that most of the S. aureus isolates had enterotoxin genes which might cause foodborne intoxications. The high antibiotic resistance rates observed in these strains, including MRSA, may also result in some public health hazards.Cilj je istraživanja bio odrediti prevalenciju, enterotoksigena svojstva i rezistenciju na antimikrobne lijekove bakterije Staphilococcus aureus izolirane iz 850 uzoraka hrane u Turskoj. Navedeno je uključivalo spremnike za mlijeko, sir Tulum, pileće meso i goveđe trupove. Stopa kontaminacije bakterijom S. aureus i srednja stopa kontaminacije u 86 pozitivnih uzoraka iznosile su: 10,8% (n:49) i 3,01±0,48 log cfu/mL za spremnike mlijeka, 17% (n:17) i 3,08±0,42 log cfu/g za sir Tulum, 12% (n:12) i 2,89±0,27 log cfu/g za pileće meso te 4% (n:8) i 1.28±0.54 log cfu/cm2 za goveđe trupove. Trideset i devet od 86 izolata (45,3%) imalo je jedan ili više gena za enterotoksin (sea-see, seg-selj, sep). Najčešći je gen za klasične, poznate enterotoksine bio sed, dok je sei bio najčešći gen za nove enterotoksine. Uporabom VITEK 2 uređaja za 16 antibiotika analizirana je osjetljivost na antimikrobne lijekove a rezultati su pokazali da je 61 izolat (70,9%) bio otporan na antibiotike. Ukupno je 32,8% pozitivnih izolata bilo otporno na više lijekova (engl. multidrug resistant, MDR), a indeks prosječne višestruke otpornosti na antimikrobne lijekove (MAR) bio je 0,301. Izolati su najčešće bili otporni na penicilin (63,9%), zatim na oksacilin (24,4%), klindamicin (19,7%) i eritromicin (12,7%). Gen mecA pronađen je u 13 izolata (15,1%), dok gen mecC nije pronađen. Zaključeno je da je većina izolata bakterije S. aureus imala gene za enterotoksine koji mogu uzrokovati trovanja hranom. Uz navedeno, visoka stopa otpornosti na antibiotike kod izoliranih sojeva, uključujući MRSA-u, upućuje i na javnozdravstveni rizik

An Analysis of Density And Degree-Centrality According To The Social Networking Structure Formed in An Online Learning Environment

In this study, we assessed the communication structure in an educational online learning environment using social network analysis (SNA). The communication structure was examined with respect to time, and instructors' participation. The course was implemented using ELGG, a network learning environment, blended with face-to-face sessions over a 14-week period. Data were collected from 114 undergraduate students who were enrolled in Instructional Technology and Material Design course. The program functions on the basis of a matrix; in this case a square matrix with rows and columns being the students' ID numbers. Density and centrality measures were visualized and interpreted. In terms of the density of the groups, it was found that the lowest density occurred during the first week. The highest density, on the other hand, occurred during the week when the instructor participated, in all the groups except for the third and sixth groups. The students placed in the center and those on the edges of the network differed on the basis of time as well as the instructor's participation. Other online learning environments could be assessed in a similar fashion using SNA in order to understand levels of participation and changes in interaction over time.Wo

A Therapeutic Role for Survivin in Mitigating the Harmful Effects of Ionizing Radiation

Background. Radiation therapy is a form of adjuvant care used in many oncological treatment protocols. However, nonmalignant neighboring tissues are harmed as a result of this treatment. Therefore, the goal of this study was to induce the production of survivin, an antiapoptotic protein, to determine if this protein could provide protection to noncancerous cells during radiation exposure. Methods. Using a murine model, a recombinant adenoassociated virus (rAAV) was used to deliver survivin to the treatment group and yellow fluorescence protein (YFP) to the control group. Both groups received targeted radiation. Visual inspection, gait analysis, and tissue histology were used to determine the extent of damage caused by the radiation. Results. The YFP group demonstrated ulceration of the irradiated area while the survivin treated mice exhibited only hair loss. Histology showed that the YFP treated mice experienced dermal thickening, as well as an increase in collagen that was not present in the survivin treated mice. Gait analysis demonstrated a difference between the two groups, with the YFP mice averaging a lower speed. Conclusions. The use of gene-modification to induce survivin expression in normal tissues allows for the protection of nontarget areas from the negative side effects normally associated with ionizing radiation