Pancreatic carcinoma: The contribution of CA 19-9 to the enhancement of diagnostic precision of imaging techniques

Background: Ultrasonography (US) and magnetic resonance (MR) are the most important imaging techniques in the diagnostics of pancreatic carcinoma and disease staging; they are also very useful in monitoring and follow-up of treatment efficacy. The problems with imaging diagnostics arise in certain cases of pancreatic focal lesions - for example in the differentiation of focal chronic pancreatitis and pancreatic carcinoma. Our objectives were the evaluation of US and MR reliability and determination of the importance of oncomarker CA 19-9 in the diagnostics of pancreatic carcinoma. Methods: Our investigation included patients with pancreatic focal mass suspected of malignancy. All patients were examined by ultrasonography, MR, and ultrasound-guided needle biopsy. Cytopathologic examination of the bioptic samples was used to diagnose the disease. Oncomarker CA 19-9 was done in all patients. Results: MR imaging and US examination made possible the correct diagnosis of carcinoma in case of 17 patients; in three patients with focal chronic pancreatitis the diagnosis was false positive. No case of false negative diagnosis was found. The value of oncomarker CA 19-9 was determined and it was clearly positive (over 150 U/ml) in all patients. Conclusion Imaging techniques gave good results in the evaluation of pancreatic pathology. However, when using imaging techniques differential diagnosis between focal chronic pancreatitis and pancreatic carcinoma seems to be major problem. Correlation of imaging technique and identification of CA 19-9 has an important role in the diagnostics of pancreatic carcinoma. Imaging techniques and identification of oncomarker CA 19-9 are complementary methods in the examination and diagnostics of pancreatic carcinoma and they allow better precision of diagnosis of pancreatic focal lesions

Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial

Background After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1.4-1.8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary syndrome and diabetes. However, the efficacy and safety of further reduction in LDL cholesterol with an inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) after acute coronary syndrome is unknown. We aimed to explore this issue in a prespecified analysis of the ODYSSEY OUTCOMES trial of the PCSK9 inhibitor alirocumab, assessing its effects on cardiovascular outcomes by baseline glycaemic status, while also assessing its effects on glycaemic measures including risk of new-onset diabetes

Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab.

Background: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. Methods: The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score–matched models. Results: Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9–3.6], 4.0 [95% CI, 3.6–4.5], and 5.5 [95% CI, 5.0–6.1] events per 100 patient-years in strata 35–<50, and ≤35 mg/dL, respectively). Compared with propensity score–matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol but not vice versa. Conclusions: In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01663402.gov; Unique identifier: NCT01663402.URL: https://www