Local relapse of nasopharyngeal cancer and Voxel-based analysis of FMISO uptake using PET with semiconductor detectors

Background: Hypoxic cancer cells are thought to be radioresistant and could impact local recurrence after radiotherapy (RT). One of the major hypoxic imaging modalities is [18F]fluoromisonidazole positron emission tomography (FMISO-PET). High FMISO uptake before RT could indicate radioresistant sites and might be associated with future local recurrence. The predictive value of FMISO-PET for intra-tumoral recurrence regions was evaluated using high-resolution semiconductor detectors in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT). Methods: Nine patients with local recurrence and 12 patients without local recurrence for more than 3 years were included in this study. These patients received homogeneous and standard doses of radiation to the primary tumor irrespective of FMISO uptake. The FMISO-PET image before RT was examined via a voxel-based analysis, which focused on the relationship between the degree of FMISO uptake and recurrence region. Results: In the pretreatment FMISO-PET images, the tumor-to-muscle ratio (TMR) of FMISO in the voxels of the tumor recurrence region was significantly higher than that of the non-recurrence region (p < 0.0001). In the recurrent patient group, a TMR value of 1.37 (95% CI: 1.36-1.39) corresponded to a recurrence rate of 30%, the odds ratio was 5.18 (4.87-5.51), and the area under the curve (AUC) of the receiver operating characteristic curve was 0.613. In all 21 patients, a TMR value of 2.42 (2.36-2.49) corresponded to an estimated recurrence rate of 30%, and the AUC was only 0.591. Conclusions: The uptake of FMISO in the recurrent region was significantly higher than that in the non-recurrent region. However, the predictive value of FMISO-PET before IMRT is not sufficient for up-front dose escalation for the intra-tumoral high-uptake region of FMISO. Because of the higher mean TMR of the recurrence region, a new hypoxic imaging method is needed to improve the sensitivity and specificity for hypoxia

Interference of Descemet's Membrane with Aqueous Humor Drainage via an ExPRESS Mini Shunt

Purpose: To describe a case in which Descemet's membrane interfered with aqueous humor drainage through an ExPRESS mini shunt. This problem was successfully solved by Nd:YAG laser membranotomy. Case Report: A 70-year-old male, diagnosed with corticosteroid-induced glaucoma in his right eye, presented to our hospital. Topical betamethasone treatment was discontinued, and the patient was treated with intravenous D-mannitol and acetazolamide, followed by oral acetazolamide, oral potassium L-aspartate, topical dorzolamide hydrochloride, topical carteolol hydrochloride, and topical latanoprost. However, his right intraocular pressure (IOP) remained elevated. We performed ExPRESS shunt surgery in the patient's right eye. His postoperative IOP was initially within the normal range, but it reincreased 1 month after surgery. We found that the Descemet's membrane was interfering with both the primary (axial) and reserve orifices at the tip of the ExPRESS mini shunt. Nd:YAG laser membranotomy was performed and the patient's IOP again improved without any other medical treatment. Conclusion: Descemet's membrane interfered with aqueous humor drainage via ExPRESS mini shunt, causing an increased IOP, which was resolved by Nd:YAG laser membranotomy

A New Brain Positron Emission Tomography Scanner with Semiconductor Detectors for Target Volume Delineation and Radiotherapy Treatment Planning in Patients with Nasopharyngeal Carcinoma.

Two treatment planning methods for nasopharyngeal carcinoma were compared: conventional whole-body BGO scintillator positron emission tomography and a new brain PET system using semiconductor detec- tors. The average absolute volume of GTV contoured with the use of the new brain PET system was significantly smaller than that of conven- tional whole-body BGO PET. The new brain PET system using semiconductor detectors can provide more accurate tumor delineatio

[18F]fluoromisonidazole and a New PET System With Semiconductor Detectors and a Depth of Interaction System for Intensity Modulated Radiation Therapy for Nasopharyngeal Cancer

Purpose: The impact of a new type of positron emission tomography with semiconductor detectors (New PET) on an 18F-fluoromisonidazole (FMISO)-guided intensity-modulated radiation therapy (IMRT) plan was investigated by comparing the plan with the use of a state-of-the-art PET/computed tomography system (PET/CT) in nasopharyngeal cancer (NPC) patients. Methods and Materials: Twenty-four patients with non-NPC malignant tumors (control group) and 16 patients with NPC were subjected to FMISO-PET. The threshold of the tumor-to-muscle (T/M) ratio in each PET scan was calculated. The hypoxic volume within the gross tumor volume was determined using each PET ([NewPET]GTVh and [PET/CT]GTVh, respectively). Dose-escalation IMRT plans prescribing 84Gy to each GTVh were carried out. Results: The threshold of the T/M ratio was calculated to be 1.35 for New PET and 1.23 for PET/CT. The mean volume of [NewPET]GTVh was significantly smaller than that of [PET/CT]GTVh (1.5±1.6cc vs. 4.7±4.6cc, respectively, P =0.0020). The dose-escalation IMRT plans using New PET were superior in dose distribution to those using PET/CT. Dose escalation was possible in all 10 New PET-guided plans but not in one PET/CT-guided plan, because the threshold dose to the brainstem was exceeded. Conclusion: New PET was suggested to be useful for accurate dose escalation in FMISO-guided IMRT for patients with NPC

Additional file 1: of Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery

Preoperative and postoperative MRD1 values, and preoperative distance between medial and lateral canthi. (XLSX 13 kb

Case reports of pregnancies complicated with kidney disease and their fetal prognosis

　The number of patients with chronic kidney disease (CKD) has been increasing every year, with a current prevalence of one in eight adults. Although the frequency of complications due to kidney disease before pregnancy is not high (0.02–0.12%), frequency of pregnancy with CKD, including cases receiving continuous dialysis therapy is expected to increase in the future. The fertility and birth rates among dialysis patients are low, and perinatal management in these patients is currently difficult. However, even under such circumstances, the probability of having a live-born baby in pregnant women on dialysis has increased due to improvements in dialysis technology, perinatal management, and neonatal care. There are some case reports written about them, and I think that it is possible to approach term delivery with careful care through the cases experienced this time.　In this study, we examined the pregnant patients, on dialysis or requiring postpartum dialysis, at Kawasaki Medical School Hospital between January 2005 and March 2018. Six patients (86%) had a live-born baby, while one had a miscarriage. One patient underwent two pregnancies on dialysis; one case gave a full-term birth, while the rest had a premature delivery. The modes of delivery were vaginal delivery (n = 1), elective cesarean section (n = 3), and emergency cesarean section (n = 2). Five patients delivered successfully and had a good prognosis, while in one case, the neonate died.　Over the years, owing to continuous improvement at our hospital, we have achieved better pregnancy prognosis and longer gestation periods in the patients. In particular, one case, which had a natural second pregnancy, 9 years after the beginning of dialysis, was worthy of note; we were able to manage her second pregnancy using the process followed during her first pregnancy as reference