MIBG scans in patients with stage 4 neuroblastoma reveal two metastatic patterns, one is associated with MYCN amplification and in MYCN-amplified tumours correlates with a better prognosis

Methods: Diagnostic 123I-MIBG scans from 249 patients (123 from a European and 126 from the COG cohort) were assessed for metastatic spread in 14 body segments and the form of the lesions: “focal” (clear margins distinguishable from adjacent background) or “diffuse” (indistinct margins, dispersed throughout the body segment). The total numbers of diffuse and focal lesions were recorded. Patients were then categorized as having lesions exclusively focal, lesions more focal than diffuse, lesions more diffuse than focal, or lesions exclusively diffuse.Results: Diffuse lesions affected a median of seven body segments and focal lesions a median of two body segments (P < 0.001, both cohorts). Patients with a focal pattern had a median of 2 affected body segments and those with a diffuse pattern a median of 11 affected body segments (P < 0.001, both cohorts). Thus, two MIBG-avid metastatic patterns emerged: “limited-focal” and “extensive-diffuse”. The median numbers of affected body segments in MYCN-amplified (MNA) tumours were 5 (European cohort) and 4 (COG cohort) compared to 9 and 11, respectively, in single-copy MYCN (MYCNsc) tumours (P < 0.001). Patients with exclusively focal metastases were more likely to have a MNA tumour (60 % and 70 %, respectively) than patients with the other types of metastases (23 % and 28 %, respectively; P < 0.001). In a multivariate Cox regression analysis, focal metastases were associated with a better event-free and overall survival than the other types of metastases in patients with MNA tumours in the COG cohort (P < 0.01).Conclusion: Two metastatic patterns were found: a “limited and focal” pattern found mainly in patients with MNA neuroblastoma that correlated with prognosis, and an “extensive and diffuse” pattern found mainly in patients with MYCNsc neuroblastoma.Purpose: The aim of this study was to find clinically relevant MIBG-avid metastatic patterns in patients with newly diagnosed stage 4 neuroblastoma

Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy: arrest of bone loss

OBJECTIVE: To explore the effects of anti-TNFalpha antibody therapy on bone mineral density (BMD) of the lumbar spine and femur neck in patients with rheumatoid arthritis (RA). METHODS: /B> 50 patients with active RA (DAS28 >/= 3.2) who started adalimumab (40 mg subcutaneously / 2 weeks) were included in an open label prospective study. All patients used stable methotrexate and were allowed to use prednisone ("T 10 mg/day). The BMD of the lumbar spine and femur neck was measured before, and one year after start of treatment. RESULTS: Both disease activity at baseline (DAS28) and disease duration were inversely correlated with femoral neck BMD and lumbar spine BMD (P < 0.05). Mean BMD of both lumbar spine and femur neck remained unchanged after one year of adalimumab therapy (+0.3% and +0.3%, respectively). Of interest, a beneficial effect of prednisone on change in femur neck BMD was observed with a relative increase with prednisone use (+2.5%) compared to no concomitant prednisone use (-0.7%), (P = 0.015). CONCLUSION: /B> In contrast to the progressive bone loss observed after conventional disease modifying anti rheumatic drug therapy, TNF blockade may result in an arrest of general bone loss. Consistent with previous observations, the data also suggest that the net effect of low dose corticosteroids on BMD in RA may be beneficial, possibly resulting from their anti-inflammatory effect

The Role of Migration and Acculturation in Moderating Risk of Schizophrenia: An Australian Case-Control Study

Background: Compared to Native Born (NB) populations, elevated rates of schizophrenia have been identified in the First-Generation Migrants (FGMs) and Second-Generation Migrants (SGMs) of numerous countries (‘the migration effect’). However, recent data suggest that FGMs have a reduced risk of psychotic illness in Australia. Methods: Study 1 utilised data from the Australian Schizophrenia Research Bank (ASRB) (N= 1528, cases N=714) and Study 2 consisted of 217 participants recruited from the ASRB (cases N=103). Bivariate and multivariate logistic regression models were employed to examine the effects of migrant status and other psychosocial factors on risk of schizophrenia (expressed as odds ratios (OR)). Results: Overall, FGM status was associated with a significantly reduced relative-risk of schizophrenia compared to NB participants (Study 1 OR = 0.53, p0.05). These effects were moderated by cannabis abuse as well as childhood adversity, which were found to strongly predict schizophrenia in Study 1. Experiences of discrimination increased the odds of schizophrenia in Study 2 (OR=1.27, p<0.05), however this effect was rendered non-significant when substance abuse history was taken into account. Study 2 also found that having a negative affiliation towards mainstream Australian culture and a Marginalised acculturation style more than doubled risk of schizophrenia in the overall sample ((OR = 2.12 and OR = 2.67, p<0.05, respectively) but reduced risks for FGMs who more often had a Separated Identity style. Conclusions: The normalisation of risk for SGMs may be attributed to comparative levels of childhood adversity and substance use compared to NBs, coupled with the deleterious effects of being treated as an subordinate position in one’s own country of birth. Conclusions are discussed in relation to sociodevelopmental model of schizophrenia

Low Bone Mineral Density in Patients With Well- Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Background Human immunodeficiency virus (HIV) and combination antiretroviral therapy (cART) may both contribute to the higher prevalence of osteoporosis and osteopenia in HIV-infected individuals. Methods Using dual-energy X-ray absorptiometry, we compared lumbar spine, total hip, and femoral neck bone mineral density (BMD) in 581 HIV-positive (94.7% receiving cART) and 520 HIV-negative participants of the AGE<inf>h</inf>IV Cohort Study, aged 45 years. We used multivariable linear regression to investigate independent associations between HIV, HIV disease characteristics, ART, and BMD. Results The study population largely consisted of men who have sex with men (MSM). Osteoporosis was significantly more prevalent in those with HIV infection (13.3% vs 6.7%; P <. 001). After adjustment for body weight and smoking, being HIV-positive was no longer independently associated with BMD. Low body weight was more strongly negatively associated with BMD in HIV-positive persons with a history of a Centers for Disease Control and Prevention class B or C event. Interestingly, regardless of HIV status, younger MSM had significantly lower BMD than older MSM, heterosexual men, and women. Conclusions The observed lower BMD in treated HIV-positive individuals was largely explained by both lower body weight and more smoking. Having experienced symptomatic HIV disease, often associated with weight loss, was another risk factor. The low BMD observed in younger MSM remains unexplained and needs further study

Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis?

Background: There is no international consensus on surveillance strategies for differentiated thyroid carcinoma (DTC) after radiotherapy for childhood cancer. Ultrasonography could allow for early detection of DTC, however, its value is yet unclear since the prognosis of DTC is excellent. We addressed the evidence for the question: 'is outcome of DTC influenced by tumor stage at diagnosis?'. Methods: A multidisciplinary working group answered the sub-questions: 'is recurrence or mortality influenced by DTC stage at diagnosis? Does detection of DTC at an early stage contribute to a decline in adverse events of treatment?' The literature was systematically reviewed, and conclusions were drawn based on the level of evidence (A: high, B: moderate to low, C: very low). Results: In children, level C evidence was found that detection of DTC at an early stage is associated with lower recurrence and mortality rates. No evidence was found that it influences morbidity rates. In adults, clear evidence was found that less advanced staged DTC is a favorable prognostic factor for recurrence (level B) and mortality (level A). Additionally, it was found that more extensive surgery increases the risk to develop transient hypoparathyroidism (level A) and that higher doses of radioiodine increases the risk to develop second primary malignancies (level B). Conclusion: Identification of DTC at an early stage is beneficial for children (very low level evidence) and adults (moderate to high level evidence), even considering that the overall outcome is excellent. These results are an important cornerstone for the development of guidelines for childhood cancer survivors at risk for DTC. (C) 2014 Elsevier Ltd. All rights reserved

Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis?

Item does not contain fulltextBACKGROUND: There is no international consensus on surveillance strategies for differentiated thyroid carcinoma (DTC) after radiotherapy for childhood cancer. Ultrasonography could allow for early detection of DTC, however, its value is yet unclear since the prognosis of DTC is excellent. We addressed the evidence for the question: 'is outcome of DTC influenced by tumor stage at diagnosis?'. METHODS: A multidisciplinary working group answered the sub-questions: 'is recurrence or mortality influenced by DTC stage at diagnosis? Does detection of DTC at an early stage contribute to a decline in adverse events of treatment?' The literature was systematically reviewed, and conclusions were drawn based on the level of evidence (A: high, B: moderate to low, C: very low). RESULTS: In children, level C evidence was found that detection of DTC at an early stage is associated with lower recurrence and mortality rates. No evidence was found that it influences morbidity rates. In adults, clear evidence was found that less advanced staged DTC is a favorable prognostic factor for recurrence (level B) and mortality (level A). Additionally, it was found that more extensive surgery increases the risk to develop transient hypoparathyroidism (level A) and that higher doses of radioiodine increases the risk to develop second primary malignancies (level B). CONCLUSION: Identification of DTC at an early stage is beneficial for children (very low level evidence) and adults (moderate to high level evidence), even considering that the overall outcome is excellent. These results are an important cornerstone for the development of guidelines for childhood cancer survivors at risk for DTC