Superior detection of metastatic cystic lymphadenopathy in patients with papillary thyroid cancer by utilization of thyroglobulin washout

Abstract

Background

Fine‐needle aspiration (FNA) cytology has been the standard of care in the workup of cervical lymph nodes (LNs) in patients with recurrent papillary thyroid cancer (PTC) and suspicious cervical LNs. Recently, FNA thyroglobulin (TG) washout measurement has been proposed as an adjunct in the management of these patients. We hypothesize that using FNA‐TG washout for suspicious cervical LNs would increase the accuracy of diagnosing metastatic disease especially in cystic and highly vascular cervical LN in patients with recurrent PTC.

Methods

This is a retrospective study of a prospectively collected database for patients with thyroid cancer who underwent preoperative FNA followed by selective neck dissection by one surgeon at an academic institution. FNA‐cytology and FNA‐TG washout were performed simultaneously. A total of 138 patients were included in our study, of which 92 (66.7%) had undergone surgical intervention. Results of both methods were then correlated with the final surgical pathology.

Results

FNA‐cytology alone showed a sensitivity of 80.0%, specificity of 100.0% with a negative predictive value (NPV) of 60.0%. By contrast, FNA‐TG washout had a sensitivity of 95.8%, specificity of 90.5% with a NPV of 86.4%. Combination of the FNA‐cytology with FNA‐TG washout of cystic/highly vascular LN increased the accuracy of diagnosis with a sensitivity of 98.2%, specificity of 100.00% with a NPV of 95.0%. All 14 malignant cervical LNs with false‐negative FNA‐cytology showed elevated FNA‐TG washout, 10 (71.4%) of which were cystic in nature and 4 were highly vascular on ultrasonography.

Conclusion

FNA‐TG washout increases the diagnostic accuracy in detecting metastatic disease in patients with recurrent thyroid cancer. FNA‐TG washout may be of special diagnostic importance in cystic or highly vascular LNs, which might have falsely negative cytology.

Level of Evidence

2B

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Classification challenges in the field of eating disorders: can severe and enduring anorexia nervosa be better defined?

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The impact of human herpesvirus detection in pemphigus vulgaris

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The impact of human herpesvirus detection in pemphigus vulgaris

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Evaluation of the effects of formulation, food, or a proton-pump inhibitor on the pharmacokinetics of glasdegib (PF-04449913) in healthy volunteers: a randomized phase I study

Abstract

Purpose

To demonstrate the bioequivalence of the planned maleate salt-based commercial glasdegib tablet formulation [International Council for Harmonization (ICH) glasdegib] to the clinical di-hydrochloride (di-HCl) salt-based glasdegib formulation (di-HCl glasdegib). Additionally, to estimate the effects of a high-fat, high-calorie meal and proton-pump inhibitor (PPI) on the pharmacokinetics of ICH glasdegib.

Methods

This Phase I open-label study (ClinicalTrials.gov: NCT03130556) enrolled 24 healthy subjects to receive two different tablet formulations of single-dose 100-mg glasdegib under fasted conditions. A subset of healthy volunteers (n = 12) received single-dose 100-mg ICH glasdegib following a high-fat, high-calorie meal or concurrently with a PPI (rabeprazole).

Results

The adjusted geometric mean ratio (ICH glasdegib:di-HCl glasdegib) and 90% confidence intervals (CI) of area under the plasma concentration–time curve from time zero to infinity (AUC_inf) and maximum plasma concentration (C_max) were 104.0% (99.7‒108.5%) and 101.6% (96.1‒107.4%), respectively, within the acceptance range for bioequivalence (80‒125%). The adjusted geometric mean ratio (90% CIs) for AUC_inf and C_max under fed conditions were 84.3% (78.6‒90.6%) and 69.0% (61.8‒77.0%), respectively, relative to fasted conditions. When ICH glasdegib was administered concurrently with the PPI, the adjusted geometric mean ratio (90% CI) of AUC_inf and C_max were 100.6% (93.2‒108.6%) and 80.5% (70.7‒91.6%), respectively, relative to fasted conditions. Glasdegib was generally well tolerated under all conditions studied.

Conclusions

The ICH glasdegib tablet formulation was bioequivalent to the clinical di-HCl formulation under fasted conditions. A high-fat, high-calorie meal or concurrent PPI treatment had a minimal effect on glasdegib exposure, and was not considered clinically meaningful.

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Dermatitis and alopecia in a patient treated with dupilumab: a new adverse effect?

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Dermatitis and alopecia in a patient treated with dupilumab: a new adverse effect?

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Large-scale comparative neuroimaging: Where are we and what do we need?

Publication date: Available online 8 December 2018

Source: Cortex

Author(s): Michel Thiebaut de Schotten, Paula L. Croxson, Rogier B. Mars

Abstract

Neuroimaging has a lot to offer comparative neuroscience. Although invasive "gold standard" techniques have a better spatial resolution, neuroimaging allows fast, whole-brain, repeatable, and multi-modal measurements of structure and function in living animals and post-mortem tissue. In the past years, comparative neuroimaging has increased in popularity. However, we argue that its most significant potential lies in its ability to collect large-scale datasets of many species to investigate principles of variability in brain organisation across whole orders of species—an ambition that is presently unfulfilled but achievable. We briefly review the current state of the field and explore what the current obstacles to such an approach are. We propose some calls to action.

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Nasal function and CPAP compliance

Publication date: Available online 8 December 2018

Source: Auris Nasus Larynx

Author(s): Akiko Inoue, Shintaro Chiba, Kentaro Matsuura, Hiroshi Osafune, Robson Capasso, Kota Wada

Abstract

Objective

Continuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specific criteria or recommendations for the evaluation and management of these patients exist. The aim of this retrospective study is to evaluate the effects of nasal anatomic features and disease on adherence to CPAP therapy for patients with OSA and determine the indications for pre-CPAP nasal treatment by using data obtained at clinical examination.

Methods

In total, 711 adult patients with initial diagnosis of OSA and an apnea–hypopnea index of ≥20 who were amenable to CPAP were included. We analyzed nasal parameters, past history of nasal disease, subjective symptoms, and disease severity in addition to whether CPAP therapy had been initiated, rate of CPAP therapy use (initial and 1 year), treatment continuation rate at 2 months and 1 year, and nasal treatments for all patients.

Results

CPAP therapy was initiated in 543 of 711 patients. Nasal resistance was significantly higher in patients who discontinued therapy soon after CPAP initiation. Nasal disease and nasal parameters were not found to be predictors of treatment adherence at 1 year.

Allergic rhinitis, moderate to severe nasal congestion at bedtime, slight or extensive sinus opacification, and a high nasal septum deviation score were found to be independent predictors of nasal treatment, while strong awareness of nasal congestion, a past history of sinusitis, and a total nasal resistance (supine position) of ≥0.35 Pa/cm³/s were independent predictors of surgical treatment.

Conclusion

Long-term CPAP therapy adherence in patients with OSA can be predicted from initial CPAP adherence. Nasal disease and nasal parameters are important factors for early CPAP therapy discontinuation and should be adequately treated before therapy initiation to ensure long-term adherence. Indications for pre-CPAP nasal treatment and nasal surgery for patients with OSA can be predicted from the data obtained at the first examination, and these patients should be treated differently from those without OSA.

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Large Font Patient Written Instructions

Publication date: Available online 8 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Christopher Dallo, Brett Neill, Zachary Bryan, Daniel Aires

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Seizure and Acute Vision Loss in a Filipino Lupus Patient: A Case of Posterior Reversible Encephalopathy Syndrome with Intraparenchymal Hemorrhage

Posterior reversible encephalopathy syndrome (PRES) is a rare and poorly understood neurologic condition that has been described in some patients with systemic lupus erythematosus (SLE). Intracerebral hemorrhage is a unique and atypical presentation of PRES and has been described only in a small number of patients with SLE. We present the case of a 33-year-old female, diagnosed with SLE and active nephritis, who was admitted for seizures. She had acute-onset headache, confusion, and bilateral vision loss associated with severe hypertension. CT scan revealed right occipital and parietal lobe hemorrhage. MRI showed vasogenic edema and hyperintense foci in bilateral cortical and subcortical regions of the occipital and posterior parietal lobes which are consistent with posterior reversible encephalopathy syndrome (PRES). Strict blood pressure control and medical ICP-lowering treatment were immediately instituted, while maintaining her on anticonvulsants, high-dose steroids, and mycophenolate mofetil. The patient was discharged with improvement in vision and resolution of headache. On follow-up, she had gained her premorbid visual acuity and reported no recurrence of headache or seizures. Despite its name, reversibility remains to be conditional in PRES. A high index of suspicion is important, especially among those who present with seizure, headache, and visual loss. Early diagnosis and timely initiation of therapy is recommended, as clinical symptoms are potentially reversible and delayed therapy may result in life-threatening complications, such as coma or death.

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Serious Asthma Events with Mometasone Furoate Plus Formoterol Compared With Mometasone Furoate

Publication date: Available online 8 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Cindy L.J. Weinstein, Nicholas Ryan, Tulin Shekar, Davis Gates, Stephen J. Lane, Ioana Agache, Robert A. Nathan, SPIRO Investigators

Abstract

Background

The safety of long-acting beta agonists added to inhaled corticosteroids for the treatment of persistent asthma has been controversial.

Objective

To determine whether administering formoterol in combination with mometasone furoate increases the risk of serious asthma outcomes compared to mometasone furoate alone.

Methods

We conducted a 26-week, randomized, double-blind trial in adolescent and adult patients (≥12 years) with persistent asthma in 35 countries with the primary objective of evaluating whether mometasone furoate-formoterol increases the risk of serious asthma outcomes (adjudicated hospitalization, intubation, or death) compared to mometasone furoate alone. The key efficacy endpoint was asthma exacerbation (composite of hospitalizations ≥24 h, emergency visits <24 h requiring systemic corticosteroid, or systemic corticosteroid for ≥3 consecutive days).

Results

Among 11,729 patients (mometasone furoate-formoterol, n=5868; mometasone furoate, n=5861), a total of 81 serious asthma outcomes, all asthma-related hospitalizations, were observed in 71 patients; 45 events from 39 patients on mometasone furoate-formoterol and 36 events from 32 patients on mometasone furoate. The hazard ratio for the first serious asthma outcome in the mometasone furoate-formoterol versus mometasone furoate group was 1.22 (95% CI: 0.76 to 1.94, p=0.411). Asthma exacerbation occurred in 1487 patients; 708 on mometasone furoate-formoterol and 779 on mometasone furoate. The hazard ratio for the first asthma exacerbation in the mometasone furoate-formoterol versus mometasone furoate group was 0.89 (95% CI: 0.80 to 0.98, p=0.021).

Conclusions

The addition of formoterol to mometasone maintenance therapy did not increase the risk of serious asthma-related events and reduced the risk of asthma exacerbation.

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Identification of novel allergic diathesis genes: are we closer to novel therapeutic targets?

Publication date: Available online 8 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Michelle Daya, Kathleen C. Barnes

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