Spinal cord stimulation and return to work of patients with failed back surgery syndrome

alexandrossfakianakis shared this article with you from Inoreader Spinal cord stimulation and return to work of patients with failed back surgery syndrome via Pain Practice Abstract Objectives Chronic pain has a substantial negative impact on work-related outcomes, which underlines the importance of interventions to reduce the burden. Spinal cord stimulation (SCS) efficiently relieves pain in specific chronic pain syndromes and is recommended for treating failed back surgery syndrome (FBSS) or post-surgical chronic back pain that is refractory to other treatments. To examine the impact of SCS in patients with FBSS on the return to work (RTW), we determined the RTW rate and the factors positively associated with the RTW. Materials and Methods Among 106 patients with FBSS who benefitted from SCS at a single institution in France between September 1999 and March 2010, we retrospectively included 59 who had stopped work at the time of SCS because of disability or sick leave and evaluated the RTW (rate and predictors, estimating odds ratios [ORs] and 95% confidence intervals [CIs]). Results The mean (SD) post-surgery follow-up for the 59 patients (34 men; mean [SD] age 46.9 [7.4] years) was 7.5 (3.6) years (range 5–15). The RTW rate was 30.5%, with a median [IQR] recovery time of 5.5 months [3–8.5]. RTW was improved with functional improvement evolution (OR 1.1, 95% CI [1.01–1.1], p=0.02) and was reduced with unemployment > 3 years (OR 0.1, 95% CI [0.01-0.7], p=0.02). Conclusions Our protocol for SCS for patients with FBSS, including a strict selection of patients and a multidisciplinary approach, led to good results, especially for the RTW. RTW should be a therapeutic goal, directly affecting indirect costs related to FBSS. View on Web

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Pediatric autoimmune myelofibrosis: Experience from a large pediatric tertiary care center

alexandrossfakianakis shared this article with you from Inoreader Pediatric autoimmune myelofibrosis: Experience from a large pediatric tertiary care center via Pediatric Blood & Cancer Abstract Autoimmune myelofibrosis (AIMF) is a rare disorder characterized by cytopenias and autoimmunity, with characteristic bone marrow findings that include lymphocytic infiltration and fibrosis. AIMF is described predominantly in adult populations who have systemic lupus erythematosis (SLE), with scant pediatric cases described mainly in older adolescents with SLE. Here, we described the largest single-center pediatric experience of pediatric autoimmune myelofibrosis (PAIMF) series, demonstrating both similarities and distinctions from the adult experience. Patients overall respond well to steroid therapy, but these patients were significantly younger, infrequently carried a diagnosis of SLE, and causative genetic lesions were identified in many cases. View on Web

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Regulatory B cells (Bregs) in Helicobacter pylori chronic infection

alexandrossfakianakis shared this article with you from Inoreader Regulatory B cells (Bregs) in Helicobacter pylori chronic infection via Helicobacter Abstract Background Helicobacter pylori (H. pylori) infection is linked with a wide variety of diseases and was reported in more than half of the world's population. Chronic H. pylori infection and its final clinical outcome depend mainly on the bacterial virulence factors and its ability to manipulate and adapt to human immune responses. Bregs blood levels have been correlated with increased bacterial load and infection chronicity, especially Gram-negative bacterial infection. This study aimed to identify prevalence and virulence factors of chronic H. pylori infection among symptomatic Egyptian patients and to examine its possible correlation to levels of regulatory B cells (Bregs) in blood. Materials and Methods Gastric biopsies and blood samples from each of 113 adult patients, who underwent upper endoscopy, were examined for the detection of H. pylori by culture and PCR methods. Conventional PCR was used to determine various virulent genes prevalence and association to clinical outcome. Flow cytometry was used to evaluate Bregs levels. Results Helicobacter pylori prevalence was 49.1% (55/112). Regarding virulence genes incidence, flaA gene was detected in 73% (40/55), vir B11 in 56.4% (31/55), hopZ1 in 34.5% (19/55), hopZ2 in 89% (49/55), babA2 in 52.7% (29/55), dupA jhp917 in 61.8% (34/55), vacA m1/m2 in 70.9% (39/55), and vacA s1/s2 in 69% (38/55) strains. Bregs levels were significantly lower in H. pylori-infected patients (p = 0.013), while total leukocyte count (TLC) showed no significant differences. Conclusion Helicobacter pylori infection prevalence was almost 49%, and the infection was found to be related to inflammatory conditions as gastritis and ulcers rather than malignant transformations. Also, we found that CD24+CD38+ B cells were downregulated in H. pylori-infected patients. View on Web

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Developmental Outcomes in Children Born to Women with Possible Subclinical Rubella Exposures During Pregnancy

alexandrossfakianakis shared this article with you from Inoreader Developmental Outcomes in Children Born to Women with Possible Subclinical Rubella Exposures During Pregnancy via Journal of Medical Virology Abstract This study investigated outcomes of children born to women who seroconverted to rubella immune during pregnancy. In a prior 2012-2013 study of 296 women who were rubella non-immune, 26 (8.8%) seroconverted to rubella immune during pregnancy. These same women and their now 8-9 years-old children were queried as to the children's developmental health. After removing exclusions and those lost to follow-up, the total response rate was 115/204 (56.4%). Three sets of twins in the non-immune group increased the total to 118. The seroconversion group had more autism (12.5% versus 3.9%, P=.19), ADHD (37.5% versus 18.6%, P=.10), and any developmental disability (43.8% versus 31.4%, P=.39) but none showed a statistical difference between the two groups. Compared to Autism and Developmental Disabilities Monitoring data, the seroconversion group had a greater prevalence of autism (OR 6.07, P=0.051, nonsignificant); and to data derived from the National Health Interview Survey, a nonsignificant higher odds of autism (OR 5.57, P=0.060), higher odds of ADHD (OR 5.65, P=0.0027) and of an y developmental disability (OR 3.59, P=0.014).The non-immune group also demonstrated a statistically significant increase for both ADHD and any developmental disability, but not for autism. This article is protected by copyright. All rights reserved. View on Web

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Extranodal Extension Improves AJCC‐8 Accuracy in HPV+ Oropharyngeal Cancer in a High‐Risk Population

alexandrossfakianakis shared this article with you from Inoreader Extranodal Extension Improves AJCC‐8 Accuracy in HPV+ Oropharyngeal Cancer in a High‐Risk Population via The Laryngoscope Although American Joint Committee on Cancer's 8th edition (AJCC-8) has demonstrated an improved ability to stratify OPSCCs into stages that predict overall survival, high-risk populations may be predisposed to worse outcomes. The goal of this manuscript is to validate the AJCC-8 as a better metric of survivability over AJCC-7 in a historically under-served rural population with confounding variables such as tobacco use, alcohol consumption, and poor healthcare access, and to analyze the role of extranodal extension in this population. Objectives The American Joint Committee on Cancer's 8th edition (AJCC-8) separates oropharyngeal squamous cell carcinomas (OPSCCs) into human papillomavirus-positive (HPV+) tumors and HPV-negative tumors. Although AJCC-8 improves prognostic prediction for survival for the majority of HPV+ OPSCC, outliers are still encountered. The goal of this manuscript is to validate the AJCC-8 as a better metric of survivability than the AJCC-7 in an historically under-served rural population with confounding variables, such as tobacco use, alcohol consumption, and poor health care access and to analyze the role of extranodal extension (ENE) in this population. Design Retrospective cohort study. Results Compared to AJCC-7, AJCC-8 had a higher odds ratio (OR) for predicting mortality of stage IV HPV+ OPSCCs versus stages I–III. On multivariate analysis, HPV+ OPSCCs with ENE had a higher OR of mortality compared to ENE- OPSCCs. In addition, HPV+ OPSCC patients with a Charlson Comorbidity Index (CCI) > 3 had a higher OR of mortality compared to those with a CCI ≤ 3. Patients with Medicaid/self-pay status had a higher OR of mortality compared to those with private insurance/Medicare. Finally, patients from rural populations had a higher OR of presenting with stage IV disease, a CCI > 3, and Medicaid/self-pay status. Conclusions Despite not being a discrete part of the AJCC-8 staging rubric, ENE was found to have a significant impact on mortality among this population, whereas tobacco use had no effect. Rural patients were more likely to present with stage IV disease, CCI > 3, and Medicaid/self-pay status. Stage IV disease was also associated with a higher OR of mortality. Level of Evidence 4 Laryngoscope, 2023 View on Web

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FDG PET/CT in a Case of Lung Adenocarcinoma With Diffuse Cavitary Intrapulmonary Metastases

alexandrossfakianakis shared this article with you from Inoreader FDG PET/CT in a Case of Lung Adenocarcinoma With Diffuse Cavitary Intrapulmonary Metastases via Clinical Nuclear Medicine - Published Ahead-of-Print We describe FDG PET/CT findings in a case of lung adenocarcinoma with diffuse cavitary intrapulmonary metastases at initial diagnosis. High-resolution CT of the chest showed the primary solid tumor in the right upper lobe and numerous cavitating metastases ranging from a few millimeters to 1 cm in the bilateral lungs. FDG PET/CT showed intense activity of the primary tumor, diffuse activity of the lung metastases, and hypermetabolic metastases in the mediastinal lymph nodes and bones. Familiarity with this atypical intrapulmonary metastatic pattern of lung cancer may be helpful for the diagnosis and differential diagno sis. View on Web

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Asymptomatic Prostate Cancer Metastasis in Rectal Mucosa Revealed by 18F-PSMA-1007 PET/CT

alexandrossfakianakis shared this article with you from Inoreader Asymptomatic Prostate Cancer Metastasis in Rectal Mucosa Revealed by 18F-PSMA-1007 PET/CT via Clinical Nuclear Medicine - Published Ahead-of-Print Prostate cancer metastasis to the rectal mucosa, a relatively rare metastatic site, leads to a higher clinical stage and poorer prognosis. A 65-year-old man with prostate cancer underwent 18F–prostate-specific membrane antigen (PSMA) PET/CT for staging. Intense 18F-PSMA uptake occurred at the primary lesion, bladder, adjacent seminal vesicle, and rectum. PET/CT imaging revealed increased homogeneous round activity of the rectal wall. The final diagnosis was prostate cancer metastasis to the rectal mucosa. This case suggested that 18F-PSMA PET/CT may assist in locating rare metastases of prostate cancer, with potenti al value for early staging. View on Web

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Extrastriatal 99mTc-TRODAT-1 Uptake in the Previous Hemorrhage With Hemosiderin Deposition

alexandrossfakianakis shared this article with you from Inoreader Extrastriatal 99mTc-TRODAT-1 Uptake in the Previous Hemorrhage With Hemosiderin Deposition via Clinical Nuclear Medicine - Published Ahead-of-Print We reported a 91-year-old man who was suspected of having parkinsonism, and brain 99mTc-TRODAT-1 scan revealed an extrastriatal uptake in the left side of brainstem, which was correlated to a previously hemorrhagic lesion with hemosiderin deposition. Macrophage or microglia might accumulate in the previous hemorrhagic lesion to phagocytize hemosiderin. We assumed that the 99mTc-TRODAT-1 uptake in the hemosiderin deposition might be partially mediated by macrophage expressing dopamine transporter. View on Web

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Treatment Response to Lycopene in Recurrent Prostate Cancer Confirmed on 18F-Fluciclovine PET/CT

alexandrossfakianakis shared this article with you from Inoreader Treatment Response to Lycopene in Recurrent Prostate Cancer Confirmed on 18F-Fluciclovine PET/CT via Clinical Nuclear Medicine - Published Ahead-of-Print 18F-fluciclovine (Axumin; Blue Earth Diagnostics, Ltd, Oxford, United Kingdom) PET has shown value in detecting biochemical recurrent prostatic cancer. Lycopene, a plant-based carotenoid, is reported to have potential inhibitory effect on prostate cancer, as a complementary treatment. We report a case of biochemically recurrent prostate cancer showing treatment response to lycopene as seen on an 18F-fluciclovine PET/CT correlating with serum prostate-specific antigen response. View on Web

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Malignant Transformation of Warthin Tumor in the Cervical Lymph Node

alexandrossfakianakis shared this article with you from Inoreader Malignant Transformation of Warthin Tumor in the Cervical Lymph Node via Clinical Nuclear Medicine - Published Ahead-of-Print Warthin tumor is the second most common benign tumor of salivary glands. Here we present an interesting case of squamous cell carcinoma arising from the Warthin tumor in the cervical lymph node. The patient had another Warthin tumor in the parotid gland as well. Both the malignant transformation of Warthin tumor and the heterotopic occurrence of Warthin tumor in the cervical lymph node are rare. This exceptionally rare case demonstrates that the 2 rare clinical entities can occur simultaneously and affect clinical decisions. View on Web

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18FDG PET/CT Tumoral and Neurologic Therapeutic Response in a Case of Anti-GABABR Paraneoplastic Limbic Encephalitis

alexandrossfakianakis shared this article with you from Inoreader 18FDG PET/CT Tumoral and Neurologic Therapeutic Response in a Case of Anti-GABABR Paraneoplastic Limbic Encephalitis via Clinical Nuclear Medicine - Published Ahead-of-Print A 70-year-old man with a history of small cell lung carcinoma 2 years earlier was addressed for the suspicion of a paraneoplastic limbic encephalitis. Brain 18FDG PET/CT revealed a bilateral amygdalian and hippocampal hypermetabolism, confirming a limbic encephalitis, and concurrent whole-body 18FDG PET/CT showed a small cell lung carcinoma plurifocal metastatic recurrence, consistent with a paraneoplastic limbic encephalitis. 18FDG PET/CT follow-up under chemotherapy revealed an almost complete normalization of brain metabolism and a partial metabolic response of the metastatic recurrence, consistent with the good clin ical neurological evolution of the patient. This case highlights the clinical-metabolic imaging correlation in paraneoplastic limbic encephalitis. View on Web

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