Publications by authors named "Luis Beltran"

84 Publications

Susceptibility Weighted Imaging for evaluation of musculoskeletal lesions.

Eur J Radiol 2021 May 28;138:109611. Epub 2021 Feb 28.

MRI Unit, Radiology Department, HT Medica, Carmelo Torres nº2, Jaén, 23007, Spain. Electronic address:

The presence of blood or calcium in the musculoskeletal (MSK) system may be linked to specific pathological conditions. The ability of MRI for calcium detection is usually limited compared with other techniques such as CT. In a similar manner, the accuracy of MRI for detection and evaluation of hemorrhage in soft tissues is closely linked to the degree of degradation of blood products. Blood and calcium are substances that cause local inhomogeneity of the magnetic field resulting in susceptibility artifacts. To try to evaluate these substances, specific MRI sequences which are highly sensitive to these local magnetic field inhomogeneities such as Susceptibility Weighted Imaging (SWI) have been developed and successfully applied in the Central Nervous System, but scarcely used in MSK. SWI may increase the overall sensitivity of MRI to detect blood and calcium in several clinical scenarios such as degenerative joint disease or bone and soft tissue lesion assessment and discriminate between both compounds, something which is not always possible with conventional MRI approaches. In this paper, physical basis and technical adjustment for SWI acquisition at MSK are detailed reviewing the potential application of SWI in different MSK clinical scenarios.
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http://dx.doi.org/10.1016/j.ejrad.2021.109611DOI Listing
May 2021

Proteomic comparison of adult and juvenile Santa Catalina rattlesnake (Crotalus catalinensis) venom.

Toxicon 2021 Apr 2;193:55-62. Epub 2021 Feb 2.

ISBI Biosciences S.C. Huitzilac, Morelos, CP, 62510, Mexico. Electronic address:

Rattlesnake's venom constitutes an important ecological trait that dynamically changes over time. Venoms of adult and juvenile rattleless rattlesnakes, Crotalus catalinensis, an endemic insular species from the Gulf of California, were compared by electrophoretic profile, fibrinogenolytic activity, and proteomic composition to assess ontogenetic variability. The SDS-PAGE profiles show important differences at 12, 22, and 45 kDa, which were prominent in adult samples and absent in juvenile samples, while bands around 20, 25, and 70 kDa are almost absent in adults. Both venoms hydrolyze Aa and Bb chains of fibrinogen generating different patterns of degradation products. This activity was partially inhibited by EDTA and PMSF and completely abolished only in the presence of both inhibitors. More than 260 proteins were identified and quantified in both venoms by proteomic analysis. Metalloproteinases (more than 60%), serine proteinases (14.5% in adult venom and 17.7% in juvenile venom), and C-type lectins (7.1 and 5.9%) represent the three most abundant toxin-related protein families. Bradykinin inhibitor peptides and L-amino acid oxidases were not detected in juvenile venom. A protein-specific comparison shows that adult and juvenile venom share about 30.5% of total toxin-related proteins, while 32% and 35% are exclusively present in adult and juvenile venoms, respectively. This work represents one of the first efforts to understand phenotypic diversity in the venom composition of insular rattlesnake species from Mexico.
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http://dx.doi.org/10.1016/j.toxicon.2021.01.014DOI Listing
April 2021

The Transcriptomic Landscape of Prostate Cancer Development and Progression: An Integrative Analysis.

Cancers (Basel) 2021 Jan 19;13(2). Epub 2021 Jan 19.

Bioinformatics Unit, Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London EC1M 6BQ, UK.

Next-generation sequencing of primary tumors is now standard for transcriptomic studies, but microarray-based data still constitute the majority of available information on other clinically valuable samples, including archive material. Using prostate cancer (PC) as a model, we developed a robust analytical framework to integrate data across different technical platforms and disease subtypes to connect distinct disease stages and reveal potentially relevant genes not identifiable from single studies alone. We reconstructed the molecular profile of PC to yield the first comprehensive insight into its development, by tracking changes in mRNA levels from normal prostate to high-grade prostatic intraepithelial neoplasia, and metastatic disease. A total of nine previously unreported stage-specific candidate genes with prognostic significance were also found. Here, we integrate gene expression data from disparate sample types, disease stages and technical platforms into one coherent whole, to give a global view of the expression changes associated with the development and progression of PC from normal tissue through to metastatic disease. Summary and individual data are available online at the Prostate Integrative Expression Database (PIXdb), a user-friendly interface designed for clinicians and laboratory researchers to facilitate translational research.
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http://dx.doi.org/10.3390/cancers13020345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838904PMC
January 2021

Pathological predictors of metastatic disease in testicular non-seminomatous germ cell tumors: which tumor-node-metastasis staging system?

Mod Pathol 2021 04 15;34(4):834-841. Epub 2020 Dec 15.

Barts Cancer Institute, Queen Mary University of London, London, UK.

Pathological risk factors for metastatic disease in patients with testicular non-seminomatous germ cell tumors are debated. The tumor-node-metastasis (TNM) classification eighth edition for testicular cancers includes divergent versions, by the International Union Against Cancer (UICC) and by the American Joint Committee for cancer (AJCC). We investigated pathological predictors of metastatic disease at presentation in 219 non-seminomatous germ cell tumors with reference to both classifications. Age, tumor size, percentage of embryonal carcinoma, lymphovascular invasion, invasion of stromal rete testis, hilar soft tissue, epididymis, spermatic cord, and tunica vaginalis, as well as tumor at spermatic cord margin, were assessed and correlated with clinical stage at presentation. Of the 219 NSGCT cases, 151 (69%) were clinical stage I, 68 (31%) were clinical stage II/III. On univariate analysis, tumor size (P = 0.028), percentage of embryonal carcinoma (P = 0.004), lymphovascular invasion (P = 0.001), stromal rete testis invasion (P = 0.001), hilar soft tissue invasion (P = 0.010), epididymis invasion (P = 0.010), direct spermatic cord invasion (P = 0.001), and tumor at spermatic cord margin ((P = 0.009) were associated with higher clinical stage. On multivariate analysis, lymphovascular invasion (P = 0.003), tumor size (P = 0.005), percentage of embryonal carcinoma (P = 0.005), stromal rete testis invasion (P = 0.008) remained significant. A tumor size of 6 cm and an embryonal carcinoma percentage of 70% were the significant cut-off values. We conclude that in addition to lymphovascular invasion, stromal rete testis invasion, tumor size, and embryonal carcinoma percentage are strong predictors of metastatic disease at presentation and their inclusion should be considered in any future TNM revision. Further, our results support the changes in the AJCC TNM eighth edition as invasion of the epididymis and hilar soft tissue were both univariately significant.
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http://dx.doi.org/10.1038/s41379-020-00717-2DOI Listing
April 2021

Review of Interventional Musculoskeletal US Techniques.

Radiographics 2020 Oct;40(6):1684-1685

From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.).

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http://dx.doi.org/10.1148/rg.2020200036DOI Listing
October 2020

Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study.

Skeletal Radiol 2020 Oct 7;49(10):1581-1588. Epub 2020 May 7.

Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA.

Objective: The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis.

Materials And Methods: A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars).

Results: Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000.

Conclusion: Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
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http://dx.doi.org/10.1007/s00256-020-03444-6DOI Listing
October 2020

The Postoperative Rotator Cuff.

Magn Reson Imaging Clin N Am 2020 May 12;28(2):181-194. Epub 2020 Feb 12.

Department of Radiology, Brigham and Women's Hospital, RA3, 75 Francis Street, Boston, MA 02115, USA.

MR imaging interpretation following rotator cuff repair can be challenging and requires familiarity with various types of rotator cuff tear, their surgical treatments, normal postoperative MR imaging appearance, and complications. This article reviews the common surgical procedures for the reparable and nonreparable massive rotator cuff tears, their expected postoperative MR imaging findings, and imaging appearance of a range of complications.
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http://dx.doi.org/10.1016/j.mric.2019.12.003DOI Listing
May 2020

A novel way to synthesize pantothenate in bacteria involves β-alanine synthase present in uracil degradation pathway.

Microbiologyopen 2020 04 29;9(4):e1006. Epub 2020 Feb 29.

Programa de Ingeniería Genómica, Centro de Ciencias Genómicas, Universidad Nacional Autonoma de México, Cuernavaca, Morelos, México.

Pantothenate is an indispensable vitamin precursor of the synthesis of coenzyme A (CoA), a key metabolite required in over 100 metabolic reactions. β-Alanine (β-ala) is an indispensable component of pantothenate. Due to the metabolic relevance of this pathway, we assumed that orthologous genes for ß-alanine synthesis would be present in the genomes of bacteria, archaea, and eukaryotes. However, comparative genomic studies revealed that orthologous gene replacement and loss of synteny occur at high frequency in panD genes. We have previously reported the atypical plasmid-encoded location of the pantothenate pathway genes panC and panB (two copies) in R. etli CFN42. This study also revealed the unexpected absence of a panD gene encoding the aspartate decarboxylase enzyme (ADC), required for the synthesis of β-ala. The aim of this study was to identify the source of β-alanine in Rhizobium etli CFN42. In this study, we present a bioinformatic analysis and an experimental validation demonstrating that the source of β-ala in this R. etli comes from β-alanine synthase, the last enzyme of the uracil degradation pathway.
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http://dx.doi.org/10.1002/mbo3.1006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142369PMC
April 2020

Prospective molecular and morphological assessment of testicular prepubertal-type teratomas in postpubertal men.

Mod Pathol 2020 04 6;33(4):713-721. Epub 2019 Nov 6.

Department of Molecular Oncology, Barts Cancer Institute, Charterhouse Square, Queen Mary University of London, London, UK.

In 2016, the World Health Organization classification system of testicular tumors included the new entity prepubertal-type teratoma based on its morphological and molecular profile, and the realization that these tumors may occur in postpubertal men. For treatment and prognostic purposes, it is important to distinguish prepubertal-type teratoma from the usual postpubertal-type teratoma, because the former is benign unlike the latter. The distinction may be challenging. In this study, we investigated clinical, morphological, and molecular criteria for distinguishing prepubertal-type teratoma from postpubertal-type teratoma in a prospective series of pure testicular teratomas. All cases of pure teratoma in postpubertal men assessed at Barts Health NHS Trust or in consultation since the introduction of routine investigation of chromosome 12p status in 2010 were reviewed. Morphological features suggestive of prepubertal-type teratoma were observed in 14 out of 35 cases. All underwent molecular testing and none displayed 12p amplification. Mean tumor size was 16 mm (range 7-28 mm). None had associated germ cell neoplasia in situ or significant atrophy. Four incorporated a well-differentiated neuroendocrine tumor, 1-2 mm in size. Of the ten patients with follow-up information, none have recurred or metastasized. Twenty-one of the 35 cases were diagnosed as postpubertal-type teratoma, mean tumor size 40 mm (range 6-90 mm). One case underwent molecular testing: a tumor of pure skeletal muscle differentiation and possessed 12p amplification. Three cases presented with clinical metastases. Eight cases contained immature areas, ten cases had associated germ cell neoplasia in situ, and 17 cases had severe atrophy of the parenchyma. One case with neither germ cell neoplasia in situ nor atrophy showed necrosis. We conclude that both morphological and molecular features are of help in differentiating prepubertal-type teratoma from postpubertal-type teratoma. In nearly all postpubertal-type teratomas, molecular testing was unnecessary, and merely confirmed the morphological impression in the prepubertal-type teratomas. Our study confirmed the high incidence of well-differentiated neuroendocrine tumors in the prepubertal-type.
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http://dx.doi.org/10.1038/s41379-019-0404-8DOI Listing
April 2020

Pathological risk factors for metastatic disease at presentation in testicular seminomas with focus on the recent pT changes in AJCC TNM eighth edition.

Hum Pathol 2019 12 27;94:16-22. Epub 2019 Oct 27.

Department of Molecular Oncology, Barts Cancer Institute, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK.

Management of clinical stage (CS) 1 testicular seminoma is controversial. Treatment choice is based on a number of pathological risk factors. However, they have been inconsistently associated with risk of metastatic disease. The eighth edition of the American Joint Committee on Cancer Tumor-Node-Metastasis staging system has separated pT1a and pT1b tumors according to a 3-cm size cutoff and upstaged invasion of hilar soft tissue and epididymis as pT2. We investigated pathological predictors of metastatic disease at presentation in 332 testicular seminomas. Age, tumor size, invasion of vessels, hilar soft tissue, rete testis, epididymis, spermatic cord, tunica vaginalis and tumor at spermatic cord margin were assessed and correlated with CS at presentation. A total of 290 (87%) tumors were CS 1; 42 (13%) were CS 2/3. Median patient age of CS 1 was 36 years (20-81); that of CS 2/3 was 36 years (26-63). Mean tumor size of CS 1 was 38 mm (5-95 mm); that of CS 2/3 was 54 mm (8-95 mm). On univariate analysis, lymphovascular invasion (P = .044), epididymal invasion (P = .009) and tumor size (P = .0001) were associated with higher CS. On multivariate analysis, tumor size (P = .0001) and epididymis invasion (P = .023) remained significant. Optimal tumor size cutoff was 4.25 cm. We conclude that tumor size and epididymal invasion are the strongest predictors of metastatic disease at presentation. The results validate changes in American Joint Committee on Cancer Tumor-Node-Metastasis staging eighth edition but suggest a tumor size of 4 cm as better cutoff value.
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http://dx.doi.org/10.1016/j.humpath.2019.10.004DOI Listing
December 2019

Ultrasound-guided Therapeutic Injection and Cryoablation of the Medial Plantar Proper Digital Nerve (Joplin's Nerve): Sonographic Findings, Technique, and Clinical Outcomes.

Acad Radiol 2020 04 3;27(4):518-527. Epub 2019 Jul 3.

NYU Center for Musculoskeletal Care, Department of Radiology, Center for Musculoskeletal Care, New York, New York.

Rationale And Objectives: The medial plantar proper digital nerve, also called Joplin's nerve, arises from the medial plantar nerve, courses along the medial hallux metatarsophalangeal joint, and can be a source of neuropathic pain due to various etiologies, following acute injury including bunion surgery and repetitive microtrauma. We describe our clinical experience with diagnostic ultrasound assessment of Joplin's neuropathy and technique for ultrasound-guided therapeutic intervention including both injection and cryoablation over a 6-year period.

Materials And Methods: Retrospective review of all diagnostic studies performed for Joplin's neuropathy and therapeutic Joplin's nerve ultrasound-guided injections and cryoablations between 2012 and 2018 was performed. Indications for therapeutic injection and cryoablation, were recorded. Studies were assessed for sonographic abnormalities related to the nerve and perineural soft tissues. Post-treatment outcomes including immediate pain scores, clinical follow-up, and periprocedural complications were documented.

Results: Twenty-four ultrasound-guided procedures were performed, including 15 perineural injections and nine cryoablations. With respect to sonographic abnormalities, nerve thickening (33%) and perineural hypoechoic scar tissue (27%) were the most common findings. The mean pain severity score prior to the therapeutic injection was 6.4/10 (range 4-10) and 0.25/10 (range 0-2) following the procedure; mean follow-up was 26.2 months (range 3-63 months). All of the cryoablation patients experienced sustained pain relief with a mean length follow-up of 3.75 months (range 0.2-10 months).

Conclusion: Therapeutic injection of Joplin's nerve is a safe and easily performed procedure under ultrasound guidance, with high rates of immediate symptom improvement. For those experiencing a relapse or recurrent symptoms, cryoablation offers an effective secondary potential treatment option.
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http://dx.doi.org/10.1016/j.acra.2019.05.014DOI Listing
April 2020

Functional analysis of new variants at the low-density lipoprotein receptor associated with familial hypercholesterolemia.

Hum Mutat 2019 08 18;40(8):1181-1190. Epub 2019 Jun 18.

Department of Genetics of Metabolics Diseases, Institute of Medical & Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain.

Familial hypercholesterolemia is an autosomal dominant disease of lipid metabolism caused by defects in the genes LDLR, APOB, and PCSK9. The prevalence of heterozygous familial hypercholesterolemia (HeFH) is estimated between 1/200 and 1/250. Early detection of patients with FH allows initiation of treatment, thus reducing the risk of coronary heart disease. In this study, we performed in vitro characterization of new LDLR variants found in our patients. Genetic analysis was performed by Next Generation Sequencing using a customized panel of 198 genes in DNA samples of 516 subjects with a clinical diagnosis of probable or definitive FH. All new LDLR variants found in our patients were functionally validated in CHO-ldlA7 cells. The LDLR activity was measured by flow cytometry and LDLR expression was detected by immunofluorescence. Seven new variants at LDLR were tested: c.518 G>C;p.(Cys173Ser), c.[684 G>T;694 G>T];p.[Glu228Asp;Ala232Ser], c.926C>A;p.(Pro309His), c.1261A>G;p.(Ser421Gly), c.1594T>A;p.(Tyr532Asn), and c.2138delC;p.(Thr713Lysfs*17). We classified all variants as pathogenic except p.(Ser421Gly) and p.(Ala232Ser). The functional in vitro characterization of rare variants at the LDLR is a useful tool to classify the new variants. This approach allows us to confirm the genetic diagnosis of FH, avoiding the classification as "uncertain significant variants", and therefore, carry out cascade family screening.
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http://dx.doi.org/10.1002/humu.23801DOI Listing
August 2019

The percentage of high-grade prostatic adenocarcinoma in prostate biopsies significantly improves on Grade Groups in the prediction of prostate cancer death.

Histopathology 2019 Oct 13;75(4):589-597. Epub 2019 Aug 13.

UK Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.

Aims: It has been recommended that the percentage of high-grade (HG) Gleason patterns 4 and 5 should be quantified in prostate cancer. However, this has not been assessed in a cohort using prostate cancer death as an outcome, and there is debate as to whether the biopsy with the 'worst' percentage of HG disease or an 'overall' percentage of HG disease should be reported. Such data may assist in active surveillance decisions.

Methods And Results: Men with clinically localised prostate cancer diagnosed by needle biopsy from 1990 to 2003 were included. The endpoint was prostate cancer death. Clinical variables included Gleason score (GS), prostate-specific antigen level, age, clinical stage, and disease extent. Deaths were divided into those from prostate cancer and those from other causes, according to World Health Organization criteria. Nine hundred and eighty-eight biopsy cases were centrally reviewed according to criteria agreed at the Chicago International Society of Urological Pathology conference in 2014. Cores were given individual GSs and Grade Groups (GGs), and a percentage of each grade was given for each core. Both the worst percentage of HG disease seen in a biopsy series and overall percentage of HG disease were calculated. The overall percentage of HG disease was highly significant, with a hazard ratio of 4.45 for the interquartile range (95% confidence interval 3.30-6.01, P < 2.2 × 10 ), and was similar to the percentage of HG disease seen in the worst core. In multivariate analysis, both were highly significant. GG2 cases with ≤5% Gleason pattern 4 showed similar survival to GG1 cases.

Conclusions: These data validate the use of percentage of HG disease to predict prostate cancer death. As both worst and overall percentage of HG disease are powerful predictors of outcome, either could be chosen to provide prognostic information.
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http://dx.doi.org/10.1111/his.13888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790619PMC
October 2019

Ki-67 is an independent predictor of prostate cancer death in routine needle biopsy samples: proving utility for routine assessments.

Mod Pathol 2019 09 11;32(9):1303-1309. Epub 2019 Apr 11.

Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, EC1A 7BE, UK.

Standard clinical parameters fail to accurately differentiate indolent from aggressive prostate cancer. Our previous studies showed that immunohistochemical testing for Ki-67 improved prediction of prostate cancer death in a previous cohort of conservatively treated clinically localized prostate cancer. However there is a need for validation of usage with whole biopsy sections rather than tissue micro-arrays for use in routine diagnostics. Prostate cancer biopsy cases were identified in the UK, between 1990 and 2003, treated conservatively. Tumor extent and prostate-specific antigen (PSA) serum measurements were available. Biopsy cases were centrally reviewed by three uropathologists and Gleason conformed to contemporary ISUP 2014 criteria. Follow-up was through cancer registries up until 2012. Deaths were divided into those from prostate cancer and those from other causes. The percentage of Ki-67 in tumor cells was evaluated by immunohistochemistry on whole biopsy sections and was available for 756 patients. This percentage was used in analysis of cancer specific survival using a Cox proportional hazards model. In univariate analysis, the interquartile hazard ratio (HR) (95% confidence intervals) for continuous Ki-67 was 1.68 (1.49, 1.89), χ = 47.975, P < 0.001. In grade groups 1 and 2, continuous Ki-67 was a statistically significant predictor of time to death from prostate cancer, HR (95% CI) = 1.97 (1.34, 2.88), χ = 9.017, p = 0.003. In multivariate analysis, continuous Ki-67 added significant predictive information to that provided by grade groups, extent of disease and serum PSA, HR (95% CI) = 1.34 (1.16, 1.54), Δχ = 13.703, P < 0.001. We now advocate the introduction of Ki-67 as a viable and practicable prognostic biomarker in clinical practice. The association of Ki-67 with mortality was highest in grade groups 1 and 2, showing that Ki-67 can be used as a routine biomarker in patients being considered for active surveillance.
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http://dx.doi.org/10.1038/s41379-019-0268-yDOI Listing
September 2019

Radiological Response Heterogeneity Is of Prognostic Significance in Metastatic Renal Cell Carcinoma Treated with Vascular Endothelial Growth Factor-targeted Therapy.

Eur Urol Focus 2020 09 6;6(5):999-1005. Epub 2019 Feb 6.

Barts Cancer Institute, CRUK Experimental Cancer Medicine Centre, London, UK; Department of Oncology, Royal Free NHS Foundation Trust, London, UK. Electronic address:

Background: Response evaluation criteria in solid tumours (RECIST) is widely used to assess tumour response but is limited by not considering disease site or radiological heterogeneity (RH).

Objective: To determine whether RH or disease site has prognostic significance in patients with metastatic clear-cell renal cell carcinoma (ccRCC).

Design, Setting, And Participants: A retrospective analysis was conducted of a second-line phase II study in patients with metastatic ccRCC (NCT00942877), evaluating 138 patients with 458 baseline lesions.

Intervention: The phase II trial assessed vascular endothelial growth factor-targeted therapy±Src inhibition.

Outcome Measurements And Statistical Analysis: RH at week 8 was assessed within individual patients with two or more lesions to predict overall survival (OS) using Kaplan-Meier method and Cox regression model. We defined a high heterogeneous response as occurring when one or more lesion underwent a ≥10% reduction and one or more lesion underwent a ≥10% increase in size. Disease progression was defined by RECIST 1.1 criteria.

Results And Limitations: In patients with a complete/partial response or stable disease by RECIST 1.1 and two or more lesions at week 8, those with a high heterogeneous response had a shorter OS compared to those with a homogeneous response (hazard ratio [HR] 2.01; 95% confidence interval [CI]: 1.39-2.92; p<0.001). Response by disease site at week 8 did not affect OS. At disease progression, one or more new lesion was associated with worse survival compared with >20% increase in sum of target lesion diameters only (HR 2.12; 95% CI: 1.43-3.14; p<0.001). Limitations include retrospective study design.

Conclusions: RH and the development of new lesions may predict survival in metastatic ccRCC. Further prospective studies are required.

Patient Summary: We looked at individual metastases in patients with kidney cancer and showed that a variable response to treatment and the appearance of new metastases may be associated with worse survival. Further studies are required to confirm these findings.
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http://dx.doi.org/10.1016/j.euf.2019.01.010DOI Listing
September 2020

Percutaneous Ultrasound-Guided Intervention for Upper Extremity Neural and Perineural Abnormalities: A Retrospective Review of 242 Cases.

AJR Am J Roentgenol 2019 03 30;212(3):W73-W82. Epub 2019 Jan 30.

3 Department of Radiology, Brigham and Women's Hospital, Boston, MA.

Objective: The purpose of this study was to describe clinical experience with ultrasound-guided therapeutic procedures and associated pathologic conditions involving the peripheral nerves of the upper extremity over 5 years at a large academic institution.

Materials And Methods: A retrospective database search of procedure codes was performed for all ultrasound-guided upper extremity peripheral nerve procedures between 2012 and 2017. Retrospective review of the electronic medical record for patient demographics, indications, interval follow-up pain relief, and complications was undertaken. Retrospective review of ultrasound and other correlative imaging findings was performed to assess for neural and perineural abnormalities.

Results: In total, 242 procedures performed on a cohort of 183 patients (53% women, 47% men; mean age, 53 years; range, 15-97 years) were reviewed. Nine patients underwent multifocal injections in a single encounter, and 39 underwent repeat injections of previously documented symptom generators. Perineural injections included ulnar (n = 109), median (n = 81), posterior interosseous-deep radial (n = 39), sensory branch of the radial (n = 7), anterior interosseous (n = 2), axillary (n = 2), suprascapular (n = 1), and digital (n = 1) nerves. Structural or dynamic abnormality seen either during the procedure or at preprocedural imaging included loss of normal morphologic features (n = 148), nerve subluxation (n = 8), ganglion cyst (n = 4), and neuroma (n = 7). Forty-four patients reported immediate pain relief after the procedure. Of the 89 patients with documented clinical follow-up, 52 reported a period of symptom relief (mean, 125 days), and six reported complete resolution of symptoms. Subsequent surgical procedures were performed on 32 patients, a combination of those who did (n = 12) and did not (n = 20) experience a period of symptom relief from the perineural injection. There were no complications with regard to the site or distribution of perineural injections. Three episodes of vasovagal reaction were reported.

Conclusion: Ultrasound-guided percutaneous interventions for upper extremity neural abnormalities can be safely performed for a variety of indications. Real-time ultra-sound evaluation during the procedure allows assessment for neural and perineural abnormalities and tailoring of the procedure to potentially symptomatic structural abnormalities.
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http://dx.doi.org/10.2214/AJR.18.20047DOI Listing
March 2019

MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon.

Clin Imaging 2019 Mar - Apr;54:126-132. Epub 2019 Jan 7.

NYU Langone Orthopedic Hospital, Department of Radiology, 301 E 17th St, New York, NY 10003, United States of America.

Purpose: To correlate the histopathologic appearances of resected long head of the biceps tendon (LHBT) specimens following biceps tenodesis, with pre-operative MRI and arthroscopic findings, with attention to the radiologically normal biceps.

Material And Methods: Retrospective analysis of patients who had undergone preoperative MRI, subsequent arthroscopic subpectoral tenodesis for SLAP tears and histopathologic inspection of the excised sample between 2013 and 16. Those with a normal MRI appearance or mildly increased intrasubstance signal were independently analyzed by 2 blinded radiologists. A blinded orthopedic surgeon and pathologist reviewed all operative imaging and pathologic slides, respectively.

Results: Twenty-three LHBT resected samples were identified on MRI as either normal (Reader 1 n = 15; Reader 2 n = 14) or demonstrating low-grade increased signal (Reader 1 n = 8; Reader 2 n = 9). Of these, 86.9% demonstrated a histopathological abnormality. 50% of samples with histopathological abnormality demonstrated normal appearance on MRI. The most common reported histopathology finding was myxoid degeneration (73.9%) and fibrosis (52.2%). The most common arthroscopic abnormality was fraying (18.2%) and erythema (13.6%). Utilizing histopathology as the gold standard, the two radiologists demonstrated a sensitivity of 35.0% v 42.9%, specificity of 66.7% v 100%, PPV of 87.5% v 100%, and NPV of 13.3% v 14.3%. Corresponding arthroscopic inspection demonstrated a sensitivity of 31.6%, specificity of 66.6%, PPV 85.7% and NPV of 13.3%. There was moderate agreement between the two radiologists, κ = 0.534 (95% CI, 0.177 to 0.891), p = 0.01.

Conclusion: Histopathological features of low grade tendinosis including mainly myxoid degeneration and fibrosis are frequently occult on MR imaging.
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http://dx.doi.org/10.1016/j.clinimag.2019.01.001DOI Listing
May 2019

MRI of synovitis and joint fluid.

J Magn Reson Imaging 2019 06 8;49(6):1512-1527. Epub 2019 Jan 8.

Department of Radiology, NYU Langone Health, New York, New York, USA.

Synovitis and joint effusion are common manifestations of rheumatic disease and play an important role in the disease pathophysiology. Earlier detection and accurate assessment of synovial pathology, therefore, can facilitate appropriate clinical management and hence improve prognosis. Magnetic resonance imaging (MRI) allows unparalleled assessment of all joint structures and associated pathology. It has emerged as a powerful tool, which enables not only detection of synovitis and effusion, but also allows quantification, detailed characterization, and noninvasive monitoring of synovial processes. The purpose of this article is to summarize the pathophysiology of synovitis and to review the role of qualitative, semiquantitative, and quantitative MRI in the assessment of synovitis and joint fluid. We also discuss the utility of MRI as an outcome measure to assess treatment response, particularly with respect to osteoarthritis and rheumatoid arthritis. Emerging applications such as hybrid positron emission tomography / MRI and molecular imaging are also briefly discussed. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.
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http://dx.doi.org/10.1002/jmri.26618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504589PMC
June 2019

Histopathologic False-positive Diagnoses of Prostate Cancer in the Age of Immunohistochemistry.

Am J Surg Pathol 2019 03;43(3):361-368

Department of Cellular Pathology, Barts Health NHS Trust.

There are few studies into the rate and causes of histopathologic false-positive diagnosis of prostate cancer. Only 2 of these, including a previous one from our group, incorporate survival data. In addition, in none of the previous studies had immunohistochemistry (IHC) been originally requested on any of the misdiagnosed cases. Diagnostic biopsies (n=1080) and transurethral resection of prostate specimens (n=314) from 1394 men with clinically localized prostate cancer diagnosed in the United Kingdom but treated conservatively between 1990 and 2003 were reviewed by a panel of 3 genitourinary pathologists. Thirty-five cases were excluded for being potentially incomplete. Of the remaining 1359, 30 (2.2%) were reassigned to a nonmalignant category (26 benign and 4 suspicious for malignancy). IHC had been originally performed on 7 of these. The reasons for the errors were recorded on each case: adenosis (19), partial atrophy (3), prostatic intraepithelial neoplasia (2), seminal vesicle epithelium (1), and hyperplasia (1). Follow-up of these men revealed only one prostate cancer-related death, possibly due to unsampled tumor. In conclusion, a relatively small number of prostate cancer mimics were responsible for a large proportion of the false-positive prostate cancer diagnoses and the use of IHC did not prevent the overcall of benign entities as cancer in approximately a quarter of these cases. Targeting these mimics at educational events and raising awareness of the pitfalls in the interpretation of IHC in prostate cancer diagnosis, emphasizing that glands within a suspicious focus should be treated as a whole rather than individually, may be beneficial in lowering the rate of false-positive diagnosis.
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http://dx.doi.org/10.1097/PAS.0000000000001202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375390PMC
March 2019

mPGES-1 (Microsomal Prostaglandin E Synthase-1) Mediates Vascular Dysfunction in Hypertension Through Oxidative Stress.

Hypertension 2018 08 11;72(2):492-502. Epub 2018 Jun 11.

From the Departmento de Farmacología, Instituto de Investigación Hospital La Paz, Universidad Autónoma de Madrid, Spain (M.S.A., A.B.G.-R., M.G.-A., A.A., S.M.-R., M.S., A.M.B.)

mPGES-1 (microsomal prostaglandin E synthase-1), the downstream enzyme responsible for PGE (prostaglandin E) synthesis in inflammatory conditions and oxidative stress are increased in vessels from hypertensive animals. We evaluated the role of mPGES-1-derived PGE in the vascular dysfunction and remodeling in hypertension and the possible contribution of oxidative stress. We used human peripheral blood mononuclear cells from asymptomatic patients, arteries from untreated and Ang II (angiotensin II)-infused mPGES-1 and mPGES-1 mice, and vascular smooth muscle cells exposed to PGE In human cells, we found a positive correlation between mPGES-1 mRNA and carotid intima-media thickness (=0.637; <0.001) and with NADPH oxidase-dependent superoxide production (=0.417; <0.001). In Ang II-infused mice, mPGES-1 deletion prevented all of the following: (1) the augmented wall:lumen ratio, vascular stiffness, and altered elastin structure; (2) the increased gene expression of profibrotic and proinflammatory markers; (3) the increased vasoconstrictor responses and endothelial dysfunction; (4) the increased NADPH oxidase activity and the diminished mitochondrial membrane potential; and (5) the increased reactive oxygen species generation and reduced NO bioavailability. In vascular smooth muscle cells or aortic segments, PGE increased NADPH oxidase expression and activity and reduced mitochondrial membrane potential, effects that were abolished by antagonists of the PGE receptors (EP), EP1 and EP3, and by JNK (c-Jun N-terminal kinase) and ERK1/2 (extracellular-signal-regulated kinases 1/2) inhibition. Deletion of mPGES-1 augmented vascular production of PGI suggesting rediversion of the accumulated PGH substrate. In conclusion, mPGES-1-derived PGE is involved in vascular remodeling, stiffness, and endothelial dysfunction in hypertension likely through an increase of oxidative stress produced by NADPH oxidase and mitochondria.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.10833DOI Listing
August 2018

Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review.

JMIR Mhealth Uhealth 2018 May 30;6(5):e130. Epub 2018 May 30.

Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.

Background: Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments.

Objective: The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice.

Methods: A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts.

Results: The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments.

Conclusions: mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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http://dx.doi.org/10.2196/mhealth.9671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000483PMC
May 2018

Postoperative Imaging in Anterior Glenohumeral Instability.

AJR Am J Roentgenol 2018 09 29;211(3):528-537. Epub 2018 May 29.

1 Department of Radiology, NYU Langone Medical Center-Hospital for Joint Diseases, 301 E 17th St, Rm 600, New York, NY 10003.

Objective: Postoperative imaging after surgery for anterior glenohumeral instability poses a great challenge, which can be compounded by a lack of familiarity with the many different operative techniques and their expected normal appearances and complications. In this article, we discuss the postoperative imaging appearances of anterior glenohumeral instability surgery with a review of currently recommended treatment guidelines.

Conclusion: It is important for radiologists to accurately detect complications of anterior shoulder instability surgery at postoperative imaging.
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http://dx.doi.org/10.2214/AJR.17.19304DOI Listing
September 2018

Postoperative MRI of Massive Rotator Cuff Tears.

AJR Am J Roentgenol 2018 Jul 24;211(1):146-154. Epub 2018 May 24.

1 Department of Radiology, NYU Langone Orthopedic Hospital, 301 East 17th St, Rm 600, New York, NY 10003.

Objective: The aim of this article is to review the postoperative MRI appearances of irreparable massive rotator cuff tears (RCTs) after surgery was performed using newer techniques, including patch repair, muscle tendon transfer, superior capsular reconstruction, and subacromial balloon implantation.

Conclusion: Newer surgical techniques are emerging for the management of massive RCTs. As radiologists become increasingly likely to encounter postoperative imaging studies of RCTs repaired using these techniques, familiarity with the normal postoperative appearances and complications associated with these techniques becomes important.
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http://dx.doi.org/10.2214/AJR.17.19281DOI Listing
July 2018

Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively.

Oncotarget 2018 Apr 17;9(29):20555-20562. Epub 2018 Apr 17.

Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK.

The identification of perineural invasion (PNI) and extraprostatic extension (ECE) in prostate cancer (PC) biopsies is time consuming and can be difficult. Although this is required information in many datasets, there is little evidence on their effect on outcome in patients treated conservatively. Cases of PC were identified from three cancer registries in the UK from men with clinically localized prostate cancer diagnosed by needle biopsy from 1990-2003. The endpoint was prostate cancer death (DOD). Patients treated radically within 6 months, those with objective evidence of metastases or who had prior hormone therapy were excluded. Follow-up was through cancer registries up until 2012. Deaths were divided into those from PC and those from other causes, according to WHO criteria. 988 biopsy cases (6522 biopsy cores) were centrally reviewed by three uropathologists and assigned a Gleason score and Grade Group (GG). The presence of both PNI and ECE was recorded. Of 988 patients, PNI was present in 288 (DOD = 75) and ECE in 23 (DOD = 5). On univariable analysis PNI was highly significantly associated with DOD (hazard ratio [HR] 2.28, 95% CI: 1.68, 3.1, log-rank test -value = 4.8 × 10), but ECE was not (log-rank test -value = 0.334). On multivariable analysis with GG, serum PSA (per 10%), clinical stage and extent of disease (per 10%), PNI lost significance (HR 1.16, 95% CI: 0.83, 1.63, likelihood ratio test -value = 0.371). The utility of routinely examining prostate biopsies for ECE and PNI is doubtful as it is not independently associated with higher grade, stage or prognosis.
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http://dx.doi.org/10.18632/oncotarget.24994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945501PMC
April 2018

Does the Addition of DWI to Fluid-Sensitive Conventional MRI of the Sacroiliac Joints Improve the Diagnosis of Sacroiliitis?

AJR Am J Roentgenol 2018 Jun 9;210(6):1309-1316. Epub 2018 Apr 9.

1 Department of Radiology, NYU Medical Center, Hospital for Joint Diseases, 301 E 17th St, Rm 600, New York, NY 10003.

Objective: The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis.

Materials And Methods: MR images of the sacroiliac joints of 63 patients with lower back pain obtained between January 2016 and December 2016 were analyzed retrospectively. Three readers reviewed the MRI studies for bone marrow edema lesions around the sacroiliac joints as a marker of active sacroiliitis and gave a diagnostic confidence score of 0-4 using MRI without DWI and MRI with DWI in separate sessions. The normalized apparent diffusion coefficient mean (nADC) was measured. Clinical and radiologic data using the Assessment of Spondyloarthritis International Society criteria were the reference for the diagnosis of sacroiliitis. Diagnostic performance, confidence scores, and interreader agreement for the MRI methods were compared. The nADC values of patients with and those without sacroiliitis were compared.

Results: The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p > 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADC in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p ≤ 0.001). The nADC AUC was 0.758 (95% CI, 0.67-0.83).

Conclusion: The addition of DWI to conventional MRI does not significantly improve overall diagnostic performance in terms of accuracy, sensitivity, or confidence in the detection of inflammatory sacroiliitis, but it does have increased specificity and interobserver agreement. ADC threshold values can be used as predictors of sacroiliitis but give no added advantage over MRI with DWI.
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http://dx.doi.org/10.2214/AJR.17.18636DOI Listing
June 2018

Cystitis cystica and glandularis producing large bladder masses in a 16-year-old boy.

JRSM Open 2018 Mar 8;9(3):2054270417746060. Epub 2018 Mar 8.

1Department of Urology, Barts Health NHS Trust, London E11 1NR, UK.

The macroscopic appearances of florid cystitis cystica et glandularis can be mistaken for malignancy, and it is therefore important to perform a prompt resection to confirm the histological diagnosis and exclude sinister pathology.
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http://dx.doi.org/10.1177/2054270417746060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846953PMC
March 2018

Bone biopsy protocol for advanced prostate cancer in the era of precision medicine.

Cancer 2018 03 19;124(5):1008-1015. Epub 2017 Dec 19.

Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.

Background: Metastatic biopsies are increasingly being performed in patients with advanced prostate cancer to search for actionable targets and/or to identify emerging resistance mechanisms. Due to a predominance of bone metastases and their sclerotic nature, obtaining sufficient tissue for clinical and genomic studies is challenging.

Methods: Patients with prostate cancer bone metastases were enrolled between February 2013 and March 2017 on an institutional review board-approved protocol for prospective image-guided bone biopsy. Bone biopsies and blood clots were collected fresh. Compact bone was subjected to formalin with a decalcifying agent for diagnosis; bone marrow and blood clots were frozen in optimum cutting temperature formulation for next-generation sequencing. Frozen slides were cut from optimum cutting temperature cryomolds and evaluated for tumor histology and purity. Tissue was macrodissected for DNA and RNA extraction, and whole-exome sequencing and RNA sequencing were performed.

Results: Seventy bone biopsies from 64 patients were performed. Diagnostic material confirming prostate cancer was successful in 60 of 70 cases (85.7%). The median DNA/RNA yield was 25.5 ng/μL and 16.2 ng/μL, respectively. Whole-exome sequencing was performed successfully in 49 of 60 cases (81.7%), with additional RNA sequencing performed in 20 of 60 cases (33.3%). Recurrent alterations were as expected, including those involving the AR, PTEN, TP53, BRCA2, and SPOP genes.

Conclusions: This prostate cancer bone biopsy protocol ensures a valuable source for high-quality DNA and RNA for tumor sequencing and may be used to detect actionable alterations and resistance mechanisms in patients with bone metastases. Cancer 2018;124:1008-15. © 2017 American Cancer Society.
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http://dx.doi.org/10.1002/cncr.31173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821525PMC
March 2018

Exceptional Response to Temsirolimus in a Metastatic Clear Cell Renal Cell Carcinoma With an Early Novel -Activating Mutation.

J Natl Compr Canc Netw 2017 11;15(11):1310-1315

mTOR pathway inhibitors are important drugs for the treatment of advanced renal cell carcinoma (RCC). However, no valid predictive markers have been identified to guide treatment selection and identify patients who are sensitive to these drugs. Mutations activating the mTOR pathway have been suggested to predict response; however, their predictive value is still unclear. Here, we present the genomic and functional characterization of a patient with metastatic clear cell RCC (ccRCC) who experienced a partial response to temsirolimus after a poor response to 2 previous lines of treatment. At the time of publication, the patient was disease-free 8 years after temsirolimus treatment. Multiregion whole-exome sequencing (WES) on 3 regions of the primary tumor, 1 metastasis, and blood revealed tumor mutations in driver genes in ccRCC: a missense mutation in (p.W88L), a loss-of-function mutation in (p.E454Rfs*15), and a novel missense mutation in (p.Y1974H). The mutation was present in all tumor regions, with similar allele frequency as the mutation, and in vitro functional assessment of the variant demonstrated that it increased mTORC1 activity. Consistently, immunohistochemistry in the tumor samples demonstrated increased levels of phospho-S6. In conclusion, multiregion WES identified a novel mutation acquired early during tumor development as the event leading to a high sensitivity to temsirolimus treatment. This study supports tumor multiregion sequencing to detect truncal mutations in the mTOR pathway to identify patients sensitive to mTOR inhibitors.
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http://dx.doi.org/10.6004/jnccn.2017.7018DOI Listing
November 2017

Atherosclerosis as a potential pitfall in the diagnosis of giant cell arteritis.

Rheumatology (Oxford) 2018 Feb;57(2):318-321

Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain.

Objectives: To explore whether the increase in the intima-media thickness (IMT) in arteriosclerotic disease correlates with the increase in the IMT in temporal arteries (TAs) and if that could mimic the US GCA halo sign.

Methods: Consecutive patients ⩾50 years old with high vascular risk and without signs or symptoms of GCA were included. The carotid US IMT measurements were obtained using a standardized software radiofrequency-tracking technology. Colour Doppler US and grey-scale measurements of the IMT in the branches of both TAs were performed by a second sonographer using a 22 MHz probe.

Results: Forty patients were studied (28 men) with a mean age of 70.6 years. The carotid IMT exhibited significant correlation with the TA IMT. A carotid IMT >0.9 mm was associated with a temporal IMT >0.3 mm. Only one patient had an IMT >0.34 mm in two branches.

Conclusions: Atherosclerotic disease with a carotid IMT >0.9 mm increases the TA IMT and might mimic the halo sign. As atherosclerosis is common in this age group, we propose a cut-off of TA IMT >0.34 mm in at least two branches to minimize false positives in a GCA diagnosis.
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http://dx.doi.org/10.1093/rheumatology/kex381DOI Listing
February 2018
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