In our retrospective analysis, patients undergoing CRT experienced improved OS and CSS over those receiving BRT; however, disease control did not significantly differ. These findings may inform management of LAHNSCC patients.
Anti-glutamic acid decarboxylase (anti-GAD) antibodies are linked with both autoimmune diabetes and the rare neurological disorder stiff person syndrome (SPS). SPS is an uncommon autoimmune-mediated condition characterized by painful episodic spasms and progressive muscle rigidity. We present the case of a 23-year-old nondiabetic, insulin-naïve woman with known SPS who was hospitalized for SPS-related symptomatology. The patient quickly developed type 1 diabetes mellitus (T1DM) with unexpectedly large insulin requirements. To our knowledge, there are no other reports describing rapid T1DM development during an acute hospitalization for SPS and fewer than 5 case reports describing the association of SPS with extreme insulin resistance. Our case highlights the key clinical features, pathology, and pathogenesis of both SPS and T1DM and explores the relationship between the two disease processes.KEY WORDS: stiff person syndrome; type 1 diabetes mellitus; antiglutamic acid decarboxylase (anti-GAD) antibodies.
Purpose/Objective(s): Plasma OPN and Hb may be a putative parameters associated with tumor hypoxia in HNSCC patients. Additionally, OPN has been recognized as important marker in the processes of tumorigenicity and may be responsible for metastasis. The prognostic value of these markers before and after therapy in patients with HNSCC was assessed in this study. Materials/Methods: Between 01/2009 and 08/2013 251 patients in the mean age of 59 years with squamous cell carcinoma of oropharynx (39%), hypopharynx (13%), larynx (44%) and oral cavity (4%) were treated with RT alone (48%) or combined with chemotherapy (52%). The median duration of symptoms prior the treatment was 40 months (range: 6 e 88). The stage of disease was determined due to a TNM scale. There were 15 (6%), 112 (45%), 74 (29%), and 50 (20%) patients with T1, T2, T3 and T4 tumor stage and 99 (40%), 26 (10%), 105 (42%), and 21 (8%) patients with N0, N1, N2 and N3 nodal stage of disease respectively (no patients with distant metastases were included). OPN and Hb were estimated in plasma or blood before treatment and immediately after treatment completion. U Mann-Whitney test was used for analysis of correlation between markers levels and the stage of the disease. Univariate analysis of factors related to OS was performed. Log-rank test was used to compare markers as categorized value acc. to median respectively. Results: Pretreatment OPN level was higher in patients with advanced T stage compared with early stage (pZ0.024). Pretreatment Hb level was lower in patients with advanced T stage compared with early stage (pZ0.001). There was no correlation between N stage and OPN (pZ0.58), but there was a significant correlation between N stage and Hb (pZ0.0001). Difference between median plasma level of OPN estimated before (67.9 ng/ ml) and after (97.8 ng/ml) treatment was significant (pZ0.0001). Also, difference between median level of Hb estimated before (13.9 g/dl) and after (12.2 g/dl) therapy was significant (pZ0.0001). Significantly higher OS ratio was found for patients with lower OPN (pZ0.019) and higher Hb (pZ0.04) before treatment. Posttreatment OPN (pZ0.02) and Hb (pZ0.001) levels were also associated with survival time. OPN after treatment was significantly higher in patients with distant metastasis (pZ0.015). Conclusion: Elevated level of OPN and reduced level of Hb before therapy have been associated with tumor advance. OPN after therapy may play important role in tumor progression and metastasis. Pre-and posttreatment OPN and Hb are an independent prognostics determinant of survival.
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