The PRP group had shown more favorable response compared to steroid group at 1 week post-injection, which suggests that PRP therapy can be considered as a conservative treatment choice for grade 2 proximal hamstring injuries with better short-term pain relief based on limited pilot data.
Laser Doppler flowmetry (LDF) is commonly used in combination with reactivity tests to noninvasively evaluate skin sympathetic nerve activity and skin microvascular function. In manual medicine research, LDF has been used as a marker for global peripheral sympathetic nervous system function, but these results should be considered with caution because skin sympathetic nerve activity physiology is often overlooked. Another limitation of LDF in manual medicine research is the processing of LDF recordings. Two methods have been suggested: the time-domain analysis and the frequency-domain analysis. Standardization is required for data collection and processing in either domain to accurately interpret these changes in skin blood flow that occur after manual procedures. For physiologic studies using LDF, the authors recommend the use of noninvasive reactivity tests (positive controls) to evaluate the different mechanisms involved in overall skin blood flow changes and to compare the magnitude of these changes with those specifically elicited by manual procedures.
403 Background: mPDAC is a deadly disease with dismal survival. Newer systemic therapies including gemcitabine/nab-paclitaxel (GA) and FOLFIRINOX (FF) have resulted in modest increases in median overall survival(mOS). Currently, no good predictors exist to prioritize the use of one regimen over the other. We investigated imaging patterns in patients receiving these two regimens. Methods: A single institution retrospective analysis of pts with mPDAC receiving either GA or FF as the front-line therapy between Jan 2012 - Dec 2014 was conducted. Data included demographics and systemic therapy.Baseline CT evaluated six imaging features; lung metastases, liver metastases, peripancreatic adenopathy, retroperitoneal adenopathy, mesentery/omentum infiltration and ascites. Statistical analysis included Kaplan Meier survival analysis with Chi-square test to compare imaging features that predict mOS or median response duration (mRD). Results: N = 27 pts; median age:GA-66 years( range: 52-76), FF-55 years (range: 40-67); 13 pts (48 %) were women and 24 pts had an ECOG performance status of ≤ 1. 18 pts received GA and 9 received FF. mOS with GA = 6.1 months(m) ( range: 1.9-15.7) and FF = 9.9 m (range: 2.5-24.1). 5/18 (28%) of the GA group and 7/9(78%) of the FF group received subsequent therapies. The presence of peripancreatic adenopathy in GA pts correlated with prolonged mRD (2.2 vs. 0.6 m; p < 0.001) without statistical difference in mOS (8.5 vs. 2.9 m; p = 0.4). In pts receiving FF the absence of hepatic metastasis resulted in a significant mRD (2.3 vs. 0.9 m; p = 0.01) and mOS (7.9 vs. 1.9 m; p = 0.04). The remainder of the radiological features did not show any statistically significant difference. Conclusions: In patients with mPDAC receiving GA or FF in front-line therapy; we observed that metastasis to the liver predicts worse outcome with FF than GA. Interestingly, peripancreatic lymphadenopathy was predictive of longer mRD for GA pts, without difference in mOS. Our pilot data demonstrates the potential of using CT imaging features to predict likelihood of response to different chemotherapy regimens. A larger study is needed to confirm these findings.
593 Background: Prognosis of colorectal cancer (CRC) is greatly influenced by stage at diagnosis. Early colorectal cancer can be subtle on CT scans showing only mild wall thickening, small polyps, or subtle lymph nodes. Identifying these lesions on CT performed for nonspecific symptoms can help identify interval CRC and improve patient outcome. The purpose of the present study is to classify missed CRC on abdominal CT by their imaging features and whether early identification can downstage CRC patients. Methods: A retrospective analysis was conducted of patients (pts) diagnosed with CRC. Data collection included age, gender, ECOG, KRAS mutation status, overall survival (OS). CT obtained prior to and at diagnosis were evaluated. Images were reviewed for multiple CT features including appearance of mass, mesenteric infiltration, abnormal draining lymph nodes, contrast enhancement relative to adjacent mucosa, and intralesional calcifications. Staging was evaluated using available CT scan and based on the TNM staging system for CRC. Results: The 41 pts with 51 prediagnostic CTs from 1/1/2012 - 12/31/2015 had mean age of 68 years (range:44-90 ) Mean ECOG status for the population was 1.46. 41% of the prediagnostic CTs had missed findings. 52 and 43 % of the missed findings were in the rectosigmoid and ascending colon respectively. Of the 15 missed masses, 9 appeared as asymmetric wall thickening, 3 as concentric wall thickening, and 3 as polyps. Of the 14 missed lymph node groups, 2 were excluded due to stability or nonrelated condition. The remaining lymph nodes were found in the associated draining station and averaged 3±1.2 mm in size. On average, the stage at prediagnostic CT was 3A and the diagnostic CT was 3C (p = 0.0015). Average time lapse between prediagnostic and diagnostic CT was 21 months (3-64 months). Conclusions: High percentage of CRC findings are missed on abdominal CT due to their subtle feature, with most misses in the rectosigmoid and ascending colon. A dedicated search can improve detection by specifically looking for polyps, wall thickening, and small lymph nodes in the draining station. Early detection of CRC can improve survival by lowering the stage from 3C to 3A, thus providing 36% improvement in 5-year survival.
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