BackgroundThe present study aims to assess the performance of 18F-FDG PET-CT on mediastinal staging of non-small cell lung cancer (NSCLC) in a location with endemic granulomatous infectious disease.MethodsDiagnostic test study including patients aged 18 years or older with operable stage I-III NSCLC and indication for a mediastinal lymph node biopsy. All patients underwent a 18F-FDG PET-scan before invasive mediastinal staging, either through mediastinoscopy or thoracotomy, which was considered the gold-standard. Surgeons and pathologists were blinded for scan results. Primary endpoint was to evaluate sensitivity, specificity and positive and negative predictive values of PET-CT with images acquired in the 1st hour of the exam protocol, using predefined cutoffs of maximal SUV, on per-patient basis.ResultsOverall, 85 patients with operable NSCLC underwent PET-CT scan followed by invasive mediastinal staging. Mean age was 65 years, 49 patients were male and 68 were white. One patient presented with active tuberculosis and none had HIV infection. Using any SUV_max > 0 as qualitative criteria for positivity, sensitivity and specificity were 0.87 and 0.45, respectively. Nevertheless, even when the highest SUV cut-off was used (SUV_max ≥5), specificity remained low (0.79), with an estimated positive predictive value of 54%.ConclusionsOur findings are in line with the most recent publications and guidelines, which recommend that PET-CT must not be solely used as a tool to mediastinal staging, even in a region with high burden of tuberculosis.Trial registrationThe LACOG 0114 study was registered at ClinicalTrials.gov, before study initiation, under identifier NCT02664792.
Preeclampsia is the most common hypertensive disorder of pregnancy, often responsible for severe maternal and fetal complications, which can lead to early pregnancy termination and death. Despite the numerous studies, its pathophysiology is still unclear, although it seems to involve a multiplicity of complex factors related to angiogenesis, ineffective vasodilation, oxidative stress, inflammatory cytokines, and endothelial dysfunction. It has been hypothetically suggested that the use of phosphodiesterase inhibitors is capable of improving placental and fetal perfusion, contributing to gestational scenario, by decreasing the symptomatology and severity of this syndrome. In this literature review, it has been found that most of the studies were conducted in animal models, and there is still lack of evidence supporting its use in clinical practice. Research in human indicates conflicting findings; randomized controlled trials were scarce and did not demonstrate any benefit in morbidity or mortality. Data regarding to pathophysiological and interventional research are described and commented in this review. The use of phosphodiesterase inhibitors in the treatment of preeclampsia is controversial and should not be encouraged taking into account recent data.
e20065 Background: Evaluation of the mediastinum is critical for therapeutic decision in patients with operable non-small cell lung cancer. This analysis aims to evaluate specificity and positive predictive value (PPV) of PET-CT in mediastinal staging of patients diagnosed with NSCLC in South Brazil, an area with high prevalence of infectious granulomatous disease, such as tuberculosis (estimated incidence of 45 cases/100.000 and only 63.7% of cure rate) (http://www.saude.rs.gov.br/upload/1459169540_RELATÓRIO%20TUBERCULOSE%202016.pdf). Methods: Patients with stages I-III NSCLC underwent 18FDG PET-CT before invasive mediastinal staging. Different SUV cut-offs were evaluated, but for the purpose of this analysis were considered positive all PET-CTs showing any mediastinal uptake > 5 SUV. This abstract shows the specificity and the PPV associated with PET-CT when this high-uptake cut-of is considered. Results: From Aug/2014 to Aug/2016, 100 patients were enrolled, all treated at the Brazilian Public Health System, of which 85 were submitted to mediastinoscopy after PET-CT. Median age was 65 years (range 47-80). At baseline, 49 (58%) patients were male and 68 (80%) white. Current or former smokers accounted for 94% (80/85) of the sample. The prevalence of mediastinal involvement was 27% (23/85) confirmed by histopathological evaluation. PET-CT showed specificity of 79% (95% CI 67%–88%) and PPV of 54% (95% CI 40%–67%) when a SUV > 5 was used as cut-off for positivity (see table). Conclusions: These findings consolidate the clinical impression that a positive PET-CT does not confirm the diagnosis of mediastinal involvement in NSCLC patients treated in areas with high prevalence of infectious granulomatous diseases. In this scenario, all positive findings should be confirmed with histopathological evaluation to assure the diagnosis. Clinical trial information: NCT02664792. [Table: see text]
0,87 (0,79-0,94) e AUC ROC 0,698 (0,6-0,79), em gestantes com <35 semanas, a acurácia diminuiu com o aumento das idades gestacionais. Conclusões-O modelo fullPIERS e a concentração de PLGF mostraram baixa acurácia na predição de desfechos adversos maternos em mulheres com doença hipertensiva gestacional, incluindo pré-eclâmpsia. O modelo fullPIERS teve desempenho inferior na nossa amostra quando comparado com o estudo que validou este teste. O PLGF parece ser um biomarcador para uso como ferramenta adicional na predição de parto dentro de 14 dias e recém-nascidos PIG, especialmente em gestantes antes da 35ª semana gestacional. Palavras-chave-Hipertensão-induzida-pela-gravidez, Prognóstico, Biomarcador, Indutoresda-angiogênese.
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