THU0531 A PROSPECTIVE STUDY EVALUATING THE ROLE OF 68GA-RGD2 PET/CT ANGIOGENESIS IMAGING IN ASSESSING DISEASE ACTIVITY AND TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS AND ITS COMPARISON WITH DAS28

Background:

PET/CT imaging of synovial angiogenesis using68Ga-RGD (cyclic tripeptide agent targeting αvβ3integrin) to study disease activity in rheumatoid arthritis (RA) has been demonstrated earlier in a few patients. However, post treatment changes in disease activity on68Ga-RGD2PET/CT imaging have not been adequately assessed.

Objectives:

To compare the performance of68Ga-RGD2PET/CT with disease activity score (DAS) 28 in assessing disease activity and treatment response in RA.

Methods:

Thirty patients (24F, 6M) aged 43±12 years with clinically diagnosed RA were prospectively studied. After calculation of DAS28 by a rheumatologist, all 30 patients underwent68Ga-RGD2PET/CT scan. Of these, 27 patients underwent a second68Ga-RGD2PET/CT scan and clinical assessment after at least 3 months of treatment. Total body and regional images of the upper limbs were acquired and interpreted by two nuclear medicine physicians blinded to the clinical findings. Joints showing focally increased tracer uptake compared to the background were considered positive and joints showing uptake equal to or less than background were considered negative. Data of 30 patients were used for inter-observer and inter-modality agreement calculations. Changes in PET parameters and DAS28 were compared in 27 patients to assess treatment response.

Results:

Out of 1560 joints examined in the initial scan, 394 were positive on PET/CT compared to 348 on clinical evaluation. Inter-observer agreement between nuclear medicine physicians was excellent (Cohen’s kappa 0.92, p<0.05) and inter-modality agreement between PET and clinical examination was moderate (Cohen’s kappa 0.55, p<0.05). The DAS28 and SUVmax values (highest and average) of 27 patients showed significant reduction on follow-up compared to the initial evaluation. There was significant correlation between percentage change in DAS28 and percentage change in scan parameters like PET positive joint counts (0.689, p<0.001), average SUVmax (0.712, p<0.001) and highest SUVmax values (0.558, p=0.003) of scan-positive joints in 27 patients. Additional advantages of68Ga-RGD2PET/CT included objective assessment, whole body evaluation of all small and large joints, and greater reproducibility.

Conclusion:

68Ga-RGD2PET/CT is a promising tool for objective assessment of disease activity and treatment response in patients with RA.

Table 1.

Clinical and PET parameters of the patients

ParameterInitial data (n=27)Mean (SD)/Median (IQR)Follow-up data (n=27)Mean (SD)/Median (IQR)TJC(28)10 (5-13)3 (2-4)SJC(28)6 (3-7)1 (0-2)ESR25 (20-41)24 (18-35)PtGA6.0 (5.0-6.0)3.0 (2.0-4.0)DAS28(3)5.14 (0.85)3.74 (0.88)DAS28(4)5.60 (0.90)3.80 (0.96)PET positive Joints12 (7-8)4 (2-9)aSUVmax2.08 (1.68-2.52)1.79 (1.00-2.06)hSUVmax3.45 (2.71-4.70)3.34 (1.95-4.25)

TJC/SJC: tender/swollen joint counts; ESR: erythrocyte sedimentation rate; PtGA: patients global assessment scale; DAS: disease activity score; aSUVmax/hSUVmax: average/highest SUVmax (maximum standardized uptake value); SD: standard deviation; IQR: interquartile range

Figure 1.

68Ga-RGD2PET scan of a 26-year female RA patient on treatment.A.Initial scan shows increased tracer uptake in multiple joints of upper and lower limbs and tendon sheaths of hands and ankle region (arrows); DAS28 was 4.56 (moderate disease activity) and ESR 12 mm/1sthour.B. Follow-up scan after 4 months shows resolution of tracer activity in the previously involved joints with only a mild focus persisting in the left knee joint; DAS28 was 1.73 (clinical remission according to ARA) and ESR 08 mm/1sthour.

Acknowledgments:

This study was supported by Indian Council of Medical Research, New Delhi [grant no.3/2/June-2017/PG-Thesis-HRD (23)]

Disclosure of Interests:

None declared

Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm

PURPOSE

The purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique.

MATERIAL AND METHODS

Patients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield.

RESULTS

A total of 25 patients (19 men, six women) with a mean age of 50.8±17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n=16) or Ga-68 PSMA (n=8) and Ga-68 chemokine-analogue (n=1). The biopsy samples were obtained from the liver (n=9), bone (n=8), lymph-nodes (n=3), lung (n=1), pancreas (n=1), anterior mediastinal lesion (n=1), peritoneal-deposit (n=1) and thigh-lesion (n=1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7μSv/year for the interventionist.

CONCLUSION

PET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.

Nasal prosthesis rehabilitation: a case report

Facial defects resulting from neoplasm, congenital malformation or trauma can be restored with facial prosthesis using different materials and retention methods to achieve life-like look and function. A nasal prosthesis can re-establish esthetic form and anatomic contours for mid-facial defects, often more effectively than by surgical reconstruction as the nose is relatively immobile structure. For successful results, lot of factors such as harmony, texture, color matching and blending of tissue interface with the prosthesis are important. The aim of the presented case report is to describe the non-surgical rehabilitation, with polymethyl meth-acrylate resin, nasal prosthesis for a patient who received partial rhinectomy as a result of squamous cell carcinoma of the nose. The prosthesis was made to restore the esthetic appearance of the patient with a mechanical retained design using a spectacle glass frame without inserting craniofacial implants.

Amazon deforestation and climate change

A coupled numerical model of the global atmosphere and biosphere has been used to assess the effects of Amazon deforestation on the regional and global climate. When the tropical forests in the model were replaced by degraded grass (pasture), there was a significant increase in surface temperature and a decrease in evapotranspiration and precipitation over Amazonia. In the simulation, the length of the dry season also increased; such an increase could make reestablishment of the tropical forests after massive deforestation particularly difficult.

Influence of Land-Surface Evapotranspiration on the Earth's Climate

Calculations with a numerical model of the atmosphere show that the global fields of rainfall, temperature, and motion strongly depend on the land- surface evapotranspiration. This confirms the long-held idea that the surface vegetation, which produces the evapotransporation, is an important factor in the earth's climate.

Myelodysplastic syndrome

Pediatric myelodysplastic syndrome (MDS), though rare, constitutes a distinct entity quite different from adult MDS. They have unique clinical features, aggressive clinical course with an overall mean survival of only 9.9 months. A pediatric approach to the WHO classification has become necessary since the WHO classification of MDS has failed to address the uniqueness of pediatric MDS. A new prognostic system also needs to be evolved since the international prognostic system has limited prognostic impact in children. Intensive chemotherapy such as the one used in de novo-acute myeloid leukemia (AML) leads to complete remission in some children and this may be the treatment of choice in pediatric MDS.

Autoimmune hemolytic anemia

OBJECTIVE

To study the clinico-hematological profile and treatment outcome in children suffering from auto immune hemolytic anemia (AIHA).

METHODS

Twelve children were diagnosed with auto immune hemolytic anemia over a period of four years. Direct antiglobulin test was positive in all the cases. Other causes of hemolytic anemia like thalassemia syndromes, hereditary spherocytosis, G6PD deficiency were excluded by appropriate tests. The children were followed up for 6 months to 4 years.

RESULTS

The age ranged from 7 mth to 9 yr with a mean age of 4.51 yr. All patients had pallor as the presenting complaint followed by splenomegaly (83.3%), jaundice (66.7%), fever (50%) and bleeding manifestations (16.7%). 9 patients had primary disease and 3 had secondary disease. Tubercular infection was seen in 2 patients with secondary disease. Jaundice was seen equally in both the groups. Oral prednisolone produced remission in 83.3% cases. 4 patients (3 in primary and one in secondary group) had relapse after initial response. All responded to a second course of steroids but had subsequent relapses and developed a chronic course.

CONCLUSION

Autoimmune hemolytic anemia is an uncommon cause of hemolytic anemia in children. Tubercular infection is an underlying pathology in cases of secondary autoimmune hemolytic anemia. Although oral steroids induce remission in most of the cases, relapses are common.

5-Fluorouracil induces defects in platelet function

Platelet factor-3 (PF(3)) availability and platelet aggregation to ADP (4 micromol/l) and adrenaline (1.2 micromol/l) were evaluated in patients being treated with 5-fluorouracil (5-FU) for gastrointestinal malignancy. It produced a significant reduction in platelet aggregation and platelet factor-3 (PF(3)) availability ( P < 0.001) without being associated with thrombocytopenia. The changes in platelet aggregation occurred during the first week of chemotherapy and continued with subsequent courses. This acquired abnormality may be responsible for a haemorrhagic diathesis even without obvious thrombocytopenia. Study of platelet function is important and may be considered to assess the haematological toxicity in patients being treated with systemic 5-FU therapy.

188Rhenium(V)-dimercaptosuccinic acid loaded poly(lactic-co-glycolic)acid microspheres for targeted radiotherapy: production and effectivity

Poly(lactic-co glycolic)acid (75:25) (PLGA) microspheres for the delivery of a radiation dose to tumors were synthesized after loading the 188Re(V) labeled DMSA. The 188ReO4- in place of 99mTcO4- was replaced to label DMSA, because of their structural and chemical similarities and to make the molecule site specific for radiotherapy. The radiolabeling efficiency of DMSA was more than 97% as confirmed by ITLC. A solvent evaporation technique was used to encapsulate DMSA in PLGA microspheres. Electron microscopy demonstrated the microspheres size ranged between 0.4-1.8 microm. As demonstrated by DSC, DMSA was encapsulated (20-30%) within the microspheres in solid solution, metastable molecular dispersion or crystallization forms. In vitro release studies confirmed the stability of DMSA.

Molecular detection of Yersinia pestis isolates of Indian origin by using Pla specific monoclonal antibodies

Monoclonal antibodies (MAbs) were generated against the recombinant plasminogen activator (Pla) protein of Yersinia pestis. These MAbs detected Pla in all the 18 isolates of Y. pestis obtained from the sputum of pneumonic plague patients and from the liver and spleen of rodents from plague-affected areas of India during 1994-1995 as well as in seven of the eight isolates obtained from rodents in the surveillance regions of Hosur and Palmner in India during 1998 by simple dot-ELISA. In immunoblotting, the MAbs reacted with the Pla antigen only in Y. pestis isolates at 37 and 35kDa region. These monoclonal antibodies, being strictly specific, can be used for detecting Y. pestis isolates that are Fraction 1 antigen-negative. Also, the radiolabelled pla fragment hybridized specifically to the representative DNA samples of Y. pestis isolates.

16S rRNA PCR for differentiation of pathogenic and non-pathogenic leptospira isolates

PURPOSE

To determine the risk factors, microbiological features, clinical features and other epidemiological characteristics of Nocardia keratitis seen at a tertiary eye care centre in south India.

METHODS

We evaluated 31 patients with Nocardia keratitis seen over two years, from September 1999 to September 2001. Corneal scrapings were subjected to microscopy and culture using standard protocols.

RESULTS

Out of 2184 corneal ulcers cultured, 31(1.42%) were found to be Nocardia asteroides. All 31(100%) were detected correctly by 10% potassium hydroxide wet mount preparation. The highest percentage of isolates was susceptible to gentamicin (100%) followed by ciprofloxacin(93.55%). Twenty four (77.42%) patients were from rural areas; 22(70.97%) were agricultural workers; 29(93.55%) had history of trauma; 2(6.45%) had previous ocular surgery; 28(90.32%) had ocular injury with soil and sand; and 22(70.97%) had ocular injury while working in the agricultural fields. Ten (32.26%) patients presented at our institute between 15 to 35 days of onset of illness, 26(83.87%) had previous medical treatment, and 15(48.39%) patients had used traditional eye medicines. The average age of the patients was 46.16 years, with a range of 11 to 75 years. No seasonal variation was observed.

CONCLUSIONS

A high index of suspicion of Nocardia infection should exist in patients with a history of trauma to the eye by soil or sand. The organisms are sensitive to commonly used topical ocular antibiotics.

Non-Hodgkin's lymphoma with pure red cell aplasia

Pure red cell aplasia (PRCA) associated with non-Hodgkin's lymphoma, is an extremely rare condition, with few cases reported worldwide. More commonly PRCA is associated with thymoma or viral infections. Steroids and other immunosuppressive drugs are the preferred treatment of PRCA.

Low dose cyclosporine-a therapy in severe aplastic anaemia

OBJECTIVE

The present study was conducted to evaluate the efficacy of low dose cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford allogenic bone marrow transplantation and immunosuppressive therapy with antithymocyte globulin.

METHODS

The diagnosis of severe aplastic anaemia was established by standard criteria. Twelve patients were given cyclosporine-A orally at a dose of 6 mg/kg body weight in divided doses in two daily equal proportions for six months. Eleven patients were put on oral stanozolol in the dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were evaluated at three and six months.

RESULTS

At the end of six months, 41.66% of twelve patients responded to cyclosporine-A. One patient had complete response and four patients had partial response. Only one out of 11 patients receiving stanozolol responded.

CONCLUSIONS

i) Cyclosporine-A is a viable therapeutic option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A is able to slow down the stormy course of the severe aplastic anaemia, iii) Androgens have very little effect on the survival of patients of severe aplastic anaemia.

Diagnosis of microfilaria in gastric brush cytology. A case report

BACKGROUND

Filariasis due to Wuchereria bancrofti is endemic to southern Asia. While the laboratory diagnosis has been conventionally made by demonstrating microfilariae in peripheral blood smears, these have also been occasionally diagnosed on aspiration cytology of various organs.

CASE

A 54-year-old male presented with a burning sensation in the epigastrium of five months' duration. Endoscopic brush biopsy revealed numerous sheathed microfilariae of W bancrofti. The patient had had no symptoms suggestive of filarial infection in the past. Cytology revealed numerous microfilariae among lymphocytes and neutrophils.

CONCLUSION

This case illustrates that a thorough examination of gastric brushings can at times reveal unexpected findings and may prove to be a useful supplement to endoscopic biopsy.

Role of bio-metal Fe(III) in anticancer behaviour of tamoxifen

Physicochemical, microbial and pharmacological studies on Fe (III)--Tamoxifen complex have been carried out in solid and aqueous phases. On the basis of elemental analysis, polarographic studies, amperometric titrations and IR spectral studies the probable formula for the complex has been worked out to be 1:1, Fe(III)--Tamoxifen. A tentative structure has been suggested to the complex. The metal ligand interaction has been studied using polarographic method at 27 degrees +/- 1 degree C and at ionic strength of mu = 1.0 (KCl). Microbial studies on the complex was carried out against various pathogenic bacteria and fungi using Raper's method. Mouse sarcoma cell line 180 and Balb/C mice were used for the anticancer screening of solid complex, in vitro and in vivo, respectively. The results of microbial and pharmacological studies with the M:Drug complex revealed that the complex is more potent as compared to the pure drug as regards to its anticancer activity. As such Fe (III) Tamoxifen complex may be recommended to the therapeutic experts for its possible use as more potent anticancer drug.

Bioinorganic study on [Fe(promethazine)2H2O Cl]2+ complex

The coordination chemistry of iron (III) is the environment of an antihistaminic drug, promethazine has been explained to include a low spin, six-coordinate complex [Fe(Prometha)2(H2O) Cl] Cl2. Metaldrug interaction in vitro in aqueous KCl phase was studied polarographically at physiological pH and temperature. On the basis of elemental, magnetic, conductometric, IR, UV-visible, NMR spectroscopic analysis it is concluded that in solid phase two promethazine molecules with their N,N donor sites encompass the metal. Mass spectral study on the complex confirms that one of the three chlorides is involved in the coordination. The respective changes in the antihistaminic activity of the drug as a result of complexation has been determined and a possible mechanism is suggested.

Predictability in the midst of chaos: A scientific basis for climate forecasting

The Earth's atmosphere is generally considered to be an example of a chaotic system that is sensitively dependent on initial conditions. It is shown here that certain regions of the atmosphere are an exception. Wind patterns and rainfall in certain regions of the tropics are so strongly determined by the temperature of the underlying sea surface that they do not show sensitive dependence on the initial conditions of the atmosphere. Therefore, it should be possible to predict the large-scale tropical circulation and rainfall for as long as the ocean temperature can be predicted. If changes in tropical Pacific sea-surface temperature are quite large, even the extratropical circulation over some regions, especially over the Pacific-North American sector, is predictable.

Role of bio-metal Fe(III) in anticancer effect of dacarbazine

Physicochemical, Microbial and Pharmacological studies on Fe(III)-Dacarbazine complex have been done in solid and aqueous phase. On the basis of elemental analysis, polarographic studies, amperometric titrations and IR spectral studies the probable formula for the complex has been worked out to be 1:1, Fe(III)-Dacarbazine. The metal ligand interaction has been studied using polarographic method at 25 +/- 1 degrees C and at ionic strength of mu = 1.0 (KCl). Microbial studies on the complex was done against various pathogenic bacteria viz. Pseudomonas mangiferae, Staphylococcus aureus, Salmonella typhi and Vibrio cholarae and fungi i.e. Trichothecium and Chrysosporium sp. using Raper's method. Mouse sarcoma cell line 180 and Balb/C mice were used for the anticancer screening of solid complex in vitro and in vivo respectively. The observed polarographic data, on lingane treatment revealed the formation of single (1:1) (M:L) complex with Fe(III) and dacarbazine ligands. The results of amperometric titrations of Fe(III) with dacarbazine in IM KCl supporting electrolyte pH 7.0 +/- 0.1 supported the above findings the IR data speaks of the complex formation between the metal and the dacarbazine ligand through the two nitrogen one each of primary amide and trizo groups. The results of microbial and pharmacological studies with the M:Drug complex revealed that the anticancer activity of the drug metal complex is nearly doubled as compared to the pure drug. As such Fe(III) dacarbazine complex may be recommended to the therapeutic experts for its possible use as more potent anticancer drug.

Non-Hodgkin's lymphoma presenting with prominent splenomegaly--clinicopathologic diversity in relationship to immunophenotype

Splenomegaly is an uncommon presenting feature of non-Hodgkin's lymphoma. This is a study of 16 cases of non-Hodgkin's lymphoma presenting with prominent splenomegaly, which includes ten B-cell lymphomas and six T-cell lymphomas. There were distinct clinical and morphologic differences between these two immunologic types of splenic lymphomas, the B-cell types being predominantly low grade and occurring in older individuals whereas the T-cell lymphomas were predominantly high grade and occurred in adolescents and young adults.

Effects of HIV infection on VH3 (D12 idiotope) B cells in vivo

The abnormalities of B lymphocytes in human immunodeficiency virus (HIV) infection usually have been attributed to secondary consequences of disturbed immunoregulation. However, recent work has revealed avid binding of HIV gp120 to a conserved immunoglobulin motif unique to the VH3 gene family and the selective gp120-induced activation of VH3 B cells in vitro. This cross-sectional clinical study tests whether HIV infection is associated with a selective response of VH3 B cells in vivo. Levels of blood B cells and serum immunoglobulins (Ig) expressing the D12 idiotope of the VH3 gene family were measured in subjects of the Multicenter AIDS Cohort Study grouped according to clinical stages of HIV infection. A 3-fold elevation in D12 B cells was observed in HIV seropositive versus seronegative groups. This was selective for the D12 population, since total B cell numbers were identical in the two groups. The levels of D12 B cells and CD4 T cells were significantly correlated, and D12 B cells were markedly reduced in the AIDS group (4- and 10-fold, compared to the seronegative and seropositive groups). Analogous differences were also seen in the levels of serum anti-gp120 D12 Ig. This change in VH3 B cells among groups of HIV-infected individuals provides further evidence identifying gp120 as a VH3 B cell superantigen.

Effect of cement dust on the growth and yield of Brassica campestris L

Plants of Brassica campestris L. var. G-S20 were treated with cement dust, at rates of 3 (B(1)), 5 (B(2)) and 7 (B(3)) gm(-2) day(-1) for 90 days. Treated plants showed a consistent reduction in growth, photosynthetic pigments, yield and oil content over control plants. The overall phytomass of treated plants was significantly decreased, the maximum reduction being 64.8% in B(3) plants, followed by B(2) plants (55.3%) and B(1) plants (43.69%) at 60 days. The effect on oil content was also greatest in B(3) plants, where it was decreased by 6.13%.

Polyamine concentrations in bone marrow aspirates of children with leukemia and other malignancies

High-pressure liquid chromatography analysis of polyamines in bone narrow from leukemic and nonleukemic subjects demonstrated increased concentrations of putrescine, spermidine, and spermine associated with increased cellularity. The most striking abnormality was the marked elevation of putrescine. Bone marrow polyamine analysis may be an adjunct for evaluation of leukemia patients.