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Ji-Youn Kim,1 Hyun Chul Song,1 Hyeon-Gun Jee21Division of Oral & Maxillofacial Surgery, Department of Dentistry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 2Healthcare Innovation Park, Seoul National University Bundang Hospital, Seongnam, Republic of KoreaPurpose: Osteonecrosis of the jaw (ONJ), both medication-related and non medication-related, mainly occurs in aged patients. It needs surgical intervention. Refractory healing after an operation of ONJ can significantly lower the quality of life of elderly patients. The purpose of this study was to determine risk factors associated with refractory healing in aged patients.Patients and methods: We performed a retrospective study of ONJ in aged patients who underwent surgical treatments in a single institute during a 12-year period. Multiple logistic regression analysis was used to determine independent risk factors associated with refractory healing.Results: A total of 122 patients were included. Of them, 25 patients were identified as the refractory group and 97 patients as the control group. Diabetes mellitus (DM) (AOR=5.03, 95% CI: 1.74–14.52) and glucocorticoid administration (AOR=7.97, 95% CI: 2.52–25.23) were found to be significant risk factors for refractory healing of ONJ.Conclusion: DM and medication of glucocorticoid might be risk factors for refractory healing of ONJ.Keywords: osteomyelitis, osteonecrosis, medication-related osteonecrosis of the jaw, surgical therapy, refractory healing, diabetes mellitus, glucocorticoid

Purpose: The presence of central lymph node (LN) metastasis increases the risk of cervical LN recurrence or distant metastasis in patients with papillary thyroid microcarcinoma (PTMC). We investigated the value of preoperative (18)F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET)-computerized tomography (CT) and ultrasonography (US) to predict central LN metastasis from PTMC. Patients and Methods: Two hundred patients with newly diagnosed unifocal PTMC were enrolled. Preoperative FDG PET-CT was performed, and the highest SUV (SUV(max)) of focally increased uptake at thyroid was measured. Tumor size was measured using preoperative US. Uni- and multivariate analyses were performed using the presence of focally increased uptake at thyroid (FDG positivity), SUV(max), tumor size, and clinical risk factor for central LN metastasis. ROC curves for risk factors were then analyzed. These analyses were undertaken in two groups: the all patients group and the FDG-positive group. Finally, we combined risk factors associated with central LN metastasis to improve predictive accuracy. Results: Tumor size >6 mm was associated with central LN metastasis. FDG positivity was identified in 110 patients (55.0%) and the SUV(max) ranged from 1.8 to 12.8 (median 3.0). In FDG-positive group, SUV(max) >2.8 was associated with central LN metastasis. Addition of SUV(max) >2.8 to size >6 mm of PTMC improved sensitivity of predicting central LN metastasis from 55.0 to 67.5%, while specificity remained at 70.6%. Conclusion: Both FDG PET-CT and US are valuable for preoperative prediction of central LN metastasis from PTMC. Combined use of SUV(max) and tumor size improves sensitivity without changing specificity. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed to assess pancreas beta cell activity using (99m)Tc-diethyleneaminepentaacetic acid-glipizide (DTPA-GLP), a sulfonylurea receptor agent. The effect of DTPA-GLP on the blood glucose level in rats was also evaluated.Methods: DTPA dianhydride was conjugated with GLP in the presence of sodium amide, yielding 60%. Biodistribution and planar images were obtained at 30-120 min after injection of (99m)Tc-DTPA-GLP (1 mg/rat, 0.74 and 11.1 MBq per rat, respectively) in normal female Fischer 344 rats. The control group was given (99m)Tc-DTPA. To demonstrate pancreas beta cell uptake of (99m)Tc-DTPA-GLP via a receptor-mediated process, a group of rats was pretreated with streptozotocin (a beta cell toxin, 55 mg/kg, i.v.) and the images were acquired at immediately-65 min on day 5 post-treatment. The effect on the glucose levels after a single administration (ip) of DTPA-GLP was compared to glipizide (GLP) for up to 6 h.Results: The structure of DTPA-GLP was confirmed by NMR, mass spectrometry and HPLC. Radiochemical purity assessed by ITLC was >96%. (99m)Tc-DTPA-GLP showed increased pancreas-to-muscle ratios, whereas (99m)Tc-DTPA showed decreased ratios at various time points. Pancreas could be visualized with (99m)Tc-DTPA-GLP in normal rat, however, (99m)Tc-DTPA has poor uptake suggesting the specificity of (99m)Tc-DTPA-GLP. Pancreas beta cell uptake could be blocked by pre-treatment with streptozotocin. DTPA-GLP showed an equal or better response in lowering the glucose levels compared to the existing GLP drug.Conclusions: It is feasible to use (99m)Tc-DTPA-GLP to assess pancreas beta cell receptor recognition. (99m)Tc-DTPA-GLP may be helpful in evaluating patients with diabetes, pancreatitis and pancreatic tumors. [ABSTRACT FROM AUTHOR]

Acquired Gitelman syndrome (GS) associated with Sjögren syndrome (SS) is rare, and the test to determine the pathophysiological state of acquired GS in patients with primary SS has not been reported previously. A 47-year-old woman with sicca complex presented to our clinic with intermittent muscle cramping and weakness involving both lower extremities over several months. Laboratory findings showed hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria, which met the criteria for GS. Diagnostic evaluation identified primary SS as the cause of the acquired GS. Light microscopic examination of renal tissue from the patient showed mild tubulointerstitial nephritis. Immunohistochemical staining of renal tissue showed the absence of the sodium-chloride cotransporter (NCCT) in the distal convoluted tubules. Incubation of the patient's serum with normal mouse kidney tissue showed a pattern of NCCT in the distal convoluted tubules similar to that of incubation of normal mouse kidney with the rabbit polyclonal anti-NCCT antibody. This is a rare case of acquired GS associated with primary SS, and our findings suggest the presence of circulating autoantibodies to NCCT. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the metabolic response of uterine cervix and pelvic lymph nodes (LNs) using consecutive 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) immediately after RT and to correlate survival outcome with the metabolic response. Methods and Materials: We retrospectively reviewed 48 patients with cervical cancer who had positive pelvic LNs by preradiation therapy (pre-RT) PET/CT. All patients underwent PET/CT scans immediately after RT (inter-RT PET/CT) after median 63 Gy to the gross LNs. The metabolic response of the LNs was assessed quantitatively and semiquantitatively by measurement of the maximal standardized uptake value (SUVmax). Results: Classifying the metabolic response of all nodal lesions, 37 patients (77%) had LNs with complete metabolic response on the inter-RT PET/CT (LNCMRi), and 11 patients had a non-LNCMRi, including 4 patients with progressive metabolic disease. The overall 3-year survival rates were 83% for the patients with LNCMRi and 73% for the non-LNCMRi group (P=.038). The disease-free survival for patients with LNCMRi were significantly better than that for the non-LNCMRi group (71% vs 18%, respectively, P<.001). The 3-year distant metastasis-free survival rates were 79% for the patients with LNCMRi and 27% for the non-LNCMRi group (P<.001). There were no statistically significant differences in overall survival (76% vs 86%, respectively, P=.954) and disease-free survival rates (58% vs 61%, respectively, P=.818) between the CMR of primary cervical tumor and the non-CMR groups. Conclusions: The results showed a significant correlation between survival outcome and the interim metabolic response of pelvic LNs. CMR of nodal lesion on inter-RT PET/CT had excellent overall survival, disease-free survival and distant metastasis-free survival rates. This suggested that PET/CT immediately after RT can be a useful tool for the evaluation of the interim response of the LNs and identify a subset of patients with a high risk of recurrence and poor survival in patients with cervical cancer with initial positive LNs. [ABSTRACT FROM AUTHOR]