Neoadjuvant chemotherapy for breast cancer is a new strategy that was introduced towards the end of the 20th century with the aim of reducing tumour size - rendering an otherwise inoperable tumour operable, allowing more conservative surgery, and hopefully improving overall survival. Although data indicate that the first rationale remains valid,...

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress. Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women...

Margaret Heffernan has thought a lot about whistleblowing, and why companies don't respond well to it. She wrote the "Book Wilful Blindness: Why We Ignore the Obvious at our Peril". In this podcast she talks about how culture, and groupthink, leads to a culture where whistleblowers are ignored, and why the NHS needs to change the way it treats...

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died. 51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing...

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of...

Alan R Saltiel
Dec 1, 1996; 45:1661-1669
Perspectives in Diabetes

Ralph A. DeFronzo
Apr 1, 2009; 58:773-795
Banting Lecture

Thomas A. Buchanan
Sep 1, 2002; 51:2796-2803
Pathophysiology

¹⁶⁶Ho-microspheres have recently been approved for clinical use for hepatic radioembolization in the European Union. The aim of this study was to investigate the absorbed dose–response relationship and its association with overall survival for ¹⁶⁶Ho radioembolization in patients with liver metastases. Methods: Patients treated in the HEPAR I and II studies who underwent an ¹⁸F-FDG PET/CT scan at baseline, a posttreatment ¹⁶⁶Ho SPECT/CT scan, and another ¹⁸F-FDG PET/CT scan at the 3-mo follow-up were included for analysis. The posttreatment ¹⁶⁶Ho-microsphere activity distributions were estimated with quantitative SPECT/CT reconstructions using a quantitative Monte Carlo–based method. The response of each tumor was based on the change in total lesion glycolysis (TLG) between baseline and follow-up and was placed into 1 of 4 categories, according to the PERCIST criteria, ranging from complete response to progressive disease. Patient-level response was grouped according to the average change in TLG per patient. The absorbed dose–response relationship was assessed using a linear mixed model to account for correlation of tumors within patients. Median overall survival was compared between patients with and without a metabolic liver response, using a log-rank test. Results: Thirty-six patients with a total of 98 tumors were included. The relation between tumor-absorbed dose and both tumor-level and patient-level response was explored. At a tumor level, a significant difference in geometric mean absorbed dose was found between complete response (232 Gy; 95% confidence interval [CI], 178–303 Gy; n = 32) and stable disease (147 Gy; 95% CI, 113–191 Gy; n = 28) (P = 0.01) and between complete response and progressive disease (117 Gy; 95% CI, 87–159 Gy; n = 21) (P = 0.0008). This constitutes a robust absorbed dose–response relationship. At a patient level, a significant difference was found between patients with complete or partial response (210 Gy; 95% CI, 161–274 Gy; n = 13) and patients with progressive disease (116 Gy; 95% CI, 81–165 Gy; n = 9) (P = 0.01). Patients were subsequently grouped according to their average change in TLG. Patients with an objective response (complete or partial) exhibited a significantly higher overall survival than nonresponding patients (stable or progressive disease) (median, 19 mo vs. 7.5 mo; log-rank, P = 0.01). Conclusion: These results confirm a significant absorbed dose–response relationship in ¹⁶⁶Ho radioembolization. Treatment response is associated with a higher overall survival.

In glioma patients, differentiation between tumor progression (TP) and treatment-related changes (TRCs) remains challenging. Difficulties in classifying imaging alterations may result in a delay or an unnecessary discontinuation of treatment. PET using O-(2-¹⁸F-fluoroethyl)-l-tyrosine (¹⁸F-FET) has been shown to be a useful tool for detecting TP and TRCs. Methods: We retrospectively evaluated 127 consecutive patients with World Health Organization grade II–IV glioma who underwent ¹⁸F-FET PET imaging to distinguish between TP and TRCs. ¹⁸F-FET PET findings were verified by neuropathology (40 patients) or clinicoradiologic follow-up (87 patients). Maximum tumor-to-brain ratios (TBR_max) of ¹⁸F-FET uptake and the slope of the time–activity curves (20–50 min after injection) were determined. The diagnostic accuracy of ¹⁸F-FET PET parameters was evaluated by receiver-operating-characteristic analysis and ² testing. The prognostic value of ¹⁸F-FET PET was estimated using the Kaplan–Meier method. Results: TP was diagnosed in 94 patients (74%) and TRCs in 33 (26%). For differentiating TP from TRCs, receiver-operating-characteristic analysis yielded an optimal ¹⁸F-FET TBR_max cutoff of 1.95 (sensitivity, 70%; specificity, 71%; accuracy, 70%; area under the curve, 0.75 ± 0.05). The highest accuracy was achieved by a combination of TBR_max and slope (sensitivity, 86%; specificity, 67%; accuracy, 81%). However, accuracy was poorer when tumors harbored isocitrate dehydrogenase (IDH) mutations (91% in IDH-wild-type tumors, 67% in IDH-mutant tumors, P < 0.001). ¹⁸F-FET PET results correlated with overall survival (P < 0.001). Conclusion: In our neurooncology department, the diagnostic performance of ¹⁸F-FET PET was convincing but slightly inferior to that of previous reports.

Posttreatment high-grade gliomas are usually monitored with contrast-enhanced MRI, but its diagnostic accuracy is limited as it cannot adequately distinguish between true tumor progression and treatment-related changes. According to recent Response Assessment in Neuro-Oncology recommendations, PET overcomes this limitation. However, it is currently unknown which tracer yields the best results. Therefore, a systematic review and metaanalysis were performed to compare the diagnostic accuracy of the different PET tracers in differentiating tumor progression from treatment-related changes in high-grade glioma patients. Methods: PubMed, Web of Science, and Embase were searched systematically. Study selection, data extraction, and quality assessment were performed independently by 2 authors. Metaanalysis was performed using a bivariate random-effects model when at least 5 studies were included. Results: The systematic review included 39 studies (11 tracers). ¹⁸F-FDG (12 studies, 171 lesions) showed a pooled sensitivity and specificity of 84% (95% confidence interval, 72%–92%) and 84% (95% confidence interval, 69%–93%), respectively. O-(2-¹⁸F-fluoroethyl)-l-tyrosine (¹⁸F-FET) (7 studies, 172 lesions) demonstrated a sensitivity of 90% (95% confidence interval, 81%–95%) and specificity of 85% (95% confidence interval, 71%–93%). For S-¹¹C-methyl)-l-methionine (¹¹C-MET) (8 studies, 151 lesions), sensitivity was 93% (95% confidence interval, 80%–98%) and specificity was 82% (95% confidence interval, 68%–91%). The numbers of included studies for the other tracers were too low to combine, but sensitivity and specificity ranged between 93%–100% and 0%–100%, respectively, for ¹⁸F-FLT; 85%–100% and 72%–100%, respectively, for 3,4-dihydroxy-6-¹⁸F-fluoro-l-phenylalanine (¹⁸F-FDOPA); and 100% and 70%–88%, respectively, for ¹¹C-choline. Conclusion: ¹⁸F-FET and ¹¹C-MET, both amino-acid tracers, showed a comparably higher sensitivity than ¹⁸F-FDG in the differentiation between tumor progression and treatment-related changes in high-grade glioma patients. The evidence for other tracers is limited; thus, ¹⁸F-FET and ¹¹C-MET are preferred when available. Our results support the incorporation of amino-acid PET tracers for the treatment evaluation of high-grade gliomas.

While media and academic discussions of "climate refugees" paint a picture of mass displacement of millions, in reality many communities vulnerable to climate change may choose to stay as a result of strong cultural, historical, and spiritual attachments to place. This article explores this "voluntary immobility" and its implications in the Pacific Islands.

Jason A. Winston
Oct 1, 2006; 24:160-166
Feature Articles

Warren Clayton
Mar 1, 2009; 27:52-58
Features

Timothy J. Church
Apr 1, 2016; 34:97-104
Feature Articles

Evan M. Benjamin
Jul 1, 2004; 22:137-138
Case Studies

Ingrid Kruse
Apr 1, 2006; 24:91-93
Practical Pointers

OBJECTIVE

Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D.

Pratik Choudhary
Jun 1, 2015; 38:1016-1029
Type 1 Diabetes at a Crossroads

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
May 1, 2016; 39:686-693
Cardiovascular Disease and Diabetes

Francesco Rubino
Jun 1, 2016; 39:861-877
Metabolic Surgery and the Changing Landscape for Diabetes Care

Kellee M. Miller
Jun 1, 2015; 38:971-978
Type 1 Diabetes at a Crossroads

Ehud Grossman
May 1, 2011; 34:S313-S319
Hypertension

Francesco Rubino
Jun 1, 2016; 39:861-877
Metabolic Surgery and the Changing Landscape for Diabetes Care

W. Timothy Garvey
May 1, 2020; 43:1085-1093
Emerging Therapies: Drugs and Regimens

Ofri Mosenzon
Aug 1, 2016; 39:S146-S153
II. Diabetes Treatment Options

OBJECTIVE

Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone.

The American Dental Association Standards Committee on Dental Products has approved the document for circulation and comment.

The Central Arizona Dental Society hosted a Mission of Mercy event Dec. 13-14 at the Arizona State Fairgrounds in Phoenix, providing treatment to 1,785 patients totaling just over $2 million in free dental service.

Greater compliance with dietary guidelines may reduce the chance of untreated caries in adults, according to a study published in the February issue of The Journal of the American Dental Association.

“Our nation’s veterans deserve the best.” Those were the words of ADA President Chad P. Gehani following his Jan. 7 visit to the Orlando VA Healthcare System’s dental clinic.

The American Dental Association is urging the Centers for Disease Control and Prevention to provide immediate guidance on the best way to protect dental patients and staff from the transmission of COVID-19 during emergency and urgent care situations.

The American Dental Association has released interim guidance for dentists on how to minimize the risk of COVID-19 transmission before, during and after treating dental emergencies.

A North Carolina oral health coalition, in collaboration with multiple state partners, has developed an interactive map to help guide the public to sites where emergency dental services are available throughout the Tar Heel State both during and after the COVID-19 outbreak.

A team of researchers at the University of California, Los Angeles School of Dentistry has developed a nanoparticle that could improve treatment for bone defects.

Cancer patients on Medicaid or who don't have insurance benefit less from experimental treatments, even if they get into clinical trials, a study published Thursday by JAMA Network Open has found.

The U.S. Food and Drug Administration on Friday granted emergency use authorization to the antiviral remdesivir to treat COVID-19.

Johns Hopkins University will start two clinical trials of convalescent blood plasma for treatment of COVID-19, the disease caused by the new coronavirus.

OBJECTIVE

To compare the risk of lactic acidosis hospitalization between patients treated with metformin versus sulfonylureas following development of reduced kidney function.

OBJECTIVE

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

OBJECTIVE

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

Research into the brain’s protein-disposal systems, electrical activity and three other areas looks promising

-- Read more on ScientificAmerican.com

Amyloid, the leading target for dementia therapy, faces skepticism after drug failures

-- Read more on ScientificAmerican.com

OBJECTIVE

To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

OBJECTIVE

To assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes.

As millions of U.S. workers lose jobs and the health insurance associated with them, Medicaid and similar programs are increasingly important for people seeking COVID-19 testing and treatment. Yet many low-income uninsured noncitizens, including green-card holders, are excluded from such programs because of their immigration status, as this fact sheet explores.

Jennifer M. Perkins
Apr 1, 2007; 25:57-62
Feature Articles