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Focal incidental colorectal fluorodeoxyglucose uptake:Should it be spotlighted?

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World Journal of Clinical Cases 2024年第15期12卷 2466-2474页

作者： Haejun Lee Kyung-Hoon Hwang Department of Nuclear Medicine Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea

Fluorine-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)has emerged as a cornerstone in cancer evaluation imaging,with a well-established history spanning several years.This imaging modality,encompassing the examination of the body from the base of the skull to the upper thighs,comprehensively covers the chest and abdominopelvic regions in a singular scan,allowing for a holistic assessment of nearly the entire body,including areas of marginal interest.The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas.The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence,albeit fraught with challenges associated with non-specific FDG uptake.The presence of benign colorectal lesions or physiological uptake poses a particular obstacle,as these may manifest with FDG uptake levels that mimic malignancy.Consequently,physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas.Existing studies have presented divergent results concerning these uptakes.Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images.In this article,we aim to succinctly explore the distinctive characteristics of FDG,delve into imaging findings,and elucidate the clinical significance of incidental focal colorectal uptake.This discussion aims to contribute valuable insights into the nuanced interpretation of such findings,fostering a comprehensive understanding.

关键词： Focal Incidental Colorectal Fluorodeoxyglucose Positron emission tomography hypermetabolism

Mucosa-associated lymphoid tissue lymphoma with unusual 18F-FDG hypermetabolism arising at the colorectal anastomosis

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World Journal of Gastroenterology 2017年第3期23卷 551-559页

作者： Na-Sha Zhang Fang Shi Li Kong Hui Zhu Department of Radiation Oncology Shandong Cancer Hospital affiliated to Shandong UniversityShandong Academy of Medical SciencesJinan 250117Shandong ProvinceChina

Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low ^(18)F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage Ⅱ MALT lymphoma with unexpected higher ^(18)F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission.

关键词： Colorectal anastomosis Mucosa-associated lymphoid tissue lymphoma Etiopathogenesis Unusual 18F-FDG hypermetabolism 18F-FDG-PET/CT imaging Patient-tailored treatment

Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism,adrenergic stress and hypothalamic regulation-a systematic review

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Burns & Trauma 2022年第1期10卷 272-282页

作者： Viktoria Mertin Patrick Most Martin Busch Stefan Trojan Christian Tapking Valentin Haug Ulrich Kneser Gabriel Hundeshagen Department of Hand Plastic and Reconstructive SurgeryBurn Trauma CenterBG Trauma Center LudwigshafenUniversity of Heidelberg67071 Ludwigshafen am RheinGermany Division of Molecular and Translational Cardi-ology Department of Internal MedicineⅢUniversity Hospital Heidelberg69120 HeidelbergGermany Deutsches Zentrum für Herz-und Kreislaufforschung(GCCR) Partner site Heidelberg/MannheimGermany Department of Anesthesiology and Intensive Care Medicine Merheim Medical CenterHospitals of CologneUniversity of Witten/Herdecke51109 CologneGermany

Background:In this systematic review,we summarize the aetiology as well as the current knowl-edge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options.Severe burn injuries with>20%total body surface area(TBSA)affected commonly leave the patient requiring several surgical procedures,prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase.Particularly in severely burned patients,the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications.Methods:A systematic and protocol-based search for suitable publications was conducted fol-lowing the PRISMA guidelines.Articles were screened and included if deemed eligible.This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients Results:Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are,nonetheless,lacking in detail.We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems.Lastly,the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized,as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being.Conclusions:The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury,especially concerning thermoregulation.We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest a

关键词： Animal model Burn shock Hypothermia Thermoregulation Temperature management Burn injury hypermetabolism

Disruption of orbitofrontal-hypothalamic projections in a murine ALS model and in human patients

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Translational Neurodegeneration 2021年第2期10卷 213-229页

作者： David Bayer Stefano Antonucci Hans-Peter Muller Rami Saad Luc Dupuis Volker Rasche Tobias M.Bockers Albert C.Ludolph Jan Kassubek Francesco Roselli Department of Neurology Ulm UniversityUlmGermany CEMMA(Cellular and Molecular Mechanisms in Aging)Research Training Group UlmGermany University of Strasbourg StrasbourgFrance Department of Internal Medicine II Ulm University Medical CentreUlmGermany Institute of Anatomy and Cell Biology Ulm UniversityUlmGermany German Center for Neurodegenerative Diseases-DZNE UlmGermany

Background:Increased catabolism has recently been recognized as a clinical manifestation of amyotrophic lateral sclerosis(ALS).The hypothalamic systems have been shown to be involved in the metabolic dysfunction in ALS,but the exact extent of hypothalamic circuit alterations in ALS is yet to be determined.Here we explored the integrity of large-scale cortico-hypothalamic circuits involved in energy homeostasis in murine models and in ALS patients.Methods:The rAAV2-based large-scale projection mapping and image analysis pipeline based on Wholebrain and Ilastik software suites were used to identify and quantify projections from the forebrain to the lateral hypothalamus in the SOD1(G93A)ALS mouse model(hypermetabolic)and the FusΔNLS ALS mouse model(normo-metabolic).3 T diffusion tensor imaging(DTI)-magnetic resonance imaging(MRI)was performed on 83 ALS and 65 control cases to investigate cortical projections to the lateral hypothalamus(LHA)in ALS.Results:Symptomatic SOD1(G93A)mice displayed an expansion of projections from agranular insula,ventrolateral orbitofrontal and secondary motor cortex to the LHA.These findings were reproduced in an independent cohort by using a different analytic approach.In contrast,in the FusΔNLS ALS mouse model hypothalamic inputs from insula and orbitofrontal cortex were maintained while the projections from motor cortex were lost.The DTI-MRI data confirmed the disruption of the orbitofrontal-hypothalamic tract in ALS patients.Conclusion:This study provides converging murine and human data demonstrating the selective structural disruption of hypothalamic inputs in ALS as a promising factor contributing to the origin of the hypermetabolic phenotype.

关键词： rAAV2 Agranular insula Orbitofrontal cortex Lateral hypothalamus hypermetabolism Amyotrophic lateral sclerosis

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

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Burns & Trauma 2021年第1期9卷 613-628页

作者： David R.Schieffelers Eric van Breda Nick Gebruers Jill Meirte Ulrike Van Daele Multidisciplinary Metabolic Research Unit(M2RUN) MOVANT Research GroupDepartment of Rehabilitation Sciences and PhysiotherapyFaculty of Medicine and Health SciencesUniversity of AntwerpUniversiteitsplein 12610WilrijkAntwerpBelgium Multidisciplinary Edema Clinic Antwerp University HospitalWilrijkstraat 102650EdegemAntwerpBelgium OSCARE Organisation for burnsscar after-care and researchVan Roiestraat 182170 MerksemAntwerpBelgium

Background:hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently managed.This study aimed to describe the current practice of inpatient rehabilitation across Europe.Methods:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and dieticians.Questions concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic sequelae.Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae.Results:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries responded.Resistance and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,respectively.The assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and methods.Not all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were reported.Significant interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic sequelae.The prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status was rated as the most important.Knowledge of bur

关键词： Burn care Burn rehabilitation Exercise Early mobilization hypermetabolism Adults

The pathogenesis and diagnosis of sepsis post burn injury

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Burns & Trauma 2021年第1期9卷 678-693页

作者： Pengju Zhang Bingwen Zou Yih-Cherng Liou Canhua Huang State Key Laboratory of Biotherapy and Cancer Center West China Hospitaland West China School of Basic Medical Sciences&Forensic MedicineSichuan Universityand Collaborative Innovation Center for BiotherapyNo.17 People’s South RoadChengdu610041China Department of Thoracic Oncology and Department of Radiation Oncology Cancer CenterWest China HospitalSichuan UniversityNo.37 Guoxue AlleyWuhou DistrictChengdu610041China Department of Biological Sciences Faculty of ScienceNational University of Singapore14 Science Drive 4117543Singapore

Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality.Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care,nutritional and fluid resuscitation and improved infection control practices,there are still large numbers of patients at a high risk of death.One of the most common complications of burn is sepsis,which is defined as“severe organ dysfunction attributed to host’s disordered response to infection”and is the primary cause of death in burn patients.Indeed,burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome,such as a hypovolaemic state,immune and inflammatory responses and metabolic changes.Therefore,clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock.In this review,we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis.Moreover,the clinical and promising biomarkers of burn sepsis will also be summarized.

关键词： Burn Infection Sepsis Septic shock Multiple organ dysfunction syndrome Immune dysregulation hypermetabolism Trauma Biomaker Inflammation