SUMMARY:The current standard of care for newly diagnosed cases of high-grade glioma is surgical resection followed by RT with concurrent chemotherapy. The most widely used criteria for assessing treatment response are based on a 2D measurement of the enhancing area on MR imaging known as the Macdonald Criteria. Recently, nontumoral increases (pseudoprogression) and decreases (pseudoresponse) in enhancement have been found, and these can confuse outcome evaluation. Here we review pseudoprogression and pseudoresponse and describe how better understanding of these phenomena can aid interpretation.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; BBB ϭ blood-brain barrier; Cho ϭ choline; DSC ϭ dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging; DTI ϭ diffusion tensor imaging; DWI ϭ diffusion-weighted imaging; FDG ϭ fluorodeoxyglucose; FLAIR ϭ fluidattenuated inversion recovery; GBM ϭ glioblastoma multiforme; MGMT ϭ methyltransferase; NAA ϭ N-acetylaspartate; PET ϭ positron-emission tomography; PSR ϭ percentage of signalintensity recovery; RANO ϭ Response Assessment in Neuro-Oncology; rCBV ϭ relative cerebral blood volume; RECIST ϭ Response Evaluation Criteria in Solid Tumors; ROC ϭ receiver operating characteristic analysis; RT ϭ radiation therapy; TMZ ϭ temozolomide; VEGF ϭ vascular endothelial growth factor G BM is the most common primary malignant type of brain neoplasm in adults and is associated with a dismal prognosis. The current standard of care is surgical resection followed by RT and concomitant and adjuvant TMZ chemotherapy. This is a relatively recent standard, with pivotal data published in 2005, and it represents a milestone, because this approach has been shown to prolong the overall survival of these patients.1 With the standardization of treatment around surgery/RT/TMZ, certain patterns are beginning to emerge that were not previously noticed. In addition, in May 2009, the US Food and Drug Administration approved bevacizumab for recurrent glioblastoma. This anti-VEGF agent also can have a marked pattern of change on MR imaging. In addition to impacting individual patient care, these changes have also had an impact on clinical trials of new therapies. Macdonald CriteriaThe Macdonald Criteria 2 are currently the most widely used guideline for assessing response to therapy in patients with highgrade gliomas. These are based on 2D tumor measurements made in MR imaging scans, in conjunction with clinical assessment and corticosteroid dose. According to the Macdonald Criteria, tumor progression is considered to have occurred when an increase of Ͼ25% in the size of the contrast-enhancing lesion is observed. There are important limitations to these criteria, which only address the contrast-enhancing component of the tumor, and various updated guidelines for RANO have been published.3,4 As radiologists learn early in their training, contrast enhancement in posttreatment brain tumors is nonspecific and may not always be considered a true surrogate of tumor response.The limitations of th...

Aim Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40–49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22–40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5–19.2) (P < 0.001). Conclusions The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.

We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3-24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) (P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was euro198 and that of a hospital visit was euro177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B (P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.

Between October 1998 and April 1999, 51 persons belonging to two separate groups developed acute pulmonary histoplasmosis after visiting a cave in Costa Rica. The first group consisted of 61 children and 14 adults from San Jose, Costa Rica; 44 (72%) were diagnosed with acute histoplasmosis. The second group comprised 14 tourists from the United States and Canada; 9 (64%) were diagnosed with histoplasmosis. After a median incubation time of 14 days, the most common symptoms were headache, fever, cough, and myalgias. Risk factors for developing histoplasmosis included crawling (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 2.3-802) and visiting one specific room (OR = 3.4, 95% CI = 1.0-12.3) in the cave. Washing hands (OR = 0.1, 95% CI = 0.01-0.6) after exiting the cave was associated with a decreased risk of developing histoplasmosis. Histoplasma capsulatum was isolated from bat guano collected from inside the cave. Persons who explore caves, whether for recreation or science, should be aware of the risk bat-inhabited caves pose for developing histoplasmosis, especially if they are immunocompromised in any way.

Measurement of malaria specific antibody responses represents a practical and informative method for malaria control programs to assess recent exposure to infection. Technical advances in recombinant antigen production, serological screening platforms, and analytical methods have enabled the identification of several target antigens for laboratory based and point-of-contact tests. Questions remain as to how these serological assays can best be integrated into malaria surveillance activities to inform programmatic decision-making. This report synthesizes discussions from a convening at Institut Pasteur in Paris in June 2017 aimed at defining practical and informative use cases for serology applications and highlights five programmatic uses for serological assays including: documenting the absence of transmission; stratification of transmission; measuring the effect of interventions; informing a decentralized immediate response;  and testing and treating P. vivax hypnozoite carriers.