XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Methods for Staging Non-small Cell Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Subependymoma is a rare, slow growing, rarely recurrent tumor We report a case of recurrent subependymoma with subependymal seeding An intraventricular tumor in the left temporal horn was detected in a 48-year-old female who presented with a 4-year history of dizziness and memory disturbance Following near total surgical resection, a tumor diagnosis of subependymoma was confirmed by scattered clusters of isomorphic nuclei embedded in a dense fibrillary matrix of glial cell processes Twenty-six months after surgery, follow-up (F/U) magnetic resonance (MR) imaging revealed tumor recurrence in the previous site which necessitated linear accelerator radiosurgery (LINAC) A further 21 months later, F/U MR imaging showed recurrent, multiple, enhanced, nodular lesions in the enlarged left lateral ventricle for which the patient underwent reoperation Radiological and operative findings revealed local relapse with subependymal seeding The pathological finding was similar to that of the previous tumor and compatible with subependymoma The patient underwent radiation therapy for the residual tumor This case history suggests that symptomatic residual tumors require close observation even though the clinical course of subependymoma is usually benign

A case of recurrent subependymoma with subependymal seeding: case report.

Serum irisin level is independent of sarcopenia and related muscle parameters in older adults

Dear Editor: The most common type of primary brain tumor is glioma, which includes astrocytomas, oligodendrogliomas, ependymomas, anaplastic astrocytomas, and glioblastomas (GBLs). GBL is the most frequent and malignant brain tumor and accounts for 12-15% of all primary brain tumors (Zulch, 1986). Oligodendroglioma accounts for 4.2% of all primary brain tumors (Mork et al., 1985). GBL has been cultured in vitro, and several human GBL cell lines have been reported recently (Manuelidis, 1965; Collins, 1983; Bakir et al., 1998; Perzelova et al., 1998). However, a very limited number of oligodendroglioma cell lines have been established and characterized. The abundance of established brain tumor cell lines and the diversity among them are of great advantage to cancer research. Well-characterized human malignant brain tumor cell lines can contribute significantly to the understanding of the biology of human brain tumors in many fields. Herein, we describe the characteristics of newly-established human brain tumor cell lines including six GBL (SNU-201, -444, -466, -489, -626, and -1105), two oligodendroglioma (SNU-738 and -791), and one primitive neuroectodermal tumor (PNET) (SNU-1118) cell lines. The cell lines were established from pathologically proven brain tumors (Table 1). Solid tumors were finely minced with scissors and dissociated into small aggregates by pipetting. Appropriate amounts of fine neoplastic tissue fragments were seeded into 25-cm 2 flasks. Tumor cells were initially cultured in ACL-4 medium supplemented with 5% heat-inactivated fetal bovine serum (AR5). The AR5 medium has proved useful in the establishment of human cancer cell lines (Park et al., 1995; Ku et al., 1997). The composition of AR5 medium has been described previously (Park et al., 1995). Once established, the cultures were maintained in Roswell Park Memorial Institute 1640 medium (GIBCO/BRL, Grand Island, NY) supplemented with 10% heat-inactivated fetal bovine serum. Cell cultures were maintained in a humidified incubator at 37 ~ C in an atmosphere containing 5% CO2. We began to establish human brain cancer cell lines in 1989 and have obtained a culture success rate of 26% (9 in 34 trials). All tumor lines grew as monolayers and showed high viability (85-95%) with varying doubling times (48-92 h) and absence of mycoplasma and bacteria contamination. Deoxyribonucleic acid (DNA) fingerprinting using two highly polymorphic microsatellite markers showed that the newly-established brain tumor cell lines were unique and unrelated (Fig. 1). These data excluded any possibility of cross-contamination between the cell lines. Clinical and morphologic characteristics are summarized in Table 1. The tumor cells from GBLs showed nuclear augulation, hyperchromatism, and pleomorphism. Mitoses were frequently noted, and vascular proliferation was prominent. Necroses were extensive in all tumors. In the original tumors of SNU-201, -466, -489, and -1105, pseudopalisading necrosis was noted. In immunohistochemical studies, the tumor cells expressed glial fibrillary acidic protein (GFAP), the marker for astrocytic cells, in the cytoplasm. The original tumor of SNU-444 was a recurrent GBL (Fig. 2A). Six months before initiation of the cell line, the patient had undergone craniotomy followed by radiation therapy. The initial tumor was diagnosed as GBL by histologic examination. The other patients in this study received no prior therapy. The original tumors of anaplastic oligodendrogliomas consisted of rather uniform cells with round, delicate nuclei and perinuclear halos (Fig. 2C). The tumors showed hypercellularity, nuclear hyperchromasia, conspicuous mitotic activity, and endothelial proliferation. Necrosis was present in the original tumor of SNU-738. In immunohistochemical studies, most of the tumor cells did not express GFAP. GFAP was focally expressed in the cytoplasm of minigemistocytes. The SNU-738 patient received no prior therapy. Five years before initiation of the cell line, the SNU-791 patient had undergone craniotomy, and the initial tumor was diagnosed as oligodendroglioma by histologic examination. The patient had received postoperative radiation therapy with 5550 rad. The cell line of SNU-1118 was derived from a PNET (Fig. 2E). One year before initiation of the cell line, the patient was diagnosed by biopsy as having a PNET. The extracranial component of the tumor was located in the left infratemporal fossa with the intracranial tumor in the left temporal lobe. The patient received 13 cycles of chemotherapy followed by craniotomy. The intracranial component of the tumor consisted of hypercellular primitive cells with extensive necrosis. The tumor cells had hyperchromatic nuclei and scanty cytoplasm (Fig. 2E). The tumor focally showed nodular arrangement. In immunohistochemical studies, the tumor cells focally expressed GFAP, S100 protein, neuron-specific enolase, vimentin, and desmin. The histological features were consistent with those of a PNET with glial, neuronal, and mesenchymal differentiation. The extracranial component of the tumor showed the histological features of a melanotic neuroectodennal tumor. The tumor was diagnosed as a malignant melanotic neuroectodermal tumor with glial, neuronal, and mesenchymal differentiation. The molecular mechanisms that underlie the development of brain tumor have not been elucidated. However, the inactivation of tumor suppressor genes has been increasingly recognized as a major mechanism in tumor development. This study demonstrated the inactivation of various tumor suppressor genes such as p53, p16, p15, PTEN, FHIT, and DCC in the nine new human brain cancer cell lines (Table 2). For the p53 gene, we examined exons 4-9, in which about 98% of the mutations have been detected (Nigro et al., 1989). Mutation of the p53 gene was found in five cell lines. The SNU201 cell line showed a point mutation of cagTAC to caaTAC at a splice acceptor of intron 4 (Fig. 3A); the SNU-444 line had a missense mutation of TGT (Cys) to TAT (Tyr) at codon 275; the SNU-

Establishment and characterization of nine human brain tumor cell lines.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.27370

Which one is associated with nonalcoholic fatty liver disease? Small muscle mass or large fat mass.

OBJECTIVE With improved technology, the values of intraoperative computed tomography (iCT) have been reevaluated. We describe our early clinical experience with a mobile CT (mCT) system for iCT and discuss its clinical applications, advantages and limitations. METHODS Compared with intraoperative magnetic resonance imaging, this mCT system has no need for major reconstruction of a preexisting operating room for shielding, or for specialized instruments or equipment. Patients are placed on a radiolucent head clamp that fits within the gantry. Because it consists simply of a scanner and a workstation, it can be moved between locations such as an operating room, an intensive care unit (ICU) or an emergency room without difficulty. Furthermore, it can achieve nearly all types of CT scanning procedures such as enhancement, temporal bone imaging, angiography and three-dimensional reconstruction. RESULTS For intracranial surgery, mCT can be used for intraoperative real-time neuronavigation by interacting with preoperative images. It can also be used for intraoperative confirmation of the extent of resection of intracranial lesions and for immediate checks for preventing intraoperative unexpected accidents. Therefore, the goals of maximal resection or optimal treatment can be achieved without any guesswork. Furthermore, mCT can achieve improved patient care with safety and faster diagnosis for patients in an ICU who might be subjected to a ventilator and/or various monitoring devices. CONCLUSION Our initial experience demonstrates that mCT with high-quality imaging offers very useful information in various clinical situations.

Hee-Won Jung

Papers

A case of recurrent subependymoma with subependymal seeding: case report.

Serum irisin level is independent of sarcopenia and related muscle parameters in older adults

Establishment and characterization of nine human brain tumor cell lines.

Which one is associated with nonalcoholic fatty liver disease? Small muscle mass or large fat mass.

Mobile computed tomography : early experience in Korea.