A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes – a randomized controlled trial

Background

Although monitoring foot skin temperatures has been associated with diabetic foot ulcer recurrence, no studies have been carried out to test the feasibility among European Caucasians. Moreover, the educational and/or motivational models that promote cognitive or psychosocial processes in these studies are lacking. Thus, we conducted a pilot randomized controlled trial to test the feasibility of monitoring foot skin temperatures in combination with theory-based counselling to standard foot care to reduce diabetic foot ulcer recurrence.

Methods

In a single-blinded nurse-led 1-year controlled trial, conducted at a hospital setting in Norway, 41 patients with diabetic neuropathy and previous foot ulcer were randomized to the intervention (n?=?21) or control groups (n?=?20). All participants were instructed in foot care and recording observations daily. Additionally, the intervention group was taught how to monitor and record skin temperature at baseline, and received counselling every third month supporting them to use the new treatment. Subjects observing temperature differences >2.0 °C between corresponding sites on the left and right foot on two consecutive days were asked to contact the study nurse and reduce physical activity. Fisher exact test was used to evaluate the effect of the intervention on the proportion of subjects with a foot ulcer. Kaplan-Meier survival analysis was performed to compare the two groups in regard to the time to development of a foot ulcer.

Results

In the intervention group, 67 % (n?=?14/21) monitored and recorded skin temperatures ≥80 % of the time while 70 % (n?=?14/20) of the controls recorded foot inspections. Foot ulcer incidence was 39 % (7/21) vs. 50 % (10/20) in the intervention and control groups, respectively (ns).

Conclusions

This feasibility study showed that the addition of counselling to promote self-monitoring of skin temperature to standard care to prevent recurrence of foot ulcer is feasible in patients with diabetes in Norway. Home skin temperature monitoring was performed as frequently by the intervention group as usual foot observations in the controls despite the extra effort required. We did not detect a difference in foot ulcer recurrence between groups, but our study may inform future full scale studies.

Trial registration

Clinicaltrials.gov NCT01269502

     

The varied presentation of metastatic melanoma in fine needle aspiration cytology of the breast

D. L. Ribu, P. W. Shield and J. F. Bligh
The varied presentation of metastatic melanoma in fine needle aspiration cytology of the breast Objective: To identify cytomorphological patterns of metastatic melanoma (MM) in breast fine needle aspiration (FNA) specimens and highlight the differential diagnoses and features most useful in identifying MM. Methods: The clinical, radiological and FNA findings of 16 cases were reviewed. Cytological features evaluated related to cell arrangement, size and shape of cells, nuclear and cytoplasmic features, and the presence or absence of necrosis. Results: The series consisted of 14 females and two males, ranging in age from 24 to 83 years (mean = 50 years). A previous history of melanoma was available in 12/16 (75%) cases at the time of FNA reporting; however the clinical/radiological impression in 4/16 cases was of a breast cyst. The cases were classified into six morphological variants: classical (8/16), pseudopapillary (3/16), spindle‐cell (1/16), melanin‐rich (1/16), pleomorphic (2/16) and lymphoma‐like (1/16). The varying patterns raised a wide range of differential diagnoses; however, discohesion, binucleation and granular cytoplasm were the major features seen in 94% of all cases. In 14/16 cases (88%), plasmacytoid cells, prominent nucleoli and cytoplasmic vacuolation were identified. Melanin and multinucleation were detected in 44% of cases and intranuclear cytoplasmic invaginations in 63%. Necrosis was present in more than half of the cases (56%). Conclusion: MM should be considered in the differential diagnosis of breast FNA specimens when atypical cells are seen that present as plasmacytoid cells in a dispersed or pseudopapillary pattern, or as spindle, pleomorphic or pigmented cells. These features, combined with clinical history and immunocytochemistry, may assist in correctly identifying MM and directing optimal treatment.     

Synthesis and evaluation of 18F-hexafluorophosphate as a novel PET probe for imaging of sodium/iodide symporter in a murine C6-glioma tumor model

Noninvasive imaging of iodide uptake via the sodium/iodide symporter (NIS) has received great interest for evaluation of thyroid cancer and reporter imaging of NIS-expressing viral therapies. In this study, we investigate ¹⁸F-labeled hexafluorophosphate (HFP or PF₆^?) as a high-affinity iodide analog for NIS imaging. ¹⁸F-HFP was synthesized by radiofluorination of phosphorus pentafluoride·N-methylpyrrolidine complex and evaluated in human NIS (hNIS)-expressing C6 glioma cells and a C6 glioma xenograft mouse model. ¹⁸F-HFP was obtained in radiochemical yield of 10?±?5%, radiochemical purity of >96% and specific radioactivity of 604?±?18?MBq/µmol. Specific uptake of ¹⁸F-HFP and high affinity of ¹⁹F-HFP were observed in hNIS+ C6-glioma cells. PET imaging showed robust uptake of ¹⁸F-HFP in NIS-expressing tissues (thyroid, stomach, and hNIS+ C6 glioma xenografts), and the uptake of ¹⁸F-HFP was blocked by NaClO₄ pretreatment. Specific accumulation in hNIS-expressing xenograft (hNIS+) was observed relative to isogenic control tumor (hNIS?). Clearance of ¹⁸F-HFP was predominantly through renal excretion. The biodistribution showed consistent results with PET imaging. Minimal bone uptake was observed over 2?h period post-injection, indicating excellent in vivo stability of ¹⁸F-HFP. Although improvement in specific radioactivity is desirable, the results indicate that ¹⁸F-HFP is a promising candidate radiotracer for further evaluation for NIS imaging.     

RNA-Dependent Protein Kinase Is Essential for 2-Methoxyestradiol-Induced Autophagy in Osteosarcoma Cells

Osteosarcoma is the most common primary malignant bone tumor in children and young adults. Surgical resection and adjunctive chemotherapy are the only widely available options of treatment for this disease. Anti-tumor compound 2-Methoxyestradiol (2-ME) triggers cell death through the induction of apoptosis in osteosarcoma cells, but not in normal osteoblasts. In this report, we have investigated whether autophagy plays a role in 2-ME actions on osteosarcoma cells. Transmission electron microscopy imaging shows that 2-ME treatment leads to the accumulation of autophagosomes in human osteosarcoma cells. 2-ME induces the conversion of the microtubule-associated protein LC3-I to LC3-II, a biochemical marker of autophagy that is correlated with the formation of autophagosomes. Conversion to LC3-II is accompanied by protein degradation in 2-ME-treated cells. 2-ME does not induce autophagosome formation in normal primary human osteoblasts. In addition, 2-ME-dependent autophagosome formation in osteosarcoma cells requires ATG7 expression. Furthermore, 2-ME does not induce accumulation of autophagosomes in osteosarcoma cells that express dominant negative mutant RNA-dependent protein kinase (PKR) and are resistant to anti-proliferative and anti-tumor effects of 2-ME. Taken together, our study shows that 2-ME treatment induces PKR-dependent autophagy in osteosarcoma cells, and that autophagy could play an important role in 2-ME-mediated anti-tumor actions and in the control of osteosarcoma.     

Moravecia australiensis n. g., n. sp. (Dracunculoidea: Guyanemidae) from the gills of the green porcupine fish Tragulichthys jaculiferus (Cuvier) in Australia

A new dracunculoid genus and species, Moravecia australiensis, is described from gill-filaments of the green porcupine fish Tragulichthys jaculiferus (Cuvier) (Tetraodontiformes: Diodontidae) from Moreton Bay, Queensland, Australia. Abundant mobile larvae and a few adult males with females occurred in the gill-filament between the epithelial basement membrane and efferent artery. Gills of all 69 fish examined contained larvae. Eleven harboured adult nematodes of a previously undescribed species belonging to the family Guyanemidae. The new species is placed within a newly proposed genus because it differs from the four existing genera in the family in possessing fine cuticular transverse striations, two forward protruding cephalic elevations, a circumoral elevation, a small triangular mouth surrounded by six cephalic papillae arranged in two lateral clusters of three each and a pair of large lateral amphids. Males have two pairs of pedunculate caudal papillae supporting the caudal alae. A key to the genera of the Guyanemidae is presented.     

Opistholobetines (Digenea: Opecoelidae) in Australian tetraodontiform fishes

Opistholebetine opecoelids are reported following examination of 1,041 individual tetraodontiform fishes, comprising 60 species and seven families, collected in Australian waters between 1986 and 2018. Nine species consistent with Opistholebes Nicoll, 1915, Heterolebes Ozaki, 1935 or Maculifer Nicoll, 1915 were recovered. However, phylogenetic analysis of sequence data, generated for some of these species, suggested that five genera, not three, are required to adequately accommodate these taxa. Thus, the concept and composition for each is revised, Pseudoheterolebes Yamaguti, 1959 nec Gupta, 1968 is resurrected and Parallelolebes n. g. is proposed. Of the nine species examined, five are new. Four new species are from fishes endemic to subtropical and temperate Australian waters for which no trematodes have previously been reported: Pa. australis n. sp. and Ps. corazonae n. sp. from the slender-spined porcupinefish Diodon nicthemerus Cuvier (Diodontidae) off Stanley, Tasmania; Pa. virilis n. sp. from the horse-shoe leatherjacket Meuschenia hippocrepis (Quoy & Gaimard) (Monacanthidae) off Stanley; and Ps. stellaglobulus n. sp. from the threebar pocupinefish Dicotylichthys punctulatus Kaup (Diodontidae) in Moreton Bay, south-east Queensland. The fifth new species is M. diodontis n. sp., collected from the spotted porcupinefish Diodon hystrix Linnaeus and the blackblotched porcupinefish D. liturosus Shaw, in tropical waters on the Great Barrier Reef. Species reported previously include the type-species of Opistholebes, O. amplicoelus Nicoll, 1915 from the rough golden puffer Lagocephalus lunaris (Bloch & Schneider) (Tetraodontidae) and the common toadfish Tetractenos hamiltoni (Richardson) (Tetraodontidae) in Moreton Bay, and three species reported for the first time from fishes in Australian waters: H. maculosus Ozaki, 1935, Pa. elongatus Ozaki, 1937 n. comb. and Ps. diodontis (Cable, 1956) n. comb., each from both D. hystrix and D. liturosus on the Great Barrier Reef. Following the revisions, Opistholebes is recognised for two species, Heterolebes for five, Maculifer for eight, Pseudoheterolebes for five and Parallelolebes for three.