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28.06.2016
Spurge can tolerate compact soil conditions and is often found invading high traffic or otherwise stressed turf areas. AbstractResponse criteria represent the standard by which the efficacy of therapeutic agents is determined in cancer trials. An estimated 569,490 Americans are expected to die of cancer in 2010, accounting for approximately 25% of the overall mortality (1).
Change in tumor size following therapy, also known as objective response (4, 5), is a robust indicator of outcome in the treatment of numerous solid tumors (6-9) and forms the basis for anatomic response criteria.
PET has the potential to revolutionize the definition of measurable tumors because it introduces imaging criteria based on function. All criteria are subject to minimum lesion size limitations and PERCIST is also subject to minimum FDG uptake limitations. The MDA criteria can allow more bone lesions to be considered measurable disease than does the RECIST 1.1 system by allowing physical measurement of well-defined bone lesions regardless of soft tissue extension, by allowing regimented subjective assessment of ill-defined lesions, and by taking into account characteristic behaviors such as the development of healing sclerosis.
The pumpkin seed oil, when used in combination with saw palmetto in human studies, showed effective reduction in symptoms of BPH.
Studies have also illustrated that ash gourd contains plenty of moisture and petite amounts of fat, protein, carbohydrates and fibre, apart from calcium, phosphorous, iron, riboflavin, thiamine, niacin and Vitamin C.
Kills intestinal worms: The seeds of ash gourd are anabolic and encourages tissue growth, particularly, when consumed with coconut milk.
Treats constipation: It provides good relief from constipation and tones up the general digestive system.
Treats common cold: It helps in controlling common cold, cough, fever, sinusitis, bronchitis, influenza and more, without any side effects. In Ayurveda, ash gourd is used to treat epilepsy, asthma, lung diseases, urine retention, internal haemorrhage, and cough. A glass or two of tart cherry juice before bedtime may improve sleep, suggest results from a randomized, double-blind, placebo-controlled trial.
Results showed that urine levels of melatonin increased following tart cherry consumption, while no such increases were observed in the placebo group.Improvements in sleep measures were also reported by the researchers.
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Watch this free webinar about patented ingredient, BioCell Collagen®, a clinically tested ingredient for promoting healthy joints. While similar to prostate spurge, there are several subtle differences in the two varieties. It is generally not found in dense, healthy stands of turf grass, so good maintenance practices constitute good prevention of spurge infestation.
Bone metastases are a common manifestation of advanced disease with autopsy studies showing an incidence of 33-36% in patients with lung cancer (2, 3), 68% in prostate cancer (3), and 73% in breast cancer (2, 3). RECIST (10), updated to RECIST 1.1 in 2009 (11), was designed to standardize the assessment of therapeutic response to allow meaningful comparison of drug efficacy among individuals in the same study and across different studies (12, 13). The International Union Against Cancer (UICC) (17) and the World Health Organization (WHO) (4) published criteria in 1977 and 1979, respectively. The regular, well-defined tumor margins that are necessary for reproducible anatomic measurements are of lesser importance in functional imaging. Metabolic imaging criteria can allow bone metastases to be measured in the absence of anatomic change by assessing tumor metabolism. Modern study has confirmed its effectiveness in the treatment of Benign Prostatic Hyperplasia (BPH) or prostate enlargement. Researchers suggest zinc free fatty acid, or plant sterol content of pumpkin seed may prove beneficial in men with BPH. Being low in calories, it is ideal for diabetic patients, and those seeking weight-control.
The juice derived from shredded ash gourd, when mixed with equal amount of water, could be taken every morning in an empty stomach, and thereafter no food should be consumed for three hours.
It counteracts acidity created in the stomach due to intake of acidic foods like fried, soft drinks and denatured food. Since ancient times, its fresh juice, when mixed with a teaspoon of gooseberry or lime juice, is used as a specific medicine to stop profuse bleeding from lungs and presence of blood cells in the urine.
The participants were randomly assigned to consume either the tart cherry concentrate or placebo for seven days.A 30 ml serving of tart cherry juice concentrate – containing the equivalent of 90-100 cherries – was given in the morning and one in the evening, and diluted with 200 ml of water. Specifically, sleep efficiency increased by 5-6%, while total sleep time increased by an average of 34 minutes per night, compared with a decline in the placebo group.Bioactives? Where high traffic is the problem, core aerate and attempt to divert traffic where possible.
Because bone metastases are typically located in irregularly shaped bones and are difficult to measure with rulers, they have been previously considered unmeasurable disease. While many patients receive therapy at major cancer centers, numerous other patients choose local or regional hospitals, and most imaging studies include the skeleton secondarily if not primarily (e.g. RECIST 1.1 specifies that up to 5 target lesions, representing all affected organ systems but with no more than 2 target lesions per organ, be selected for measurement throughout the course of a therapeutic trial.


While at the time representing the most sophisticated attempts to standardize the evaluation of tumor response, these criteria were published before the widespread availability of CT.
According to the MDA criteria, CR is defined as complete sclerotic fill-in of lytic lesions on radiographs or CT, the restoration of normal bone density on radiography or CT, the disappearance of abnormal tracer uptake on skeletal scintigraphy (SS), and the normalization of signal intensity on MRI (Fig. The MDA criteria identified nonresponders earlier and better correlated with clinical response in the first 2-6 months of therapy than did the WHO criteria. FDG is a radiolabeled form of glucose that cannot be metabolized and therefore accumulates in cells, which take up the molecules as if they were normal glucose. Response criteria are of crucial importance to the care of many cancer patients, and the tumor response assessment of bone metastases is assuming a greater role in therapeutic management.
Studies have shown that the pumpkin seed extracts can improve functioning of the bladder and urethra, which might help in achieving BPH symptom relief. It can even treat mouth cancer, protecting teeth and gums when a mouth gargle of the juice is done regularly. They have similar leaves, which are small and oblong shaped with an irregular red to purple spot, but the leaf of spotted spurge is slightly larger than that of prostrate spurge. New developments in cancer response criteria have increased awareness of the importance of the response of bone metastases to therapy.
The interval development of an FDG-avid focus, in the absence of any other indication of disease progression, is considered progressive disease under RECIST 1.1 unless it corresponds to a pre-existing, anatomically stable abnormality.
Both sets of criteria, which have been largely supplanted by RECIST and RECIST 1.1, consider bone metastases to be measurable disease. In isolation, this response qualifies as complete response even though progressive sclerosis may be seen on subsequent examinations. Early signs of disease progression are valuable, allowing the halting of ineffective therapy in a timely fashion and the possible substitution of effective therapy. Knowledge of the fundamental concepts of tumor response criteria (anatomic, bone, and functional) and the appearance of bone metastases as they respond to treatment or progress can aid in the interpretation of studies in a manner that will render them of optimal value to the patient and clinician. Both spurges will have leaves that grow opposite on the stem, but spotted spurge has fewer leaves per stem.
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Thus, the appearance and behavior of bone metastases can be detected on a wide variety of imaging studies that are performed for many different indications.Response criteria represent the standard by which the efficacy of new therapeutic agents is determined in cancer treatment trials. Lesions may be measured using CT or magnetic resonance imaging (MRI), but CT is preferred in most situations because of the variability of MRI scan parameters.
The metastasis to the severely compressed T6 vertebral body is an example of a lesion that remains unmeasurable with anatomic response criteria. In isolation, these findings might be representative of disease progression, but lytic lesions in other locations (not shown) demonstrated sclerotic fill-in, raising the possibility of an osteoblastic flare rather than progressive disease. In addition to their utility for guiding treatment decisions, the MDA bone response criteria closely reflect the behavior of bone metastases on radiography and CT and can be used as guidelines for the interpretation of these studies whether or not a patient is enrolled in a therapeutic trial. Since many malignancies are highly metabolic and accumulate FDG, it is the most commonly used PET agent for oncologic indications. Assessment of tumor metabolism allowed therapeutic response to be measured in the absence of any other indication of change. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. Response criteria specific to bone metastases have been developed at The University of Texas MD Anderson Cancer Center (MDA criteria) and can be used to assess therapeutic response in numerous types of bone metastases.
The most commonly used set of criteria is the Response Evaluation Criteria in Solid Tumors (RECIST).
The resultant void regarding the evaluation of bone metastases led to the development of bone-specific response criteria at The University of Texas MD Anderson Cancer Center in 2004 (18). The MDA criteria can be considered for use in conjunction with other cancer response criteria or in patients with bone-only metastases and no measurable disease.
The following review of the PERCIST criteria includes many of the concepts discussed in the source article (27).Evaluation of tumor response with FDG PET has several advantages over anatomically based criteria. Functional imaging criteria, such as the recently developed Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) allow response to be measured in the absence of anatomic change through assessment of metabolic activity. These and similar anatomic criteria focus predominantly on the physical measurement of solid tumors. This increase of 91% exceeds the required > 20% increase that is necessary to qualify for the progressive disease category. The MDA criteria updated the UICC and WHO bone response criteria by expanding radiographic assessment and incorporating both CT and MRI.The MDA criteria divide response into 4 standard categories (CR, PR, PD, and SD) and include quantitative and qualitative assessments of the behavior of bone metastases (Table 2). Incidental note is made of interval insufficiency fracture of the superior endplate of L4 on (f).
Some chemotherapeutic agents are cytostatic rather than cytocidal and therefore do not result in a profound change in tumor size despite their effectiveness (28-30), and some malignancies, such as gastrointestinal stromal tumors, do not demonstrate PR through a large decrease in size (31). As monitoring tumor response of bone metastases becomes more important in the management of cancer, so does the demand on radiologists and nuclear medicine physicians for accurate interpretation of the behavior of these lesions.
Disease that is not easily measurable with a ruler or calipers, such as most bone metastases, is designated as unmeasurable. The soft tissue component is to be measured in an identical manner to that used for other target lesions (Fig. The increased MDP uptake on the bone scan (b) was the result of healing sclerosis and representative of a scintigraphic flare in a patient undergoing partial response rather than progressive disease.


By reflecting change in tumor metabolism, FDG PET scanning can provide a method by which tumor response can be measured in the absence of marked anatomic change (32).
Both spotted and prostrate spurge reproduce from seed, although prostrate spurge also roots at the nodes.
Measurements are to be made in the plane of acquisition (typically axial for CT unless isotropic reconstructions are performed). Interval visualization of sclerotic lesions or lytic lesions with sclerotic rims, in the setting of other signs of PR, does not indicate disease progression but the healing of previously inconspicuous lesions (19).
FDG PET has also been shown to provide more rapid response data than anatomic measurements (43-45).
Therefore, the absence of measurable tumors can significantly affect patient disease management.
Osteoblastic flare cannot be diagnosed if any preexisting lesions show signs of progression (e.g.
This article reviews anatomic (RECIST 1.1), bone (MD Anderson [MDA]), and metabolic (Positron Emission Tomography Response Criteria in Solid Tumors [PERCIST]) cancer response criteria, with a focus on the developing role of bone metastases and the interpretation of the treatment response of bone metastases seen on imaging studies.
Many acceptable scan acquisition parameters are in clinical use, and several previous attempts have been made to standardize PET for cancer trials through guidelines such as those published by the European Organization for Research and Treatment of Cancer (EORTC) (49), the Netherlands Society of Nuclear Medicine (50), and the National Cancer Institute (51). PERCIST, published in the Journal of Nuclear Medicine (27), represents the most recent effort to create standardized criteria that accurately reflect response in the largest number of malignancies. However, MRI has been shown superior to CT in delineating the extent of primary bone tumors (which are similar to target bone lesions because they typically produce large soft tissue masses) and their relationship to adjacent structures (14, 15).
The value of the high soft tissue contrast resolution of MRI was shown in a prospective study comparing MRI and CT for the detection of locally recurrent tumors in 49 patients following the resection of musculoskeletal malignancies (16). An increase in tracer uptake on SS may need correlation with other imaging studies to exclude the scintigraphic flare phenomenon, which is typically seen within the first 3 months after therapy. Scintigraphic flare occurs when healing sclerosis results in more tracer uptake than was caused by the untreated lesion (Fig. MRI scans with and without the use of intravenous gadolinium contrast can be considered for the follow-up of measurable bone lesions. CR is defined as the disappearance of all target lesions and reduction of the short axes of target lymph nodes to < 10 mm.
Fludeoxyglucose F18 (FDG) positron emission tomography (PET) can be used in place of biopsy to verify CR when a residual mass is thought to represent scarring or fibrosis. PERCIST specifies that the SUL peak is to be obtained on the single most active lesion on each scan.
SUL peak is the average of the activity within a spherical region of interest measuring 1.2 cm in diameter (for a volume of 1 cm3) centered at the most active portion of the tumor.
The SUL peak may be located in a different lesion on a follow-up scan because the current most avid lesion is to be measured.
Additionally, the interval development of a malignant FDG uptake pattern is considered an indicator of PD unless it corresponds to an anatomically stable lesion. Using a concept similar to RECIST, it is also recommended that a sum of the activity of up to 5 target lesions (no more than 2 per organ) be measured as a secondary determinant of response. Future studies will show which of the 2 methods of response determination most accurately reflects treatment outcome.An alternative metric that can be used to determine FDG avidity according to the PERCIST criteria is total lesion glycolysis (TLG). This is a measure of the FDG uptake of the entire tumor above a pre-set threshold and is calculated by multiplying the mean SUV by total tumor volume (mL) (27, 56) TLG has been tested in several malignancies and has produced mixed results in comparison to SUV metrics, showing a weaker correlation with response in bone metastases in breast cancer patients (57) and in sarcomas(41, 58) but equal or better in esophageal, lung, gastric and rectal cancer (59) (60, 61). PERCIST suggests that SUL peak and TLG can be measured simultaneously in order to further evaluate the efficacy of TLG. For further specifics regarding PET scanning, such as information regarding patient preparation and scan acquisition, please see the PERCIST source article by Wahl et al. While no focus of unmeasurable disease can be used as a target lesion, the progression of such tumors can have an effect on the RECIST response assessment under the designation of unequivocal progression of nontarget lesions. In general, progression of nontarget lesions is to be estimated as a 20% increase in the sum of the greatest tumor diameters, which is calculated to be a 73% increase in volume, by the authors of the RECIST criteria (11).
Complete metabolic response is defined as the disappearance of metabolic tumor activity in target and nontarget lesions.
Therefore, frank progression of bone metastases on any imaging modality can contribute to the classification of overall patient response through the designation of unequivocal progression (Fig. Residual FDG uptake can be seen despite effective therapy, possibly due to macrophage activity (62), and therefore PERCIST define complete metabolic response as a decrease in tumor SUL to the level of surrounding normal tissue. In the absence of clear evidence of disease progression on the fused CT image, new FDG-avid foci are to be verified on a follow-up scan 1 month after discovery.
Stable metabolic disease is the absence of change or mild changes that do not meet the minimum qualifications of the other categories. Anatomic change in tumor size remains an important factor under PERCIST and is to be measured according to RECIST 1.1. Functional imaging criteria can also be considered for use in conjunction with anatomic criteria such as RECIST or MDA (Table 4).



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