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Goertz L, Kabbasch C, Borggrefe J, Hamisch C, Telentschak S, von Spreckelsen N, Stavrinou P, Timmer M, Brinker G, Goldbrunner R, Krischek B. Preoperative Three-Dimensional Angiography May Reduce Ischemic Complications During Clipping of Ruptured Intracranial Aneurysms. World Neurosurg 2018; 120:e1163-e1170. [DOI: 10.1016/j.wneu.2018.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
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Stavrinou P, Kalyvas A, Grau S, Hamisch C, Galldiks N, Katsigiannis S, Kabbasch C, Timmer M, Goldbrunner R, Stranjalis G. Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression. J Neurosurg 2018; 131:1136-1141. [PMID: 30544353 DOI: 10.3171/2018.7.jns18228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Data on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression. METHODS The authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis. RESULTS One hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3-8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5-5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17-2.15; p = 0.002). CONCLUSIONS Treatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.
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Zheng F, Goertz L, Timmer M, Stavrinou P, Goldbrunner R, Krischek B. MNGI-16. TREATMENT FOR TUBERCULUM SELLAE MENINGIOMAS: ENDONASAL ENDOSCOPIC TRANSSPHENOIDAL VERSUS TRANSCRANIAL SURGERY. A META-ANALYSIS OF COMPARATIVE COHORT STUDIES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Krischek B, Goertz L, Timmer M, Goldbrunner R, Stavrinou P. MNGI-19. SURGICAL RESECTION OF SPHENO-ORBITAL MENINGIOMAS AND ORBITAL RECONSTRUCTION USING PATIENT SPECIFIC CAD/CAM IMPLANTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Goertz L, Kasuya H, Hamisch C, Kabbasch C, von Spreckelsen N, Ludyga D, Timmer M, Stavrinou P, Goldbrunner R, Brinker G, Krischek B. Impact of aneurysm shape on morbidity after clipping of unruptured intracranial aneurysms. Acta Neurochir (Wien) 2018; 160:2169-2176. [PMID: 30225810 DOI: 10.1007/s00701-018-3675-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Complex aneurysm shape is a predominant risk factor for aneurysm rupture but its impact on clinical outcome after clipping remains unclear. The objective of the present study was to compare complications and morbidity after clipping of unruptured single-sac aneurysms (SSAs) and aneurysms with multiple sacs (MSAs). METHODS A retrospective, single-center study was conducted for patients that were treated between 2010 and 2018. We analyzed surgical parameters, treatment-related complications, and morbidity, defined as any increase in the modified Rankin scale at 3-month follow-up. RESULTS We identified 101 patients (mean age: 52.9 ± 10.5 years) that underwent clipping for 57 SSAs and 44 MSAs. The two groups were comparable regarding aneurysm size and neck width. Clipping of MSAs was associated with a longer operation time (p = 0.008) and increased use of intraoperative indocyanine green (p = 0.016) than SSAs. Complications occurred more often in the MSA group (29.5%) than in the SSA group (14.0%; p = 0.057). Morbidity was significantly higher in the MSA group (20.5%) than in the SSA group (3.5%, p = 0.009). In the univariate analysis, the odds of morbidity were 7.1 times greater for MSAs than for SSAs (95% CI 1.4-34.7). CONCLUSIONS Morbidity after microsurgical clipping is significantly increased in MSAs as compared to SSAs. This may be attributed to a more difficult clip placement with stronger manipulation of the aneurysm dome and the surrounding brain tissue.
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Goertz L, Hamisch C, Telentschak S, Kabbasch C, von Spreckelsen N, Stavrinou P, Timmer M, Goldbrunner R, Brinker G, Krischek B. Impact of Aneurysm Shape on Intraoperative Rupture During Clipping of Ruptured Intracranial Aneurysms. World Neurosurg 2018; 118:e806-e812. [DOI: 10.1016/j.wneu.2018.07.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/30/2022]
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Papazacharias E, Röhn G, Goldbrunner R, Timmer M. P04.68 Relation of the expression between TERT and GABPA/B isoforms in gliomas using quantitative real time-PCR. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stegmann S, Werner J, Kuhl S, Röhn G, Goldbrunner R, Timmer M. P04.77 Death receptor 6 (DR6) is overexpressed in astrocytomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dinh DTD, Kuhl S, Röhn G, Goldbrunner R, Timmer M. P02.17 CHMP4B is upregulated in meningiomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Timmer M, Kauke M, Safi A, Krischek B, Goldbrunner R. P05.79 Semiautomatic image segmentation based volume approximation of intracranial meningiomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dinh DTD, Kuhl S, Röhn G, Goldbrunner R, Timmer M. P04.63 ENO1 ist downregulated in meningiomas and upregulated in low grade gliomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Werner J, Kuhl S, Krischek B, Goldbrunner R, Timmer M. P01.124 The expression of CD40 correlates negatively with overall survival of gliomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kuhl S, Röhn G, Goldbrunner R, Timmer M. P04.76 The expression of cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) is upregulated in high grade gliomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zheng F, Xu H, von Spreckelsen N, Stavrinou P, Timmer M, Goldbrunner R, Cao F, Ran Q, Li G, Fan R, Zhang Q, Chen W, Yao S, Krischek B. Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: A systematic review and meta-analysis. J Int Med Res 2018; 46:2503-2512. [PMID: 29779445 PMCID: PMC6124291 DOI: 10.1177/0300060518755148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/19/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the effectiveness of early (<3 months) cranioplasty (CP) and late CP (>3 months) on post-operative complications in patients receiving decompressive craniotomy (DC) for traumatic brain injury (TBI). Methods The Cochrane Library, PubMed and EMBASE databases were systematically searched for studies published prior to May 21, 2017. A meta-analysis examined post-operative overall complication rates, infection rates, subdural fluid collection and operating times according to early and late CP. Results Of the initial 1675 references, five studies, all cohort, involving a total of 413 patients, were selected for the review. There was no difference between early and late CP in post-operative overall complication rate (RR=0.68, 95%CI [0.36, 1.29]) and the post-operative infection rate (RR=0.50, 95%CI [0.20, 1.24]) in patients receiving DC for TBI. However, there was a significant difference in post-operative subdural effusion (RR=0.24, 95%CI [0.07, 0.78]) and mean operative time (mean difference = -33.02 min, 95%CI [-48.19, -17.84]) both in favour of early CP. Conclusions No differences were found between early and late CP in post-operative overall complications and procedural related infections in patients receiving DC for TBI, but early CP reduced the complication of subdural effusion and the mean operating time. These findings need to be confirmed by large, randomised controlled trials.
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Safi AF, Safi S, Tayeh M, Timmer M, Goldbrunner R, Kauke M. A novel microsurgical anastomosis training model using gradually thawed cryopreserved microvessels of rat cadavers. J Craniomaxillofac Surg 2018; 46:1126-1131. [DOI: 10.1016/j.jcms.2018.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
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Safi AF, Kauke M, Jung H, Timmer M, Borggrefe J, Persigehl T, Nickenig HJ, Zinser M, Maintz D, Kreppel M, Zöller J. Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma? J Craniomaxillofac Surg 2018; 46:1013-1018. [DOI: 10.1016/j.jcms.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
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Haas B, Klinger V, Keksel C, Bonigut V, Kiefer D, Caspers J, Walther J, Wos-Maganga M, Weickhardt S, Röhn G, Timmer M, Frötschl R, Eckstein N. Inhibition of the PI3K but not the MEK/ERK pathway sensitizes human glioma cells to alkylating drugs. Cancer Cell Int 2018; 18:69. [PMID: 29755294 PMCID: PMC5935937 DOI: 10.1186/s12935-018-0565-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/14/2018] [Indexed: 12/19/2022] Open
Abstract
Background Intrinsic chemoresistance of glioblastoma (GBM) is frequently owed to activation of the PI3K and MEK/ERK pathways. These signaling cascades are tightly interconnected however the quantitative contribution of both to intrinsic resistance is still not clear. Here, we aimed at determining the activation status of these pathways in human GBM biopsies and cells and investigating the quantitative impact of both pathways to chemoresistance. Methods Receptor tyrosine kinase (RTK) pathways in temozolomide (TMZ) treatment naive or TMZ resistant human GBM biopsies and GBM cells were investigated by proteome profiling and immunoblotting of a subset of proteins. Resistance to drugs and RTK pathway inhibitors was assessed by MTT assays. Apoptotic rates were determined by Annexin V staining and DNA damage with comet assays and immunoblotting. Results We analyzed activation of RTK pathways by proteome profiling of tumor samples of patients which were diagnosed a secondary GBM and underwent surgery and patients which underwent a second surgery after TMZ treatment due to recurrence of the tumor. We observed substantial activation of the PI3K and MEK/ERK pathways in both groups. However, AKT and CREB phosphorylation was reduced in biopsies of resistant tumors while ERK phosphorylation remained unchanged. Subsequent proteome profiling revealed that multiple RTKs and downstream targets are also activated in three GBM cell lines. We then systematically describe a mechanism of resistance of GBM cell lines and human primary GBM cells to the alkylating drugs TMZ and cisplatin. No specific inhibitor of the upstream RTKs sensitized cells to drug treatment. In contrast, we were able to restore sensitivity to TMZ and cisplatin by inhibiting PI3K in all cell lines and in human primary GBM cells. Interestingly, an opposite effect was observed when we inhibited the MEK/ERK signaling cascade with two different inhibitors. Conclusions Temozolomide treatment naive and TMZ resistant GBM biopsies show a distinct activation pattern of the MEK/ERK and PI3K signaling cascades indicating a role of these pathways in resistance development. Both pathways are also activated in GBM cell lines, however, only the PI3K pathway seems to play a crucial role in resistance to alkylating agents and might serve as drug target for chemosensitization.
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Harmancı AS, Youngblood MW, Clark VE, Coşkun S, Henegariu O, Duran D, Erson-Omay EZ, Kaulen LD, Lee TI, Abraham BJ, Simon M, Krischek B, Timmer M, Goldbrunner R, Omay SB, Baranoski J, Baran B, Carrión-Grant G, Bai H, Mishra-Gorur K, Schramm J, Moliterno J, Vortmeyer AO, Bilgüvar K, Yasuno K, Young RA, Günel M. Integrated genomic analyses of de novo pathways underlying atypical meningiomas. Nat Commun 2018; 9:16215. [PMID: 29676392 PMCID: PMC5919704 DOI: 10.1038/ncomms16215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This corrects the article DOI: 10.1038/ncomms14433.
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Werner JM, Kuhl S, Stavrinou P, Röhn G, Krischek B, Blau T, Goldbrunner R, Timmer M. Expression of FAS-L Differs from Primary to Relapsed Low-grade Gliomas and Predicts Progression-free Survival. Anticancer Res 2017; 37:6639-6648. [PMID: 29187439 DOI: 10.21873/anticanres.12121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The tumor necrosis factor FAS is overexpressed in high-grade gliomas (HGG). Only little is known about FAS or FAS ligand (FAS-L) in low-grade gliomas (LGG). We explored FAS/FAS-L expression in LGG, focusing on differences in primary and relapsed LGG and on its prognostic value. PATIENTS AND METHODS A total of 133 glioma samples (73 LGG, 60 HGG) were collected. The LGG samples included 15 matched pairs of primary and relapsed tumors. RT-PCR was performed to measure FAS/FAS-L expression, using subunit A, flavoprotein variant (SDHA) as housekeeper. Clinical data included progression free- (PFS) and overall survival (OS). RESULTS LGG showed significantly lower FAS but higher FAS-L expression than HGG. The FAS-L expression was higher in primary compared to relapsed LGG and had a positive prognostic value concerning PFS (median 45.20 vs. 31.37 months). CONCLUSION FAS-L could act as a prognostic marker and potential target in primary LGG.
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Timmer M, Röhn G, Goldbrunner R, Werner J. CSIG-29. THE PROGNOSTIC VALUE OF FAS AND FASL IN WHO GRADE II GLIOMA PROGRESSION. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Timmer M, Werner J, Röhn G, Goldbrunner R. CSIG-06. ENPP3 OVEREXPRESSION IN ASTROCYTOMAS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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72
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Timmer M, Telentschak S, Röhn G, Goldbrunner R. CBIO-17. GENE EXPRESSION OF MITOTIC DRIVERS TPX2 AND RAN IS UPREGULATED DEPENDENT ON MENINGIOMA GRADE AND CORRELATES WITH MIB-1 LABELING INDEX. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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von Spreckelsen N, Röhn G, Goertz L, Goldbrunner R, Timmer M. CSIG-41. UPREGULATED EXPRESSION OF THE ARYL HYDROCARBON RECEPTOR PATHWAY IN BRAIN METASTASES FROM MALIGNANT MELANOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zheng F, von Spreckelsen N, Zhang X, Stavrinou P, Timmer M, Dohmen C, Goldbrunner R, Cao F, Zhang Q, Ran Q, Li G, Fan R, Yao S, Krischek B. Should preventive antibiotics be used in patients with acute stroke? A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0186607. [PMID: 29049353 PMCID: PMC5648227 DOI: 10.1371/journal.pone.0186607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infection is a common complication in acute stroke. Whether or not preventive antibiotics reduce the risk of infection or even lead to a favorable outcome and reduction of mortality after a stroke still remains equivocal. This review was performed to update the current knowledge on the effect and possible benefits of prophylactic antibiotic therapy in patients with stroke. METHODS A systematic review and meta-analysis of preventive antibiotics`effect on the incidence of infection, favorable outcome (mRS≤2) and mortality in patients with acute stroke is performed with relevant randomized controlled trials. RESULTS Six studies were identified, involving 4125 participants. Compared with the control group, the treated groups were significantly less prone to suffer from early overall infections [RR = 0.52, 95%CI (0.39, 0.70), p<0.0001], early pneumonia [RR = 0.64, 95%CI (0.42, 0.96), p = 0.03] and early urinary tract infections [RR = 0.35, 95%CI (0.25, 0.48), p<0.00001]. However, there was no significant difference in overall mortality [RR = 1.07, 95%CI (0.90, 1.27), p = 0.44], early mortality [RR = 0.99, 95%CI (0.78, 1.26), p = 0.92], late mortality [RR = 1.12, 95%CI (0.94, 1.35), p = 0.21] or favorable outcome [RR = 1.00, 95%CI (0.92, 1.08), p = 0.98]. CONCLUSION Although preventive antibiotic treatment did reduce the occurrence of early overall infections, early pneumonia and early urinary tract infection in patients with acute stroke, this advantage was not eventually translated to a favorable outcome and reduction in mortality. Future studies are warranted to identify any subgroup of stroke patients who might benefit from preventive antibiotic treatment.
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Timmer M, Werner JM, Röhn G, Ortmann M, Blau T, Cramer C, Stavrinou P, Krischek B, Mallman P, Goldbrunner R. Discordance and Conversion Rates of Progesterone-, Estrogen-, and HER2/neu-Receptor Status in Primary Breast Cancer and Brain Metastasis Mainly Triggered by Hormone Therapy. Anticancer Res 2017; 37:4859-4865. [PMID: 28870906 DOI: 10.21873/anticanres.11894] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Knowing the molecular footprint of tumors is a precondition for personalized medicine. For breast cancer, targeted therapies are frequently based on the molecular status of the tissue gained from the primary tumor operation. However, it is unclear whether metastases in different organs maintain the same status. PATIENTS AND METHODS We compared the estrogen- (ER), progesterone- (PgR) and HER2/neu receptor status of the primary tumor with brain metastases in a series of 24 consecutive breast cancer patients. RESULTS 62.5-75% of patients exhibited a constant receptor status between the primary tumor and the brain metastasis, whereas discordance rates of 25-37.5% were found, depending on the receptor. The rate of ER and PgR expression was each 41.6% in the primary tumors and decreased to 12.5% and 16.6% in the brain metastases. In contrast, the rate for Her2+ tumors increased from 41.6% in primary breast cancer to 65.2% in the respective brain metastases. The Ki-67 proliferation index increased significantly from a mean of 21% at the primary tumor site to 60% in brain metastases (p<0.001). All anti-estrogen treated breast tumors lost the estrogen receptor expression in the brain metastases, whereas no Her2/neu conversions occurred after treatment with trastuzumab. CONCLUSION In summary, receptor conversion is frequent during disease progression. Therefore, the receptor status of the primary tumor is invalid for planning a therapy targeted against brain metastases, especially after hormone-therapy. In these cases, new tissue collection by biopsy or resection is mandatory for the selection of adequate therapeutic targets and accurate decision-making for systemic therapies.
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