Asthma characteristics and biomarkers from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) longitudinal profiling study

BACKGROUND

Asthma is a heterogeneous disease and development of novel therapeutics requires an understanding of pathophysiologic phenotypes. The purpose of the ADEPT study was to correlate clinical features and biomarkers with molecular characteristics, by profiling asthma (NCT01274507). This report presents for the first time the study design, and characteristics of the recruited subjects.

METHODS

Patients with a range of asthma severity and healthy non-atopic controls were enrolled. The asthmatic subjects were followed for 12 months. Assessments included history, patient questionnaires, spirometry, airway hyper-responsiveness to methacholine, fractional exhaled nitric oxide (FENO), and biomarkers measured in induced sputum, blood, and bronchoscopy samples. All subjects underwent sputum induction and 30 subjects/cohort had bronchoscopy.

RESULTS

Mild (n = 52), moderate (n = 55), severe (n = 51) asthma cohorts and 30 healthy controls were enrolled from North America and Western Europe. Airflow obstruction, bronchodilator response and airways hyperresponsiveness increased with asthma severity, and severe asthma subjects had reduced forced vital capacity. Asthma control questionnaire-7 (ACQ7) scores worsened with asthma severity. In the asthmatics, mean values for all clinical and biomarker characteristics were stable over 12 months although individual variability was evident. FENO and blood eosinophils did not differ by asthma severity. Induced sputum eosinophils but not neutrophils were lower in mild compared to the moderate and severe asthma cohorts.

CONCLUSIONS

The ADEPT study successfully enrolled asthmatics across a spectrum of severity and non-atopic controls. Clinical characteristics were related to asthma severity and in general asthma characteristics e.g. lung function, were stable over 12 months. Use of the ADEPT data should prove useful in defining biological phenotypes to facilitate personalized therapeutic approaches.

Optimal Virtual Monochromatic Images for Evaluation of Normal Tissues and Head and Neck Cancer Using Dual-Energy CT

BACKGROUND AND PURPOSE

Dual-energy CT is not used routinely for evaluation of the head and neck, and there is no consensus on the optimal virtual monochromatic image energies for evaluating normal tissues or head and neck cancer. We performed a quantitative evaluation to determine the optimal virtual monochromatic images for visualization of normal tissues, head and neck squamous cell carcinoma, and lymphadenopathy.

MATERIALS AND METHODS

Dual-energy CT scans from 10 healthy patients and 30 patients with squamous cell carcinoma were evaluated at different virtual monochromatic energy levels ranging from 40 to 140 keV. The signal-to-noise ratios of muscles at 6 different levels, glands (parotid, sublingual, submandibular, and thyroid), 30 tumors, and 17 metastatic lymph nodes were determined as measures of optimal image quality. Lesion attenuation and contrast-to-noise ratios (compared with those of muscle) were evaluated to assess lesion conspicuity.

RESULTS

The optimal signal-to-noise ratio for all the tissues was at 65 keV (P < .0001). However, tumor attenuation (P < .0001), attenuation difference between tumor and muscles (P = .03), and lesion contrast-to-noise ratios (P < .0001) were highest at 40 keV.

CONCLUSIONS

The optimal image signal-to-noise ratio is at 65 keV, but tumor conspicuity compared with that of muscle is greatest at 40 keV. Optimal evaluation of the neck may be best achieved by a multiparametric approach, with 65-keV virtual monochromatic images providing the best overall image quality and targeted use of 40-keV virtual monochromatic images for tumor evaluation.

Technical considerations for ligation of ruptured hepatic artery aneurysm: is arterial reconstruction necessary?

Ruptured hepatic artery aneurysm is a rare life-threatening condition. Open surgery with ligation of the aneurysm is the treatment of choice if the patient presents with haemodynamic instability. Controversies exist on whether hepatic artery reconstruction is needed after exclusion of the aneurysm. Involvement of the gastroduodenal artery origin was proposed as an indication for reconstruction, but this might be difficult to ascertain upon laparotomy. Recent studies showed that arterial ligation distal to the gastroduodenal artery origin does not necessarily result in ischaemic liver injury, implying that reconstruction in such cases may not be required, especially in a haemodynamically unstable patient. A patient with common hepatic artery aneurysm involving the gastroduodenal artery origin presented with rupture and underwent aneurysm ligation. Adequacy of intrahepatic arterial flow was determined by intra-operative Doppler ultrasonography and arterial reconstruction was not performed. The technical considerations during the operative management of ruptured hepatic artery aneurysms are discussed.

Unexplained childhood anaemia: idiopathic pulmonary hemosiderosis

This report demonstrates pulmonary haemorrhage as a differential cause of anaemia. Idiopathic pulmonary hemosiderosis is a rare disease in children; it is classically described as a triad of haemoptysis, pulmonary infiltrates on chest radiograph, and iron-deficiency anaemia. However, anaemia may be the only presenting feature of idiopathic pulmonary hemosiderosis in children due to occult pulmonary haemorrhage. In addition, the serum ferritin is falsely high in idiopathic pulmonary hemosiderosis which increases the diagnostic difficulty. We recommend that pulmonary haemorrhage be suspected in any child presenting with iron-deficiency anaemia and persistent bilateral pulmonary infiltrates.

Different spectral hounsfield unit curve and high-energy virtual monochromatic image characteristics of squamous cell carcinoma compared with nonossified thyroid cartilage

BACKGROUND AND PURPOSE

The attenuation of normal nonossified thyroid cartilage can be similar to that of head and neck squamous cell carcinoma on CT. We compared dual-energy CT spectral Hounsfield unit attenuation characteristics of nonossified thyroid cartilage with that of squamous cell carcinoma to determine the optimal virtual monochromatic image reconstruction energy levels for distinguishing tumor from normal nonossified thyroid cartilage.

MATERIALS AND METHODS

Dual-energy CT scans from 30 patients with histopathology-proved squamous cell carcinoma at different primary sites (laryngeal and nonlaryngeal) and 10 healthy patients were evaluated. Patients were scanned with a 64-section single-source scanner with fast-kilovolt (peak) switching, and scans were reconstructed at different virtual monochromatic energy levels ranging from 40 to 140 keV. Spectral attenuation curves of tumor and nonossified thyroid cartilage were quantitatively evaluated and compared. Any part of the tumor invading the cartilage, when present, was excluded from ROI analysis to avoid cross-contamination from areas where there could be a mixture of cartilage and invading tumor.

RESULTS

Normal nonossified thyroid cartilage had a characteristic, predictable spectral attenuation curve that was different from that of tumors. The greatest difference in attenuation of nonossified cartilage compared with tumor was on virtual monochromatic images of ≥95 keV (P < .0001), with sharp contrast between the relatively high attenuation of nonossified cartilage compared with that of tumor.

CONCLUSIONS

Head and neck squamous cell carcinoma has significantly different attenuation on virtual monochromatic images of ≥95 keV, compared with nonossified thyroid cartilage.

Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review

BACKGROUND

Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct.

METHODS

We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009-2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery.

RESULTS

Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease.

CONCLUSIONS

To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

American Society of Hematology 55th Annual Meeting and Exposition (December 7-13, 2013 - New Orleans, Louisiana, USA)

The 55th American Society of Hematology (ASH) Annual Meeting and Exposition took place in New Orleans, Louisiana, and attracted more than 20,000 hematology experts from the healthcare, pharmaceutical and biotechnology industries and academia. The conference offered a diverse range of clinical research sessions, along with poster sessions that covered all aspects of hematology from disease pathogenesis, genomics and potential targets for blood disorders, to novel therapeutics and treatment outcomes of recently developed drugs. The meeting also provided a platform for networking, allowing attendees from various clinical backgrounds to discuss and share opinions and ideas related to hematology.

PFO closure: rational, procedure and devices

Patent foramen ovale (PFO) is a common anatomical variant occurring in 20-25% of the population. In most cases, a PFO remains asymptomatic. However it allows for any venous particle such as thrombus, air or vasoactive substances to bypass the lung and enter the arterial circulation. Accordingly, PFO's have been linked to cryptogenic stroke, migraine and decompression illness. While the number of device closures have been increasing the therapy remains controversial as ‑ until recently ‑ data supporting PFO closure came from non randomized studies only. In this review we will discuss the existing data on PFO closure including results of the three randomized controlled trials comparing device closure with medical therapy in patients with cryptogenic stroke. We will also focus on the implantation technique, the complications and the different devices that are used for this procedure.

Influence of ureteric anastomosis technique on urological complications after kidney transplantation

The best technique for anastomosis of the donor ureter remains unresolved and an individual surgeon's preferred technique is likely to be based on training background. This retrospective analysis compares three ureteroneocystostomy techniques in 204 consecutive transplants with an overall ureteric complication rate of 7.3%. Ureteric complications after kidney transplantation present early, are more common when using deceased donor kidneys, and, require complex reconstructive surgery to resolve. Three significant and related findings have been demonstrated with a common theme related to the length of the transplanted ureter, and not, the debate over extravesical versus intravesical techniques.

Robust T cell responses to aspergillosis in chronic granulomatous disease: implications for immunotherapy

Chronic granulomatous disease (CGD) patients are highly susceptible to invasive aspergillosis and might benefit from aspergillus-specific T cell immunotherapy, which has shown promise in treating those with known T cell defects such as haematopoietic stem cell transplant (HSCT) recipients. But whether such T cell defects contribute to increased risks for aspergillus infection in CGD is unclear. Hence, we set out to characterize the aspergillus-specific T cell response in CGD. In murine CGD models and in patients with CGD we showed that the CD4(+) T cell responses to aspergillus were unimpaired: aspergillus-specific T cell frequencies were even elevated in CGD mice (P < 0·01) and humans (P = 0·02), compared to their healthy counterparts. CD4-depleted murine models suggested that the role of T cells might be redundant because resistance to aspergillus infection was conserved in CD4(+) T cell-depleted mice, similar to wild-type animals. In contrast, mice depleted of neutrophils alone or neutrophils and CD4(+) T cells developed clinical and pathological evidence of pulmonary aspergillosis and increased mortality (P < 0·05 compared to non-depleted animals). Our findings that T cells in CGD have a robust aspergillus CD4(+) T cell response suggest that CD4(+) T cell-based immunotherapy for this disease is unlikely to be beneficial.