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Dörr A, Flörcken A, Bullinger L, Capper D, Deimling AV, Kaul D, Märdian S, Starck C, Horst D, Dragomir MP, Schäfer FM, Jarosch A. Thrombus or tumor? A case report of a rare sarcoma entity: intimal sarcoma of the pulmonary arteries. Mol Biol Rep 2024; 51:568. [PMID: 38656400 PMCID: PMC11043182 DOI: 10.1007/s11033-024-09467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Tumor embolism is a very rare primary manifestation of cancers and the diagnosis is challenging, especially if located in the pulmonary arteries, where it can mimic nonmalignant pulmonary embolism. Intimal sarcoma is one of the least commonly reported primary tumors of vessels with only a few cases reported worldwide. A typical location of this malignancy is the pulmonary artery. Herein, we present a case report of an intimal sarcoma with primary manifestation in the pulmonary arteries. A 53-year-old male initially presented with dyspnea. On imaging, a pulmonary artery embolism was detected and was followed by thrombectomy of the right ventricular outflow tract, main pulmonary artery trunk, and right pulmonary artery after ineffective lysis therapy. Complementary imaging of the chest and abdomen including a PET-CT scan demonstrated no evidence of a primary tumor. Subsequent pathology assessment suggested an intimal sarcoma further confirmed by DNA methylation based molecular analysis. We initiated adjuvant chemotherapy with doxorubicin. Four months after the completion of adjuvant therapy a follow-up scan revealed a local recurrence without distant metastases. DISCUSSION Primary pulmonary artery intimal sarcoma (PAS) is an exceedingly rare entity and pathological diagnosis remains challenging. Therefore, the detection of entity-specific molecular alterations is a supporting argument in the diagnostic spectrum. Complete surgical resection is the prognostically most important treatment for intimal cardiac sarcomas. Despite adjuvant chemotherapy, the prognosis of cardiac sarcomas remains very poor. This case of a PAS highlights the difficulty in establishing a diagnosis and the aggressive natural course of the disease. CONCLUSION In case of atypical presentation of a pulmonary embolism, a tumor originating from the great vessels should be considered. Molecular pathology techniques support in establishing a reliable diagnosis.
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Affiliation(s)
- A Dörr
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - A Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Capper
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Von Deimling
- Department of Neuropathology, and CCU Neuropathology, University Hospital Heidelberg, DKFZ, Heidelberg, Germany
| | - D Kaul
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt and Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - S Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - C Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - D Horst
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pathology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M P Dragomir
- German Cancer Consortium (DKTK), Partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pathology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - F M Schäfer
- Institute for Radiology, Charité - Universitätsmedizin Berlin, Universität zu Berlin, Corporate member of Freie Universität Berlin and Humboldt, Berlin, Germany
| | - A Jarosch
- Department of Pathology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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2
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Callegari M, Danziger-Isakov LA, Rose A, Kaul D, Shaffer K, Chong PP, Florescu D, German K, Avery R, Nguyen MH, Wildfeuer B, Michaels MG, Green M, Guo K, Zhao L, Daud A, Ison MG. Presentation, anagement, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study. Transpl Infect Dis 2024:e14270. [PMID: 38526183 DOI: 10.1111/tid.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/20/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Norovirus (NoV) can cause chronic relapsing and remitting diarrhea in immunocompromised patients. Few multicenter studies have described the clinical course, outcomes, and complications of chronic NoV in transplant recipients. METHODS A multicenter retrospective study of adult and pediatric SOT and HSCT recipients diagnosed with NoV between November 1, 2017, and February 28, 2021. Data were obtained from electronic medical records (EMR) and entered into a central REDCap database. Descriptive statistics were calculated. RESULTS A total of 280 NoV+ patients were identified across eight sites. The majority were adults (74.1%) and SOT recipients (91.4%). Initial diagnosis of NoV occurred a median of 36 months post-Tx (IQR [15.0, 90.0]). Most NoV cases had >3 diarrheal episodes daily (66.0%), nausea and vomiting (60.1%). Duration of diarrhea varied greatly (median = 10 days, mean = 85.9 days, range (1, 2100)). 71.3% were hospitalized. Adjustment of immunosuppression, including reduction and discontinuation of mToR inhibitor, CNI, and/or MMF, was the most common management intervention for NoV. Other therapies resulted only in temporary improvement. Four patients died within 30 days and three others died by 180 days postdiagnosis. Clinically significant renal dysfunction was observed in 12.5% by 30 days and 21.4% by 180 days post-NoV diagnosis. CONCLUSION In HSCT and SOT patients, NoV frequently resulted in severe symptoms, prolonged diarrhea (30% persistent with diarrhea for >30 days), and clinically significant renal dysfunction (up to 21% of patients). Utilized therapies did not reliably result in the resolution of infection demonstrating the need for more effective treatment.
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Affiliation(s)
- Michelle Callegari
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lara A Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anne Rose
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Kaul
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly Shaffer
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Pearlie P Chong
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diana Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaci German
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robin Avery
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brett Wildfeuer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Green
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kexin Guo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amna Daud
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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3
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Rao K, Zhao Q, Bell J, Krishnan J, Henig O, Daniel J, Sawaya K, Albin O, Mills JP, Petty LA, Gregg K, Kaul D, Malani AN, Pogue J, Kaye KS. An Open-Label, Randomized Trial Comparing Fidaxomicin With Oral Vancomycin for the Treatment of Clostridioides difficile Infection in Hospitalized Patients Receiving Concomitant Antibiotics for Concurrent Infections. Clin Infect Dis 2024; 78:277-282. [PMID: 37797310 DOI: 10.1093/cid/ciad606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/17/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Recurrent Clostridioides difficile infection (rCDI) occurs frequently, and concomitant antibiotic (CA) during the initial episode for treatment of non-CDI is a major risk factor. We sought to address the comparative efficacy of fidaxomicin versus vancomycin in the setting of CA during the initial CDI episode. METHODS We conducted a randomized, controlled, open-label trial at 2 hospitals in Ann Arbor, Michigan. We consecutively consented and enrolled hospitalized patients ≥18 years old with diarrhea, a positive test for C. difficile, and ≥1 qualifying CA. Complicated CDI, CDI treatment for >24 hours prior to enrollment, and planned long-term (>12 weeks) CA use were notable exclusions. Clinical cure was defined as resolution of diarrhea for 2 consecutive days maintained until 2 days after therapy, and rCDI as recurrent diarrhea with positive testing ≤30 days after initial treatment. Patients were randomized to fidaxomicin or vancomycin. RESULTS Baseline characteristics were similar in the 2 groups of 144 patients. Rates of clinical cure (73% vs 62.9%, P = .195) and rCDI (3.3% vs 4.0%; P > .99) were similar for fidaxomicin and vancomycin in the intention-to-treat and per-protocol cohorts, respectively. Only 4 patients developed rCDI. CONCLUSIONS In this study of patients with CDI receiving CA, a numerically higher proportion were cured with fidaxomicin versus vancomycin, but this result did not reach statistical significance. Overall recurrence was lower than anticipated in both arms compared with previous studies that did not extend duration of CDI treatment during CA. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov (NCT02692651).
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Affiliation(s)
- Krishna Rao
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Qianzi Zhao
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Justin Bell
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Jay Krishnan
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Oryan Henig
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Jolene Daniel
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Sawaya
- Division of Infectious Diseases, Trinity Health Michigan, Ann Arbor, Michigan, USA
| | - Owen Albin
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - John P Mills
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsay A Petty
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin Gregg
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Kaul
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Anurag N Malani
- Division of Infectious Diseases, Trinity Health Michigan, Ann Arbor, Michigan, USA
| | - Jason Pogue
- Department of Clinical Pharmacy at the University of Michigan College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith S Kaye
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Zoumplis A, Kolody B, Kaul D, Zheng H, Venepally P, McKnight DM, Takacs-Vesbach C, DeVries A, Allen AE. Impact of meltwater flow intensity on the spatiotemporal heterogeneity of microbial mats in the McMurdo Dry Valleys, Antarctica. ISME Commun 2023; 3:3. [PMID: 36690784 PMCID: PMC9870883 DOI: 10.1038/s43705-022-00202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 01/24/2023]
Abstract
The meltwater streams of the McMurdo Dry Valleys are hot spots of biological diversity in the climate-sensitive polar desert landscape. Microbial mats, largely comprised of cyanobacteria, dominate the streams which flow for a brief window of time (~10 weeks) over the austral summer. These communities, critical to nutrient and carbon cycling, display previously uncharacterized patterns of rapid destabilization and recovery upon exposure to variable and physiologically detrimental conditions. Here, we characterize changes in biodiversity, transcriptional responses and activity of microbial mats in response to hydrological disturbance over spatiotemporal gradients. While diverse metabolic strategies persist between marginal mats and main channel mats, data collected from 4 time points during the austral summer revealed a homogenization of the mat communities during the mid-season peak meltwater flow, directly influencing the biogeochemical roles of this stream ecosystem. Gene expression pattern analyses identified strong functional sensitivities of nitrogen-fixing marginal mats to changes in hydrological activities. Stress response markers detailed the environmental challenges of each microhabitat and the molecular mechanisms underpinning survival in a polar desert ecosystem at the forefront of climate change. At mid and end points in the flow cycle, mobile genetic elements were upregulated across all mat types indicating high degrees of genome evolvability and transcriptional synchronies. Additionally, we identified novel antifreeze activity in the stream microbial mats indicating the presence of ice-binding proteins (IBPs). Cumulatively, these data provide a new view of active intra-stream diversity, biotic interactions and alterations in ecosystem function over a high-flow hydrological regime.
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Affiliation(s)
- A Zoumplis
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
- Microbial and Environmental Genomics Group, J. Craig Venter Institute, La Jolla, CA, USA
| | - B Kolody
- Earth and Planetary Science, University of California, Berkeley, Berkeley, CA, USA
| | - D Kaul
- Microbial and Environmental Genomics Group, J. Craig Venter Institute, La Jolla, CA, USA
| | - H Zheng
- Microbial and Environmental Genomics Group, J. Craig Venter Institute, La Jolla, CA, USA
| | - P Venepally
- Microbial and Environmental Genomics Group, J. Craig Venter Institute, La Jolla, CA, USA
| | - D M McKnight
- Institute of Arctic and Alpine Research, University of Colorado, Boulder, CO, USA
| | - C Takacs-Vesbach
- Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - A DeVries
- Evolution, Ecology and Behavior, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - A E Allen
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
- Microbial and Environmental Genomics Group, J. Craig Venter Institute, La Jolla, CA, USA.
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5
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Winter SF, Gardner M, Parsons MW, Grassberger C, Bussière M, Kaul D, Boehmerle W, Endres M, Shih HA, Dietrich J. P03.05.A Radiation-induced leukoencephalopathy (RIL) in glioma: unique injury dynamics following proton vs photon beam radiotherapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
White matter injury after brain-directed radiotherapy (RT), aka radiation-induced leukoencephalopathy (RIL), is common in brain tumor patients. Differentiation from progressive disease can be challenging. Dosimetric advantages of protons (PRT) over photons (XRT) minimize radiation to healthy brain tissue, potentially limiting radiotoxic sequelae including RIL. We characterized RIL during periods of progression-free survival (PFS) in glioma patients irradiated with either PRT or XRT, hypothesizing that PRT would result in reduced RIL outside of the target field.
Material and Methods
34 patients (19 male; mean age = 40.10y) with grade 2/3 gliomas and a history of partial cranial RT were stratified by RT modality [XRT (n=17) vs PRT (n=17)] and matched on 11 criteria [age, sex, tumor type/location/laterality, mutational status (IDH; 1p19q deletion), concurrent/adjuvant chemotherapy, radiation dose/fractions] for retrospective analysis. RIL development was characterized longitudinally for up to 3 years post-RT via analysis of serial MRI T2/FLAIR sequences. A novel RIL scoring system with embedded Fazekas scale was designed to quantify injury severity at both global (whole brain) and hemispheric levels.
Results
Matched groups did not differ significantly on any demographic or clinical characteristics. Median PFS post-RT was 4.7 (XRT) and 5.1 (PRT) years. The novel RIL scoring system was reliable (intraclass correlation coefficient >0.9). There was a significant increase in global RIL in both XRT [F(3, 57)=8.63, p< .001] and PRT [F(3, 61)=4.69, p< .005] groups over time, relative to baseline (1-month post-RT). A majority [62% (XRT) and 72% (PRT)] developed moderate or severe RIL within 3 years, with the ipsilesional hemisphere more severely affected. Analysis of RIL injury dynamics (i.e., average % change between 1 and 3 years post-RT) at hemispheric level identified radiation modality-specific differences: XRT resulted in greater contralesional hemispheric injury than PRT [F(1, 31)=4.32, p<.05]. This effect was not observed in ipsilesional hemispheres.
Conclusion
RIL is common in glioma patients and quantifiable by characteristic imaging features, including early onset post-RT, greater ipsilesional injury burden, and progression over time. RIL injury dynamics appear to be radiation modality-specific, whereby XRT causes greater delayed injury in the remote, contralesional hemisphere. These findings may reflect dosimetric differences between protons and photons. The impact of such sequelae on cognitive function is subject of current investigation.
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Affiliation(s)
- S F Winter
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program , Berlin , Germany
| | - M Gardner
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
| | - M W Parsons
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
| | - C Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
| | - M Bussière
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
| | - D Kaul
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - W Boehmerle
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - M Endres
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - H A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
| | - J Dietrich
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , United States
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Münch A, Teichmann D, Kuzman P, Spille D, Perez E, May S, Mueller W, Kombos T, Nazari-Dehkordi S, Onken J, Vajkoczy P, Ntoulias G, Paulus W, Heppner F, Koch A, Capper D, Kaul D, Thomas C, Schweizer L. P05.05.B A new IDH-wildtype glioma subtype characterized by highly diffuse growth pattern, distinct epigenetic profile and relatively favorable prognosis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
DNA methylation profiling has emerges as a powerful approach to CNS tumor classification and the discovery of novel, molecularly distinct entities. With the release of the 12.5 version of the Heidelberg Brain Tumor Classifier, some unclassifiable cases can be assigned to novel methylation classes. We retrospectively reviewed our databases and identified 16 previously unclassifiable cases, all of which belong to the provisional methylation class “adult-type diffuse high-grade glioma, IDH-wildtype, subtype F (HGG_F)”.
Material and Methods
We clinically, radiologically and morphologically characterized 16 HGG_F cases and compared them to 347 glioblastomas. We additionally analyzed copy-number alterations and performed DNA exome sequencing.
Results
Median age at diagnosis of the 12 males and 4 females was 65 years. Upon initial diagnostic workup, specimens were classified as CNS tissue with reactive changes (n=3) or suspicious for the infiltration zone of a diffuse glioma (n = 13). None of the cases demonstrated endothelial proliferation or necrosis and 10/16 tumors had flat copy number profiles. Radiological characteristics were reminiscent of gliomatosis cerebri in eight cases and 9/9 cases had normal FET-PET scans. Whole-exome sequencing revealed genetic alterations frequently found in IDH-wildtype glioblastomas, including TERT promoter mutations in 11/14 (78.6%) and PIK3 mutations (10/14, 71.4%). Outcome was significantly better compared to TCGA IDH-wildtype glioblastomas with a median progression-free survival of 58 months and overall survival of 73 months (both p<0.001).
Conclusion
We provide evidence that TERT promoter mutations in diffusely infiltrating gliomas without further morphological or molecular signs of high-grade glioma should be interpreted in the context of the clinico-radiological presentation as well as epigenetic prolife and may not be suitable as standalone diagnostic marker for glioblastoma, IDH wildtype.
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Affiliation(s)
- A Münch
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Teichmann
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - P Kuzman
- Institute of Neuropathology, University Hospital Leipzig , Leipzig , Germany
| | - D Spille
- Department of Neurosurgery, University Hospital Münster , Münster , Germany
| | - E Perez
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - S May
- Klinikum Chemnitz, Department of Neurosurgery , Chemnitz , Germany
| | - W Mueller
- Institute of Neuropathology, University Hospital Leipzig , Leipzig , Germany
| | - T Kombos
- Schlosspark-Klinik Charlottenburg, Department of Neurosurgery , Berlin , Germany
| | - S Nazari-Dehkordi
- Schlosspark-Klinik Charlottenburg, Department of Neurosurgery , Berlin , Germany
| | - J Onken
- Charité - Universitätsmedizin Berlin, Department of Neurosurgery , Berlin , Germany
| | - P Vajkoczy
- Charité - Universitätsmedizin Berlin, Department of Neurosurgery , Berlin , Germany
| | - G Ntoulias
- Vivantes Klinikum Neukölln, Department of Neurosurgery , Berlin , Germany
| | - W Paulus
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - F Heppner
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - A Koch
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Capper
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Kaul
- Charité - Universitätsmedizin Berlin, Department of Radiation Oncology and Radiotherapy , Berlin , Germany
| | - C Thomas
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - L Schweizer
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
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7
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Kassab I, Isada C, Azar MM, Sarsam N, Jiang M, Camelo-Piragua S, Kaul D, Malinis M. Into the Unknown: Diagnosing Mysterious Brain Lesions. Transpl Infect Dis 2022; 24:e13829. [PMID: 35307917 DOI: 10.1111/tid.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
The case discussed involves a 49-year-old male with simultaneous pancreas-kidney transplant who presented with fever, headache and was found to have multifocal brain lesion on brain imaging. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ihab Kassab
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carlos Isada
- Department of Infectious Disease, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nadine Sarsam
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Min Jiang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Daniel Kaul
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Dapper H, Belka C, Bock F, Budach V, Budach W, Christiansen H, Debus J, Distel L, Dunst J, Eckert F, Eich H, Eicheler W, Engenhart-Cabillic R, Fietkau R, Fleischmann DF, Frerker B, Giordano FA, Grosu AL, Herfarth K, Hildebrandt G, Kaul D, Kölbl O, Krause M, Krug D, Martin D, Matuschek C, Medenwald D, Nicolay NH, Niewald M, Oertel M, Petersen C, Pohl F, Raabe A, Rödel C, Rübe C, Schmalz C, Schmeel LC, Steinmann D, Stüben G, Thamm R, Vordermark D, Vorwerk H, Wiegel T, Zips D, Combs SE. Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO). Strahlenther Onkol 2021; 198:1-11. [PMID: 34786605 PMCID: PMC8594460 DOI: 10.1007/s00066-021-01861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.
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Affiliation(s)
- H Dapper
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany. .,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany.
| | - C Belka
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - F Bock
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - V Budach
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - W Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - H Christiansen
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - L Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Eckert
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - H Eich
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - W Eicheler
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - B Frerker
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - A L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - D Kaul
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - O Kölbl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - M Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Heidelberg and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Dresden, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - D Medenwald
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - N H Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Freiburg, Germany
| | - M Niewald
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - M Oertel
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - C Petersen
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Pohl
- Department of Radiotherapy, University of Regensburg, Regensburg, Germany
| | - A Raabe
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Frankfurt, Germany
| | - C Rübe
- Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg, Germany
| | - C Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L C Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Steinmann
- Department of Radiation Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - G Stüben
- Department of Radiation Oncology, University of Augsburg, Augsburg, Germany
| | - R Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Vordermark
- Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - H Vorwerk
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Marburg, Germany
| | - T Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - D Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Tübingen, Germany
| | - S E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
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9
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Henig O, Putler RKB, Albin O, Patel TS, Kaul D, Rao K, Kaye KS. The Performance of Sepsis-3 Criteria to Predict Mortality Among Patients With Hematologic Malignancy and Post-transplant who Have Suspected Infection. Open Forum Infect Dis 2021; 8:ofab529. [PMID: 35187190 DOI: 10.1093/ofid/ofab529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sepsis is a leading cause of death, particularly in immunocompromised people. The revised definition of sepsis (Sepsis-3) uses the Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) to identify patients with sepsis. The aim of this study was to evaluate the performance of SOFA, qSOFA, and systemic inflammatory response syndrome (SIRS) in immunocompromised patients. METHODS Adult immunocompromised patients admitted to Michigan Medicine between 2012 and 2018 with suspected infection were included based on criteria adopted from the Sepsis-3 study. Each clinical score (SOFA ≥2, qSOFA ≥2, SIRS ≥2) was added to the baseline risk model as an ordinal variable as well as a dichotomous variable, and area under the receiver operating characteristic curve (AUROC) values were calculated. In addition, breakpoints of SOFA between 2 and 10 were assessed to identify the breakpoints with the highest sensitivity and specificity for hospital mortality. The analysis was stratified for intensive care unit (ICU) status. RESULTS Of 2822 immunocompromised patients with a mean age of 56.8±15.6 years, 213 (7.5%) died during hospitalization. When added to the baseline risk model, SOFA score had the greatest predictive validity for hospital mortality (AUROC,0.802; 95% CI, 0.771-0.832), followed by qSOFA (AUROC,0.783; 95% CI, 0.754-0.812) and SIRS (AUROC,0.741; 95% CI, 0.708-0.774). Among the SOFA breakpoints that were evaluated, SOFA ≥6 had the greatest predictive validity and a moderate positive likelihood ratio (2.75) for hospital mortality. CONCLUSIONS The predictive validity for hospital mortality of qSOFA was similar among immunocompromised patients as that reported in the Sepsis-3 study. The sensitivity of qSOFA ≥2 for hospital mortality was low. SOFA ≥6 might be an effective tool to identify immunocompromised patients with suspected infection at high risk for clinical deterioration.
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Affiliation(s)
- Oryan Henig
- Infection Prevention Unit, Division of Infection Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Owen Albin
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Twisha S Patel
- Department of Pharmacy, University of Michigan, Michigan Medicine, Ann Arbor, Michigan USA
| | - Daniel Kaul
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Krishna Rao
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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10
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Bixby AL, Fitzgerald L, Park JM, Kaul D, Tischer S. Comparison of standard versus low-dose valganciclovir regimens for cytomegalovirus prophylaxis in high-risk liver transplant recipients. Transpl Infect Dis 2021; 23:e13713. [PMID: 34428337 DOI: 10.1111/tid.13713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to compare the safety and efficacy of two valganciclovir (VGCV) institutional dosing protocols for cytomegalovirus (CMV) prophylaxis in liver transplant (LT) recipients with CMV serotype donor +/recipient- (D+/R-). METHODS This was a single-center review of CMV D+/R- adult LT recipients who received VGCV 450 mg/day for 90 days (low-dose) or VGCV 900 mg/day for 180 days (standard-dose). The primary outcome was incidence of CMV disease at 1 year. Secondary outcomes included rates of CMV syndrome, end-organ disease, breakthrough infection, and resistance. Neutropenia, early discontinuation of VGCV, growth colony stimulating factors use (G-CSF), biopsy-proven rejection (BPAR), graft loss, and death at 1 year were analyzed. RESULTS Ninety-six CMV D+/R- LT recipients were included. Although no difference in CMV disease was observed (low-dose 26% vs. standard-dose 23%, p = 0.71), 75% of CMV infections in the low-dose group presented with end-organ disease. Ganciclovir (GCV) resistance was observed only in the low-dose group (n = 2). Significantly more patients in the standard-dose group developed neutropenia (low-dose 10% vs 60% standard-dose, p < 0.001). In the standard-dose group, 29% required early discontinuation of VGCV (vs. 5% in the low-dose group, p < 0.001), and 20% were treated with G-CSF. Both cohorts had similar rates of BPAR, graft loss, and death at 1 year. CONCLUSIONS VGCV 900 mg/day for 180 days had higher rates of hematologic adverse effects resulting in frequent treatment interruptions. However, the occurrence of two cases of GCV-resistant CMV disease raises concerns about routinely using low-dose VGCV prophylaxis.
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Affiliation(s)
- Alexandra L Bixby
- Department of Pharmacy Services, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Linda Fitzgerald
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jeong M Park
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Daniel Kaul
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sarah Tischer
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
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11
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Kroeze S, Schaule J, Spaas M, Kahl K, Verhoeff J, Schneiders F, Blanck O, Lohaus F, Rogers S, Kaul D, Benavente S, Combs S, Skazikis G, Baumann K, Popp I, Koppe F, Geinitz H, de Jaeger K, Siva S, Stera S, Wittig-Sauerwein A, Lewitzki V, Eckert F, Schymalla M, Guckenberger M. OC-0626 Toxicity of SRT combined with targeted agents: prospective analysis of the TOaSTT database. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06982-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Correction to: Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:560-561. [PMID: 33674905 PMCID: PMC8154766 DOI: 10.1007/s00066-021-01750-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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13
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Brandes F, Striefler JK, Dörr A, Schmiester M, Märdian S, Koulaxouzidis G, Kaul D, Behzadi A, Thuss-Patience P, Ahn J, Pelzer U, Bullinger L, Flörcken A. Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma - a single-centre retrospective analysis. BMC Palliat Care 2021; 20:16. [PMID: 33446180 PMCID: PMC7809873 DOI: 10.1186/s12904-020-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients. AIM Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients. DESIGN/SETTING We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge. RESULTS Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027). CONCLUSIONS Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.
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Affiliation(s)
- F Brandes
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - J K Striefler
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Dörr
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schmiester
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Märdian
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Centre for Musculoskeletal Surgery, Campus Virchow-Klinikum, Berlin, Germany
| | - G Koulaxouzidis
- Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Plastic and Reconstructive Surgery, Berlin, Germany
| | - D Kaul
- Department of Radiation Oncology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Behzadi
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Thuss-Patience
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Ahn
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Pelzer
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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14
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:385-395. [PMID: 33410959 PMCID: PMC8062351 DOI: 10.1007/s00066-020-01727-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In radical radiochemotherapy (RCT) of inoperable non-small-cell lung cancer (NSCLC) typical prognostic factors include T- and N-stage, while there are still conflicting data on the prognostic relevance of gross tumor volume (GTV) and particularly its changes during RCT. The NCT03055715 study of the Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) evaluated the prognostic impact of GTV and its changes during RCT. METHODS A total of 21 university centers for radiation oncology from five different European countries (Germany, Switzerland, Spain, Belgium, and Austria) participated in the study which evaluated n = 347 patients with confirmed (biopsy) inoperable NSCLC in UICC stage III A/B who received radical curative-intent RCT between 2010 and 2013. Patient and disease data were collected anonymously via electronic case report forms and entered into the multi-institutional RadPlanBio platform for central data analysis. GTV before RCT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) was delineated. Absolute GTV before/during RCT and relative GTV changes were correlated with overall survival as the primary endpoint. Hazard ratios (HR) of survival analysis were estimated by means of adjusted Cox regression models. RESULTS GTV1 was found to have a mean of 154.4 ml (95%CI: 1.5-877) and GTV2 of 106.2 ml (95% CI: 0.5-589.5), resulting in an estimated reduction of 48.2 ml (p < 0.001). Median overall survival (OS) was 18.8 months with a median of 22.1, 20.9, and 12.6 months for patients with high, intermediate, and low GTV before RT. Considering all patients, in one survival model of overall mortality, GTV2 (2.75 (1.12-6.75, p = 0.03) was found to be a stronger survival predictor than GTV1 (1.34 (0.9-2, p > 0.05). In patients with available data on both GTV1 and GTV2, absolute GTV1 before RT was not significantly associated with survival (HR 0-69, 0.32-1.49, p > 0.05) but GTV2 significantly predicted OS in a model adjusted for age, T stage, and chemotherapy, with an HR of 3.7 (1.01-13.53, p = 0.04) per 300 ml. The absolute decrease from GTV1 to GTV2 was correlated to survival, where every decrease by 50 ml reduced the HR by 0.8 (CI 0.64-0.99, p = 0.04). There was no evidence for a survival effect of the relative change between GTV1 and GTV2. CONCLUSION Our results indicate that independently of T stage, the re-planning GTV during RCT is a significant and superior survival predictor compared to baseline GTV before RT. Patients with a high absolute (rather than relative) change in GTV during RT show a superior survival outcome after RCT.
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Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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15
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Kroeze S, Fritz C, Blanck O, Kahl K, Kaul D, Siva S, Gerum S, Claes A, Sundahl N, Adebahr S, Nateghian A, Schymalla M, Wittig A, Buergy D, Geier M, Szuecs M, Lohaus F, Henke G, Combs S, Guckenberger M. OC-0453: Efficacy and safety of stereotactic radiotherapy combined with TKIs for metastatic lesions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Heitmann J, Kroeze S, Blanck O, Kahl K, Gerum S, Combs S, Kaul D, Claes A, Schymalla M, Grosu A, Eckert F, Lohaus F, Abbasi-Senger N, Henke G, Szuecs M, Geier M, Sundahl N, Buergy D, Guckenberger M. OC-0275 Safety and efficacy of concurrent SRT and targeted- or immunotherapy for melanoma brain metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Kroeze S, Fritz C, Kaul D, Blanck O, Kahl K, Roeder F, Siva S, Verhoeff J, Grosu A, Schymalla M, Glatzer M, Szücs M, Geier M, Mose S, Sackerer I, Lohaus F, Eckert F, Guckenberger M. OC-0059 Stereotactic radiotherapy for oligoprogressive NSCLC: clinical scenarios affecting survival. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30479-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Kroeze S, Fritz C, Kaul D, Blanck O, Kahl K, Roeder F, Siva S, Verhoeff J, Grosu A, Schymalla M, Glatzer M, Szuecs M, Geier M, Skazikis G, Sackerer I, Lohaus F, Eckert F, Guckenberger M. Stereotactic radiotherapy concurrent to immune or targeted therapy for oligometastatic NSCLC: Clinical scenarios affecting survival. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Ramdas M, Sharma S, Kaul D, Bhatia A. Possible role of miR-2909 RNomics in arsenic mediated pancreatic β-cell dysfunction. J Trace Elem Med Biol 2018; 50:263-267. [PMID: 30262289 DOI: 10.1016/j.jtemb.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/01/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
Chronic exposure of humans to inorganic arsenic as a potential risk for the incidence of diabetes has received wide attention. However, the biological mechanism through which arsenic plays a role in the development of diabetes is still being evaluated. One of the hallmark of diabetes is the β-cell dysfunction followed by the changes in the insulin secretion. Pancreatic duodenal homeobox 1 (PDX1) has been widely recognized to play crucial role in the β-cell development, survival and its regulation of insulin gene expression. Many of the arsenic mediated cellular affects have been shown to be regulated by miR-2909 in vitro. Our present study provides evidence to reveal that arsenic affects miR-2909 expression in the pancreatic β-cell and this novel miRNA regulates PDX1 transcriptional expression indirectly through genes coding for c-Jun, MafA, PI3K and directly at the translational level by targeting the PDX1 mRNA. We provide further evidence for this miR-2909 RNomics in pancreatic tissue obtained from NOD mice where the expression of miR-2909 was high compared to the control mice. Keeping in view the fact that arsenic is known to cause β-cell dysfunction and most of the cellular effects of arsenic have been shown to be mediated through miR-2909 RNomics, our study revealed that arsenic employs miR-2909 (at low doses) and c-Jun (at high doses) to down regulate PDX1 in order to cause β-cell dysfunction leading to diabetic state.
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Affiliation(s)
- M Ramdas
- Department of Experimental Medicine & Biotechnology, Post-graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - S Sharma
- Department of Experimental Medicine & Biotechnology, Post-graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - D Kaul
- Department of Experimental Medicine & Biotechnology, Post-graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - A Bhatia
- Department of Experimental Medicine & Biotechnology, Post-graduate Institute of Medical Education & Research, Chandigarh, 160012, India
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20
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Henig O, Rao K, Albin O, Putler R, Kaul D, Kaye KS. 1567. Predicting Mortality Among Immunocompromised Patients Who Present with Infection. Open Forum Infect Dis 2018. [PMCID: PMC6252879 DOI: 10.1093/ofid/ofy210.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Recent sepsis definitions for the general population include Sequential Organ Failure Assessment (SOFA) ≥ 2 for patients admitted to intensive care unit (ICU), and quick SOFA (qSOFA) ≥ 2 for non-ICU patients. The objective of this study was to validate the predictive value of SOFA and qSOFA in immunocompromised patients. Methods Adult patients admitted between 2014 and 2017 with ICD-9 and ICD-10 codes for hematologic malignancies or transplant diagnoses who had suspected infection were included. Index date of suspected infection was defined as the time when blood culture was obtained, followed by intravenous antibiotic therapy, or vice versa (based on the definition used in SEPSIS-3 study, Seymour et al.). SOFA, qSOFA and SIRS components within 1 day of the index date were extracted from the medical record. A baseline risk model of mortality was created including age, race, gender, and Charlson comorbidity index. Each score was added to the baseline mortality risk model as a dichotomous variable (SOFA ≥ 2, qSOFA ≥ 2, and SIRS ≥ 2). For each risk model, a receiver operating characteristic (ROC) curve was developed and the area under ROC (AUROC) was calculated. Sensitivities of SOFA ≥ 2, qSOFA ≥ 2, and SIRS ≥ 2 for predicting in-hospital mortality were calculated. Results A total of 2,917 patients with a mean age of 57.0 ± 15.7 were included; 57% were male and 84% white. The most common immunocompromising conditions were solid-organ transplantation (45%), lymphoma (24%), acute leukemia (17%) and hematopoietic stem cell transplantation (6%). Two hundred and seventeen patients died during index admission (7.4%). The sensitivities of SOFA ≥ 2, qSOFA ≥ 2 and SIRS ≥ 2 for predicting in-hospital mortality were 94.9, 64.1 and 91.7%, respectively (P < 0.001 for each score ≥2 compared with <2). In the mortality risk model, the AUROCs for qSOFA, SOFA and SIRS were 0.75, 0.70 and 0.71, respectively (Figure). The AUROC for qSOFA ≥2 was significantly higher than for SIRS ≥2 and SOFA ≥2 (P = 0.004, P < 0.001, respectively). Conclusion qSOFA ≥2 was the strongest predictor of mortality in immunocompromised patients and may aid in risk stratification and clinical decision-making. Additional analyses are needed to evaluate alternative and potentially improved scoring systems for sepsis in immunocompromised populations. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Oryan Henig
- Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Krishna Rao
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Owen Albin
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Rosemary Putler
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Daniel Kaul
- Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan
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21
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Böning G, Kahn JF, Kaul D, Rotzinger R, Freyhardt P, Pavel M, Streitparth F. CT follow-up in patients with neuroendocrine tumors (NETs): combined radiation and contrast dose reduction. Acta Radiol 2018; 59:517-526. [PMID: 28786299 DOI: 10.1177/0284185117726101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Frequent computed tomography (CT) follow-ups involve significant radiation related risks for patients with low-grade neuroendocrine tumors (NETs). Contrast agent (CA) application is essential for diagnostic evidence and has additional risks especially in patients with limited renal function. Purpose To investigate if a combination of dose and contrast agent (CA) reduction affects image quality and diagnostic evidence in neuroendocrine tumor (NET) patients. Material and Methods A total of 51 NET patients were enrolled in the study and 153 CT scans were analyzed. Patients underwent a baseline CT scan (A = 120 kVp, filtered back projection [FBP]) and two follow-up CTs (B = 120 kVp, adaptive statistical iterative reconstruction [ASIR] 40%; C1 = 100 kVp, ASIR 40%; C2 = 100 kVp, ASIR 60%; the latter two protocols were applied with a 30% reduction in CA volume). We evaluated image quality and applied dose. Results In C1/2, the combination of low kV (100 kVp) with ASIR 40%/60% reduced the mean applied dose significantly by 28% compared to B and by 57% compared to A. Signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) of tumor to liver/muscle were significantly increased by using C1/2 compared to B and A. With respect to subjective image quality, a slight loss of diagnostic confidence in C1 could be counterbalanced by the higher ASIR blending in C2. Conclusion Combined dose reduction techniques can be used to reduce radiation dose and CA volume without sacrificing image quality and diagnostic confidence in staging CT of NET patients.
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Affiliation(s)
- G Böning
- Department of Radiology Charité, Humboldt-University Medical School, Berlin, Germany
| | - JF Kahn
- Department of Radiology Charité, Humboldt-University Medical School, Berlin, Germany
| | - D Kaul
- Department of Radiation Oncology Charité, Humboldt-University Medical School, Berlin, Germany
| | - R Rotzinger
- Department of Radiology Charité, Humboldt-University Medical School, Berlin, Germany
| | - P Freyhardt
- Department of Radiology Charité, Humboldt-University Medical School, Berlin, Germany
| | - M Pavel
- Department of Gastroenterology Charité, Humboldt-University Medical School, Berlin, Germany
| | - F Streitparth
- Department of Radiology Charité, Humboldt-University Medical School, Berlin, Germany
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22
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Niyazi M, Adeberg S, Kaul D, Boulesteix A, Bougatf N, Fleischmann D, Grün A, Krämer A, Rödel C, Eckert F, Paulsen F, Kessel K, Combs S, Oehlke O, Grosu A, Seidlitz A, Lattermann A, Krause M, Baumann M, Guberina M, Stuschke M, Budach V, Belka C, Debus J. OC-0588: Validation of the reRT risk score (RRRS) in glioma patients: A multicenter DKTK/ROG analysis. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Ostheimer C, Baues C, Baumann R, Billiet C, Dobiasch S, Ebert N, Fleischmann D, Gauer T, Goy Y, Haussmann J, Henkenberens C, Kaessmann L, López guerra J, Kaul D, Krug D, Maeurer M, Niyazi M, Oertel M, Panje C, Sautter L, Schmitt D, Suess C, Trommer-Nestler M, Ziegler S, Medenwald D. OC-0329: Predictive value of GTV in radiotherapy of NSCLC - early results of the NCT03055715 trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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24
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Triebwasser M, Duvall A, Hoffman T, Bloye K, Braun T, Kaul D, Magenau JM, Riwes MM, Pawarode A, Choi S, Lugt MV, Bonifant C, Abusin G, Sekerak K, Bulte C, Paglia D, O'Dwyer D, Brisson J, Yanik GA. Impact of Broncho-Alveolar Lavage on the Diagnosis and Management of Pulmonary Complications Following Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Wani S, Kaul D, Mavuduru RS, Kakkar N, Bhatia A. Urinary-exosomal miR-2909: A novel pathognomonic trait of prostate cancer severity. J Biotechnol 2017; 259:135-139. [PMID: 28764970 DOI: 10.1016/j.jbiotec.2017.07.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/15/2022]
Abstract
The global occurrence of prostate cancer with a range of patient outcome has prompted various investigators to explore novel molecular biomarkers that can precisely detect and track this type of cancer severity. Several studies suggest that micro-RNAs have emerged to act as a new largely unexplored class of biomarkers because of their inherent stability, resilience and recruitment into exosomes present in various human body fluids. With this study, we aim to reveal the nature of urinary-exosomal miR-2909 & miR-615-3p recruitment in patients suffering from either prostate cancer (n=90) or bladder cancer (n=60) as compared to that in either prostate disease-control subjects having benign prostate hyperplasia (n=10) or healthy subjects (n=50). Unlike miR-615-3p, the urinary- exosomal miR-2909 recruitment was not only observed conspicuously in subjects having prostate cancer in comparison to bladder cancer but also the extent of urinary exosomal miR-2909 recruitment showed characteristic variation as a function of prostate cancer aggressiveness as compared to that of either urinary- exosomal miR-615-3p level or existing widely recognised serum prostate specifics antigen (PSA) biomarker of this cancer. In summary, we propose that the extent of urinary exosomal miR-2909 recruitment may provide a potential non-invasive candidate diagnostic marker for the detection of prostate cancer and its aggressiveness.
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Affiliation(s)
- S Wani
- Department of Experimental Medicine & Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - D Kaul
- Department of Experimental Medicine & Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - R S Mavuduru
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - N Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Bhatia
- Department of Experimental Medicine & Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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26
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Beck M, Barelkowski T, Thieme A, Wecker S, Kaul D, Wlodarczyk W, Budach V, Wust P, Ghadjar P. EP-1325: Risk adapted dose-intensified postoperative Tomotherapy RT in prostate cancer using a SIB. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Della Seta M, Kaul D, Chapiro J, Hamm B, Collettini F. 3D imaging biomarkers for the prediction of survival in patients with non-small cell lung cancer brain metastases treated with stereotactic body radiation therapy. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Della Seta
- Charité Universitätsmedizin Berlin, Radiologie, Berlin
| | - D Kaul
- Charité Universitätsmedizin Berlin, Strahlentherapie, Berlin
| | - J Chapiro
- Yale School of Medicine, Radiologie, New Haven
| | - B Hamm
- Charité Universitätsmedizin Berlin, Radiologie, Berlin
| | - F Collettini
- Charité Universitätsmedizin Berlin, Radiologie, Berlin
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28
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Nikbakht M, Jha AK, Malekzadeh K, Askari M, Mohammadi S, Marwaha RK, Kaul D, Kaur J. Aberrant promoter hypermethylation of selected apoptotic genes in childhood acute lymphoblastic leukemia among North Indian population. Exp Oncol 2017; 39:57-64. [PMID: 28361856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Promoter hypermethylation mediates gene silencing in many neoplasms. Acute leukemia has been reported to harbor multiple genes aberrantly silenced by hypermethylation. AIM In present study, we investigated the prevalence of hypermethylation of caspase-8 (CASP8), TMS1 and DAPK genes in correlation with clinicopathological factors in childhood acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS A case-control study has been conducted based on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls. Methylation specific polymerase chain reaction (PCR) and bisulfite sequencing PCR was performed to analyze the methylation status of these genes. Reverse transcription PCR and real time PCR was carried out to determine changes in the mRNA expression level of the genes due to hypermethylation. RESULTS Hypermethylation of the 5´CpG islands of the CASP8, TMS1 and DAPK gene promoters was found in 3.2, 6.4, and 13.6% of 125 childhood ALL samples from north Indian population, respectively. There were significant differences in pattern of hypermethylation of TMS1 (p = 0.045) and DAPK (p < 0.001) between patients and healthy controls. Down-regulation of mRNA expression was found in cases in which CASP8, TMS1 and DAPK were hypermethylated. CONCLUSIONS The present study indicated the impact of hypermethylation-mediated inactivation of CASP8, TMS1 and DAPK genes, which is associated with risk of childhood ALL. This abnormality occurs in leukemogenesis and it may be used as a biomarker and for predicting the prognosis of ALL.
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Affiliation(s)
- M Nikbakht
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran 1411713131, Iran
| | - A K Jha
- Department of Biotechnology, IMS Engineering College, Ghaziabad (U.P.) 160012, India
| | - K Malekzadeh
- Molecular Medicine Research Center (MMRC); Hormozgan University of Medical Science (HUMS); Bandar Abbass 7919915519, Iran
| | - M Askari
- Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - S Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran 14176-13151, Iran
| | - R K Marwaha
- Advanced Pediatrics Center, PGIMER, Chandigarh 160014, India
| | - D Kaul
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160014, India
| | - J Kaur
- Department of Biotechnology, Panjab University, Chandigarh 160014, India
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Imlay H, Kaul D, Rao K. Risk factors for Clostridium difficile infection in HIV-infected patients. SAGE Open Med 2016; 4:2050312116684295. [PMID: 28348742 PMCID: PMC5354176 DOI: 10.1177/2050312116684295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clostridium difficile infection is a healthcare-associated infection resulting in significant morbidity. Although immunosuppression is associated with Clostridium difficile infection acquisition and adverse outcomes, the epidemiology of Clostridium difficile infection in HIV-infected patients has been little studied in the era of antiretroviral therapy. This study identifies the risk factors for acquisition of Clostridium difficile infection in HIV-infected patients. METHODS A retrospective, propensity score-matched case-control study design was employed, with patients selected from our institution's outpatient HIV clinic. Clostridium difficile infection cases were defined as having positive stool testing plus an appropriate clinical presentation. The propensity score was generated via multiple logistic regression from year of HIV diagnosis, age at first contact, duration of follow-up, gender, and initial CD4 count. RESULTS The 46 cases included were matched to a total of 180 controls. Prior antibiotic treatment was a significant predictor of Clostridium difficile infection (odds ratio: 13, 95% confidence interval: 3.49-48.8, p < .001) as was number of hospital admissions in the preceding year (odds ratio: 4.02, confidence interval: 1.81-8.94, p < .001). Having both proton pump inhibitor use and CD4 count <200 cells/µL significantly increased odds of Clostridium difficile infection in the multivariable model (odds ratio: 15.17, confidence interval: 1.31-175.9, p = .021). CONCLUSION As in the general population, frequent hospitalizations and exposure to antimicrobials are independent predictors of Clostridium difficile infection acquisition in patients with HIV. Additionally, low CD4 count and proton pump inhibitor use are new potentially modifiable variables that can be targeted for prevention of Clostridium difficile infection in future interventional studies.
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Affiliation(s)
- Hannah Imlay
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Kaul
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Kaul D, Kahn J, Huizing L, Wiener E, Böning G, Renz DM, Streitparth F. Dose reduction in paediatric cranial CT via iterative reconstruction: a clinical study in 78 patients. Clin Radiol 2016; 71:1168-77. [PMID: 27595622 DOI: 10.1016/j.crad.2016.06.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/24/2016] [Accepted: 06/24/2016] [Indexed: 01/18/2023]
Abstract
AIM To assess how adaptive statistical iterative reconstruction (ASIR) contributes to dose reduction and affects image quality of non-contrast cranial computed tomography (cCT) in children. MATERIALS AND METHODS Non-contrast cranial CT acquired in 78 paediatric patients (age 0-12 years) were evaluated. The images were acquired and processed using four different protocols: Group A (control): 120 kV, filtered back projection (FBP), n=18; Group B: 100 kV, FBP, n=22; Group C: 100 kV, scan and reconstruction performed with 20% ASIR, n=20; Group D1: 100 kV, scan and reconstruction performed with 30% ASIR, n=18; Group D2: raw data from Group D1 reconstructed using a blending of 40% ASIR and 60% FBP, n=18. The effective dose was calculated and the image quality was assessed quantitatively and qualitatively. RESULTS Compared to Group A, Groups C and D1/D2 showed a significant reduction of the dose-length product (DLP) by 34.4% and 64.4%, respectively. All experimental groups also showed significantly reduced qualitative levels of noise, contrast, and overall diagnosability. Diagnosis-related confidence grading showed Group C to be adequate for everyday clinical practice. Quantitative measures of Groups B and C were comparable to Group A with only few parameters compromised. Quantitative scores in Groups D1 and D2 were mainly lower compared to Group A, with Group D2 performing better than Group D1. Group D2 was considered adequate for follow-up imaging of severe acute events such as bleeding or hydrocephalus. DISCUSSION The use of ASIR combined with low tube voltage may reduce radiation significantly while maintaining adequate image quality in non-contrast paediatric cCT.
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Affiliation(s)
- D Kaul
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany; Department of Radiation Oncology, Charité School of Medicine and University Hospital, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - J Kahn
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany
| | - L Huizing
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany
| | - E Wiener
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany
| | - G Böning
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany
| | - D M Renz
- Department of Radiology, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - F Streitparth
- Department of Radiology, Charité School of Medicine and University Hospital, Charitéplatz 1, 10117 Berlin, Germany
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Schaenman J, Wilk A, Tlusty S, Nalesnik M, Michaels M, Wolfe C, Kaul D. Donor Derived Disease Transmission Events in Thoracic Organ Transplantation: Data Reviewed by the OPTN Ad Hoc Disease Transmission Advisory Committee. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thieme A, Kaul D, Stromberger C, Ghadjar P, Budach V. EP-1925: Online open source software to assess adverse events of patients undergoing radiochemotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kahn J, Kaul D, Huizing L, Böning G, Grupp U, Wiener E, Renz D, Streitparth F. Dosisreduktion bei der cranialen CT mithilfe iterativer Rekonstruktion – eine klinische Studie an 177 Patienten. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kahn J, Kaul D, Böning G, Streitparth F. Qualitäts- und dosisoptimiertes CT-Polytraumaprotokoll – Empfehlung eines universitären Level-I Traumazentrums. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kaul D, Kahn J, Huizing L, Wiener E, Grupp U, Böning G, Ghadjar P, Renz DM, Streitparth F. Reducing Radiation Dose in Adult Head CT using Iterative Reconstruction - A Clinical Study in 177 Patients. ROFO-FORTSCHR RONTG 2015; 188:155-62. [PMID: 26529264 DOI: 10.1055/s-0041-107200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess how ASIR (adaptive statistical iterative reconstruction) contributes to dose reduction and affects image quality of non-contrast cranial computed tomography (cCT). MATERIALS AND METHODS Non-contrast emergency CT scans of the head acquired in 177 patients were evaluated. The scans were acquired and processed using four different protocols: Group A (control): 120 kV, FBP (filtered back projection) n = 71; group B1: 120 kV, scan and reconstruction performed with 20 % ASIR (blending of 20 % ASIR and 80 % FBP), n = 86; group B2: raw data from group B1 reconstructed using a blending of 40 % ASIR and 60 % FBP, n = 74; group C1: 120 kV, scan and reconstruction performed with 30 % ASIR, n = 20; group C2: raw data from group C1 reconstructed using a blending of 50 % ASIR and 50 % FBP, n = 20. The effective dose was calculated. Image quality was assessed quantitatively and qualitatively. RESULTS Compared to group A, groups B1/2 and C1/2 showed a significantly reduced effective dose of 40.4 % and 73.3 % (p < 0.0001), respectively. Group B1 and group C1/2 also showed significantly reduced quantitative and qualitative image quality parameters. In group B2, quantitative measures were comparable to group A, and qualitative scores were lower compared to group A but higher compared to group B1. Diagnostic confidence grading showed groups B1/2 to be adequate for everyday clinical practice. Group C2 was considered acceptable for follow-up imaging of severe acute events such as bleeding or subacute stroke. CONCLUSION Use of ASIR makes it possible to reduce radiation significantly while maintaining adequate image quality in non-contrast head CT, which may be particularly useful for younger patients in an emergency setting and in follow-up. KEY POINTS ASIR may reduce radiation significantly while maintaining adequate image quality. cCT protocol with 20 % ASIR and 40 %ASIR/60 %FBP blending is adequate for everyday clinical use. cCT protocol with 30 % ASIR and 50 %ASIR/50 %FBP blending is adequate for follow-up imaging
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Affiliation(s)
- D Kaul
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - J Kahn
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - L Huizing
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - E Wiener
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - U Grupp
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - G Böning
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - P Ghadjar
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Berlin, Germany
| | - D M Renz
- Department of Radiology, Jena University Hospital, Jena, Germany
| | - F Streitparth
- Department of Radiology, Charité School of Medicine and University Hospital, Berlin, Germany
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Böning G, Schäfer M, Grupp U, Kaul D, Kahn J, Pavel M, Maurer M, Denecke T, Hamm B, Streitparth F. Comparison of applied dose and image quality in staging CT of neuroendocrine tumor patients using standard filtered back projection and adaptive statistical iterative reconstruction. Eur J Radiol 2015; 84:1601-1607. [DOI: 10.1016/j.ejrad.2015.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/12/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
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Green M, Covington S, Taranto S, Wolfe C, Bell W, Biggins SW, Conti D, DeStefano GD, Dominguez E, Ennis D, Gross T, Klassen-Fischer M, Kotton C, LaPointe-Rudow D, Law Y, Ludrosky K, Menegus M, Morris MI, Nalesnik MA, Pavlakis M, Pruett T, Sifri C, Kaul D. Donor-derived transmission events in 2013: a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee. Transplantation 2015; 99:282-7. [PMID: 25594557 DOI: 10.1097/tp.0000000000000584] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Organ Procurement Transplant Network Disease Transmission Advisory Committee (DTAC), a multidisciplinary committee, evaluates potential donor-derived transmission events (PDDTE), including infections and malignancies, to assess for donor transmitted events. METHODS Reports of unexpected PDDTE to Organ Procurement Transplant Network in 2013 were fully reviewed by DTAC. A standardized algorithm was used to assess each PDDTE from a given donor and to classify each individual recipient from that donor. RESULTS Of 443 total PDDTE submitted, 159 were triaged and not sent out to the full DTAC. Of 284 fully evaluated reports, 32 (11.3%) resulted in a proven/probable (P/P) transmission of infection, malignancy or other conditions to 42 recipients. Of 204 infection events, 24 were classified as P/P affecting 30 recipients, with four deaths. Bacteria were the most frequently reported type of infection, accounting for 99 reports but only 12 recipients from 11 donors experienced P/P transmission. There were 65 donors reported with potential malignancy events and 5 were classified as P/P transmissions with 8 affected recipients and 2 deaths. Additionally, there were 16 noninfection, nonmalignancy reports resulting in 3 P/P transmissions to 4 recipients and 1 death. CONCLUSIONS There was a 43% increase in the number of PDDTE reported and reviewed in 2013 over 2012. However, the percent with P/P transmission remains low, affecting recipients from 32 donors especially when compared with the more than 14,000 donors recovered annually in the United States. The continued use of the new standard algorithm and triaging process will enhance the reproducibility of DTAC assessments and allow more robust analysis of our aggregate DTAC experience.
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Affiliation(s)
- Michael Green
- 1 Division of Pediatric Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA. 2 United Network for Organ Sharing, Richmond, VA. 3 Division of Transplant Infectious Disease, Duke University Medical Center, Durham, NC. 4 Division of Anatomic Pathology, University of Alabama, Birmingham, AL. 5 Division of Gastroenterology, University of Colorado, Aurora, CO. 6 Department of Transplant Surgery, Albany Medical College, Albany, NY. 7 Lifesharing, San Diego, CA. 8 Division of Infectious Disease, Methodist Dallas Medical Center, Dallas, TX. 9 Transplant Clinical Operations, Indiana University Hospital, Indianapolis, IN. 10 Center for Global Health, National Cancer Institute, Rockville, MD. 11 Joint Pathology Center, Silver Spring, MD. 12 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA. 13 Mount Sinai Medical Center, New York, NY. 14 Division of Cardiac Transplant, Seattle Children's Hospital, Seattle, WA. 15 Cleveland Clinic, Cleveland, OH. 16 Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY. 17 Division of Internal Medicine, University of Miami Hospital, Miami, FL. 18 Division of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA. 19 Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA. 20 Division of Transplantation, University of Minnesota Medical Center, Minneapolis, MN. 21 Division of Infectious Diseases, University of Virginia Health System, Charlottesville, VA. 22 Division of Infectious Diseases, University of Michigan Medical Center, Ann Arbor, MI
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Kaul D, Kahn J, Ulrich G, Ghadjar P, Edzard W, Hamm B, Florian S. CT-Angiografie zur Diagnostik der Lungenarterienembolie – Reduktion der Strahlendosis mittels adaptiver statistischer iterativer Rekonstruktion und erniedrigter Röhrenspannung. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kahn J, Kaul D, Grupp U, Böning G, Maurer M, Hamm B, Streitparth F. Computer-Tomografie bei Patienten mit zystischer Fibrose – Dosisreduktionstechniken erlauben Routine-Scan im Submillisievert-Bereich. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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40
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Grupp U, Kahn J, Kaul D, Böning G, Wieners G, Hamm B, Streitparth F. Einsatz iterativer Rekonstruktionen in der CT-Diagnostik von Schwerverletzten – Reduzierung der Strahlenexposition ohne Verlust der diagnostischen Bildqualität. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miller R, Covington S, Taranto S, Carrico R, Ehsan A, Friedman B, Green M, Ison MG, Kaul D, Kubak B, Lebovitz DJ, Lyon GM, Nalesnik MA, Pruett TL, Teperman L, Vasudev B, Blumberg E. Communication gaps associated with donor-derived infections. Am J Transplant 2015; 15:259-64. [PMID: 25376342 DOI: 10.1111/ajt.12978] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/21/2014] [Accepted: 08/04/2014] [Indexed: 01/25/2023]
Abstract
The detection and management of potential donor-derived infections is challenging, in part due to the complexity of communications between diverse labs, organ procurement organizations (OPOs), and recipient transplant centers. We sought to determine if communication delays or errors occur in the reporting and management of donor-derived infections and if these are associated with preventable adverse events in recipients. All reported potential donor-derived transmission events reviewed by the Organ Procurement and Transplantation Network Ad Hoc Disease Transmission Advisory Committee from January 2008 to June 2010 were evaluated for communication gaps between the donor center, OPO and transplant centers. The impact on recipient outcomes was then determined. Fifty-six infection events (IEs; involving 168 recipients) were evaluated. Eighteen IEs (48 recipients) were associated with communication gaps, of which 12 resulted in adverse effects in 69% of recipients (20/29), including six deaths. When IEs and test results were reported without delay, appropriate interventions were taken, subsequently minimizing or averting recipient infection (23 IEs, 72 recipients). Communication gaps in reported IEs are frequent, occur at multiple levels in the communication process, and contribute to adverse outcomes among affected transplant recipients. Conversely, effective communication minimized or averted infection in transplant recipients.
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Affiliation(s)
- R Miller
- Divisions of Infectious Diseases and Transplant Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
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Wendt JM, Kaul D, Limbago BM, Ramesh M, Cohle S, Denison AM, Driebe EM, Rasheed JK, Zaki SR, Blau DM, Paddock CD, McDougal LK, Engelthaler DM, Keim PS, Roe CC, Akselrod H, Kuehnert MJ, Basavaraju SV. Transmission of methicillin-resistant Staphylococcus aureus infection through solid organ transplantation: confirmation via whole genome sequencing. Am J Transplant 2014; 14:2633-9. [PMID: 25250717 PMCID: PMC4620542 DOI: 10.1111/ajt.12898] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/04/2014] [Accepted: 06/22/2014] [Indexed: 01/25/2023]
Abstract
We describe two cases of donor-derived methicillin-resistant Staphylococcus aureus (MRSA) bacteremia that developed after transplantation of organs from a common donor who died from acute MRSA endocarditis. Both recipients developed recurrent MRSA infection despite appropriate antibiotic therapy, and required prolonged hospitalization and hospital readmission. Comparison of S. aureus whole genome sequence of DNA extracted from fixed donor tissue and recipients' isolates confirmed donor-derived transmission. Current guidelines emphasize the risk posed by donors with bacteremia from multidrug-resistant organisms. This investigation suggests that, particularly in the setting of donor endocarditis, even a standard course of prophylactic antibiotics may not be sufficient to prevent donor-derived infection.
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Affiliation(s)
- J. M. Wendt
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Office of Surveillance Epidemiology and Laboratory Services, Atlanta, GA
| | - D. Kaul
- Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, MI
| | - B. M. Limbago
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - M. Ramesh
- Henry Ford Health System, Detroit, MI
| | - S. Cohle
- Kent County Office of the Medical Examiner, Grand Rapids, MI
| | - A. M. Denison
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - E. M. Driebe
- The Translational Genomics Research Institute, TGen North, Flagstaff, AZ
| | - J. K. Rasheed
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - S. R. Zaki
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - D. M. Blau
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - C. D. Paddock
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - L. K. McDougal
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - D. M. Engelthaler
- The Translational Genomics Research Institute, TGen North, Flagstaff, AZ
| | - P. S. Keim
- The Translational Genomics Research Institute, TGen North, Flagstaff, AZ
| | - C. C. Roe
- The Translational Genomics Research Institute, TGen North, Flagstaff, AZ
| | - H. Akselrod
- Mount Sinai School of Medicine, New York, NY
| | - M. J. Kuehnert
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA
| | - S. V. Basavaraju
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA,Corresponding author: Sridhar V. Basavaraju,
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Kaul D, Budach V, Misch M, Wiener E, Exner S, Badakhshi H. Meningioma of the skull base: long-term outcome after image-guided stereotactic radiotherapy. Cancer Radiother 2014; 18:730-5. [PMID: 25307475 DOI: 10.1016/j.canrad.2014.07.159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to analyse the feasibility, safety, and long-term efficacy of linear accelerator-based fractionated stereotactic radiotherapy for meningiomas of the skull base. We evaluated the long-term clinical outcome of patients and identified prognostic factors after fractionated stereotactic radiotherapy. PATIENTS AND METHODS Between 10/1995 and 03/2009, 136 patients with a median age of 57 years with skull base meningioma received fractionated stereotactic radiotherapy. A total of 34 patients had a grade I meningioma, in 102 cases no histology was obtained (grade 0). Fractionated stereotactic radiotherapy was delivered as primary treatment for 57 patients and postoperatively for 79. The patients received a mean total dose of 56.95 (min/max 32.4/63)Gy. RESULTS Median follow-up was 44.9 months. Overall progression-free survival was 96.9% after 3 years, 93.8% after 5 years, and 91.5% after 10 years. Patients with unknown histology showed progression-free survival rates of 100%, 98.7%, and 93.5% at 3, 5, and 10 years and patients with biopsy-proven grade I meningioma showed rates of 100% after 3 years, 91.7% after 5 years and 85.9% after 10 years. Patients with adjuvant radiotherapy showed significantly worse progression-free survival rates than patients who had been treated with primary radiotherapy (P=0.043), progression-free survival rates were independent of tumour size. The most common acute grade I symptoms were headache, fatigue, and local alopecia. The most common chronic grade I symptoms were fatigue and headache. CONCLUSIONS This large study showed that fractionated stereotactic radiotherapy is an effective and safe treatment modality with high progression-free survival rates for intracranial meningioma. We identified "prior surgery" as significant poor prognostic factor.
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Affiliation(s)
- D Kaul
- Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - V Budach
- Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M Misch
- Department of Neurosurgery, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - E Wiener
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Exner
- Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - H Badakhshi
- Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Levi ME, Kumar D, Green M, Ison MG, Kaul D, Michaels MG, Morris MI, Schwartz BS, Echenique IA, Blumberg EA. Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy. Am J Transplant 2014; 14:1003-11. [PMID: 24636427 DOI: 10.1111/ajt.12666] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/24/2013] [Accepted: 01/12/2014] [Indexed: 01/25/2023]
Abstract
In February 2013, the Organ Procurement and Transplantation Network mandated that transplant centers perform screening of living kidney donors prior to transplantation for Strongyloides, Trypanosoma cruzi and West Nile virus (WNV) infection if the donor is from an endemic area. However, specific guidelines for screening were not provided, such as the optimal testing modalities, timing of screening prior to donation and the appropriate selection of donors. In this regard, the American Society of Transplantation Infectious Diseases Community of Practice, together with disease-specific experts, has developed this viewpoint document to provide guidance for the testing of live donors for Strongyloides, T. cruzi and WNV infection, specifically identifying at-risk populations and testing algorithms, including advantages, limitations and interpretation of results.
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Affiliation(s)
- M E Levi
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO
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Badakhshi H, Kaul D, Nadobny J, Wille B, Sehouli J, Budach V. Image-guided volumetric modulated arc therapy for breast cancer: a feasibility study and plan comparison with three-dimensional conformal and intensity-modulated radiotherapy. Br J Radiol 2013; 86:20130515. [PMID: 24167182 DOI: 10.1259/bjr.20130515] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To test the feasibility of volumetric modulated arc therapy (VMAT) in breast cancer and to compare it with three-dimensional conformal radiotherapy (3D-CRT) as conventional tangential field radiotheraphy (conTFRT). METHODS 12 patients (Stage I, 8: 6 left breast cancer and 2 right breast cancer; Stage II, 4: 2 on each side). Three plans were calculated for each case after breast-conserving surgery. Breast was treated with 50 Gy in four patients with supraclavicular lymph node inclusion, and in eight patients without the node inclusion. Multiple indices and dose parameters were measured. RESULTS V95% was not achieved by any modality. Heterogeneity index: 0.16 (VMAT), 0.13 [intensity-modulated radiotherapy (IMRT)] and 0.14 (conTFRT). Conformity index: 1.06 (VMAT), 1.15 (IMRT) and 1.69 (conTFRT). For both indices, IMRT was more effective than VMAT (p=0.009, p=0.002). Dmean and V20 for ipsilateral lung were lower for IMRT than VMAT (p=0.0001, p=0.003). Dmean, V2 and V5 of contralateral lung were lower for IMRT than VMAT (p>0.0001, p=0.005). Mean dose and V5 to the heart were lower for IMRT than for VMAT (p=0.015, p=0.002). CONCLUSION The hypothesis of equivalence of VMAT to IMRT was not confirmed for planning target volume parameter or dose distribution to organs at risk. VMAT was inferior to IMRT and 3D-CRT with regard to dose distribution to organs at risk, especially at the low dose level. ADVANCES IN KNOWLEDGE New technology VMAT is not superior to IMRT or conventional radiotherapy in breast cancer in any aspect.
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Affiliation(s)
- H Badakhshi
- Department of Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
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Nikbakht M, MalekZadeh K, Kumar Jha A, Askari M, Marwaha RK, Kaul D, Kaur J. Polymorphisms of MTHFR and MTR genes are not related to susceptibility to childhood ALL in North India. Exp Oncol 2012; 34:43-48. [PMID: 22453148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most worldwide common type of childhood cancer. Methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR) participate in folate pathways and are known as critical factors for DNA integrity as well as DNA hypomethylation. The aim of this work is to investigate frequency of MTHFR (677C→T and 1298A→C) and MTR (2756A→G) polymorphisms and their interaction with respect to possible effect on risk of childhood ALL among North Indian population. PROCEDURE A case control study from has been conducted on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls using PCR-RFLP method. RESULTS No statistically significant differences were observed for different genotypes between patients and controls (p>0.05). Significant difference for the risk of ALL in individuals having genotype of MTHFR 677TT (OR=0.61, 95% CI=0.21-1.77) and MTHFR 1298CC (OR=0.56, 95% CI=0.18-1.68) was not observed. The correlation of SNP of MTR gene and risk of ALL was not observed, too. CONCLUSIONS The differences in distribution of possible combined genotypes of MTHFR (677C→T, 1298A→C) and MTR (2756A→G) between ALL patients and controls were statistically insignificant.
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Affiliation(s)
- M Nikbakht
- Department of Biotechnology, Panjab University (PU), Chandigarh, India
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Kumar R, Parsad D, Kanwar AJ, Kaul D. Altered levels of Ets-1 transcription factor and matrix metalloproteinases in melanocytes from patients with vitiligo. Br J Dermatol 2011; 165:285-91. [PMID: 21428970 DOI: 10.1111/j.1365-2133.2011.10324.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vitiligo is characterized by the loss of functional melanocytes from the epidermis. Repigmentation in vitiligo is initiated by activation, proliferation and migration of melanoblasts from the outer root sheath of hair follicles, or melanocytes from the border area of vitiligo lesions, into the depigmented epidermis. Cell migration plays a crucial role during repigmentation in vitiligo. OBJECTIVES To investigate the role of matrix metalloproteinases (MMPs) and their transcription factor Ets-1 in vitiligo. METHODS Skin biopsies were taken from 15 patients with vitiligo and six controls to culture melanocytes from clinically active perilesional and normal skin. Expression of MMP-1, MMP-2, MMP-9 and Ets-1 was examined by reverse transcriptase-polymerase chain reaction analysis. Expression of Ets-1 was also confirmed with Western blot analysis. Activity of MMP-2 and MMP-9 was assessed using gelatin zymography. RESULTS The activity of MMP-2 and MMP-9 was significantly lower in patients with vitiligo compared with the controls. The expression of MMP-2 and MMP-9 was also significantly lower in patients with vitiligo. There was no expression of Ets-1 transcription factor at either the transcriptional or translational level in melanocytes cultured from patients with vitiligo. CONCLUSION The absence of a basal level of expression of Ets-1 significantly decreases the expression and activity of MMP-2 and MMP-9. Significant decreases in MMP-2 and MMP-9 activity could possibly reduce the migration of melanocyte precursors (melanoblasts) from the outer root sheath of hair follicles or migration of melanocytes from the border of vitiligo lesions into clinically depigmented epidermis which is crucial to the repigmentation of vitiliginous skin.
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Affiliation(s)
- R Kumar
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Abstract
The optimal means for detecting and managing liver transplantation (LT) patients with latent tuberculosis (TB) are not well defined. Our study aims were to (1) determine the frequency and risk factors of latent TB in a large cohort of consecutive adult LT candidates and (2) determine the safety and efficacy of isoniazid treatment in LT recipients with latent TB. A review of patients assessed for latent TB by skin testing using purified protein derivative (PPD; January 2004 to September 2008) or with the interferon-γ release assay QuantiFERON-TB Gold (QFT; March 2008 to October 2009) was undertaken. The baseline clinical features and outcomes of subjects with latent TB and subjects without latent TB were compared. Twenty-five of 420 subjects (6.0%) were positive for PPD. In comparison, 11 of 119 subjects (9.2%) had a positive QFT assay, and 15 others (13%) had indeterminate results. Both PPD-positive and QFT-positive subjects were less likely to be Caucasian than subjects without latent TB (p < 0.001). The 3-year survival rate of the 25 LT recipients with latent TB was similar to that of the 296 LT recipients without latent TB (78.7% versus 74.6%, P = 0.58). Fifteen of the 25 latent TB patients received isoniazid at a mean of 0.67 months after LT. Although isoniazid was discontinued in 8 subjects because of possible side effects, none of the 25 latent TB patients developed TB reactivation after transplantation with a mean follow-up of 33 months. In conclusion, both QFT testing and PPD testing demonstrate similar rates of detecting latent TB infection in American LT candidates, but QFT testing also leads to a moderate rate of indeterminate test results. Early isoniazid chemoprophylaxis after LT is poorly tolerated and is frequently discontinued.
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Affiliation(s)
- Syed-Mohammed Jafri
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Stuckey LJ, Wadhwa A, Kaul D, Bauman K, Lama VN, Han MK, Ojo TC, Flaherty KR, Bartos C, Florn R, Mahidhara RS, Chan KM. Antibiotic-Resistant Cytomegalovirus Infection Following Oral Valganciclovir Prophylaxis in Lung Transplant Recipients. Chest 2010. [DOI: 10.1378/chest.10964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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