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Bender O, Khoury J, Hirsch G, Weinberg E, Sagy N, Buller S, Lapides-Levy S, Blumer S, Bar DZ. Immunorecognition of Streptococcus mutans secreted proteins protects against caries by limiting tooth adhesion. J Dent 2024; 141:104805. [PMID: 38101504 DOI: 10.1016/j.jdent.2023.104805] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Childhood caries, a prevalent chronic disease, affects 60-90 % of children in industrialized regions, leading to lesions in both primary and permanent teeth. This condition precipitates hospital admissions, emergency room visits, elevated treatment costs, and missed school days, thereby impeding the child's academic engagement and increasing the likelihood of caries into adulthood. Despite multiple identified risk factors, significant interpersonal variability remains unexplained. The immune system generates a unique antibody repertoire, essential for maintaining a balanced and healthy oral microbiome. Streptococcus mutans is a primary contributor to the development of caries. METHODS Employing mass spectrometry, we investigated the S. mutans proteins targeted by antibodies in children both with and without caries, delineating a fundamental suite of proteins discernible by the immune systems of a majority of individuals. Notably, this suite was enriched with proteins pivotal for bacterial adhesion. To ascertain the physiological implications of these discoveries, we evaluated the efficacy of saliva in thwarting S. mutans adherence to dental surfaces. RESULTS Antibodies in most children recognized a core set of ten S. mutans proteins, with additional proteins identified in some individuals. There was no significant difference in the proteins identified by children with or without caries, but there was variation in antibody binding intensity to some proteins. Functionally, saliva from caries-free individuals, but not children with caries, was found to hinder the binding of S. mutans to teeth. These findings delineate the S. mutans proteome targeted by the immune system and suggest that the inhibition of bacterial adherence to teeth is a primary mechanism employed by the immune system to maintain oral balance and prevent caries formation. CONCLUSIONS These findings enhance our knowledge of the immune system's function in oral health maintenance and caries prevention, shedding light on how immunoglobulins interact with S. mutans proteins. CLINICAL SIGNIFICANCE Targeting S. mutans proteins implicated in bacterial adhesion could be a promising strategy for preventing childhood caries.
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Affiliation(s)
- Omer Bender
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Jessica Khoury
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Gal Hirsch
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Evgeny Weinberg
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel; Department of Periodontology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Naor Sagy
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Shani Buller
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Shiri Lapides-Levy
- Department of Pediatric Dentistry, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Sigalit Blumer
- Department of Pediatric Dentistry, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel
| | - Daniel Z Bar
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University 69978, Israel.
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Medawar G, Khoury J, Salloum A, Miskovsky J. QIM23-137: Improving Hematology-Oncology Education in Internal Medicine Residency—A Single Institution Quality Improvement Project. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7185] [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: 04/03/2023]
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3
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Ekladios C, Khoury J, Mehr S, Feghali K. Osilodrostat‐induced adrenal insufficiency in a patient with Cushing's disease. Clin Case Rep 2022; 10:e6607. [DOI: 10.1002/ccr3.6607] [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] [Received: 06/21/2022] [Revised: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Jessica Khoury
- Roger Williams Medical Center Providence Rhode Island USA
| | - Shahzad Mehr
- Roger Williams Medical Center Providence Rhode Island USA
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Misako N, Sugawara S, Choi CM, Okamoto T, Yanagitani N, Nosaki K, Takahashi T, Fujiwara Y, Hayashi H, Khoury J, Nieva J, Gabayan A, Raez L, Chen H, Dimou A, Pennell N, Liu G, Ou SH, Seto T, Ohe Y. EP08.02-118 TRUST-II: A Global Phase II Study for Taletrectinib inROS1fusion Positive Lung Cancer and Other Solid Tumors. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.801] [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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5
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Nagasaka M, Sugawara S, Choi CM, Okamoto T, Yanagitani N, Nosaki K, Takahashi T, Fujiwara Y, Hayashi H, Khoury J, Nieva J, Gabayan A, Raez L, Chen H, Dimou A, Pennell N, Liu G, Ou SH, Seto T, Ohe Y. 77TiP TRUST-II: A global phase II study for taletrectinib in ROS1 fusion-positive lung cancer and other solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.086] [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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Ciprian G, Khoury J, Raimondo TJ. A Rare Case of Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Settings of Etanercept Use and Epstein-Barr Virus Infection. Cureus 2021; 13:e18507. [PMID: 34754667 PMCID: PMC8569646 DOI: 10.7759/cureus.18507] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which widespread activation of the immune system leads to a state of excessive inflammation causing tissue damage. While this condition is mainly established in the pediatric population; due to its rarity, physicians often do not suspect this condition in adults. However, while diagnostic criteria are based on protocols tailored for the pediatric society, recognizing this condition in a timely manner in adults is utterly important to prevent a dismal prognosis. In instances where a concomitant rheumatological disorder is present, the syndrome is referred to as macrophage activation syndrome (MAS). This report describes a case of an adult patient who presented with mucosal bleeding and abdominal pain who was later diagnosed with MAS.
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Affiliation(s)
- Giulio Ciprian
- Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Jessica Khoury
- Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Thomas J Raimondo
- Critical Care Medicine, Roger Williams Medical Center, Providence, USA
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7
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Assi HI, Alameh IA, Khoury J, Bou Zerdan M, Akiki V, Charafeddine M, El Saheb GI, Sukhon F, Sbaity E, Baydoun S, Shabb N, Berjawi G, Haidar MB. Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients. Front Oncol 2021; 11:740336. [PMID: 34660301 PMCID: PMC8518554 DOI: 10.3389/fonc.2021.740336] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients. Patients and Methods Preoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities. Results Axillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs. Conclusion The diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.
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Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim A Alameh
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vanessa Akiki
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghida I El Saheb
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Serine Baydoun
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nina Shabb
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad B Haidar
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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8
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Ciprian G, Khoury J, Ramirez L, Miskovsky J. Endoscopy Management of Complete Gastric Outlet Obstruction Secondary to Elipse™ Intragastric Balloon. Cureus 2021; 13:e17542. [PMID: 34646599 PMCID: PMC8478689 DOI: 10.7759/cureus.17542] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/24/2022] Open
Abstract
The Allurion Elipse™ device is a swallowable balloon in the form of a capsule placed without endoscopy that serves the same purpose as an intragastric balloon (IGB) used for weight loss. We report a case of a 43-year-old female who presented with a complete gastric outlet obstruction confirmed by computed tomography (CT) scan. The patient initially failed conservative management; therefore, the IGB was later removed endoscopically. This is a rare complication and one of the first cases described in the literature; therefore, further studies are needed before its widescale implementation.
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Affiliation(s)
- Giulio Ciprian
- Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Jessica Khoury
- Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Leandro Ramirez
- Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - John Miskovsky
- Department of Medicine, Roger Williams Medical Center, Providence, USA
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9
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Assi H, Alameh I, Bou Zerdan M, Charafeddine M, Khoury J, El Nakib C, Bou Khalil P. Outcomes of patients with malignancy admitted to the intensive care units (ICU): A prospective study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24001] [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: 11/20/2022] Open
Abstract
e24001 Background: An important aspect of improving outcomes for patients with malignancy is the provision of critical care during periods of acute deterioration. Decisions regarding whether advanced cancer patients should be admitted to the ICU is based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short- and long-term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs. Methods: Critically ill adult (≥18-year-old) cancer patients non-electively admitted to the intensive care units at the American University of Beirut Medical Center (AUBMC) between August 1st, 2015, and March 1st, 2019, were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was strictly observational and clinical decisions were left to the discretion of the ICU team and attending physician. Results: Two hundred seventy-two patients were enrolled in the study between August 1st, 2015, and March 31st, 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. Mean length of stay in our ICU was 14 days with an interquartile range of 1 to 120 days with a median overall survival of 22 days since date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). COX regression analysis showed that sepsis, uncontrolled malignancy, ARDS, multi-organ failure, use of vasopressors, use of mechanical ventilation are major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (p = 0.014). Additionally, mortality in patients with solid malignancies (47.6%) was higher than those with hematologic malignancies (34.1%) (p = 0.0048). Conclusions: Patients admitted to the ICU in a tertiary care center in the MENA region are at high risk for short term mortality.
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Affiliation(s)
- Hazem Assi
- American University of Beirut, Beirut, Lebanon
| | - Ibrahim Alameh
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jessica Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Clara El Nakib
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Assi HI, Kakati RT, Berro J, Saikali I, Youssef B, Hourany R, Alameh I, Tabbarah A, Khoury J, Darwish H, Alame S. PTEN R130Q Papillary Tumor of the Pineal Region (PTPR) with Chromosome 10 Loss Successfully Treated with Everolimus: A Case Report. ACTA ACUST UNITED AC 2021; 28:1274-1279. [PMID: 33804593 PMCID: PMC8025816 DOI: 10.3390/curroncol28020121] [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: 12/21/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
Papillary tumors of the pineal region (PTPR) can be observed among adults with poor prognosis and high recurrence rates. Standards of therapy involve total surgical excision along with radiation therapy, with no promising prospects for primary adjuvant chemotherapy, as long-term treatment options have not been explored. Chromosome 10 loss is characteristic of PTPR, and PTEN gene alterations are frequently encountered in a wide range of human cancers and may be treated with mTORC1 inhibitors such as everolimus. In parallel, there are no reports of treating PTPR with everolimus alone as a monopharmacotherapy. We report the case of a patient diagnosed with PTPR (grade III) characterized by a PTEN R130Q alteration with chromosome 10 loss that was treated with everolimus pharmacotherapy alone, resulting in an asymptomatic course and tumor regression, a rare yet notable phenomenon not described in the literature so far with potential to alter the management approach to patients with PTPR.
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Affiliation(s)
- Hazem I. Assi
- Division of Hematology & Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon; (J.B.); (J.K.)
- Correspondence:
| | - Rasha T. Kakati
- Faculty of Medicine, American University of Beirut, Bliss Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Juliett Berro
- Division of Hematology & Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon; (J.B.); (J.K.)
| | - Ibrahim Saikali
- Division of Neurosurgery, Lebanese American University Medical Center, Beirut P.O. Box 11-3288, Lebanon;
| | - Bassem Youssef
- Division of Radiation Oncology, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Roula Hourany
- Division of Diagnostic Radiology, American University of Beirut Medical Center, Bliss Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Ibrahim Alameh
- Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Abeer Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Jessica Khoury
- Division of Hematology & Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon; (J.B.); (J.K.)
| | - Houssein Darwish
- Division of Neurosurgery, American University of Beirut Medical Center, Cairo Street, Beirut P.O. Box 11-0236, Lebanon;
| | - Saada Alame
- Department of Pediatric Neurology, Faculty of Medicine, Lebanese University, Beirut P.O. Box 6573/14, Lebanon;
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Halim NA, Sayed RE, Alameh IA, Khoury J, Nakib CE, Zerdan MB, Charafeddine M, Farhat F, Karak FE, Assi HI. Safety and efficacy of pazopanib as a second-line treatment and beyond for soft tissue sarcomas: A real-life tertiary-center experience in the MENA region. Cancer Treat Res Commun 2020; 26:100275. [PMID: 33340905 DOI: 10.1016/j.ctarc.2020.100275] [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: 10/12/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sarcomas are uncommon malignancies. No advances have been recently achieved despite multiple efforts. Pazopanib is a safe and effective tyrosine kinase inhibitor used in managing soft tissue sarcomas (STS) after chemotherapy failure. However, its use is limited in developing countries and no efficacy data exist from our region. We aimed to study the efficacy of pazopanib in our population, characterized by response rates of patients with chemotherapy-refractory advanced STS receiving pazopanib. Secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicity profile. MATERIALS AND METHODS 15 patients (age≥18 year) diagnosed with advanced STS, refractory to first-line chemotherapy, receiving pazopanib as ≥second-line therapy in one tertiary center in Lebanon were included between January 1st, 2014 and October 31st, 2018. Patient and disease characteristics, disease evaluation, as well as tolerance to treatment, were extracted from charts retrospectively. Statistical analysis was done using SPSS version 24. RESULTS The mean age was 48.6 [19-66] years. Eleven patients (73.3%) received pazopanib in second-line, whereas four patients (26.7%) received it in third-line. Thirteen patients (86.7%) progressed, and two patients (13.3%) had stable disease. The median PFS was three months [1-19] and the mean OS was 25.4 months [17.2-33.6]. Five patients required dose-reductions due to poor tolerance. CONCLUSION Conclusions cannot be drawn due to small patient numbers. However, given the 3-month PFS, 13% of patients maintaining stable disease, and tolerable safety profile, it is reasonable to incorporate pazopanib in STS treatment. More focused studies with larger patient populations need to be done in Lebanon.
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Affiliation(s)
- Nour Abdul Halim
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola El Sayed
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim A Alameh
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Clara El Nakib
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Farhat
- Department of Internal Medicine, Division of Hematology and Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Fadi El Karak
- Department of Internal Medicine, Division of Hematology and Oncology, Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Hazem I Assi
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
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Nasomyont N, Keefe C, Tian C, Hornung L, Khoury J, Tilden JC, Hochwalt P, Jackson E, Rybalsky I, Wong BL, Rutter MM. Safety and efficacy of teriparatide treatment for severe osteoporosis in patients with Duchenne muscular dystrophy. Osteoporos Int 2020; 31:2449-2459. [PMID: 32676823 DOI: 10.1007/s00198-020-05549-z] [Citation(s) in RCA: 4] [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: 04/02/2020] [Accepted: 07/08/2020] [Indexed: 01/07/2023]
Abstract
UNLABELLED Osteoporosis is a major concern in patients with Duchenne muscular dystrophy. In this novel study of teriparatide treatment in 6 patients with severe osteoporosis, bone health (fractures, vertebral morphometry, and DXA) remained stable, with no adverse events. These findings will help inform future osteoporosis research in this challenging population. INTRODUCTION Despite standard therapy with vitamin D and bisphosphonates (BP), many patients with Duchenne muscular dystrophy (DMD) continue to sustain fragility fractures due to long-term glucocorticoid treatment and limited mobility. We aimed to evaluate the safety and efficacy of teriparatide for the treatment of severe osteoporosis in adolescent and young adult patients with DMD. METHODS We prospectively treated 6 patients with DMD who had severe osteoporosis with teriparatide 20 mcg subcutaneously daily for 1-2 years. Inclusion criteria were long-term glucocorticoid therapy, and severe osteoporosis despite treatment with BP, or intolerance to BP. We examined long bone and vertebral fracture outcomes, including vertebral morphometry measures, bone mineral density and content, bone formation markers, safety indices, and adverse events. RESULTS The mean age at teriparatide start was 17.9 years (range 13.9-22.1 years). All 6 patients were on daily glucocorticoids (mean ± SD; duration 10.9 ± 2.5 years) and 5 were non-ambulatory. Five patients had been treated with BP for 7.9 ± 4.2 years. All had vertebral and a history of long bone fragility fractures at baseline. Vertebral heights and Genant fracture grading remained stable. Long bone fracture rate appeared to decrease (from 0.84/year to 0.09/year); one patient sustained a long bone fracture at 6 months of treatment. Trajectories for change in bone mineral density and content were not different post- vs. pre-teriparatide. Procollagen type 1 amino-terminal propeptide (P1NP) increased, while laboratory safety indices remained stable and non-concerning. No adverse events were observed. CONCLUSION In six patients with DMD treated with teriparatide for severe osteoporosis, we observed stable bone health and modest increases in P1NP, without safety concerns. Further studies are needed to better understand teriparatide efficacy for treatment of osteoporosis in patients with DMD.
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Affiliation(s)
- N Nasomyont
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH, 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - C Keefe
- Diabetes and Endocrinology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - C Tian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - L Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Khoury
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH, 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - P Hochwalt
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - E Jackson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - I Rybalsky
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B L Wong
- Department of Pediatrics, University of Massachusetts Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - M M Rutter
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH, 45229-3026, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Saadeh FS, Morsi RZ, El-Kurdi A, Nemer G, Mahfouz R, Charafeddine M, Khoury J, Najjar MW, Khoueiry P, Assi HI. Correlation of genetic alterations by whole-exome sequencing with clinical outcomes of glioblastoma patients from the Lebanese population. PLoS One 2020; 15:e0242793. [PMID: 33237934 PMCID: PMC7688136 DOI: 10.1371/journal.pone.0242793] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Glioblastoma (GBM) is an aggressive brain tumor associated with high degree of resistance to treatment. Given its heterogeneity, it is important to understand the molecular landscape of this tumor for the development of more effective therapies. Because of the different genetic profiles of patients with GBM, we sought to identify genetic variants in Lebanese patients with GBM (LEB-GBM) and compare our findings to those in the Cancer Genome Atlas (TCGA). Methods We performed whole exome sequencing (WES) to identify somatic variants in a cohort of 60 patient-derived GBM samples. We focused our analysis on 50 commonly mutated GBM candidate genes and compared mutation signatures between our population and publicly available GBM data from TCGA. We also cross-tabulated biological covariates to assess for associations with overall survival, time to recurrence and follow-up duration. Results We included 60 patient-derived GBM samples from 37 males and 23 females, with age ranging from 3 to 80 years (mean and median age at diagnosis were 51 and 56, respectively). Recurrent tumor formation was present in 94.8% of patients (n = 55/58). After filtering, we identified 360 somatic variants from 60 GBM patient samples. After filtering, we identified 360 somatic variants from 60 GBM patient samples. Most frequently mutated genes in our samples included ATRX, PCDHX11, PTEN, TP53, NF1, EGFR, PIK3CA, and SCN9A. Mutations in NLRP5 were associated with decreased overall survival among the Lebanese GBM cohort (p = 0.002). Mutations in NLRP5 were associated with decreased overall survival among the Lebanese GBM cohort (p = 0.002). EGFR and NF1 mutations were associated with the frontal lobe and temporal lobe in our LEB-GBM cohort, respectively. Conclusions Our WES analysis confirmed the similarity in mutation signature of the LEB-GBM population with TCGA cohorts. It showed that 1 out of the 50 commonly GBM candidate gene mutations is associated with decreased overall survival among the Lebanese cohort. This study also highlights the need for studies with larger sample sizes to inform clinicians for better prognostication and management of Lebanese patients with GBM.
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Affiliation(s)
- Fadi S. Saadeh
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Rami Z. Morsi
- Department of Neurology, University of Chicago, Chicago, Illinois, United States of America
| | - Abdallah El-Kurdi
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Georges Nemer
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Khoury
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan W. Najjar
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Khoueiry
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- * E-mail: (PK); (HIA)
| | - Hazem I. Assi
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail: (PK); (HIA)
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14
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Liu Y, Augustyn A, Gunther J, Fang P, Nastoupil L, Ahmed S, Strati P, Nair R, Steiner R, Westin J, Rodriguez M, Neelapu S, Flowers C, Khoury J, Medeiros L, Dabaja B, Pinnix C. Radiation Therapy for Refractory High-grade B-cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Zhang LQ, Cho SM, Rice CJ, Khoury J, Marquardt RJ, Buletko AB, Hardman J, Wisco D, Uchino K. Valve surgery for infective endocarditis complicated by stroke: surgical timing and perioperative neurological complications. Eur J Neurol 2020; 27:2430-2438. [PMID: 32657501 DOI: 10.1111/ene.14438] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Ischaemic and hemorrhagic strokes are dreaded complications of infective endocarditis (IE). The timing of valve surgery for IE patients with stroke remains uncertain. The aim was to study perioperative neurological complications in relation to surgical timing. METHODS The study cohort consisted of patients diagnosed with acute IE from January 2010 to December 2016. Early surgery was defined as valve surgery within 14 days of IE diagnosis, and late surgery as after 14 days. Neurological complications that occurred within 14 days post-surgery were considered perioperative and classified as new ischaemic stroke or hemorrhagic stroke, expansion of an existing intracranial hemorrhage and new-onset seizures. Perioperative neurological complications were compared by surgical timing and other variables, including pre-surgical imaging. RESULTS Overall, 183 patients underwent valve surgery: 92 had early surgery at a median of 8 days (interquartile range 6-11); 91 had late surgery at a median of 28 days (interquartile range 19-50). Twenty patients (10.9%) had 24 complications: 11 ischaemic, six intraparenchymal hemorrhages, three subarachnoid hemorrhages (SAHs) and four new-onset seizures. Rates of neurological complications were similar for early and late surgery groups (10.9% vs. 11%). Enterococcal IE was more common amongst patients with perioperative neurological complications (35% vs. 12.3%, P < 0.01). An acute infarct was present on pre-surgical magnetic resonance imaging of 134 patients (74%) and was not associated with perioperative neurological complications. Thirty-five patients (19.3%) had intracranial hemorrhage on pre-surgical imaging. SAH on pre-surgical imaging was associated with developing SAH perioperatively (66.7% vs. 13.5%, P < 0.01). CONCLUSION Early valve surgery for patients with IE complicated by stroke was not associated with perioperative neurological complications.
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Affiliation(s)
- L Q Zhang
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S-M Cho
- Division of Neurocritical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C J Rice
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Khoury
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R J Marquardt
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A B Buletko
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Hardman
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Wisco
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - K Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Alameh IA, Khoury J, Abdul Halim N, Sbaity E, Assi HI. A fungating micro-invasive ductal carcinoma in situ. Surgery 2020. [DOI: 10.1016/j.surg.2020.03.014] [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: 10/24/2022]
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17
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Assi HI, Hilal L, Abu-Gheida I, Berro J, Sukhon F, Skaf G, Geara F, Boulos F, Charafeddine M, Tabbarah A, Khoury J, Najjar M. Corrigendum to "Demographics and outcomes of meningioma patients treated at a tertiary care center in the Middle East" [Clin. Neurol. Neurosurg. 195 (2020) 105846]. Clin Neurol Neurosurg 2020; 197:105926. [PMID: 32499059 DOI: 10.1016/j.clineuro.2020.105926] [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: 12/01/2022]
Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - Lara Hilal
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Ibrahim Abu-Gheida
- Department of Radiation Oncology, Burjeel Medical City, United Arab Emirates
| | - Juliett Berro
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Ghassan Skaf
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Abeer Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Marwan Najjar
- Department of Surgery, American University of Beirut Medical Center, Lebanon.
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Assi HI, Hilal L, Abu-Gheida I, Berro J, Sukhon F, Skaf G, Geara F, Boulos F, Charafeddine M, Tabbarah A, Khoury J, Najjar M. Demographics and outcomes of meningioma patients treated at a tertiary care center in the Middle East. Clin Neurol Neurosurg 2020; 195:105846. [PMID: 32334046 DOI: 10.1016/j.clineuro.2020.105846] [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: 01/21/2020] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Meningioma is the most common intracranial primary brain tumor. Risk factors such as age and exposure to radiation as well as prognostic factors such as grade, location, and extent of surgical resection have been reported in the literature worldwide; however, to our knowledge, data from the Middle East is still warranted. In this study, we aim to identify the characteristics, risk factors and outcomes of meningioma patients treated at a multidisciplinary regional referral center in the Middle East. PATIENTS AND METHODS This is a retrospective chart review with a prospective follow up of outcomes. It included patients diagnosed with meningioma between January 2005 and December 2015 at the American University of Beirut Medical Center. Patient's demographics, risk factors and outcomes were first retrospectively collected. Then, we conducted phone calls to all included alive patients to update their disease status and outcomes. RESULTS One-hundred and ninety-five patients were included. 69 % had grade I tumors and around 31 % with grades II and III meningiomas. The means of the overall survival and progression free survival (PFS) were 198 and 126 months, respectively. The residence area (city vs. countryside), occupation, alcohol use, oral contraceptive use, family history of meningioma, previous head trauma, radiation exposure for head/brain imaging, cell phone use, and finally, the tumor Ki-67 protein level did not correlate with the survival outcomes. The meningioma grade and extent of resection were significant predictors of the PFS on the univariate analysis, whereas, in the multivariate analysis only previous radiotherapy was significant in prolonging PFS. CONCLUSION In our study cohort, that included around 30 % grades II and III tumors, previous radiotherapy use was the only significant prognostic factor for longer PFS in patients diagnosed with meningioma. Future prospective studies should be conducted to evaluate genetic and molecular factors that could possibly be linked to meningioma grade and prognosis in our population of Middle Eastern patients.
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Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - Lara Hilal
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Ibrahim Abu-Gheida
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Juliett Berro
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Ghassan Skaf
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Abeer Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Marwan Najjar
- Department of Surgery, American University of Beirut Medical Center, Lebanon.
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Anakwenze C, Gunther J, Manasanch E, Noticewala S, Milgrom S, Lee H, Patel K, Thomas S, Iyer S, Weber D, Park C, Amini B, Khoury J, Medeiros L, Orlowski R, Dabaja B, Pinnix C. The Impact of PET-CT on Rates of Progression from Solitary Plasmacytoma to Multiple Myeloma after Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1368] [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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20
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Ning M, Milgrom S, Gunther J, Pinnix C, Christopherson K, Brooks E, Khoury J, Wang M, Dabaja B. Low-Dose (4 Gy) Radiation Therapy as an Effective Treatment Modality for Relapsed Refractory Mantle Cell Lymphoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1033] [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: 11/25/2022]
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21
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Pinnix C, Gunther J, Milgrom S, Cruz Chamorro R, Medeiros L, Khoury J, Amini B, Fanale M, Neelapu S, Lee H, Westin J, Fowler N, Nastoupil L, Dabaja B. Excellent Outcomes after Reduced-Dose Intensity Modulated Radiation Therapy for Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.234] [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: 10/28/2022]
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22
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Christopherson K, Gunther J, Milgrom S, Wong P, Ning M, Nastoupil L, Neelapu S, Fowler N, Fanale M, Westin J, Oki Y, Khoury J, Dabaja B, Pinnix C. Primary Gastric Diffuse Large B-Cell Lymphoma Treated with Abbreviated Chemoimmunotherapy and Contemporary Radiation Therapy has Excellent Outcomes with Minimal Toxicity. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.706] [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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23
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Gunther J, Park C, Milgrom S, Dabaja B, Cruz Chamorro R, Medeiros L, Khoury J, Garg N, Amini B, Fanale M, Lee H, Fowler N, Nastoupil L, Neelapu S, Pinnix C. Radiation Therapy for Salivary Gland MALT Lymphoma: Ultra Low Dose Treatment Spares Salivary Function and Achieves Excellent Outcomes. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.814] [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: 10/28/2022]
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24
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Cho SM, Marquardt RJ, Rice CJ, Buletko AB, Zhang LQ, Khoury J, Thatikunta P, Hardman J, Wisco D, Uchino K. Cerebral microbleeds predict infectious intracranial aneurysm in infective endocarditis. Eur J Neurol 2018; 25:970-975. [PMID: 29603515 DOI: 10.1111/ene.13641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging (MRI) features such as cerebral microbleeds and sulcal susceptibility-weighted imaging (SWI) or gradient-echo T2* lesions in infective endocarditis (IE) have been associated with the presence of infectious intracranial aneurysm (IIA). Our aim was to validate these MRI predictors for IIA in order to better assist in assessing the appropriate indications for digital subtraction angiography (DSA). METHODS The derivation cohort comprised IE patients with neurological evaluation, MRI and DSA at a single tertiary referral center from January 2015 to July 2016. Validation was performed in a cohort of IE patients who underwent MRI and DSA at the same center from 2010 to 2014. RESULTS Of 62 patients in the derivation cohort, 10 (16%) had IIAs. Of 129 in the validation cohort, 19 (15%) IIAs were identified. The MRI predictors for IIA consist of (i) contrast enhancement with microbleeds, (ii) cerebral microbleeds >5 mm or sulcal SWI lesions and (iii) any MRI hemorrhages. The sensitivity for the presence of IIA in each group of the derivation cohort was 90%, 80% and 100%, respectively. The sensitivity in the validation cohort was 47%, 68% and 94% respectively. The specificity in the derivation cohort was 87%, 85% and 18%. In the validation cohort, the specificity was similar at 87%, 75% and 27%. CONCLUSIONS The absence of MRI hemorrhages may not necessitate the need for DSA.
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Affiliation(s)
- S-M Cho
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R J Marquardt
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C J Rice
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A B Buletko
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - L Q Zhang
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Khoury
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - P Thatikunta
- Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - J Hardman
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - D Wisco
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - K Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
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25
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Ayoub Z, Andraos T, Milgrom S, Pinnix C, Dabaja B, Ng S, Fowler N, Neelapu S, Samaniego F, Khoury J, Fayad L, Nastoupil L. Grade 3 Follicular Lymphoma Patients Can Experience Favorable Outcomes With Various Management Strategies. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1621] [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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26
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Tonstad S, Anderssen S, Khoury J, Ose L, Reseland J, Retterstøl L. Weight concerns and beliefs about obesity in the Norwegian population. Scandinavian Journal of Food and Nutrition 2016. [DOI: 10.1080/11026480600632658] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Tonstad
- Departments of Preventive Cardiology, Ulleva°l University Hospital, Oslo, Norway
| | - S. Anderssen
- Oral Research Laboratory, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - J. Khoury
- Departments of Preventive Cardiology, Ulleva°l University Hospital, Oslo, Norway
| | - L. Ose
- Lipid Clinic, National Hospital, Oslo, Norway
| | - J. Reseland
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - L. Retterstøl
- Departments of Medical Genetics,, Ulleva°l University Hospital, Oslo, Norway
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Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A. Pros and cons of circumcision: an evidence-based overview. Clin Microbiol Infect 2016; 22:768-774. [PMID: 27497811 DOI: 10.1016/j.cmi.2016.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 04/24/2016] [Revised: 07/17/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made.
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Affiliation(s)
- B Friedman
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - J Khoury
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - N Petersiel
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - T Yahalomi
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel
| | - M Paul
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - A Neuberger
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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Atkinson L, Jamieson B, Khoury J, Ludmer J, Gonzalez A. Stress Physiology in Infancy and Early Childhood: Cortisol Flexibility, Attunement and Coordination. J Neuroendocrinol 2016; 28. [PMID: 27344031 DOI: 10.1111/jne.12408] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 12/14/2022]
Abstract
Research on stress physiology in infancy has assumed increasing importance due to its lifelong implications. In this review, we focus on measurement of hypothalamic-pituitary-adrenal (HPA) function, in particular, and on complementary autonomic processes. We suggest that the measure of HPA function has been overly exclusive, focusing on individual reactivity to single, pragmatically selected laboratory challenges. We advocate use of multiple, strategically chosen challenges and within-subject designs. By administering one challenge that typically does not provoke reactivity and another that does, it is possible to represent allostatic load in terms of "flexibility," the capacity to titrate response to challenge. We also recommend assessing infant reactivity in the context of the primary caregiver's physiological function. Infant-mother "attunement" is central to developmental psychology, permeating diverse developmental domains with varied consequences. A review of adrenocortical attunement suggests that attunement is a reliable process, manifest across varied populations. However, attunement appears stronger in the context of more highly stressful circumstances, such that administration of multiple, selected challenges may help evaluate the degree to which individuals titrate attunement to challenge and determine the correlates of this differential attunement. Finally, we advocate studying the "coordination" of HPA function with other aspects of stress physiology and variation in the degree of this coordination. The use of multiple stressors is important here because each stress system is differentially sensitive to different types of challenge. Therefore, use of single stressors in between-subject designs impedes full recognition of the role played by each system. Overall, we recommend measure of flexibility, attunement, and coordination in the context of multiple challenges to capture allostasis in environmental and physiological context. The simultaneous use of such inclusive and integrative metrics may yield more reliable findings than has hitherto been the case. The interrelation of these metrics can be understood in the context of the adaptive calibration model..
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Affiliation(s)
- L Atkinson
- Department of Psychology, Ryerson University, Toronto, Canada
| | - B Jamieson
- Department of Psychology, Ryerson University, Toronto, Canada
| | - J Khoury
- Department of Psychology, Ryerson University, Toronto, Canada
| | - J Ludmer
- Department of Psychology, Ryerson University, Toronto, Canada
| | - A Gonzalez
- Departments of Psychiatry and Behavioural Neurosciences and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Nehmetallah G, Khoury J, Banerjee PP. Photorefractive two-beam coupling joint transform correlator: modeling and performance evaluation. Appl Opt 2016; 55:4011-4023. [PMID: 27411127 DOI: 10.1364/ao.55.004011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/20/2016] [Indexed: 06/06/2023]
Abstract
The photorefractive two-beam coupling joint transform correlator combines two features. The first is embedded semi-adaptive optimality, which weighs the correlation against clutter and noise in the input, and the second is the intrinsic dynamic range compression nonlinearity, which improves several metrics simultaneously without metric trade-off. Although the two beam coupling correlator was invented many years ago, its outstanding performance was recognized on only relatively simple images. There was no study about the performance of this correlator on complicated images and using different figures of merit. In this paper, the study is extended to more complicated images. For the first time, to our knowledge, we demonstrate simultaneous improvement in metrics performance without metric trade-off. The performance was evaluated compared to the classical joint transform correlator. A typical experimental result to validate the simulation results was also shown in this work. The best performing operation parameters were identified to guide the experimental work and for future comparison with other well-known optimal correlation filters.
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Ajami S, Coathup MJ, Khoury J, Blunn GW. Augmenting the bioactivity of polyetheretherketone using a novel accelerated neutral atom beam technique. J Biomed Mater Res B Appl Biomater 2016; 105:1438-1446. [PMID: 27086858 DOI: 10.1002/jbm.b.33681] [Citation(s) in RCA: 10] [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] [Received: 11/29/2015] [Revised: 03/22/2016] [Accepted: 03/29/2016] [Indexed: 01/27/2023]
Abstract
Polyetheretherketone (PEEK) is an alternative to metallic implants in orthopedic applications; however, PEEK is bioinert and does not osteointegrate. In this study, an accelerated neutral atom beam technique (ANAB) was employed to improve the bioactivity of PEEK. The aim was to investigate the growth of human mesenchymal stem cells (hMSCs), human osteoblasts (hOB), and skin fibroblasts (BR3G) on PEEK and ANAB PEEK. METHODS The surface roughness and contact angle of PEEK and ANAB PEEK was measured. Cell metabolic activity, proliferation and alkaline phosphatase (ALP) was measured and cell attachment was determined by quantifying adhesion plaques with cells. RESULTS ANAB treatment increased the surface hydrophilicity [91.74 ± 4.80° (PEEK) vs. 74.82 ± 2.70° (ANAB PEEK), p < 0.001] but did not alter the surface roughness. Metabolic activity and proliferation for all cell types significantly increased on ANAB PEEK compared to PEEK (p < 0.05). Significantly increased cell attachment was measured on ANAB PEEK surfaces. MSCs seeded on ANAB PEEK in the presence of osteogenic media, expressed increased levels of ALP compared to untreated PEEK (p < 0.05) CONCLUSION: Our results demonstrated that ANAB treatment increased the cell attachment, metabolic activity, and proliferation on PEEK. ANAB treatment may improve the osteointegration of PEEK implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1438-1446, 2017.
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Affiliation(s)
- S Ajami
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics, Division of Surgery, University College London, London, UK
| | - M J Coathup
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics, Division of Surgery, University College London, London, UK
| | - J Khoury
- Exogenesis Corp., Billerica, Massachusetts, 01821
| | - G W Blunn
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics, Division of Surgery, University College London, London, UK
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Daou B, Starke RM, Chalouhi N, Tjoumakaris S, Hasan D, Khoury J, Rosenwasser RH, Jabbour P. Pipeline Embolization Device in the Treatment of Recurrent Previously Stented Cerebral Aneurysms. AJNR Am J Neuroradiol 2015; 37:849-55. [PMID: 26611991 DOI: 10.3174/ajnr.a4613] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/16/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The use of the Pipeline Embolization Device in the management of recurrent previously stented cerebral aneurysms is controversial. The aim of this study was to evaluate the efficacy and safety of the Pipeline Embolization Device in the treatment of recurrent, previously stented aneurysms. MATERIALS AND METHODS Twenty-one patients with previously stented recurrent aneurysms who later underwent Pipeline Embolization Device placement (group 1) were retrospectively identified and compared with 63 patients who had treatment with the Pipeline Embolization Device with no prior stent placement (group 2). Occlusion at the latest follow-up angiogram, recurrence and retreatment rates, clinical outcome, complications, and morbidity and mortality observed after treatment with the Pipeline Embolization Device were analyzed. RESULTS Patient characteristics were similar between the 2 groups. The mean time from stent placement to recurrence was 25 months. Pipeline Embolization Device treatment resulted in complete aneurysm occlusion in 55.6% of patients in group 1 versus 80.4% of patients in group 2 (P = .036). The retreatment rate in group 1 was 11.1% versus 7.1% in group 2 (P = .62). The rate of good clinical outcome at the latest follow-up in group 1 was 81% versus 93.2% in group 2 (P = .1). Complications were observed in 14.3% of patients in group 1 and 9.5% of patients in group 2 (P = .684). CONCLUSIONS The use of the Pipeline Embolization Device in the management of previously stented aneurysms is less effective than the use of this device in nonstented aneurysms. Prior stent placement can worsen the safety and efficacy profile of this device.
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Affiliation(s)
- B Daou
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - R M Starke
- Department of Neurological Surgery (R.M.S.), University of Virginia School of Medicine, Charlottesville, Virginia
| | - N Chalouhi
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - S Tjoumakaris
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - D Hasan
- Department of Neurosurgery (D.H.), University of Iowa, Iowa City, Iowa
| | - J Khoury
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - R H Rosenwasser
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - P Jabbour
- From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Affiliation(s)
- P. Hamilton
- Department of Physics, 366 Le Conte Hall MS 7300, University of California–Berkeley, Berkeley, CA 94720, USA
| | - M. Jaffe
- Department of Physics, 366 Le Conte Hall MS 7300, University of California–Berkeley, Berkeley, CA 94720, USA
| | - P. Haslinger
- Department of Physics, 366 Le Conte Hall MS 7300, University of California–Berkeley, Berkeley, CA 94720, USA
| | - Q. Simmons
- Department of Physics, 366 Le Conte Hall MS 7300, University of California–Berkeley, Berkeley, CA 94720, USA
| | - H. Müller
- Department of Physics, 366 Le Conte Hall MS 7300, University of California–Berkeley, Berkeley, CA 94720, USA
- Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, CA 94720, USA
| | - J. Khoury
- Center for Particle Cosmology, Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
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Khoury J, Knutsen M, Stray-Pedersen B, Thaulow E, Tonstad S. A lower reduction in umbilical artery pulsatility in mid-pregnancy predicts higher infant blood pressure six months after birth. Acta Paediatr 2015; 104:796-800. [PMID: 25865616 DOI: 10.1111/apa.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 03/04/2015] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
AIM The Norwegian-based Cardiovascular Risk Reduction Diet in Pregnancy study found that a cholesterol-lowering diet during pregnancy was associated with an accentuated reduction in the umbilical artery pulsatility index. This follow-up study assessed the possible association between the index and the infants' blood pressure at six months of age. METHODS In the original study, pregnant women consumed an anti-atherogenic or usual diet from gestational weeks 17-20 to birth and underwent Doppler velocimetry at 24, 30 and 36 gestational weeks. In this follow-up study, blood pressure was measured in 105 mother-infant pairs in the intervention group and 106 mother-infant pairs in the control group six months after birth. RESULTS Mean systolic and diastolic blood pressures were not significantly different between both groups. When the groups were combined, multivariate linear analyses showed that a lower versus higher reduction (≥-0.17 versus <-0.17) in the umbilical artery pulsatility index between gestational weeks 24 and 30 and maternal diastolic blood pressure at six months postpartum were significant predictors of higher infant systolic blood pressure (p = 0.03, 0.01, respectively). CONCLUSION A lower reduction in umbilical pulsatility index in mid-pregnancy was associated with higher infant blood pressure at six months of age. This suggests that fetoplacental intrauterine factors may influence future cardiovascular risk.
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Affiliation(s)
- J Khoury
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Bryn Medical Center; Oslo Norway
| | - M Knutsen
- Department of Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - B Stray-Pedersen
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - E Thaulow
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section of Congenital Heart Disease; Division of Women and Children; Oslo University Hospital; Oslo Norway
| | - S Tonstad
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section for Preventive Cardiology; Department of Endocrinology, Morbid Obesity and Preventive Medicine; Oslo University Hospital; Oslo Norway
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Tian C, Rutter M, Hornung L, Khoury J, Miller L, Bange J, Wong B. P.2.18 Bone mineral density and bone mineral content as measures of bone health in ambulatory boys with Duchenne Muscular Dystrophy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.423] [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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Giordano A, Gao H, Cohen EN, Anfossi S, Khoury J, Hess K, Krishnamurthy S, Tin S, Cristofanilli M, Hortobagyi GN, Woodward WA, Lucci A, Reuben JM. Clinical relevance of cancer stem cells in bone marrow of early breast cancer patients. Ann Oncol 2013; 24:2515-2521. [PMID: 23798614 DOI: 10.1093/annonc/mdt223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cancer stem cells (CSCs) are epithelial tumor cells that express CD44(+)CD24(-/lo). CSCs can be further divided into those that have aldehyde dehydrogenase (ALDH) activity (Aldefluor(+)) and those that do not. We hypothesized that if CSCs are responsible for tumor dissemination, their presence in bone marrow (BM) would be prognostic in early stages of breast cancer (EBC) patients. PATIENTS AND METHODS BM aspirates were collected at the time of surgery from 108 patients with EBC. BM was analyzed for CSCs and ALDH activity by flow cytometry. Overall survival and disease-free survival (DFS) were calculated from the date of diagnosis and analyzed with Kaplan-Meier survival plots. Cox multivariate proportional hazards model was also carried out. RESULTS Patients with CSCs in BM had a hazard ratio (HR) of 8.8 for DFS (P = 0.002); patients with Aldefluor(+) CSCs had a HR of 5.9 (P = 0.052) for DFS. All deceased patients (n = 7) had CSCs in BM. In multivariate analysis, the presence of CSCs in BM was a prognostic factor of DFS (HR = 15.8, P = 0.017). CONCLUSIONS The presence of BM metastasis is correlated with CSCs and these CSCs irrespective of ALDH activity are an independent adverse prognostic factor in EBC patients.
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Affiliation(s)
- A Giordano
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Endocrinology and Molecular and Clinical Oncology, University of Naples Federico II, Naples, Italy
| | - H Gao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E N Cohen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Anfossi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Hess
- Departments of Biostatistics
| | - S Krishnamurthy
- Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - S Tin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Cristofanilli
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | | | | | - A Lucci
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J M Reuben
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Green J, Khoury J, Rademacher E, Woo D, Khatri P, Flaherty M, Adeoye O, Ferioli S, Kissela B, Kleindorfer D. Sources of Knowledge for Stroke Warning Signs and Risk Factors within a Population (P07.051). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.051] [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: 11/15/2022] Open
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Kissela B, Alwell K, Khoury J, Moomaw C, Embi P, Rademacher E, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D. A Pilot Population-Based Outcomes Study Using a Health Information Exchange (HIE): Demographic Comparison of Groups (P07.047). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.047] [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: 11/15/2022] Open
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Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Persistent Depression after Acute Stroke Predicts Dementia (P07.048). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.048] [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: 11/15/2022] Open
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Natarajan N, Khoury J, Moomaw C, Miller R, Sailor-Smith S, Frankel M, Kleindorfer D. The Beautyshop Stroke Education Project: The Physician's Office Is an Accurate Source for Stroke Knowledge among African-American Women (P04.063). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.063] [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: 11/15/2022] Open
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Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Cognitive Outcome after Acute Stroke Does Not Correlate with Functional Outcome on Modified Rankin Scale (S53.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s53.004] [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: 11/15/2022] Open
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Kean L, Langston A, Qayed M, Khoury J, Tiwari D, Couture C, Renfroe H, Sen S, Robertson J, Waller E, Horan J. CD28-Directed T Cell Costimulation Blockade with Abatacept to Prevent GVHD During High-Risk Unrelated HSCT: A First-In-Disease Trial. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.429] [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: 11/30/2022]
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Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP. A randomised, controlled trial of home injury hazard reduction: The HOME injury study. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.612] [Citation(s) in RCA: 4] [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: 11/04/2022]
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Abstract
BACKGROUND There are no validated observational surveys to assess injury hazards in the home environment. OBJECTIVE To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children. METHODS A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child's bathroom and child's bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland-Altman analysis of agreement, analysis of variance and kappa statistics. RESULTS There were 163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r = 0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r = 0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child's bathroom. Inter-rater reliability between research assistants, as measured by the kappa statistic, was excellent with a mean of 0.81. CONCLUSIONS The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.
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Affiliation(s)
- K J Phelan
- Division of Health Policy & Clinical Effectiveness, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Khatri R, Khatri P, Khoury J, Broderick J, Carrozzella J, Tomsick T. Microcatheter contrast injections during intra-arterial thrombolysis increase intracranial hemorrhage risk. J Neurointerv Surg 2010; 2:115-9. [DOI: 10.1136/jnis.2009.000794] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Estrov Z, Cortes J, Borthakur G, Faderl S, Garcia Manero G, Ravandi F, Khoury J, Ptaszynski M, Kantarjian H. A phase I dose-escalation study of the novel KSP inhibitor ARRY-520 in advanced leukemias. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7022 ARRY-520 is a potent, selective KSP inhibitor that arrests cells in mitosis with the subsequent onset of apoptosis. ARRY-520 has shown potent activity in preclinical models of hematological cancers and is being evaluated in a phase I trial in patients with advanced or refractory leukemias. The primary objectives of this study are to establish the safety and the MTD of ARRY-520 given as a single dose each cycle. Secondary objectives are to characterize the pharmacokinetics (PK) of ARRY-520, to assess evidence of preliminary clinical activity, and to explore biomarkers of KSP inhibition. ARRY-520 is administered as a 1-h IV infusion as a single dose per cycle in a “3 + 3 phase I design”. Dose escalations are following a prespecified schema. PK analyses for ARRY-520 are performed on plasma samples collected during cycle 1 and cycle 2. Pretreatment and post-treatment peripheral blood samples are collected for analysis of markers of KSP activity. To date, 15 patients, with a median age of 69 yrs (range 44–84 yrs), have been enrolled in the single dose schedule, 3 patients each at doses of 2.5 mg/m2, 3.75 mg/m2, and 5.6 mg/m2 and 6 patients at 4.5 mg/m2 per cycle. All patients had disease refractory to, and/or relapsed from, 1 or more prior therapies with a median of 3 prior regimens (range 1–10). Two patients at 5.6 mg/m2 experienced a DLT of gr3 mucositis. ARRY-520 was well tolerated at doses below 5.6 mg/m2. 4.5 mg/m2 has been determined to be the MTD. ARRY-520 has shown promising signs of clinical activity at doses of 3.75 mg/m2 and above. 2 patients had a complete reduction in their peripheral blasts on day 5 of cycle 1. Of these, one patient experienced a 70% reduction in bone marrow blasts while on study. One patient without peripheral blood blasts at baseline had a 43% reduction in bone marrow blasts and four additional patients had marked reductions in WBC counts. This is the first reported use of a KSP inhibitor in refractory and/or relapsed leukemias. ARRY-520 has been well tolerated in patients on a single dose schedule. Mucositis was observed as the DLT at 5.6 mg/m2. At doses 3.75 mg/m2 and above, ARRY-520 has shown signs of clinical activity. Based on these data, an alternative dose schedule is being explored. Updated data including safety, PK, PD, and preliminary activity of ARRY 520 from this study will be presented. [Table: see text]
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Affiliation(s)
- Z. Estrov
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - J. Cortes
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - G. Borthakur
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - S. Faderl
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - G. Garcia Manero
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - F. Ravandi
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - J. Khoury
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - M. Ptaszynski
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
| | - H. Kantarjian
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Emory University School of Medicine, Atlanta, GA; Array BioPharma, Boulder, CO
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Woo D, Khoury J, Haverbusch MM, Sekar P, Flaherty ML, Kleindorfer DO, Kissela BM, Moomaw CJ, Deka R, Broderick JP. Smoking and family history and risk of aneurysmal subarachnoid hemorrhage. Neurology 2009; 72:69-72. [PMID: 19122033 DOI: 10.1212/01.wnl.0000338567.90260.46] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [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
OBJECTIVE Smoking and family history of aneurysmal subarachnoid hemorrhage (aSAH) are independent risk factors for aSAH. Using a population-based case-control study of hemorrhagic stroke, we hypothesized that having both a first-degree relative with a brain aneurysm or SAH (+FH) and current smoking interact to increase the risk of aSAH. METHODS Cases of aneurysmal SAH were prospectively recruited from all 17 hospitals in the five-county region around the University of Cincinnati. Controls were identified by random digit dialing. Controls were matched to cases of aSAH by age (+/-5 years), race, and sex. Conditional multiple logistic regression was used to identify independent risk factors. For deviation from the additive model, the interaction constant ratio test was used. RESULTS A total of 339 cases of aSAH were matched to 1,016 controls. Compared to current nonsmokers with no first-degree relatives with aSAH (-FH), the odds ratio (OR) for aSAH for current nonsmokers with +FH was 2.5 (95% confidence interval [CI] 0.9-6.9); for current smokers with -FH, OR = 3.1 (95% CI 2.2-4.4); and for current smokers with +FH, OR = 6.4 (95% CI 3.1-13. 2). The interaction constant ratio, which measured the deviation from the additive model, was significant: 2.19 (95% CI 0.80-5.99). The lower bound of the 95% CI >0.5 signifies a departure from the additive model. CONCLUSION Evidence of a gene-environment interaction with smoking exists for aneurysmal subarachnoid hemorrhage. This finding is important to counseling family members and for screening of intracranial aneurysm (IA) as well as the design and interpretation of genetic epidemiology of IA studies.
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Affiliation(s)
- D Woo
- Department of Neurology, University of Cincinnati College of Medicine, 260 Stetson Street ML 0525, Cincinnati, OH 45267-0525, USA.
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Abstract
BACKGROUND Few data exist on the effect of maternal depression on child injury outcomes and mediators of this relationship. OBJECTIVE To examine the relationship between mothers' depressive symptoms and medically attended injuries in their children and the potential mediating role of child behavior. DESIGN/METHODS A cohort of mother-child dyads from the National Longitudinal Study of Youth followed from 1992 to 1994. The primary exposure variable was maternal depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale in 1992. Child behavior was assessed by the Behavior Problems Index externalizing subscale. Logistic regression was used to examine the relationship between depressive symptoms, child behavior, and injury reported in the prior year in 1994. RESULTS 94 medically attended injuries were reported in the 1106 children (8.5%); two-thirds were sustained in the home environment. Maternal depressive symptoms significantly increased the risk of child injury; injury risk increased 4% for every 1-point increase in depressive symptoms (adjusted OR 1.04, 95% CI 1.01 to 1.08, p=0.02). Increasing maternal depressive symptoms also increased the risk of externalizing behavior problems (adjusted OR 1.06, 95% CI 1.03 to 1.09), but externalizing behavior problems did not significantly mediate the relationship between maternal symptoms and child injury. CONCLUSIONS Increasing depressive symptoms in mothers was associated with an increased risk of child injury. Child behavior did not significantly mediate the association between maternal depressive symptoms and child injury in this cohort. Greater recognition, referral, and treatment of depressive symptoms in mothers may have effects on child behavior and injury risk.
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Affiliation(s)
- K Phelan
- Division of Health Policy & Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA.
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Mahajan V, Minshew PT, Khoury J, Shu PP, Muzaffar M, Abruzzo T, Leach JL, Tomsick TA. Eye position information on CT increases the identification of acute ischemic hypoattenuation. AJNR Am J Neuroradiol 2008; 29:1144-6. [PMID: 18356473 DOI: 10.3174/ajnr.a0995] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It is possible that identification of eye deviation may sensitize a scan reader to early brain hypodensity associated with an arterial occlusive process. Our aim was to investigate the value of observing eye deviation on blinded CT identification of early hypoattenuation following ischemic infarct. MATERIALS AND METHODS Two staff and 2 fellow neuroradiologists reviewed 75 brain CT scans obtained within 3 hours of acute ischemia from subjects in the Interventional Management of Stroke Study. Films were reviewed 3 months apart, the first time with tape over the eyes on the images, the second with the eyes visible. Readers were asked if early hypoattenuation in the middle cerebral artery (MCA) distribution or if a hyperattenuated MCA was present. kappa statistics were calculated to determine agreement among the 4 readers and between each of the 2 readings by the same reader, not only for the original interpretation of the blinded study neuroradiologist but also for the Alberta Stroke Program Early CT Score (ASPECTS) for each subject assigned by an unblinded expert panel. A generalized estimating equations modeling approach was used to look at the overall effect of including eye information for agreement between interpretations. RESULTS Eye information availability was associated with improved agreement for detection of early ischemic hypoattenuation not only among the 4 readers but also between the 4 readers and both the blinded study neuroradiologist (P = .02) and the unblinded expert ASPECTS panel. When comparing first and second readings for hypoattenuation, we also noted increased mean values for sensitivity (46.8% first, 56.5% second), specificity (78.2%, 80.2%), positive predictive value (72.0%, 80.7%), negative predictive value (55.5%, 61.0%), and percentage agreement (61.0%, 67.5%). CONCLUSION Observation of CT eye deviation significantly improves reader identification of acute ischemic hypoattenuation.
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Affiliation(s)
- V Mahajan
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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50
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Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, Khoury J. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 2008; 29:582-7. [PMID: 18337393 DOI: 10.3174/ajnr.a0843] [Citation(s) in RCA: 290] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial. MATERIALS AND METHODS IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0-2, mortality outcomes, and results from IMS I. RESULTS Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter-treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter-treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in IMS I treatments in 23 subjects with reliable 15-minute angiograms (P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and M1 occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion (P = .0004), TICI 2B/3 reperfusion (P = .0002), and arterial occlusive lesion 2/3 recanalization (P = .03). CONCLUSION IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality.
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Affiliation(s)
- T Tomsick
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA.
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