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Smesseim I, Mets OM, Daniels JMA, Bahce I, Senan S. Diagnosis and management of pneumonitis following chemoradiotherapy and immunotherapy in stage III non-small cell lung cancer. Radiother Oncol 2024; 194:110147. [PMID: 38341099 DOI: 10.1016/j.radonc.2024.110147] [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: 11/06/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In inoperable stage III NSCLC, the standard of care is chemoradiotherapy and adjuvant durvalumab (IO) for 12 months. Pneumonitis is the commonest toxicity leading to discontinuation of IO. A failure to distinguish between expected radiation-induced changes, IO pneumonitis and infection can lead to unnecessary durvalumab discontinuation. We investigated the use of a structured multidisciplinary review of CT-scans, radiation dose distributions and clinical symptoms for the diagnosis of IO pneumonitis. METHODS A retrospective study was conducted at an academic medical center for patients treated for stage III NSCLC with chemoradiotherapy and adjuvant durvalumab between 2018 and 2021. An experienced thoracic radiologist reviewed baseline and follow-up chest CT-scans, systematically scored radiological features suspected for pneumonitis using a published classification system (Veiga C, Radioth Oncol 2018), and had access to screenshots of radiation dose distributions. Next, two experienced thoracic oncologists reviewed each patients' case record, CT-scans and radiation fields. A final consensus diagnosis incorporating views of expert clinicians and the radiologist was made. RESULTS Among the 45 included patients, 14/45 (31.1%) had a pneumonitis scored in patient records and durvalumab was discontinued in 11/45 cases (24.4%). Review by the radiologist led to a diagnosis of immune-related pneumonitis only in 6/45 patients (13.3%). Review by pulmonary oncologists led to a diagnosis of immune-related pneumonitis in only 4/45 patients (8.9%). In addition a suspicion of an immune-related pneumonitis was rejected in 3 separate patients (6.7%), after the thoracic oncologists had reviewed the patients' radiation fields. CONCLUSIONS In patients treated using the PACIFIC regimen, multidisciplinary assessment of CT-scans, radiation doses and patient symptoms, resulted in fewer diagnoses of immune-related pneumonitis (8.9%). Our study underscores the challenges in accurately diagnosing either IO-related or radiation pneumonitis in patients undergoing adjuvant immunotherapy after chemoradiotherapy and highlights the need for multidisciplinary review in order to avoid inappropriate cessation of adjuvant IO.
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Affiliation(s)
- I Smesseim
- Department of Thoracic Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - O M Mets
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - I Bahce
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S Senan
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Smesseim I, Daniels JMA, Annema J, Bonta PI, Slebos DJ. Disposable Versus Reusable Bronchoscopes: A Narrative Review of Cost-effectiveness, Risk of Cross-contamination and Environmental Impact. Arch Bronconeumol 2024; 60:250-252. [PMID: 38402049 DOI: 10.1016/j.arbres.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Illaa Smesseim
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jouke Annema
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Medicine, University Medical Center Groningen, Groningen, The Netherlands
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van Pel R, Gan T, Daniels JMA, Ruigrok D, Hellemons ME, Klooster K, Slebos DJ. Lung transplant airway complications treated with biodegradable airway stents: The Dutch multi-center experience. Clin Transplant 2024; 38:e15289. [PMID: 38486062 DOI: 10.1111/ctr.15289] [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: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Treatment of post lung-transplant airway complications is challenging, and treatment with conventional airway stents is associated with adverse events. More recently, biodegradable airway stents (BDS) have been introduced and may be used to reduce these adverse events. In this study we explore the feasibility of treatment with BDS post lung transplant. METHODS All patients treated with BDS in The Netherlands were included in this retrospective multicenter study. Feasibility, life span of the stent, occurrence of adverse events, and evolution of lung function were evaluated. RESULTS Twelve patients (six malacia and six stenosis) received a total of 57 BDS, ranging from 1 to 10 BDS per patient. Six patients had been pretreated with conventional airway stents. Median stent life span was 112 days (range 66-202). No adverse events occurred during stent placement. In 5 out of 57 stent placements, a single additional bronchoscopy was necessary because of mucus accumulation (n = 4) or excessive granulation tissue (n = 1). All stent naïve patients became airway stent independent after treatment; all patients pretreated with conventional airway stents were still airway stent dependent at the end of follow up. CONCLUSION Treatment with BDS is safe and feasible. Adverse events were mild and easily treatable. All patients with initial treatment with BDS were airway stent independent at the end of follow up with a median treatment of 4 BDS.
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Affiliation(s)
- Roel van Pel
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tji Gan
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary medicine, Amsterdam university medical center, Amsterdam, The Netherlands
| | - Dieuwertje Ruigrok
- Department of Pulmonary medicine, University medical center Utrecht, Utrecht, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin Klooster
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
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Naves DD, Reuling EMBP, Dickhoff C, Kortman PC, Broeckaert MAM, Plaisier PW, Daniels JMA, Thunnissen E, Radonic T. In-depth analysis of immunohistochemistry concordance in biopsy-resection pairs of bronchial carcinoids. Ann Diagn Pathol 2023; 67:152181. [PMID: 37598464 DOI: 10.1016/j.anndiagpath.2023.152181] [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: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
Primary diagnosis of bronchial carcinoids (BC) is always made on biopsies and additional immunohistochemistry (IHC) is often necessary. In the present study we investigated the concordance of common diagnostic (synaptophysin, chromogranin, CD56 and INSM-1) and potential prognostic (OTP, CD44, Rb and p16) IHC markers between the preoperative biopsies and resections of in total 64 BCs, 26 typical (41 %) and 38 atypical (59 %) carcinoid tumors. Synaptophysin and chromogranin had 100 % concordance in all resected carcinoids and paired diagnostic biopsies. Synaptophysin was not affected by variable expression in biopsies compared to chromogranin, CD56 and INSM-1. Notably, INSM-1 IHC was false negative in 8 % of biopsies. Of the novel and potential prognostic markers, only CD44 showed 100 % concordance between biopsies and resections, while OTP showed two (4 %) false negative results in paired biopsies. While Rb IHC was false negative in 8 % of biopsies, no strong and diffuse pattern of p16 expression was observed. In this study, most false negative IHC results (85 %, 22/26) were observed in small flexible biopsies. Taken together, our data suggest excellent concordance of synaptophysin and CD44 on the preoperative biopsy samples, while other neuroendocrine markers, Rb and OTP should be interpreted with caution, especially in small biopsies.
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Affiliation(s)
- Dwayne D Naves
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Pim C Kortman
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark A M Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Reuling EMBP, Naves DD, Kortman PC, Broeckaert MAM, Plaisier PW, Dickhoff C, Daniels JMA, Radonic T. A Multimodal Biomarker Predicts Dissemination of Bronchial Carcinoid. Cancers (Basel) 2022; 14:cancers14133234. [PMID: 35805004 PMCID: PMC9265109 DOI: 10.3390/cancers14133234] [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] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potential. Gradation into typical (TC) and atypical carcinoid (AC) is limited in terms of prognostic value, resulting in yearly follow-up of all patients. We examined the additional prognostic value of novel immunohistochemical (IHC) markers to current gradation of carcinoids. Methods: A retrospective single-institution cohort study was performed on 171 patients with pathologically diagnosed bronchial carcinoid (median follow-up: 66 months). The risk of developing distant metastases based on histopathological characteristics (Ki-67, p16, Rb, OTP, CD44, and tumor diameter) was evaluated using multivariate regression analysis and the Kaplan−Meier method. Results: Of 171 patients, seven (4%) had disseminated disease at presentation, and 164 (96%) received curative-intent treatment with either endobronchial treatment (EBT) (n = 61, 36%) or surgery (n = 103, 60%). Among the 164 patients, 13 developed metastases at follow-up of 81 months (IQR 45−162). Univariate analysis showed that Ki-67, mitotic index, OTP, CD44, and tumor diameter were associated with development of distant metastases. Multivariate analysis showed that mitotic count, Ki-67, and OTP were independent risk factors for development of distant metastases. Using a 5% cutoff for Ki-67, Kaplan−Meier analysis showed that the risk of distant metastasis development was significantly associated with the number of risk predictors (AC, Ki-67 ≥ 5%, and loss of OTP or CD44) (p < 0.0001). Six out of seven patients (86%) with all three positive risk factors developed distant metastasis. Conclusions: Mitotic count, proliferation index, and OTP IHC were independent predictors of dissemination at follow-up. In addition to the widely used carcinoid classification, a comprehensive analysis of histopathological variables including Ki-67, OTP, and CD44 could assist in the determination of distant metastasis risks of bronchial carcinoids.
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Affiliation(s)
- Ellen M. B. P. Reuling
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Dwayne D. Naves
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Pim C. Kortman
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Mark A. M. Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Peter W. Plaisier
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Johannes M. A. Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
- Cancer Center Amsterdam, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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Daniels JMA. Management of primary spontaneous pneumothorax: don't hesitate, ambulate! Thorax 2022; 77:thoraxjnl-2022-218966. [PMID: 35732491 DOI: 10.1136/thoraxjnl-2022-218966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherlands
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Reuling EMBP, Naves DD, Daniels JMA, Dickhoff C, Kortman PC, Broeckaert MAMB, Plaisier PW, Thunnissen E, Radonic T. Correction to: Diagnosis of atypical carcinoid can be made on biopsies > 4 mm2 and is accurate. Virchows Arch 2022; 480:595. [PMID: 35129676 PMCID: PMC8989927 DOI: 10.1007/s00428-022-03294-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Dwayne D Naves
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Pim C Kortman
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Mark A M B Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
- Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
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Schakenraad A, Hashemi S, Twisk J, Houda I, Ulas E, Daniels JMA, Veltman J, Bahce I. The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors. Lung Cancer 2021; 162:36-41. [PMID: 34666276 DOI: 10.1016/j.lungcan.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS). METHODS This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the 'SLD-change score' and 'early treatment discontinuation' within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated. RESULTS No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999-1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943-2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12-4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41-6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant. CONCLUSIONS Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.
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Affiliation(s)
- Alexandra Schakenraad
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sayed Hashemi
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Jos Twisk
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ilias Houda
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ezgi Ulas
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Joris Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - I Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Iyer A, Radonic T, Heukamp LC, Thunnissen E, Daniels JMA. Inflammatory myofibroblastic tumour of the central airways: treatment and molecular analysis. ERJ Open Res 2021; 7:00151-2020. [PMID: 33778057 PMCID: PMC7983254 DOI: 10.1183/23120541.00151-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Inflammatory myofibroblastic tumours (IMT) are a rare cause of endobronchial masses in adults. Surgery has been the mainstay of treatment of endobronchial IMTs, based on the potential for recurrence. Interventional pulmonology has emerged as a minimally invasive and lung function preserving modality in management of airway obstruction due to tumours. We present a series of three adult patients with IMT treated endobronchially with a short discussion on its potential role. We also discuss how molecular analysis of IMTs for mutations in genes such as ALK and ROS1 might provide insights into clinical behaviour and potential targetable therapy in advanced, unresectable and metastatic cases. Inflammatory myofibroblastic tumours in central airways: bronchoscopic treatment of a “not so pseudo-” tumourhttps://bit.ly/2KgPntq
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Affiliation(s)
- Aparna Iyer
- Dept of Pulmonary Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Teodora Radonic
- Dept of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Lukas C Heukamp
- Institute of Haematopathology Hamburg, Hamburg, Germany.,Lung Cancer Network NOWEL.org, Oldenburg, Germany
| | - Erik Thunnissen
- Dept of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Dept of Pulmonary Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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van Hoorn JE, Dahele M, Daniels JMA. Late Central Airway Toxicity after High-Dose Radiotherapy: Clinical Outcomes and a Proposed Bronchoscopic Classification. Cancers (Basel) 2021; 13:cancers13061313. [PMID: 33804058 PMCID: PMC7999982 DOI: 10.3390/cancers13061313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary High-dose radiotherapy is frequently used to treat lung cancer, however, it can cause serious central airway toxicity. Although radiation toxicity of the lung parenchyma has been studied extensively, relatively little has been published on bronchoscopic findings in the central airways and no standard classification/reporting system exists. With the growing use of high-dose (chemo)radiotherapy and high-dose hypo-fractionated radiotherapy in close proximity to central airways, as well as potential interactions with new systemic therapies, the risks and incidence of central airway toxicity may increase. In this retrospective study, we analyzed patient characteristics and clinical outcomes of 70 patients with central airway toxicity after high-dose radiotherapy. Furthermore, we analyzed the post-radiotherapy bronchoscopic images to identify main patterns of airway toxicity. We identified luminal stenosis and vascular changes as the two main patterns and have proposed a classification system. Preliminary analysis suggests that the pattern and severity of radiation toxicity may be of prognostic value. Abstract The study’s purpose was to identify the bronchoscopic patterns of central airway toxicity following high-dose radiotherapy or chemoradiotherapy, and to look at the consequences of these findings. Our institutional bronchoscopy database was accessed to identify main patterns of airway toxicity observed in a seven-year period. A total of 70 patients were identified with central airway toxicity, and the findings of bronchoscopy were used to derive a classification system. Patient characteristics, time from radiotherapy to toxicity, follow-up and survival were retrospectively analyzed. Results: The main bronchoscopic patterns of airway toxicity were vascular changes (telangiectasia, loss of vascularity, necrosis) and stenosis of the lumen (moderate, severe). Indications for bronchoscopy were airway symptoms (n = 28), assessment post-CRT/surgery (n = 12), (suspected) recurrence (n = 21) or assessment of radiological findings (n = 9). Stenosis was revealed by bronchoscopy at a median time of 10.0 months (IQR: 4–23.5) after radiotherapy and subsequent follow-up after identification was 23 months (IQR: 1.5–55). The corresponding findings for vascular changes were 29 months (IQR: 10.5–48.5), and follow-up after identification was nine months (IQR: 2.5–19.5). There was a statistically significant difference in survival rates between patients with necrosis and telangiectasia (p = 0.002) and loss of vascularity (p = 0.001). Eight out of 10 deceased patients with telangiectasia died of other causes and 4/8 patients with necrosis died of other causes. We identified two main patterns of central airway toxicity visualized with bronchoscopy after high-dose radiotherapy or chemoradiotherapy, and propose a bronchoscopic classification system based on these findings. Preliminary analysis suggests that the pattern and severity of radiation damage might be of prognostic value. Prospective data are required to confirm our findings.
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Affiliation(s)
- Juliët E. van Hoorn
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Correspondence:
| | - Max Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
| | - Johannes M. A. Daniels
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
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Prins HJ, Duijkers R, Daniels JMA, van der Molen T, van der Werf TS, Boersma W. COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD. BMJ Open Respir Res 2021; 8:8/1/e000761. [PMID: 33593795 PMCID: PMC7888334 DOI: 10.1136/bmjresp-2020-000761] [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] [Received: 09/02/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/05/2022] Open
Abstract
Background We developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score. Methods In our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed. Results Eighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach’s apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001). Conclusions c-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD. Trial registration number NCT01232140.
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Affiliation(s)
- Hendrik Johannes Prins
- Department Pulmonary Diseases, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Ruud Duijkers
- Department Pulmonary Diseases, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Johannes M A Daniels
- Pulmonary Diseases, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Thys van der Molen
- Department of Pulmonary Diseases & Tuberculosis, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Tjip S van der Werf
- Infectious diseases Service and Tuberculosis unit, University of Groningen Faculty of Medical Sciences, Groningen, Groningen, The Netherlands
| | - Wim Boersma
- pulmonary disease, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
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12
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Ronden MI, Bahce I, Hashemi SMS, Dickhoff C, de Haan PF, Becker A, Spoelstra FOB, Dahele MR, Ali R, Tiemessen MA, Tarasevych S, Maassen van den Brink K, Haasbeek CJA, Daniels JMA, van Laren M, Verbakel WFAR, Senan S. Factors influencing multi-disciplinary tumor board recommendations in stage III non-small cell lung cancer. Lung Cancer 2020; 152:149-156. [PMID: 33418430 DOI: 10.1016/j.lungcan.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/02/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Treatment patterns in patients with stage III non-small cell lung cancer (NSCLC) vary considerably between countries, for reasons that are not well understood. We studied factors influencing treatment decision-making at thoracic multidisciplinary tumor boards (MDT's) and outcome for patients treated between 2015-2017, at a regional network comprising 5 hospitals. MATERIALS AND METHODS Details of all patients, including comorbidities, with stage III NSCLC were collected in an ethics-approved database. Weekly MDT's were conducted. The preferred radical intent treatments (RIT) for suitable patients were assumed to be concurrent chemoradiotherapy and/or surgery and other therapies were non-radical intent treatments (n-RIT). RESULTS Of 197 patients identified, 95 % were discussed at an MDT. RIT were recommended in 61 % of patients, but only 48 % finally received RIT. The estimated median OS was significantly better for patients undergoing RIT (28.3 months, CI-95 % 17.3-39.3), versus those who did not (11.2 months, CI-95 % 8.0-14.3). Patient age ≥70 years and a WHO-PS ≥2 were the most important predictors of not recommending RIT. Deaths due to progressive lung cancer within 2 years were observed in 36, 26 and 29 % of patients who received RIT, sequential chemoradiotherapy or radical radiotherapy. Corresponding comorbidity related deaths within 2 years were 3, 12 and 38 %. CONCLUSION A large number of patients who underwent MDT review were considered too old or not fit for RIT. More effective and better tolerated systemic treatments are required for patients presenting with stage III NSCLC.
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Affiliation(s)
- Merle I Ronden
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands.
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Sayed M S Hashemi
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Patricia F de Haan
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Femke O B Spoelstra
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Max R Dahele
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Rania Ali
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Marian A Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | | | | | - Cornelis J A Haasbeek
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Marjolein van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Wilko F A R Verbakel
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
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13
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van Huizen LMG, Radonic T, van Mourik F, Seinstra D, Dickhoff C, Daniels JMA, Bahce I, Annema JT, Groot ML. Compact portable multiphoton microscopy reveals histopathological hallmarks of unprocessed lung tumor tissue in real time. Transl Biophotonics 2020; 2:e202000009. [PMID: 34341777 PMCID: PMC8311669 DOI: 10.1002/tbio.202000009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
During lung cancer operations a rapid and reliable assessment of tumor tissue can reduce operation time and potentially improve patient outcomes. We show that third harmonic generation (THG), second harmonic generation (SHG) and two-photon excited autofluorescence (2PEF) microscopy reveals relevant, histopathological information within seconds in fresh unprocessed human lung samples. We used a compact, portable microscope and recorded images within 1 to 3 seconds using a power of 5 mW. The generated THG/SHG/2PEF images of tumorous and nontumorous tissues are compared with the corresponding standard histology images, to identify alveolar structures and histopathological hallmarks. Cellular structures (tumor cells, macrophages and lymphocytes) (THG), collagen (SHG) and elastin (2PEF) are differentiated and allowed for rapid identification of carcinoid with solid growth pattern, minimally enlarged monomorphic cell nuclei with salt-and-pepper chromatin pattern, and adenocarcinoma with lipidic and micropapillary growth patterns. THG/SHG/2PEF imaging is thus a promising tool for clinical intraoperative assessment of lung tumor tissue.
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Affiliation(s)
- Laura M. G. van Huizen
- Faculty of Science, Department of Physics, LaserLabVrije Universiteit AmsterdamAmsterdamNetherlands
| | - Teodora Radonic
- Department of PathologyAmsterdam Universities Medical Center/VU University Medical CenterAmsterdamNetherlands
| | | | - Danielle Seinstra
- Department of PathologyAmsterdam Universities Medical Center/VU University Medical CenterAmsterdamNetherlands
| | - Chris Dickhoff
- Department of SurgeryAmsterdam Universities Medical CenterAmsterdamNetherlands
| | - Johannes M. A. Daniels
- Department of Pulmonary DiseasesAmsterdam Universities Medical CenterAmsterdamNetherlands
| | - Idris Bahce
- Department of Pulmonary DiseasesAmsterdam Universities Medical CenterAmsterdamNetherlands
| | - Jouke T. Annema
- Department of Pulmonary DiseasesAmsterdam Universities Medical CenterAmsterdamNetherlands
| | - Marie Louise Groot
- Faculty of Science, Department of Physics, LaserLabVrije Universiteit AmsterdamAmsterdamNetherlands
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14
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Daniels JMA, Reuling EMBP, Dickhoff C. Endobronchial Treatment of Bronchial Carcinoid in the Elderly. Curr Geri Rep 2020. [DOI: 10.1007/s13670-020-00322-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of the Review
Although surgical resection is considered the gold standard of curative treatment for bronchial carcinoid, endobronchial treatment (EBT) can serve as a less invasive curative or palliative treatment in a selection of patients. It is unclear whether elderly patients with bronchial carcinoid should be treated in the same way as younger patients. In order to study the characteristics and treatment of elderly patients with bronchial carcinoid, we analyzed data from a cohort of patients that have been treated for bronchial carcinoid with EBT, surgical resection, or a combination of both. We used our existing database of patients referred for EBT and defined two groups of patients: ≥ 65 and < 65 years. We compared the characteristics, treatment, and causes of death between these groups. Successful EBT was defined as definitive treatment without signs of recurrence during follow-up with CT and bronchoscopy.
Recent Findings
Thirty-five patients (19%) were ≥ 65 years. The incidence of atypical carcinoid was the same in both age groups (31%). Thirty-six of 184 patients (20%) were directly referred for surgical resection and 148 (80%) underwent EBT. There was no significant difference in success of EBT between patients <65 years (58/122, 48%) and patients ≥ 65 years (15/26, 58%) (p = 0.347). Complication rates were similar in both groups. After unsuccessful EBT, only 70% (14/20) of the elderly patients was operated, whereas 93% (85/91) of the patients < 65 years was operated (p = 0.001). Disease specific mortality was 6% (2/35) in the group ≥ 65 years and 2% (3/149) in the group < 65 years.
Summary
The incidence of atypical carcinoid is similar between the elderly and younger patients. Success rate and complication rate of EBT do not differ significantly between the age groups. After unsuccessful EBT, elderly patients were less likely to undergo surgical resection, which does not seem associated with excess disease specific mortality, although the number of events in this study is low.
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15
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Dickhoff C, Senan S, Schneiders FL, Veltman J, Hashemi S, Daniels JMA, Fransen M, Heineman DJ, Radonic T, van de Ven PM, Bartelink IH, Meijboom LJ, Garcia-Vallejo JJ, Oprea-Lager DE, de Gruijl TD, Bahce I. Ipilimumab plus nivolumab and chemoradiotherapy followed by surgery in patients with resectable and borderline resectable T3-4N0-1 non-small cell lung cancer: the INCREASE trial. BMC Cancer 2020; 20:764. [PMID: 32795284 PMCID: PMC7427738 DOI: 10.1186/s12885-020-07263-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background The likelihood of a tumor recurrence in patients with T3-4N0–1 non-small cell lung cancer following multimodality treatment remains substantial, mainly due distant metastases. As pathological complete responses (pCR) in resected specimens are seen in only a minority (28–38%) of patients following chemoradiotherapy, we designed the INCREASE trial (EudraCT-Number: 2019–003454-83; Netherlands Trial Register number: NL8435) to assess if pCR rates could be further improved by adding short course immunotherapy to induction chemoradiotherapy. Translational studies will correlate changes in loco-regional and systemic immune status with patterns of recurrence. Methods/design This single-arm, prospective phase II trial will enroll 29 patients with either resectable, or borderline resectable, T3-4N0–1 NSCLC. The protocol was approved by the institutional ethics committee. Study enrollment commenced in February 2020. On day 1 of guideline-recommended concurrent chemoradiotherapy (CRT), ipilimumab (IPI, 1 mg/kg IV) and nivolumab (NIVO, 360 mg flat dose IV) will be administered, followed by nivolumab (360 mg flat dose IV) after 3 weeks. Radiotherapy consists of once-daily doses of 2 Gy to a total of 50 Gy, and chemotherapy will consist of a platinum-doublet. An anatomical pulmonary resection is planned 6 weeks after the last day of radiotherapy. The primary study objective is to establish the safety of adding IPI/NIVO to pre-operative CRT, and its impact on pathological tumor response. Secondary objectives are to assess the impact of adding IPI/NIVO to CRT on disease free and overall survival. Exploratory objectives are to characterize tumor inflammation and the immune contexture in the tumor and tumor-draining lymph nodes (TDLN), and to explore the effects of IPI/NIVO and CRT and surgery on distribution and phenotype of peripheral blood immune subsets. Discussion The INCREASE trial will evaluate the safety and local efficacy of a combination of 4 modalities in patients with resectable, T3-4N0–1 NSCLC. Translational research will investigate the mechanisms of action and drug related adverse events. Trial registration Netherlands Trial Registration (NTR): NL8435, Registered 03 March 2020.
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Joris Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Sayed Hashemi
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Marieke Fransen
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Juan J Garcia-Vallejo
- Department of Molecular Cell Biology & Immunology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
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16
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Heuberger JAAC, Posthuma JJ, Ziagkos D, Rotmans JI, Daniels JMA, Gal P, Stuurman FE, Spronk HMH, Ten Cate H, Burggraaf J, Moerland M, Cohen AF. Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes. Eur J Appl Physiol 2020; 120:1893-1904. [PMID: 32537688 PMCID: PMC7340646 DOI: 10.1007/s00421-020-04419-0] [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: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Purpose Recombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations. Methods This double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18–50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort. Results rHuEPO increased P-selectin (+ 7.8% (1.5–14.5), p = 0.02) and E-selectin (+ 8.6% (2.0–15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0–24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6–66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group. Conclusion In conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use. Electronic supplementary material The online version of this article (10.1007/s00421-020-04419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jelle J Posthuma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Henri M H Spronk
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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17
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Hakami A, Zwartkruis E, Radonic T, Daniels JMA. Correction to: Atypical bronchial carcinoid with postobstructive mycobacterial infection: case report and review of literature. BMC Pulm Med 2019; 19:221. [PMID: 31771542 PMCID: PMC6880517 DOI: 10.1186/s12890-019-0988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Please note that an affiliation has been missed from the published article [1].
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Affiliation(s)
- Abdulrahman Hakami
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands. .,Department of Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Evita Zwartkruis
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
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18
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Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Departments of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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19
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Heuberger JAAC, van Eenoo P, Rotmans JI, Gal P, Stuurman FE, Post TE, Daniels JMA, Ram H, de Hon O, Burggraaf J, Cohen AF. Sensitivity and specificity of detection methods for erythropoietin doping in cyclists. Drug Test Anal 2019; 11:1290-1301. [PMID: 31232530 PMCID: PMC6790592 DOI: 10.1002/dta.2665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/12/2022]
Abstract
Recombinant human erythropoietin (rHuEPO) is used as doping a substance. Anti‐doping efforts include urine and blood testing and monitoring the athlete biological passport (ABP). As data on the performance of these methods are incomplete, this study aimed to evaluate the performance of two common urine assays and the ABP. In a randomized, double‐blinded, placebo‐controlled trial, 48 trained cyclists received a mean dose of 6000 IU rHuEPO (epoetin β) or placebo by weekly injection for eight weeks. Seven timed urine and blood samples were collected per subject. Urine samples were analyzed by sarcosyl‐PAGE and isoelectric focusing methods in the accredited DoCoLab in Ghent. A selection of samples, including any with false presumptive findings, underwent a second sarcosyl‐PAGE confirmation analysis. Hematological parameters were used to construct a module similar to the ABP and analyzed by two evaluators from an Athlete Passport Management Unit. Sensitivity of the sarcosyl‐PAGE and isoelectric focusing assays for the detection of erythropoietin abuse were 63.8% and 58.6%, respectively, with a false presumptive finding rate of 4.3% and 6%. None of the false presumptive findings tested positive in the confirmation analysis. Sensitivity was highest between 2 and 6 days after dosing, and dropped rapidly outside this window. Sensitivity of the ABP was 91.3%. Specificity of the urine assays was high; however, the detection window of rHuEPO was narrow, leading to questionable sensitivity. The ABP, integrating longitudinal data, is more sensitive, but there are still subjects that evade detection. Combining these methods might improve performance, but will not resolve all observed shortcomings.
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Affiliation(s)
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | - Herman Ram
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority the Netherlands, Capelle aan den IJssel, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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20
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Feroldi F, Willemse J, Davidoiu V, Gräfe MGO, van Iperen DJ, Goorsenberg AWM, Annema JT, Daniels JMA, Bonta PI, de Boer JF. In vivo multifunctional optical coherence tomography at the periphery of the lungs. Biomed Opt Express 2019; 10:3070-3091. [PMID: 31259075 PMCID: PMC6583343 DOI: 10.1364/boe.10.003070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 05/04/2023]
Abstract
Remodeling of tissue, such as airway smooth muscle (ASM) and extracellular matrix, is considered a key feature of airways disease. No clinically accepted diagnostic method is currently available to assess airway remodeling or the effect of treatment modalities such as bronchial thermoplasty in asthma, other than invasive airway biopsies. Optical coherence tomography (OCT) generates cross-sectional, near-histological images of airway segments and enables identification and quantification of airway wall layers based on light scattering properties only. In this study, we used a custom motorized OCT probe that combines standard and polarization sensitive OCT (PS-OCT) to visualize birefringent tissue in vivo in the airway wall of a patient with severe asthma in a minimally invasive manner. We used optic axis uniformity (OAxU) to highlight the presence of uniformly arranged fiber-like tissue, helping visualizing the abundance of ASM and connective tissue structures. Attenuation coefficient images of the airways are presented for the first time, showing superior architectural contrast compared to standard OCT images. A novel segmentation algorithm was developed to detect the surface of the endoscope sheath and the surface of the tissue. PS-OCT is an innovative imaging technique that holds promise to assess airway remodeling including ASM and connective tissue in a minimally invasive, real-time manner.
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Affiliation(s)
- Fabio Feroldi
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
| | - Joy Willemse
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
- These authors contributed equally
| | - Valentina Davidoiu
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
- These authors contributed equally
| | - Maximilian G. O. Gräfe
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
| | - Dirck J. van Iperen
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
| | - Annika W. M. Goorsenberg
- Amsterdam University Medical Center, Department of Pulmonology, University of Amsterdam, Amsterdam, the Netherlands
| | - Jouke T. Annema
- Amsterdam University Medical Center, Department of Pulmonology, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes M. A. Daniels
- Amsterdam University Medical Center, Department of Pulmonology, VUmc Location, Amsterdam, the Netherlands
| | - Peter I. Bonta
- Amsterdam University Medical Center, Department of Pulmonology, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes F. de Boer
- LaserLaB Amsterdam and Department of Physics and Astronomy, VU University Amsterdam, de Boelelaan 1081, 1081HV, Amsterdam, the Netherlands
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21
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Prins HJ, Duijkers R, van der Valk P, Schoorl M, Daniels JMA, van der Werf TS, Boersma WG. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions. Eur Respir J 2019; 53:13993003.02014-2018. [PMID: 30880285 DOI: 10.1183/13993003.02014-2018] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/02/2019] [Indexed: 11/05/2022]
Abstract
The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L-1).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted odds ratio (OR) 0.178, 95% CI 0.077-0.411, p=0.029). The 30-day treatment failure rate was nearly equal (44.5% in the CRP group versus 45.5% in the GOLD-group, p=0.881; adjusted OR 1.146, 95% CI 0.649-1.187, p=0.630), as was the time to next exacerbation (32 days in the CRP group versus 28 days in the GOLD group, p=0.713; adjusted hazard ratio 0.878, 95% CI 0.649-1.187, p=0.398). Length of stay was similar in both groups (7 days in the CRP group versus 6 days in the GOLD group, p=0.206). On day-30, no difference in symptom score, quality of life or serious adverse events was detected.Use of CRP as a biomarker to guide antibiotic treatment in severe acute exacerbations of COPD leads to a significant reduction in antibiotic treatment. In the present study, no differences in adverse events between both groups were found. Further research is needed for the generalisability of these findings.
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Affiliation(s)
- H J Prins
- Dept Pulmonary Diseases, Northwest Hospital, Alkmaar, The Netherlands
| | - Ruud Duijkers
- Dept Pulmonary Diseases, Northwest Hospital, Alkmaar, The Netherlands
| | - Paul van der Valk
- Dept of Pulmonary Diseases, Medic Spectrum Twente, Enschede, The Netherlands
| | - Marianne Schoorl
- Dept of Clinical Chemistry, Haematology and Immunology, Northwest Hospital, Alkmaar, The Netherlands
| | - Johannes M A Daniels
- Dept of Pulmonary Diseases, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Tjip S van der Werf
- University of Groningen, Dept of Pulmonary Diseases and Tuberculosis, University Medical Center, Groningen, The Netherlands
| | - Wim G Boersma
- Dept Pulmonary Diseases, Northwest Hospital, Alkmaar, The Netherlands
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22
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Reuling EMBP, Dickhoff C, Plaisier PW, Bonjer HJ, Daniels JMA. Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review. Lung Cancer 2019; 134:85-95. [PMID: 31320001 DOI: 10.1016/j.lungcan.2019.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 11/09/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 12/26/2022]
Abstract
The treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.
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Affiliation(s)
- E M B P Reuling
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands.
| | - C Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - P W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - H J Bonjer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - J M A Daniels
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
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23
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Hakami A, Zwartkruis E, Radonic T, Daniels JMA. Atypical bronchial carcinoid with postobstructive mycobacterial infection: case report and review of literature. BMC Pulm Med 2019; 19:41. [PMID: 30767776 PMCID: PMC6376781 DOI: 10.1186/s12890-019-0806-x] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary carcinoids are included in the group of neuroendocrine tumors (NET) and derive from pulmonary neuroendocrine cells. The incidence of these tumors is increasing, but disease awareness remains low among clinicians. The synchronous presentation of lung cancer and mycobacterial infection is well known but the combination of pulmonary carcinoid and mycobacterial infection is rare. CASE PRESENTATION We treated a 45-year-old female who presented with recurrent pneumonia. Chest X-ray showed a consolidation in the left upper lobe. The patient was treated with various courses of antibiotics without full recovery after six months. Computed tomography (CT) scan demonstrated a central mass in the left upper lobe. Bronchoscopy revealed an endobronchial, well-defined lesion that totally obstructed the left upper lobe bronchus. Bronchial biopsy showed typical carcinoid tumor. Rigid bronchoscopy with electrocautery was attempted, but we were unable to radically remove the tumor. Therefore lobectomy was performed. The surgical pathology specimen showed atypical bronchial carcinoid and consolidations in the lung parenchyma with granulomatous inflammation distally of the bronchial obstruction. Ziehl-Neelsen staining demonstrated acid fast bacilli indicative of mycobacterial infection. CONCLUSIONS This case history illustrates the importance of careful surgical pathologic examination, not only of the resected tumor, but also of the postobstructive lung parenchyma. Specific postobstructive infections such as tuberculosis or nontuberculous mycobacteria (NTM) can have clinical implications.
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Affiliation(s)
- Abdulrahman Hakami
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Evita Zwartkruis
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
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24
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Smeijsters KMG, Bijkerk RM, Daniels JMA, van de Ven PM, Girbes ARJ, Heunks LMA, Spijkstra JJ, Tuinman PR. Effect of Bronchoscopy on Gas Exchange and Respiratory Mechanics in Critically Ill Patients With Atelectasis: An Observational Cohort Study. Front Med (Lausanne) 2018; 5:301. [PMID: 30483505 PMCID: PMC6243639 DOI: 10.3389/fmed.2018.00301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Atelectasis frequently develops in critically ill patients and may result in impaired gas exchange among other complications. The long-term effects of bronchoscopy on gas exchange and the effects on respiratory mechanics are largely unknown. Objective: To evaluate the effect of bronchoscopy on gas exchange and respiratory mechanics in intensive care unit (ICU) patients with atelectasis. Methods: A retrospective, single-center cohort study of patients with clinical indication for bronchoscopy because of atelectasis diagnosed on chest X-ray (CXR). Results: In total, 101 bronchoscopies were performed in 88 ICU patients. Bronchoscopy improved oxygenation (defined as an increase of PaO2/FiO2 ratio > 20 mmHg) and ventilation (defined as a decrease of > 2 mmHg in partial pressure of CO2 in arterial blood) in 76 and 59% of procedures, respectively, for at least 24 h. Patients with a low baseline value of PaO2/FiO2 ratio and a high baseline value of PaCO2 were most likely to benefit from bronchoscopy. In addition, in intubated and pressure control ventilated patients, respiratory mechanics improved after bronchoscopy for up to 24 h. Mild complications, and in particular desaturation between 80 and 90%, were reported in 13% of the patients. Conclusions: In selected critically ill patients with atelectasis, bronchoscopy improves oxygenation, ventilation, and respiratory mechanics for at least 24 h.
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Affiliation(s)
- Kim M G Smeijsters
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald M Bijkerk
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Anesthesiology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Armand R J Girbes
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Leo M A Heunks
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Jan Jaap Spijkstra
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
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25
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van Hoorn JE, Dahele M, Daniels JMA. Bronchoscopic Manifestations of Airway Toxicity After Radiotherapy. Clin Lung Cancer 2018; 19:e875-e878. [PMID: 30197260 DOI: 10.1016/j.cllc.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/02/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Juliët E van Hoorn
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Max Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
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26
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Reuling EMBP, Dickhoff C, Plaisier PW, Coupé VMH, Mazairac AHA, Lely RJ, Bonjer HJ, Daniels JMA. Author's Reply. Respiration 2018; 96:205. [PMID: 29953996 DOI: 10.1159/000489985] [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: 11/19/2022] Open
Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert H A Mazairac
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Rutger J Lely
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
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27
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Bousema JE, Dijkgraaf MGW, Papen-Botterhuis NE, Schreurs HW, Maessen JG, van der Heijden EH, Steup WH, Braun J, Noyez VJJM, Hoeijmakers F, Beck N, van Dorp M, Claessens NJM, Hiddinga BI, Daniels JMA, Heineman DJ, Zandbergen HR, Verhagen AFTM, van Schil PE, Annema JT, van den Broek FJC. MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): study protocol of a multicenter randomised controlled trial. BMC Surg 2018; 18:27. [PMID: 29776444 PMCID: PMC5960166 DOI: 10.1186/s12893-018-0359-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/02/2018] [Indexed: 12/24/2022] Open
Abstract
Background In case of suspicious lymph nodes on computed tomography (CT) or fluorodeoxyglucose positron emission tomography (FDG-PET), advanced tumour size or central tumour location in patients with suspected non-small cell lung cancer (NSCLC), Dutch and European guidelines recommend mediastinal staging by endosonography (endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS)) with sampling of mediastinal lymph nodes. If biopsy results from endosonography turn out negative, additional surgical staging of the mediastinum by mediastinoscopy is advised to prevent unnecessary lung resection due to false negative endosonography findings. We hypothesize that omitting mediastinoscopy after negative endosonography in mediastinal staging of NSCLC does not result in an unacceptable percentage of unforeseen N2 disease at surgical resection. In addition, omitting mediastinoscopy comprises no extra waiting time until definite surgery, omits one extra general anaesthesia and hospital admission, and may be associated with lower morbidity and comparable survival. Therefore, this strategy may reduce health care costs and increase quality of life. The aim of this study is to compare the cost-effectiveness and cost-utility of mediastinal staging strategies including and excluding mediastinoscopy. Methods/design This study is a multicenter parallel randomized non-inferiority trial comparing two diagnostic strategies (with or without mediastinoscopy) for mediastinal staging in 360 patients with suspected resectable NSCLC. Patients are eligible for inclusion when they underwent systematic endosonography to evaluate mediastinal lymph nodes including tissue sampling with negative endosonography results. Patients will not be eligible for inclusion when PET/CT demonstrates ‘bulky N2-N3’ disease or the combination of a highly suspicious as well as irresectable mediastinal lymph node. Primary outcome measure for non-inferiority is the proportion of patients with unforeseen N2 disease at surgery. Secondary outcome measures are hospitalization, morbidity, overall 2-year survival, quality of life, cost-effectiveness and cost-utility. Patients will be followed up 2 years after start of treatment. Discussion Results of the MEDIASTrial will have immediate impact on national and international guidelines, which are accessible to public, possibly reducing mediastinoscopy as a commonly performed invasive procedure for NSCLC staging and diminishing variation in clinical practice. Trial registration The trial is registered at the Netherlands Trial Register on July 6th, 2017 (NTR 6528). Electronic supplementary material The online version of this article (10.1186/s12893-018-0359-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.,University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- University of Amsterdam, Amsterdam, the Netherlands.,Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Hermien W Schreurs
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erik H van der Heijden
- Department of Pulmonary Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem H Steup
- Department of Surgery, HagaZiekenhuis, Den Haag, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Naomi Beck
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Martijn van Dorp
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Niels J M Claessens
- Department of Pulmonary Medicine, Rijnstate ziekenhuis, Arnhem, the Netherlands
| | - Birgitta I Hiddinga
- Department of Pulmonary Medicine, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Harmen R Zandbergen
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul E van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jouke T Annema
- University of Amsterdam, Amsterdam, the Netherlands.,Department of Pulmonary Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Frank J C van den Broek
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.
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28
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Reuling EMBP, Dickhoff C, Plaisier PW, Coupé VMH, Mazairac AHA, Lely RJ, Bonjer HJ, Daniels JMA. Endobronchial Treatment for Bronchial Carcinoid: Patient Selection and Predictors of Outcome. Respiration 2018; 95:220-227. [PMID: 29433123 DOI: 10.1159/000484984] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/15/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditionally, surgical resection is the preferred treatment for typical carcinoids and atypical carcinoids located in the lungs. Recently however, several studies have shown excellent long-term outcome after endobronchial treatment of carcinoid tumors located in the central airways. This study investigates clinical and radiological features as predictors of successful endobronchial treatment in patients with a bronchial carcinoid tumor. OBJECTIVES To identify clinical and radiological features predictive of successful endobronchial treatment in patients with bronchial carcinoid. METHODS This analysis was performed in a cohort of patients with typical and atypical bronchial carcinoid referred for endobronchial treatment. Several patient characteristics, radiological features, and histological grade (typical or atypical carcinoid) were tested as predictors of successful endobronchial treatment. RESULTS One hundred and twenty-five patients with a diagnosis of bronchial carcinoid underwent endobronchial treatment. On multivariate analysis, a tumor diameter <15 mm (odds ratio 0.09; 95% confidence interval 0.02-0.5; p = <0.01) and purely intraluminal growth on computer tomography (CT scan) (odds ratio, 9.1; 95% confidence interval 1.8-45.8; p = <0.01) were predictive of radical endobronchial treatment. The success rate for intraluminal tumors with a diameter <20 mm was 72%. CONCLUSIONS Purely intraluminal disease and tumor diameter on CT scan seem to be independent predictors for successful endobronchial treatment in patients with bronchial carcinoid. Based on these data, patients with purely intraluminal carcinoid tumors with a diameter <20 mm on CT scan are good candidates for endobronchial treatment, regardless of histological grade. In contrast, all patients with a tumor diameter ≥20 mm should be directly referred for surgery.
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Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert H A Mazairac
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Rutger J Lely
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
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29
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, Daniels JMA, de Kam ML, Cohen AF. Erythropoietin on cycling performance - Authors' reply. Lancet Haematol 2017; 4:e462-e464. [PMID: 28962681 DOI: 10.1016/s2352-3026(17)30181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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30
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Heuberger JAAC, Rotmans JI, Gal P, Stuurman FE, van 't Westende J, Post TE, Daniels JMA, Moerland M, van Veldhoven PLJ, de Kam ML, Ram H, de Hon O, Posthuma JJ, Burggraaf J, Cohen AF. Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. Lancet Haematol 2017; 4:e374-e386. [PMID: 28669689 DOI: 10.1016/s2352-3026(17)30105-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Substances that potentially enhance performance (eg, recombinant human erythropoietin [rHuEPO]) are considered doping and are therefore forbidden in sports; however, the scientific evidence behind doping is frequently weak. We aimed to determine the effects of rHuEPO treatment in well trained cyclists on maximal, submaximal, and race performance and on safety, and to present a model clinical study for doping research on other substances. METHODS We did this double-blind, randomised, placebo-controlled trial at the Centre for Human Drug Research in Leiden (Netherlands). We enrolled healthy, well trained but non-professional male cyclists aged 18-50 years and randomly allocated (1:1) them to receive abdominal subcutaneous injections of rHuEPO (epoetin β; mean dose 6000 IU per week) or placebo (0·9% NaCl) for 8 weeks. Randomisation was stratified by age groups (18-34 years and 35-50 years), with a code generated by a statistician who was not masked to the study. The primary outcome was exercise performance, measured as maximal power output (Pmax), maximal oxygen consumption VO2 max, and gross efficiency in maximal exercise tests with 25 W increments per 5 min, as lactate threshold and ventilatory threshold 1 (VT1) and 2 (VT2) at submaximal levels during the maximal exercise test, and as mean power, VO2, and heart rate in the submaximal exercise tests at the highest mean power output for 45 min in a laboratory setting and in a race to the Mont Ventoux (France) summit, using intention-to-treat analyses. The trial is registered with the Dutch Trial Registry (Nederlands Trial Register), number NTR5643. FINDINGS Between March 7, 2016, and April 13, 2016, we randomly assigned 48 participants to the rHuEPO group (n=24) or the placebo group (n=24). Mean haemoglobin concentration (9·6 mmol/L vs 9·0 mmol/L [estimated difference 0·6, 95% CI 0·4 to 0·8]) and maximal power output (351·55 W vs 341·23 W [10·32, 3·47 to 17·17]), and VO2 max (60·121 mL/min per kg vs 57·415 mL/min per kg [2·707, 0·911 to 4·503]) in a maximal exercise test were higher in the rHuEPO group compared with the placebo group. Submaximal exercise test parameters mean power output (283·18 W vs 277·28 W [5·90, -0·87 to 12·67]) and VO2 (50·288 mL/min per kg vs 49·642 mL/min per kg [0·646, -1·307 to 2·600]) at day 46, and Mont Ventoux race times (1 h 40 min 32 s vs 1 h 40 min 15 s [0·3%, -8·3 to 9·6]) did not differ between groups. All adverse events were grade 1-2 and were similar between both groups. No events of grade 3 or worse were observed. INTERPRETATION Although rHuEPO treatment improved a laboratory test of maximal exercise, the more clinically relevant submaximal exercise test performance and road race performance were not affected. This study shows that clinical studies with doping substances can be done adequately and safely and are relevant in determining effects of alleged performance-enhancing drugs. FUNDING Centre for Human Drug Research, Leiden.
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Affiliation(s)
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands
| | | | - Juliëtte van 't Westende
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Titiaan E Post
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | | | | | | | - Herman Ram
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Olivier de Hon
- Anti-Doping Authority of the Netherlands, Capelle aan de IJssel, Netherlands
| | - Jelle J Posthuma
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands; Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
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Bekkers S, Rijken JA, Daniels JMA, Rinkel RNPM, Hendrickx JJ, Eerenstein SEJ. Silver Nitrate Aspiration: A Potentially Life-Threatening Complication. Am J Respir Crit Care Med 2017; 195:e43-e46. [DOI: 10.1164/rccm.201603-0625im] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stijn Bekkers
- Department of Otolaryngology-Head and Neck Surgery and
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Paff T, Daniels JMA, Weersink EJ, Lutter R, Vonk Noordegraaf A, Haarman EG. A randomised controlled trial on the effect of inhaled hypertonic saline on quality of life in primary ciliary dyskinesia. Eur Respir J 2017; 49:49/2/1601770. [PMID: 28232410 DOI: 10.1183/13993003.01770-2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/25/2016] [Indexed: 11/05/2022]
Abstract
Hypertonic saline inhalation lowers airway mucous viscosity. Increased cough transportability may improve quality of life (QoL) in primary ciliary dyskinesia (PCD).In this randomised controlled trial (RCT), PCD patients received twice-daily inhalations of hypertonic (7%) saline or isotonic (0.9%) saline for 12 weeks, with 4 weeks washout during crossover. Primary outcome was change in QoL measured by the St George's Respiratory Questionnaire (SGRQ) total score. Secondary outcomes were SGRQ subscores, Quality of Life Questionnaire-Bronchiectasis (QoL-B) scores, lower respiratory tract infection symptoms, exacerbations, spirometry, systemic and sputum inflammatory markers, adherence, and adverse events.There was no significant change in median (interquartile range) SGRQ total score between hypertonic saline (-2.6 (-9.0-1.5)) and isotonic saline (-0.3 (-8.1-6.1)) in 22 patients (age range 22-73 years) (p=0.38). QoL-B Health Perception scale improved with hypertonic saline (p=0.03). Adverse events occurred more frequently with hypertonic saline, but were mild.12 weeks of inhaled hypertonic saline did not improve SGRQ total score in adult PCD patients in this RCT, but the sample size was small. On the secondary and more disease-specific end-point of the QoL-B, a significant improvement was observed in the Health Perception scale. This study found little evidence to support the hypothesis that hypertonic saline improves QoL in PCD patients. We advise the use of disease-specific outcome measures in future trials.
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Affiliation(s)
- Tamara Paff
- Dept of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands .,Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.,Dept of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Dept of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Els J Weersink
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - René Lutter
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Dept of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric G Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
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van Boerdonk RAA, Smesseim I, Heideman DAM, Coupé VMH, Tio D, Grünberg K, Thunnissen E, Snijders PJF, Postmus PE, Smit EF, Daniels JMA, Sutedja TG. Close Surveillance with Long-Term Follow-up of Subjects with Preinvasive Endobronchial Lesions. Am J Respir Crit Care Med 2015; 192:1483-9. [DOI: 10.1164/rccm.201504-0822oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Prins HJ, Daniels JMA, Lindeman JH, Lutter R, Boersma WG. Effects of doxycycline on local and systemic inflammation in stable COPD patients, a randomized clinical trial. Respir Med 2015; 110:46-52. [PMID: 26616678 DOI: 10.1016/j.rmed.2015.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 01/14/2023]
Abstract
UNLABELLED Neutrophilic inflammation plays a causal role in Chronic Obstructive Pulmonary Disease (COPD). Neutrophil derived myeloperoxidase(MPO) matrix metalloproteinases(MMP's), and elastases are thought to contribute to the perpetuation of the disease. The tetracycline analogue doxycycline has been shown to inhibit neutrophil-mediated inflammation. It was thus reasoned that doxycycline may attenuate neutrophil-mediated inflammation in COPD. METHODS In this double blind randomized controlled trial the effect of a 3-week course of doxycycline on sputum and systemic inflammatory parameters was evaluated in stable COPD patients. In order to exclude inflammation by bacterial colonisation patients must have 2 negative sputum cultures in the previous year. The effect of doxycycline treatment on inflammatory markers (TNF-α, IL-1β and IL-6) and neutrophil specific markers in sputum (MPO, MMP's, and IL-8) and serum C-reactive protein was evaluated. Sputum was obtained by sputum induction with hypertonic saline. RESULTS A total of 41 patients were included. Ten patients were excluded as they were not able to produce sputum at the first or second visit. Baseline characteristics were similar in the two groups. In the remaining patients doxycycline did not influence sputum MPO concentrations. Also MMP-8 and 9, IL-6 and IL-8 concentrations as well as lung function parameters were not affected by doxycycline. Systemic inflammation by means of CRP was also not influenced by doxycycline. CONCLUSION A three week course of doxycycline did not influence MPO sputum levels nor any of the other inflammatory sputum and systemic markers. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00857038 URL: clinicaltrials.gov.
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Affiliation(s)
- Hendrik J Prins
- Department Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jan H Lindeman
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - René Lutter
- Department of Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Respiratory Medicine and Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim G Boersma
- Department Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, The Netherlands.
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Dickhoff C, Daniels JMA, van den Brink A, Paul MA, Verhagen AFTM. Does hyperbaric oxygen therapy prevent airway anastomosis from breakdown? Ann Thorac Surg 2015; 99:682-5. [PMID: 25639406 DOI: 10.1016/j.athoracsur.2014.03.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/27/2014] [Accepted: 03/26/2014] [Indexed: 10/24/2022]
Abstract
Ischemia with subsequent necrosis of anastomoses, after central airway resection and reconstruction, remains a feared complication for thoracic surgeons and their patients. To date, there is no evidence to support the use of hyperbaric oxygen in the prevention of necrosis of airway reconstructions in humans. We present a patient who underwent central airway surgery with postoperative ischemia of an end-to-side anastomosis. Repeat visit to a hyperbaric oxygen chamber seemed to prevent the anastomosis from subsequent necrosis and dehiscence with complete healing as a result. In conclusion, hyperbaric oxygen treatment can be considered when ischemia or necrosis is observed in central airway anastomoses during postoperative bronchoscopic surveillance.
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Affiliation(s)
- Chris Dickhoff
- Department of Cardiothoracic Surgery, VU University Medical Centre, Amsterdam; Department of Surgery, VU University Medical Centre, Amsterdam.
| | | | - Ad van den Brink
- Department of Hyperbaric Medicine, Academic Medical Centre, Amsterdam
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Centre, Amsterdam
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Shah PL, Daniels JMA. Training for bronchoscopists: is less more? Respiration 2015; 89:190-1. [PMID: 25676906 DOI: 10.1159/000375317] [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: 11/19/2022] Open
Affiliation(s)
- Pallav L Shah
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, UK
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Li J, Feroldi F, de Lange J, Daniels JMA, Grünberg K, de Boer JF. Polarization sensitive optical frequency domain imaging system for endobronchial imaging. Opt Express 2015; 23:3390-402. [PMID: 25836196 DOI: 10.1364/oe.23.003390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A polarization sensitive endoscopic optical frequency domain imaging (PS-OFDI) system with a motorized distal scanning catheter is demonstrated. It employs a passive polarization delay unit to multiplex two orthogonal probing polarization states in depth, and a polarization diverse detection unit to detect interference signal in two orthogonal polarization channels. Per depth location four electro-magnetic field components are measured that can be represented in a complex 2x2 field matrix. A Jones matrix of the sample is derived and the sample birefringence is extracted by eigenvalue decomposition. The condition of balanced detection and the polarization mode dispersion are quantified. A complex field averaging method based on the alignment of randomly pointing field phasors is developed to reduce speckle noise. The variation of the polarization states incident on the tissue due to the circular scanning and catheter sheath birefringence is investigated. With this system we demonstrated imaging of ex vivo chicken muscle, in vivo pig lung and ex vivo human lung specimens.
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Abstract
Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder affecting motile cilia. This can lead to neonatal respiratory distress, early onset upper and lower airway infections, laterality abnormalities and sub- or infertility. Although disease progression shows large individual variability, all adult patients eventually develop extensive bronchiectasis. As in cystic fibrosis, early diagnosis and frequent follow-up with microbiological control is the best therapeutic strategy, as other treatment options are lacking. PCD is underdiagnosed and diagnosed late due to clinical unawareness, limited availability of diagnostic tests and difficult interpretation of test results. Diagnosis is currently based on a combination of assessment of ciliary motion and ultrastructure by high-speed video microscopy and electron microscopy, respectively. As nasal nitric oxide is low in almost all PCD patients, these measurements can be used for screening. Although there are 26 PCD genes known so far, the genetic basis of the disease has not been unraveled in an estimated 30-40% of patients. However, the rapid discovery of novel PCD genes in recent years is expected to enable accurate genetic characterization of most patients in the near future. Large-scale use of next-generation sequencing and the availability of large ciliary proteomic and transcriptomic databases accelerate the identification of novel PCD genes, especially those that play a key role in cytoplasmic assembly of ciliary ultrastructural components. These genetic advances are revolutionizing the process of obtaining a molecular diagnosis for PCD as we speak and may ultimately lead to an increased understanding of ciliogenesis and function, providing novel handles for therapeutic interventions in PCD patients.
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Affiliation(s)
- Tamara Paff
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands; Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands; Department of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerard Pals
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric G Haarman
- Department of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
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van Rossum JA, Looysen EE, Daniels JMA, Killestein J. Fingolimod-induced asthma deterioration in a patient with relapsing-remitting multiple sclerosis. Mult Scler 2014; 20:1792-3. [PMID: 24866203 DOI: 10.1177/1352458514531844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J A van Rossum
- VU University Medical Center, Amsterdam, The Netherlands
| | - E E Looysen
- VU University Medical Center, Amsterdam, The Netherlands
| | - J M A Daniels
- VU University Medical Center, Amsterdam, The Netherlands
| | - J Killestein
- MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Heuberger JAAC, Cohen Tervaert JM, Schepers FML, Vliegenthart ADB, Rotmans JI, Daniels JMA, Burggraaf J, Cohen AF. Erythropoietin doping in cycling: lack of evidence for efficacy and a negative risk-benefit. Br J Clin Pharmacol 2014; 75:1406-21. [PMID: 23216370 DOI: 10.1111/bcp.12034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/09/2012] [Indexed: 11/29/2022] Open
Abstract
Imagine a medicine that is expected to have very limited effects based upon knowledge of its pharmacology and (patho)physiology and that is studied in the wrong population, with low-quality studies that use a surrogate end-point that relates to the clinical end-point in a partial manner at most. Such a medicine would surely not be recommended. The use of recombinant human erythropoietin (rHuEPO) to enhance performance in cycling is very common. A qualitative systematic review of the available literature was performed to examine the evidence for the ergogenic properties of this drug, which is normally used to treat anaemia in chronic renal failure patients. The results of this literature search show that there is no scientific basis from which to conclude that rHuEPO has performance-enhancing properties in elite cyclists. The reported studies have many shortcomings regarding translation of the results to professional cycling endurance performance. Additionally, the possibly harmful side-effects have not been adequately researched for this population but appear to be worrying, at least. The use of rHuEPO in cycling is rife but scientifically unsupported by evidence, and its use in sports is medical malpractice. What its use would have been, if the involved team physicians had been trained in clinical pharmacology and had investigated this properly, remains a matter of speculation. A single well-controlled trial in athletes in real-life circumstances would give a better indication of the real advantages and risk factors of rHuEPO use, but it would be an oversimplification to suggest that this would eradicate its use.
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van Boerdonk RAA, Daniels JMA, Snijders PJF, Grünberg K, Thunnissen E, van de Wiel MA, Ylstra B, Postmus PE, Meijer CJLM, Meijer GA, Smit EF, Sutedja TG, Heideman DAM. DNA copy number aberrations in endobronchial lesions: a validated predictor for cancer. Thorax 2013; 69:451-7. [PMID: 24227199 DOI: 10.1136/thoraxjnl-2013-203821] [Citation(s) in RCA: 11] [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] [Indexed: 01/16/2023]
Abstract
We recently identified a DNA copy number aberration (CNA)-based classifier, including changes at 3p26.3-p11.1, 3q26.2-29, and 6p25.3-24.3, as a risk predictor for cancer in individuals presenting with endobronchial squamous metaplasia. The current study was set out to validate the prediction accuracy of this classifier in an independent series of endobronchial squamous metaplastic and dysplastic lesions. The study included 36 high-risk subjects who had endobronchial lesions of various histological grades that were identified and biopsied by autofluorescence bronchoscopy and were subjected to arrayCGH in a nested case-control design. Of the 36 patients, 12 had a carcinoma in situ or invasive carcinoma at the same site at follow-up (median 11 months, range 4-24), while 24 controls remained cancer free (78 months, range 21-142). The previously defined CNA-based classifier demonstrated 92% (95% CI 77% to 98%) accuracy for cancer (in situ) prediction. All nine subjects with CNA-based classifier-positive endobronchial lesions at baseline experienced cancer outcome, whereas all 24 controls and 3 cases were classified as being low risk. In conclusion, CNAs prove to be a highly accurate biomarker for assessing the progression risk of endobronchial squamous metaplastic and dysplastic lesions. This classifier could assist in selecting subjects with endobronchial lesions who might benefit from more aggressive therapeutic intervention or surveillance.
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Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available.
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Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Diseases, Z 4A48, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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VAN Boerdonk RAA, Brokx HAP, Lee P, Kooi C, Postmus PE, Snijders PJF, Grünberg K, Thunnissen E, Sutedja TG, Daniels JMA, Heideman DAM. Can quantifying free-circulating DNA in plasma be used to identify subjects with high-grade pre-invasive endobronchial lesions? Oncol Lett 2013; 5:1591-1594. [PMID: 23761824 PMCID: PMC3678857 DOI: 10.3892/ol.2013.1262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/30/2012] [Indexed: 11/19/2022] Open
Abstract
Increased concentrations of free-circulating plasma DNA (cpDNA) are observed in patients with invasive cancer, including lung cancer. Whether cpDNA levels are elevated in subjects with high-grade pre-invasive lesions of lung squamous cell carcinoma (SqCC) and whether its detection may be of value for identifying subjects at the highest risk of developing lung SqCC is currently unknown. The present study assessed cpDNA levels in subjects with high- and low-grade pre-invasive squamous endobronchial lesions relative to patients with clinically overt lung SqCC and healthy controls using real-time quantitative PCR methodology. The median cpDNA levels of the patients with invasive lung SqCC (n=16) were significantly higher compared with those of the healthy controls (n=16; P<0.01), whereas the cpDNA levels in the subjects with pre-invasive lesions (n=20) did not differ from those of the controls (P=0.29). The cpDNA levels in subjects with high-grade pre-invasive lesions were highly similar to those diagnosed with low-grade pre-invasive lesions (P=0.85). Our data suggest that cpDNA levels are not increased during the pre-invasive stages of lung squamous carcinogenesis.
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Paff T, van der Schee MP, Daniels JMA, Pals G, Postmus PE, Sterk PJ, Haarman EG. Exhaled molecular profiles in the assessment of cystic fibrosis and primary ciliary dyskinesia. J Cyst Fibros 2013; 12:454-60. [PMID: 23361110 DOI: 10.1016/j.jcf.2012.12.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 09/03/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Early diagnosis and monitoring of disease activity are essential in cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). We aimed to establish exhaled molecular profiles as the first step in assessing the potential of breath analysis. METHODS Exhaled breath was analyzed by electronic nose in 25 children with CF, 25 with PCD and 23 controls. Principle component reduction and canonical discriminant analysis were used to construct internally cross-validated ROC curves. RESULTS CF and PCD patients had significantly different breath profiles when compared to healthy controls (CF: sensitivity 84%, specificity 65%; PCD: sensitivity 88%, specificity 52%) and from each other (sensitivity 84%, specificity 60%). Patients with and without exacerbations had significantly different breath profiles (CF: sensitivity 89%, specificity 56%; PCD: sensitivity 100%, specificity 90%). CONCLUSION Exhaled molecular profiles significantly differ between patients with CF, PCD and controls. The eNose may have potential in disease monitoring based on the influence of exacerbations on the VOC-profile.
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Affiliation(s)
- T Paff
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Li J, de Groot M, Helderman F, Mo J, Daniels JMA, Grünberg K, Sutedja TG, de Boer JF. High speed miniature motorized endoscopic probe for optical frequency domain imaging. Opt Express 2012; 20:24132-24138. [PMID: 23187176 DOI: 10.1364/oe.20.024132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We present a miniature motorized endoscopic probe for Optical Coherence Tomography with an outer diameter of 1.65 mm and a rotation speed of 3,000-12,500 rpm. This is the smallest motorized high speed OCT probe to our knowledge. The probe has a motorized distal end which provides a significant advantage over proximally driven probes since it does not require a drive shaft to transfer the rotational torque to the distal end of the probe and functions without a fiber rotary junction. The probe has a focal Full Width at Half Maximum of 9.6 µm and a working distance of 0.47 mm. We analyzed the non uniform rotation distortion and found a location fluctuation of only 1.87° in repeated measurements of the same object. The probe was integrated in a high-speed Optical Frequency Domain Imaging setup at 1310 nm to acquire images from ex vivo pig lung tissue through the working channel of a human bronchoscope.
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Affiliation(s)
- Jianan Li
- Institute for Lasers, Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands
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van Schoor NM, de Jongh RT, Daniels JMA, Heymans MW, Deeg DJH, Lips P. Peak expiratory flow rate shows a gender-specific association with vitamin D deficiency. J Clin Endocrinol Metab 2012; 97:2164-71. [PMID: 22472566 DOI: 10.1210/jc.2011-3199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT To our knowledge, no previous studies examined the longitudinal relationship between vitamin D status and pulmonary function in a population-based sample of older persons. OBJECTIVE Our objective was to examine the cross-sectional as well as the longitudinal relationship between vitamin D status and peak expiratory flow rate (PEFR) in a representative sample of the Dutch older population. DESIGN, SETTING, AND PARTICIPANTS Participants included men and women in the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people. MAIN OUTCOME MEASURE PEFR was measured using the mini-Wright peak flow meter. RESULTS Men with serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (25 nmol/liter) had a significantly lower PEFR in the cross-sectional analyses, and men with serum 25-OHD levels below 20 ng/ml (50 nmol/liter) had a significantly lower PEFR in the longitudinal analyses as compared with men with serum 25-OHD levels above 30 ng/ml (75 nmol/liter) (cross-sectional: β = -47.0, P = 0.01 for serum 25-OHD <10 ng/ml; longitudinal: β = -45.0, P < 0.01 for serum 25-OHD <10 ng/ml; and β = -20.2, P = 0.03 for serum 25-OHD = 10-20 ng/ml in the fully adjusted models). Physical performance (β = -32.5, P = 0.08 for serum 25-OHD <10 ng/ml) and grip strength (β = -40.0, P = 0.03 for serum 25-OHD <10 ng/ml) partly mediated the cross-sectional associations but not the longitudinal associations. In women, statistically significant associations between 25-OHD and PEFR were observed in the cross-sectional analyses after adjustment for age and season of blood collection but not in the fully adjusted models or in the longitudinal analyses. CONCLUSIONS A strong relationship between serum 25-OHD and PEFR was observed in older men, both in the cross-sectional as well as longitudinal analyses, but not in older women. The association in men could partly be explained by physical performance and muscle strength.
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Affiliation(s)
- N M van Schoor
- EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands.
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van Boerdonk RAA, Sutedja TG, Snijders PJF, Reinen E, Wilting SM, van de Wiel MA, Thunnissen FEBJM, Duin S, Kooi C, Ylstra B, Meijer CJLM, Meijer GA, Grünberg K, Daniels JMA, Postmus PE, Smit EF, Heideman DAM. DNA copy number alterations in endobronchial squamous metaplastic lesions predict lung cancer. Am J Respir Crit Care Med 2011; 184:948-56. [PMID: 21799074 DOI: 10.1164/rccm.201102-0218oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Autofluorescence bronchoscopy (AFB) is a valid strategy for detecting premalignant endobronchial lesions. However, no biomarker can reliably predict lung cancer risk of subjects with AFB-visualized premalignant lesions. OBJECTIVES The present study set out to identify AFB-visualized squamous metaplastic (SqM) lesions with malignant potential by DNA copy number profiling. METHODS Regular AFB examinations in 474 subjects at risk of lung cancer identified six subjects with SqM lesions at baseline, and carcinoma in situ or carcinoma (carcinoma in situ or greater) at the initial SqM site at follow-up bronchoscopy. These progressive SqM lesions were compared for immunostaining pattern and array comparative genomic hybridization-based chromosomal profiles with 23 SqM lesions of subjects who remained cancer-free. Specific DNA copy number alterations (CNAs) linked to cancer risk were identified and accuracy of CNAs to predict endobronchial cancer in this series was determined. MEASUREMENTS AND MAIN RESULTS At baseline, p53, p63, and Ki-67 immunostaining were not predictive for a differential clinical outcome of SqM lesions. The mean number of CNAs in baseline SqM of cases was significantly higher compared with control subjects (P < 0.01). Chromosomal regions significantly more frequently altered in SqM of cases were 3p26.3-p11.1, 3q26.2-q29, 9p13.3-p13.2, and 17p13.3-p11.2 (family-wise error rate <0.10). CNAs were specifically detected at the site of future cancer. In cases, baseline-detected CNAs persisted in subsequent biopsies taken from the initial site, and levels increased toward cancer progression. In this series, a model based on CNAs at 3p26.3-p11.1, 3q26.2-29, and 6p25.3-24.3 predicted cancer with 97% accuracy. CONCLUSIONS The data suggest that the presence of specific CNAs in SqM lesions predict endobronchial cancer.
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Affiliation(s)
- Robert A A van Boerdonk
- VU University Medical Center, Department of Pathology, De Boelelaan 1117, Amsterdam, The Netherlands
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Daniels JMA, Boersma WG. Criteria for Antibiotic Therapy in Acute Exacerbations of COPD. Am J Respir Crit Care Med 2010. [DOI: 10.1164/ajrccm.182.9.1207a] [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: 11/16/2022] Open
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Daniels JMA, Schoorl M, Snijders D, Knol DL, Lutter R, Jansen HM, Boersma WG. Procalcitonin vs C-reactive protein as predictive markers of response to antibiotic therapy in acute exacerbations of COPD. Chest 2010; 138:1108-15. [PMID: 20576731 DOI: 10.1378/chest.09-2927] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rational prescription of antibiotics in acute exacerbations of COPD (AECOPD) requires predictive markers. We aimed to analyze whether markers of systemic inflammation can predict response to antibiotics in AECOPD. METHODS We used data from 243 exacerbations out of 205 patients from a placebo-controlled trial on doxycycline in addition to systemic corticosteroids for AECOPD. Clinical and microbiologic response, serum C-reactive protein (CRP) level (cutoffs 5 and 50 mg/L), and serum procalcitonin level (PCT) (cutoffs 0.1 and 0.25 μg) were assessed. RESULTS Potential bacterial pathogens were identified in the majority of exacerbations (58%). We found a modest positive correlation between PCT and CRP (r = 0.46, P < .001). The majority of patients (75%) had low PCT levels, with mostly elevated CRP levels. Although CRP levels were higher in the presence of bacteria (median, 33.0 mg/L [interquartile range, 9.75-88.25] vs 17 mg/L [interquartile range, 5.0-61.0] [P = .004]), PCT levels were similar. PCT and CRP performed similarly as markers of clinical success, and we found a clinical success rate of 90% in patients with CRP ≤ 5 mg/L. A significant effect of doxycycline was observed in patients with a PCT level < .1 μg/L (treatment effect, 18.4%; P = .003). A gradually increasing treatment effect of antibiotics (6%, 10%, and 18%), although not significant, was found for patients with CRP values of ≤ 5, 6-50, and > 50 mg/L, respectively. CONCLUSIONS Contrary to the current literature, this study suggests that patients with low PCT values do benefit from antibiotics. CRP might be a more valuable marker in these patients.
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