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Ma Y, Zeng J, Ding F, Xu Y, Wang Y, Zhong G, Liu N, Wang Y, Li Y, Chen S, Wei X, Zhu P, Jian G, Niu YS, Fu G, Liu C, Li G, Zhou X, Zhang A, Weng S. Cerebral 18F-FDG PET/CT Metabolism as Diagnostic Signature for Central Nervous System Toxicity After Immune Checkpoint Blockade Cancer Treatment. J Nucl Med 2024:jnumed.123.267025. [PMID: 38697671 DOI: 10.2967/jnumed.123.267025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Our aim was to investigate probable biomarkers specific to immune-related central nervous system toxicity (CNST) in cancer patients treated with immune checkpoint inhibitors (ICI) by analysis of 18F-FDG PET/CT images. Methods: Cancer patients receiving ICI treatment were enrolled in a multicenter observational study that analyzed regional metabolic changes before and during CNST onset from January 2020 to February 2022. In 1:1 propensity score-matched pairs, the regional SUVmean of each bilateral brain lobe of CNST patients (CNST+) was compared with that of patients who had central nervous system infections (CNSIs) and patients without CNST or CNSI (CNST-). In a validation cohort, patients were recruited from February 2022 to July 2023 and followed up for 24 wk after the start of ICI. Early changes in regional SUVmean at 5-6 wk after therapy initiation were evaluated for ability to predict later CNST onset. Results: Of 6,395 ICI-treated patients, 2,387 underwent prognostic 18F-FDG PET/CT and 125 of the scanned patients had CNST (median time from ICI treatment to onset, 9 wk; quartile range, 2-23 wk). Regional 18F-FDG PET/CT SUVmean changes were higher in CNST+ than in CNST- patients (117 patient pairs) but were lower than in CNSI patients (50 pairs). Differentiating analysis reached an area under the curve (AUC) of 0.83 (95% CI, 0.78-0.88) for CNST+ versus CNST- and of 0.80 (95% CI, 0.72-0.89) for CNST+ versus CNSI. Changes in SUVmean were also higher before CNST onset than for CNST- (60 pairs; AUC, 0.74; 95% CI, 0.66-0.83). In a validation cohort of 2,878 patients, preonset changes in SUVmean reached an AUC of 0.86 (95% CI, 0.79-0.94) in predicting later CNST incidence. Conclusion: Brain regional hypermetabolism could be detected during and before CNST clinical onset. CNST may be a distinct pathologic entity versus brain infections defined by 18F-FDG PET/CT brain scans. Regional SUV differences may be translated into early diagnostic tools based on moderate differentiating accuracy in our study.
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Affiliation(s)
- Yifei Ma
- Department of Hepatobiliary and Pancreatic Surgery, Institute of Abdominal Surgery, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, and Department of Hepatobiliary and Pancreatic Surgery, National Regional Medical Center Binhai Campus, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiling Zeng
- Department of Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Fadian Ding
- Department of Hepatobiliary and Pancreatic Surgery, Institute of Abdominal Surgery, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, and Department of Hepatobiliary and Pancreatic Surgery, National Regional Medical Center Binhai Campus, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yiwei Xu
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Youlong Wang
- Department of General Surgery, Hainan Hospital of People's Liberation Army General Hospital, Sanya, China
| | - Guanqing Zhong
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Nianqi Liu
- Faculty of Psychology, Institute of Educational Science, Huazhong University of Science and Technology, Wuhan, China
| | - Yanqi Wang
- Department of Orthopedics and Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, China
| | - Shuqin Chen
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Xiaolong Wei
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Pengfei Zhu
- Department of Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangmin Jian
- Department of Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Si Niu
- Acute Communicable Disease Epidemiology Division, Dallas County Health and Human Services, Dallas, Texas
| | - Guangzhen Fu
- Key Clinical Laboratory of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; and
| | - Cantong Liu
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Guiqiang Li
- Department of Orthopedics and Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaotong Zhou
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ao Zhang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China;
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shangeng Weng
- Department of Hepatobiliary and Pancreatic Surgery, Institute of Abdominal Surgery, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, and Department of Hepatobiliary and Pancreatic Surgery, National Regional Medical Center Binhai Campus, First Affiliated Hospital of Fujian Medical University, Fuzhou, China;
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Ma Y, Zeng J, Jiang Y, Xu YW, Wang Y, Zhong G, Liu N, Wang Y, Zhang Z, Li Y, Chen S, Wei XL, Zhu P, Jian G, Lyu X, Niu YS, Li M, Liang S, Fu G, He S, Liu C, Zhang A, Wang X. Thyroid function and associated mood changes after COVID-19 vaccines in patients with Hashimoto thyroiditis. Front Immunol 2023; 14:1129746. [PMID: 37090700 PMCID: PMC10117681 DOI: 10.3389/fimmu.2023.1129746] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Context Severe acute respiratory syndrome-coronavirus 2 (COVID-19) vaccines may incur changes in thyroid functions followed by mood changes, and patients with Hashimoto thyroiditis (HT) were suggested to bear a higher risk. Objectives We primarily aim to find whether COVID-19 vaccination could induce potential subsequent thyroid function and mood changes. The secondary aim was to find inflammatory biomarkers associated with risk. Methods The retrospective, multi-center study recruited patients with HT receiving COVID-19-inactivated vaccines. C-reactive proteins (CRPs), thyroid-stimulating hormones (TSHs), and mood changes were studied before and after vaccination during a follow-up of a 6-month period. Independent association was investigated between incidence of mood state, thyroid functions, and inflammatory markers. Propensity score-matched comparisons between the vaccine and control groups were carried out to investigate the difference. Results Final analysis included 2,765 patients with HT in the vaccine group and 1,288 patients in the control group. In the matched analysis, TSH increase and mood change incidence were both significantly higher in the vaccine group (11.9% versus 6.1% for TSH increase and 12.7% versus 8.4% for mood change incidence). An increase in CRP was associated with mood change (p< 0.01 by the Kaplan-Meier method) and severity (r = 0.75) after vaccination. Baseline CRP, TSH, and antibodies of thyroid peroxidase (anti-TPO) were found to predict incidence of mood changes. Conclusion COVID-19 vaccination seemed to induce increased levels and incidence of TSH surge followed by mood changes in patients with HT. Higher levels of pre-vaccine serum TSH, CRP, and anti-TPO values were associated with higher incidence in the early post-vaccine phase.
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Affiliation(s)
- Yifei Ma
- Orthopedics and Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiling Zeng
- Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, Guangdong, China
| | - Yongluo Jiang
- Nuclear Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, Guangdong, China
| | - Yi-Wei Xu
- Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Youlong Wang
- General Surgery, Hainan Branch of People’s Liberation Army General Hospital, Sanya, Hainan, China
| | - Guanqing Zhong
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Nianqi Liu
- Faculty of Psychology, Institute of Educational Science, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanqi Wang
- Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- School of Public Health, Shantou University, Shantou, Guangdong, China
| | - Zhiying Zhang
- School of Public Health, Shantou University, Shantou, Guangdong, China
- Bone and Soft Tissue Oncology, Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yiming Li
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuqin Chen
- Pathology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiao-Long Wei
- Pathology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Pengfei Zhu
- Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guangmin Jian
- Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiajie Lyu
- Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yu Si Niu
- Acute Communicable Disease Epidemiology Division, Dallas County Health and Human Services, Dallas, TX, United States
| | - Mingwei Li
- Pediatric Dentistry, The Stomatological Hospital Affiliated to medical school of Nanjing university, Nanjing, China
| | - Shuang Liang
- Teaching Department for Students with Cerebral Palsy, Shanghai Pudong New District Special Education School, Shanghai, China
| | - Guangzhen Fu
- Clinical Laboratory, Key Clinical Laboratory of Henan Province, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shaohui He
- Orthopaedic Oncology, No.905 Hospital of People's Liberation Army (PLA) Navy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - CanTong Liu
- Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ao Zhang
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Ao Zhang, ; Xinjia Wang,
| | - Xinjia Wang
- Orthopedics and Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Ao Zhang, ; Xinjia Wang,
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Radcliffe C, Gisriel S, Niu YS, Peaper D, Delgado S, Grant M. Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study. Open Forum Infect Dis 2021; 8:ofab098. [PMID: 33884279 PMCID: PMC8047863 DOI: 10.1093/ofid/ofab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Pyomyositis is a bacterial infection of skeletal muscle that classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Approximately half of all patients received >1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies that prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.
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Affiliation(s)
| | - Savanah Gisriel
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yu Si Niu
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Peaper
- Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Santiago Delgado
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Matthew Grant
- Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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Radcliffe C, Doilicho N, Niu YS, Grant M. Efficacy and safety of chronic antimicrobial suppression therapy for left ventricular assist device driveline infections: A single-center descriptive experience. Transpl Infect Dis 2020; 22:e13379. [PMID: 32574417 DOI: 10.1111/tid.13379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/24/2020] [Accepted: 06/12/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Driveline infection (DLI) is the most common left ventricular assist device (LVAD) infectious complication. Short-term antimicrobial therapy and local debridement are the cornerstones of management for these infections, but the use of chronic antimicrobial suppression (CAS) therapy is not well characterized. METHODS To better characterize the efficacy of CAS therapy, we performed a retrospective review of all patients (N = 219) receiving care at our tertiary transplant center with continuous-flow LVADs placed between August 2007 and July 2019. RESULTS A total of 24 patients were identified as having received CAS therapy as treatment for DLIs. The mean age was 56 years, 50% were female, and chronic kidney disease affected 63% of patients. Staphylococcus aureus accounted for half of all initial DLIs, and the mean length of CAS therapy was 486 days (range 48-2287 days). All patients received per os regimens as suppression therapy. Adverse events impacted 5 of 24 patients (0.43 events per 1000 days). Overall, the use of CAS therapy led to successful outcomes in 50% of patients and 29% experienced treatment failures. The remaining patients experienced stable symptoms. Relapses were the most common cause of treatment failure, and three patients experienced reinfections while on CAS therapy. CONCLUSIONS Our study suggests that CAS therapy for DLIs can be well tolerated, and future studies are needed to determine which patients merit suppression.
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Affiliation(s)
| | | | - Yu Si Niu
- Yale School of Medicine, New Haven, CT, USA
| | - Matthew Grant
- Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale New Haven Hospital, New Haven, CT, USA
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