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Sun JR, Lou YN, Huang R, Li KX, Jia LQ. Predictive value of TCM tongue characteristics for chemotherapy-induced myelosuppression in patients with lung cancer. Medicine (Baltimore) 2024; 103:e37636. [PMID: 38608065 PMCID: PMC11018151 DOI: 10.1097/md.0000000000037636] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to investigate the clinical predictors, including traditional Chinese medicine tongue characteristics and other clinical parameters for chemotherapy-induced myelosuppression (CIM), and then to develop a clinical prediction model and construct a nomogram. A total of 103 patients with lung cancer were prospectively enrolled in this study. All of them were scheduled to receive first-line chemotherapy regimens. Participants were randomly assigned to either the training group (n = 52) or the test group (n = 51). Tongue characteristics and clinical parameters were collected before the start of chemotherapy, and then the incidence of myelosuppression was assessed after treatment. We used univariate logistic regression analysis to identify the risk predictors for assessing the incidence of CIM. Moreover, we developed a predictive model and a nomogram using multivariate logistic regression analysis. Finally, we evaluated the predictive performance of the model by examining the area under the curve value of the receiver operating characteristic, calibration curve, and decision curve analysis. As a result, a total of 3 independent predictors were found to be associated with the CIM in multivariate regression analysis: the fat tongue (OR = 3.67), Karnofsky performance status score (OR = 0.11), and the number of high-toxic drugs in chemotherapy regimens (OR = 4.78). Then a model was constructed using these 3 predictors and it exhibited a robust predictive performance with an area under the curve of 0.82 and the consistent calibration curves. Besides, the decision curve analysis results suggested that applying this predictive model can result in more net clinical benefit for patients. We established a traditional Chinese medicine prediction model based on the tongue characteristics and clinical parameters, which could serve as a useful tool for assessing the risk of CIM.
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Affiliation(s)
- Jian-Rong Sun
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, PR China
- Oncology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Yan-Ni Lou
- Oncology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Rong Huang
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, PR China
- Oncology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Kai-Xuan Li
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, PR China
- Oncology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Li-Qun Jia
- Oncology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, PR China
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Liu C, Ma G, Xu X, Song S, Yang Z. Can 18F-FES PET Improve the Evaluation of 18F-FDG PET in Patients With Metastatic Invasive Lobular Carcinoma? Clin Nucl Med 2024; 49:301-307. [PMID: 38427956 DOI: 10.1097/rlu.0000000000005085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) exhibits a low affinity for 18F-FDG. The estrogen receptor (ER) is commonly expressed in ILCs, suggesting a potential benefit of targeting with the ER probe 18F-FES in this patient population. The objective of this study was to evaluate the diagnostic performance of 18F-FES imaging in patients with metastatic ILC and compare it with that of 18F-FDG. METHODS We conducted a retrospective analysis of 20 ILC patients who underwent concurrent 18F-FES and 18F-FDG PET/CT examinations in our center. 18F-FES and 18F-FDG imaging were analyzed to determine the total count of tracer-avid lesions in nonbone sites and their corresponding organ systems, assess the extent of anatomical regions involved in bone metastases, and measure the SUVmax values for both tracers. RESULTS Among 20 ILC patients, 65 nonbone lesions were found to be distributed in 13 patients, and 16 patients were diagnosed with bone metastasis, which was distributed in 54 skeletal anatomical regions. The detection rate of 18F-FDG in nonbone lesions was higher than that of 18F-FES (57 vs 37, P < 0.001). 18F-FES demonstrated a superior ability to detect nonbone lesions in 4 patients, whereas 18F-FDG was superior in 5 patients (P > 0.05). Among 9/16 patients with bone metastasis, 18F-FES demonstrated a significant advantage in the detection of bone lesions compared with 18F-FDG (P = 0.05). Furthermore, patients with only 18F-FES-positive lesions (12/12) were administered endocrine regimens, whereas patients lacking 18F-FES uptake (2/3) predominantly received chemotherapy. CONCLUSIONS 18F-FES is more effective than 18F-FDG in detecting bone metastasis in ILC, but it does not demonstrate a significant advantage in nonbone lesions. Additionally, the results of examination with 18F-FES have the potential to guide patient treatment plans.
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Cheong SCW, Yan YY, Sheikh A, Ouellette HA, Munk PL, Murray N, Mallinson PI. Dual-energy CT applications in musculoskeletal disorders. Br J Radiol 2024; 97:705-715. [PMID: 38291893 PMCID: PMC11027318 DOI: 10.1093/bjr/tqae023] [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: 07/30/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Dual-energy CT (DECT) is an exciting application in CT technology conferring many advantages over conventional single-energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow oedema detection, metal artefact reduction, monosodium urate analysis, and collagen analysis for ligamentous, meniscal, and disc injuries are made possible through its advanced DECT post-processing capabilities. These provide superior information on tissue composition, artefact reduction and image optimization. Newer DECT applications to evaluate fat fraction for sarcopenia, Rho/Z application for soft tissue calcification differentiation, 3D rendering, and AI integration are being assessed for future use. In this article, we will discuss the established and developing applications of DECT in the setting of MSK radiology as well as the basic principles of DECT which facilitate them.
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Affiliation(s)
- Sook Chuei W Cheong
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Yet Yen Yan
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Adnan Sheikh
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Hugue A Ouellette
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Peter L Munk
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Nicolas Murray
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Paul I Mallinson
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
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Wang E, Zhao Y, Parks S, Siddiqi I. Myelokathexis in an 18-year-old male patient with severe neutropenia and lymphopenia. Am J Hematol 2024; 99:459-460. [PMID: 37740922 DOI: 10.1002/ajh.27097] [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: 08/02/2023] [Revised: 08/15/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Endi Wang
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yue Zhao
- Department of Pathology, College of Basic Medical Sciences and the First Hospital, China Medical University, Shenyang, People's Republic of China
| | - Sophie Parks
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Imran Siddiqi
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Zhou Y, Wang L, Sun LR, Zhang L, Wang HM, Liu XT, Yang F, Wu KL, Liang YL, Zhao BB, Zhuang Y, Fu JQ, Song C, Li Y, Wang LZ, Xu HJ, Gu Y, van den Anker J, Ju XL, Zhu XF, Zhao W. Individualized Use of 6-Mercaptopurine in Chinese Children with ALL: A Multicenter Randomized Controlled Trial. Clin Pharmacol Ther 2024; 115:213-220. [PMID: 37753808 DOI: 10.1002/cpt.3061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
Continuous 6-mercaptopurine (6-MP) dose titration is necessary because of its narrow therapeutic index and frequently encountered dose-limiting hematopoietic toxicity. However, evidence-based guidelines for gene-based 6-MP dosing have not been established for Chinese children with acute lymphoblastic leukemia (ALL). This multicenter, randomized, open-label, active-controlled clinical trial randomly assigned Chinese children with low- or intermediate-risk ALL in a 1:1 ratio to receive TPMT-NUDT15 gene-based dosing of 6-MP (N = 44, 10 to 50 mg/m2 /day) or standard dosing (N = 44, 50 mg/m2 /day) during maintenance therapy. The primary end point was the incidence of 6-MP myelosuppression in both groups. Secondary end points included frequencies of 6-MP hepatotoxicity, duration of myelosuppression and leukopenia, event-free survival, and steady-state concentrations of active metabolites (6-thioguaninenucleotides and 6-methylmercaptopurine nucleotides) in erythrocytes. A 2.2-fold decrease in myelosuppression, the primary end point, was observed in the gene-based-dose group using ~ 50% of the standard initial 6-MP dose (odds ratio, 0.26, 95% confidence interval, 0.11 to 0.64, P = 0.003). Patients in the gene-based-dose group had a significantly lower risk of developing thiopurine-induced myelosuppression and leukopenia (P = 0.015 and P = 0.022, respectively). No significant differences were observed in the secondary end points of the incidence of hepatotoxicity and steady-state concentrations of active metabolites in erythrocytes between the two groups. TPMT- and NUDT15-based dosing of 6-MP will significantly contribute toward further reducing the incidence of leukopenia in Chinese children with ALL. This trial is registered at www.clinicaltrial.gov as #NCT04228393.
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Affiliation(s)
- Yue Zhou
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li Wang
- Department of Pediatric Hematology Oncology, Children's Hospital of Hebei Province affiliated to Hebei Medical University, Shijiazhuang, China
| | - Li-Rong Sun
- Department of Pediatrics Hematology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Zhang
- Department of Pediatrics, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Hong-Mei Wang
- Department of Pediatrics, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xi-Ting Liu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Fan Yang
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ke-Liang Wu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu-Li Liang
- Department of Pediatric Hematology Oncology, Children's Hospital of Hebei Province affiliated to Hebei Medical University, Shijiazhuang, China
| | - Bei-Bei Zhao
- Department of Pediatrics, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yong Zhuang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Jin-Qiu Fu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Chao Song
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Yun Li
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Ling-Zhen Wang
- Department of Pediatrics Hematology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui-Juan Xu
- Department of Pediatrics Hematology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Gu
- Department of Pediatrics, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA
- Departments of Pediatrics, Pharmacology & Physiology, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - Xiu-Li Ju
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao-Fan Zhu
- Department of Pediatrics, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Shandong University, Jinan, China
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Raya JG, Duarte A, Wang N, Mazzoli V, Jaramillo D, Blamire AM, Dietrich O. Applications of Diffusion-Weighted MRI to the Musculoskeletal System. J Magn Reson Imaging 2024; 59:376-396. [PMID: 37477576 DOI: 10.1002/jmri.28870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application-specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2-70 msec) and the need for sub-millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion-weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- José G Raya
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Alejandra Duarte
- Division of Musculoskeletal Radiology, Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana, USA
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, Indiana, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Andrew M Blamire
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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Lee MH, Song A, Li JY. Erythroid variant evolving from chronic myeloid leukemia resistant to multiple tyrosine kinase inhibitors: a rare case report. Diagn Pathol 2024; 19:21. [PMID: 38268039 PMCID: PMC10807181 DOI: 10.1186/s13000-024-01446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Chronic myeloid leukemia (CML) is characterized by the presence of BCR::ABL1 fusion gene resulting from a reciprocal translocation, t(9;22)(q34;q11.2), leading to prominent granulocytic proliferation. The majority of patients initially present in chronic phase (CP), which may progress to advanced CML with predominantly granulocytic phenotypes in the absence of proper treatment or response to tyrosine kinase inhibitors (TKIs). We present an exceptionally rare case in which an erythroid variant emerged from a CML patient resistant to multiple TKIs. This variant is characterized by the detection of t(9;22) BCR::ABL1 fusion in erythroid precursors at various maturation stages and the absence of granulocytic progenitor hyperplasia typically seen in classical CML. CASE PRESENTATION A 33-year-old female with CP-CML had received multiple TKI therapies since her initial diagnosis in 2015. Due to intolerable side effects and inconsistent adherence, she exhibited an inadequate response and developed new-onset pancytopenia. Bone marrow (BM) biopsy specimen revealed a hypercellular marrow with significant erythroid hyperplasia (90% of marrow cellularity) and a reversed myeloid-to-erythroid (M: E) ratio of 1:10. Both erythroid and myeloid cells displayed progressive maturation without dysplasia or excess blasts. Chromosomal analysis identified t(9;22) (q34;q11.2) in 19 out of 20 metaphase cells. BCR::ABL1 fusion transcript (p210 isoform) was confirmed by real-time quantitative polymerase chain reaction (RT-qPCR) and next-generation sequencing (NGS). Notably, no additional pathogenic cytogenetic abnormalities or ABL1 kinase domain mutations were detected. Here, we report the first published case of an erythroid variant emerging in a CML patient resistant to multiple TKIs-a distinct entity from the erythroid blast crisis evolving from CML. CONCLUSION The erythroid variant of CML is distinguished by the presence of t(9;22) (q34;q11.2) BCR::ABL1 in predominant erythroid precursors at different stages of maturation. In a myeloid neoplasm showing predominant erythroid hyperplasia without typical CML features, it is vital to correlate morphology and t(9;22) BCR::ABL1 cytogenetic testing for accurate diagnosis, and to prevent confusion with PEL transformation in CML.
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MESH Headings
- Female
- Humans
- Adult
- Tyrosine Kinase Inhibitors
- Hyperplasia
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid
- Biopsy
- Bone Marrow Diseases
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Affiliation(s)
- Michelle Hyunju Lee
- Department of Medical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Amy Song
- Department of Internal Medicine, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 100032, USA
| | - Julie Y Li
- Department of Hematopathology and Lab Medicines, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
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Maher AK, Aristodemou A, Giang N, Tanaka Y, Bangham CR, Taylor GP, Dominguez-Villar M. HTLV-1 induces an inflammatory CD4+CD8+ T cell population in HTLV-1-associated myelopathy. JCI Insight 2024; 9:e173738. [PMID: 38193535 PMCID: PMC10906466 DOI: 10.1172/jci.insight.173738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/15/2023] [Indexed: 01/10/2024] Open
Abstract
Human T cell leukemia virus type 1 (HTLV-1) is a retrovirus with preferential CD4+ T cell tropism that causes a range of conditions spanning from asymptomatic infection to adult T cell leukemia and HTLV-1-associated myelopathy (HAM), an inflammatory disease of the CNS. The mechanisms by which HTLV-1 induces HAM are poorly understood. By directly examining the ex vivo phenotype and function of T cells from asymptomatic carriers and patients with HAM, we show that patients with HAM have a higher frequency of CD4+CD8+ double-positive (DP) T cells, which are infected with HTLV-1 at higher rates than CD4+ T cells. Displaying both helper and cytotoxic phenotypes, these DP T cells are highly proinflammatory and contain high frequencies of HTLV-1-specific cells. Mechanistically, we demonstrate that DP T cells arise by direct HTLV-1 infection of CD4+ and CD8+ T cells. High levels of CD49d and CXCR3 expression suggest that DP T cells possess the ability to migrate to the CNS, and when cocultured with astrocytes, DP T cells induce proinflammatory astrocytes that express high levels of CXCL10, IFN-γ, and IL-6. These results demonstrate the potential of DP T cells to directly contribute to CNS pathology.
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Affiliation(s)
- Allison K. Maher
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Aris Aristodemou
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nicolas Giang
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Yuetsu Tanaka
- Laboratory of Hematoimmunology, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Charles R.M. Bangham
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
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Wang Y, Wang C, Yan M. Myelopathy resulting from degenerative atlantoaxial subluxation. Eur Spine J 2024; 33:176-184. [PMID: 37659971 DOI: 10.1007/s00586-023-07860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/09/2023] [Accepted: 07/07/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS). METHODS Patients with DAAS treated in our institution from 2003 to 2020 were retrospectively reviewed. We utilized the Japanese Orthopedic Association (JOA) scale to evaluate the neurologic status and distance of Ranawat et al. (DOR) to measure vertical migration. RESULTS We recruited 40 patients with > 2 years of follow-up and an average age of 62.3 ± 7.7 years. All the patients had myelopathy; only one patient had moderate trauma before exacerbation of symptoms, and the duration of symptoms was 34 ± 36 months. The most frequent radiological features were vertical migration of C1 (100%), sclerosis (100%), and narrowing of the atlantoaxial lateral mass articulations (100%). Two patients underwent transoral release combined with posterior reduction and fusion, and 38 patients underwent posterior reduction and fusion with C1 lateral mass screws-C2 pedicle screws and plate systems only. Forty cases (100%) achieved a solid atlantoaxial fusion, and 38 cases (95%) achieved anatomic atlantoaxial reduction. The JOA score increased from 9.3 ± 2.6 to 14.8 ± 2.1 (P < 0.01). DOR increased from 14.5 ± 2.5 to 17.8 ± 2.2 mm at the final follow-up (P < 0.01). Loosening of the locking caps was detected in one case, bony fusion was achieved, and harvest-site pain was reported in five patients. CONCLUSION DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. We recommend anatomic reduction as an optimal strategy for DAAS.
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Affiliation(s)
- Yongqiang Wang
- Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Chao Wang
- Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China.
| | - Ming Yan
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
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Kaufman RM. T-cell lymphopenia in frequent volunteer platelet donors. Hematology Am Soc Hematol Educ Program 2023; 2023:305-310. [PMID: 38066852 PMCID: PMC10727108 DOI: 10.1182/hematology.2023000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In the United States, more than 2 000 000 apheresis platelet units are collected annually from volunteer donors. Platelet donors in the United States and elsewhere are permitted to donate up to 24 times per year. Recently, frequent apheresis platelet donation has been associated with severe T-cell lymphopenia. Several frequent platelet donors have been found to have peripheral blood CD4+ T-cell counts below 200 cells/µL, the threshold for AIDS in HIV-positive individuals. Independent risk factors for plateletpheresis-associated lymphopenia include lifetime donations, age, and donations on the Trima Accel instrument (Terumo BCT), which uses a leukoreduction system (LRS) chamber to trap white blood cells. Less often, severe lymphopenia can occur in donors collected on the Fenwal Amicus instrument (Fresenius Kabi), which has no LRS. For Trima Accel donors, lymphopenia can be partially mitigated by performing a plasma rinseback step at the end of collection. To date, there is no definitive evidence that plateletpheresis-associated lymphopenia is harmful. In a study of frequent platelet donors with lymphopenia who were administered COVID-19 messenger RNA vaccines, immune responses were normal. The homeostatic mechanisms responsible for maintaining a normal peripheral blood T-cell count remain obscure, as do the causal mechanisms underlying plateletpheresis-associated lymphopenia.
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Tadokoro K, Nakada Y, Sasaki R, Nakano Y, Yunoki T, Shin K, Taoka M, Ninomiya K, Nomura E, Takemoto M, Morihara R, Yamashita T. A Unique Case of Sarcoid-associated Myelopathy Accompanied by Lung Cancer. Intern Med 2023; 62:3531-3535. [PMID: 37062734 PMCID: PMC10749799 DOI: 10.2169/internalmedicine.0943-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/26/2023] [Indexed: 04/18/2023] Open
Abstract
The differential diagnosis of myelopathy in patients with malignancies may be challenging, as a spinal biopsy is not always applicable. A 66-year-old woman who had shown transient double vision and nausea developed spasticity and impaired deep sensation in both feet. Magnetic resonance imaging showed abnormal gadolinium enhancement of the brainstem, spinal meninges, and nerve root. Cerebrospinal fluid (CSF) revealed mild pleocytosis and elevated protein and decreased glucose levels, although CSF cytology was normal. Lung carcinoma was simultaneously detected, and noncaseating granuloma was detected from the hilar and axillary lymph nodes, so she was diagnosed with sarcoid-associated myelopathy. Her symptoms were kept stable by intravenous methylprednisolone, oral prednisolone, and methotrexate. This is the first case of sarcoid-associated myelopathy accompanied by lung cancer, suggesting the importance of clinical course, repetitive CSF cytology, and a biopsy of the lymph nodes to distinguish sarcoid-associated myelopathy from meningeal metastasis in patients with malignancies.
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Affiliation(s)
- Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yumi Nakada
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yumiko Nakano
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Taijun Yunoki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kotaro Shin
- Center for Graduate Medical Education, Okayama University, Japan
| | - Masataka Taoka
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Kiichiro Ninomiya
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Emi Nomura
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryuta Morihara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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Ouyang F, Wu Q, Duan B, Yuan X, Wang B, Chen Y, Yin M, Zeng X. Diagnosis of spinal dural arteriovenous fistula: a multimodal MRI assessment strategy. Clin Radiol 2023; 78:e958-e965. [PMID: 37821323 DOI: 10.1016/j.crad.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
AIM To identify more specific screening indicators at magnetic resonance imaging (MRI) for the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) and to determine an efficient diagnostic strategy. MATERIALS AND METHODS This retrospective study analysed clinical and imaging data of patients diagnosed with SDAVF and alternative myelopathy who underwent conventional MRI examinations. Additionally, three-dimensional (3D) T2-weighted sampling perfection with application-optimised contrasts using different flip-angle evolutions (3D-T2-SPACE) and contrast-enhanced magnetic resonance angiography (CE-MRA) data from patients with SDAVF were compared with digital subtraction angiography (DSA) data. RESULTS The age of onset, perimedullary flow voids (PFV), distribution of lesions, syringomyelia, degree of spinal oedema, and cauda equina disorder (CED) were factors that showed statistically significance in the identification of SDAVF with alternative myelopathy. After controlling for age, gender, PFV, degree of spinal cord swelling, and syringomyelia, the multivariable ordinal logistic regression model showed that the CED sign (OR = 32.46; 95% confidence interval [CI]: 2.47-427.15; p=0.008) was an independent predictor for SDAVF. The diagnostic model constructed using the PFV and CED signs had better diagnostic performance, with an area under the curve of 0.957 (p<0.001), maximum Youden index of 0.844, sensitivity of 92.9%, and specificity of 91.5%. Both 3D-T2-SPACE (77.8%) and CE-MRA (83.3%) sequences had good localisation values for SDAVF. Combining the two imaging examinations had better diagnostic accuracy than that of DSA. CONCLUSION CED and PFV on conventional MRI were specific indicators for the diagnosis of SDAVF. To compensate for the lack of fistula localisation on conventional MRI, 3D-T2-SPACE and CE-MRA can be used. Together they complement each other and have good diagnostic potential.
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Affiliation(s)
- F Ouyang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Q Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Duan
- Class 211, Innovation Experiment, Nanchang University, 330031 Nanchang, Jiangxi, China
| | - X Yuan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Wang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Y Chen
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - M Yin
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - X Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China.
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Meer E, Patel M, Chan D, Sheikh AM, Nicolaou S. Dual-Energy Computed Tomography and Beyond: Musculoskeletal System. Radiol Clin North Am 2023; 61:1097-1110. [PMID: 37758359 DOI: 10.1016/j.rcl.2023.05.008] [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] [Indexed: 10/03/2023]
Abstract
Traditional monoenergetic computed tomography (CT) scans in musculoskeletal imaging provide excellent detail of bones but are limited in the evaluation of soft tissues. Dual-energy CT (DECT) overcomes many of the traditional limitations of CT and offers anatomical details previously seen only on MR imaging. In addition, DECT has benefits in the evaluation and characterization of arthropathies, bone marrow edema, and collagen applications in the evaluation of tendons, ligaments, and vertebral discs. There is current ongoing research in the application of DECT in arthrography and bone mineral density calculation.
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Affiliation(s)
- Emtenen Meer
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Mitulkumar Patel
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Chan
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan M Sheikh
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
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Jiang N, Jin S, Yu C, Zhao J, Wang Q, Tian X, Li M, Zeng X. Efficacy and safety of immunosuppressive agents for adults with lupus nephritis: a systematic review and network meta-analysis. Front Immunol 2023; 14:1232244. [PMID: 37901212 PMCID: PMC10611487 DOI: 10.3389/fimmu.2023.1232244] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/08/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Various immunosuppressive regimens have been developed for the treatment of lupus nephritis (LN). This study aimed to compare the efficacy and safety of immunosuppressive regimens in adults with LN. Methods We systematically searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, including conference proceedings, trial registries, and reference lists, from inception until July 10, 2022. The effects of treatment were compared and ranked using the surface under the cumulative ranking curve (SUCRA). The primary endpoint was total remission. The secondary endpoints were complete remission, systemic lupus erythematosus disease activity index (SLEDAI), relapse, all-cause mortality, end-stage renal disease (ESRD), infection, herpes zoster, ovarian failure, myelosuppression, and cancer. Results Sixty-two trials reported in 172 studies involving 6,936 patients were included in the network meta-analysis. The combination of tacrolimus (TAC), mycophenolate mofetil (MMF), and glucocorticoid (GC) provided the best result for the total remission rate (SUCRA, 86.63%) and SLEDAI (SUCRA, 91.00%), while the combination of voclosporin (VCS) , MMF and GC gave the best improvement in the complete remission rate (SUCRA, 90.71%). The combination of cyclophosphamide (CYC), MMF and GC was associated with the lowest risk of relapse (SUCRA, 85.57%) and cancer (SUCRA, 85.14%), while the combination of obinutuzumab (OTB), MMF and GC was associated with the lowest risk of all-cause mortality (SUCRA, 84.07%). Rituximab (RTX) plus MMF plus GC was associated with the lowest risk of ESRD (SUCRA, 83.11%), while the risk of infection was lowest in patients treated with azathioprine (AZA) plus CYC plus GC (SUCRA, 68.59%). TAC plus GC was associated with the lowest risk of herpes zoster (SUCRA, 87.67%) and ovarian failure (SUCRA, 73.60%). Cyclosporine (CsA) plus GC was associated with the lowest risk of myelosuppression (SUCRA, 79.50%), while AZA plus GC was associated with the highest risk of myelosuppression (SUCRA, 16.25%). Discussion This study showed that a combination of TAC, MMF and GC was the best regimen for improving the total remission rate. The optimal regimen for specific outcomes should be highlighted for high-risk patients.
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Affiliation(s)
- Nan Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shangyi Jin
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chen Yu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Matthews M, Klein E, Weil L, Sorensen M, Fleischer A. Initial Experience With Subchondral Stabilization for Grade II Stress Fractures of the Midfoot and Forefoot. J Foot Ankle Surg 2023; 62:868-872. [PMID: 37301465 DOI: 10.1053/j.jfas.2023.05.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/01/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Stress fractures of the foot are often preceded by magnetic resonance imaging evidence of bone marrow edema. While new evidence suggests intraosseous injection of calcium phosphate ("subchondral stabilization") can alleviate symptoms associated with bone marrow edema, no data yet exist regarding its use in developing mid- and forefoot stress fractures. Fifty-four patients who underwent subchondral stabilization of various midfoot/forefoot bones in our practice were observed over a 5-year period. All patients were unresponsive to standard nonoperative measures for at least 6 weeks, and all had clinical exams and advanced imaging consistent with a Kaeding-Miller Grade II stress fracture. Forty patients were included with a mean age of 54.3 ± 14.9 years and mean follow-up of 14.1 ± 6.9 months. Patients saw a significant decrease in visual analog scale (VAS) pain as early as 1 month postoperatively (p < .05). Mean postoperative VAS at 12 months was 2.11 ± 2.50, and mean reduction in VAS pain from preoperative to 12 months postoperative was -5.00 (95% CI -3.44 to -6.56, p < .05). Fourteen patients (34%, 14/41) were entirely pain free at 12 months. Higher preoperative VAS pain scores (unadjusted odds ratio [OR] 2.13 [95% CI 1.20-3.77], p = .010) and treatment of more than 1 bone (unadjusted OR 6.23 [95% CI 1.39-27.8], p = .017) were associated with a greater likelihood of not achieving a pain free status at 12 months. Our initial experience with subchondral stabilization suggests the procedure may be safe and effective for use in many Kaeding-Miller Grade II stress fractures of the mid- and forefoot.
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Affiliation(s)
| | - Erin Klein
- Weil Foot and Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- Weil Foot and Ankle Institute, Mount Prospect, IL
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16
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Abudouaini H, Wu T, Meng Y, Wang B, Liu H. Mechanical properties of an elastically deformable cervical spine implant. J Orthop Surg Res 2023; 18:605. [PMID: 37587540 PMCID: PMC10428533 DOI: 10.1186/s13018-023-04042-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
Anterior cervical surgery is widely accepted and time-tested surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration rate and implant subsidence after the surgery using the traditional polyetheretherketone cage. Thus, we creatively designed a polyurethane cervical implant that can continuous load-sharing through elastic deformation and decrease postoperative stress concentration at adjacent segments. In this study, the design rationality and safety of this novel implant was evaluated based on several mechanical parameters including compression test, creeping test, push-out test and subsidence test. The results showed that the novel cervical implant remained intact under the compressive axial load of 8000 N and continues to maintained the elastic deformation phase. The minimum push-out load of the implant was 181.17 N, which was significantly higher than the maximum compressive shear load of 20 N experienced by a normal human cervical intervertebral disc. Besides, the creep recovery behaviour of the implant closely resembled what has been reported for natural intervertebral discs and clinically applied cervical devices in literature. Under the load of simulating daily activities of the cervical spine, the implant longitudinal displacement was only 0.54 mm. In conclusion, this study showed that the current design of the elastically deformable implant was reasonable and stable to fulfil the mechanical requirements of a cervical prosthesis under physiological loads. After a more comprehensive understanding of bone formation and stress distribution after implantation, this cervical implant is promising to be applied to certain patients in clinical practice.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd., Chengdu, China
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd., Chengdu, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd., Chengdu, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd., Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd., Chengdu, China
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Liu Y, Ding S, Sun JF, Li PP, Li XQ, Zeng LY, Xu KL, Qiao JL. [The effect of platelet infusion on the repair of bone marrow hematopoietic niche damage in mice induced by (60)Co radiation and hematopoietic reconstruction after bone marrow transplantation]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:635-641. [PMID: 37803836 PMCID: PMC10520226 DOI: 10.3760/cma.j.issn.0253-2727.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 10/08/2023]
Abstract
Objective: To observe the effect of platelets on hematopoietic stem cell (HSCs) implantation in mice with radiation-induced bone marrow injury and bone marrow transplantation models. Methods: ①Male C57BL/6 mice were divided into a single irradiation group and a radiation infusion group after receiving (60)Co semimyeloablative irradiation for 18-10 weeks. The irradiation infusion group received 1×10(8) platelets expressing GFP fluorescent protein. ② The allogeneic bone marrow transplantation model was established. The experimental groups included the simple transplantation group (BMT) and the transplantation infusion group (BMT+PLT). The BMT group was infused through the tail vein only 5 × 10(6) bone marrow cells, the BMT+PLT group needs to be infused with bone marrow cells at the same time 1× 10(8) platelets. ③ Test indicators included peripheral blood cell and bone marrow cell counts, flow cytometry to detect the proportion of hematopoietic stem cell (HSC) and hematopoietic progenitor cells, bone marrow cell proliferation and apoptosis, and pathological observation of vascular niche damage and repair. Results: ①On the 3rd, 7th, 14(th), and 21st days after irradiation, the bone marrow cell count of the infusion group was higher than that in the single irradiation group (P<0.05), and the peripheral blood cell count was also higher. A statistically significant difference was found between the white blood cell count on the 21st day and the platelet count on the 7th day (P<0.05). In the observation cycle, the percentage of bone marrow cell proliferation in the infusion group was higher, while the percentage of apoptosis was lower. ② The results of bone tissue immunofluorescence after irradiation showed that the continuity of hematopoietic niche with red fluorescence was better in the irradiation infusion group. ③The chimerism percentage in the BMT+PLT group was always higher than that in the BMT group after transplantation.④ The BMT+PLT group had higher bone marrow cell count and percentage of bone marrow cell proliferation on the 7th and 28th day after transplantation than that in the BMT group, and the percentage of bone marrow cell apoptosis on the 14th day was lower than that in the BMT group (P<0.05). After the 14th day, the percentage of stem progenitor cells in the bone marrow cells of mice was higher than that in the BMT group (P<0.05). ⑤The immunohistochemical results of bone marrow tissue showed that the continuity of vascular endothelium in the BMT+PLT group was better than that in the BMT group. Conclusion: Platelet transfusion can alleviate the injury of vascular niche, promotes HSC homing, and is beneficial to hematopoietic reconstruction.
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Affiliation(s)
- Y Liu
- Department of Clinical Laboratory, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China
| | - S Ding
- Department of Clinical Laboratory, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China
| | - J F Sun
- Department of Clinical Laboratory, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China
| | - P P Li
- Department of Clinical Laboratory, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China
| | - X Q Li
- Blood Disease Institute, Xuzhou Medical University, Key Laboratory of Bone Marrow Stem Cell, Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - L Y Zeng
- Blood Disease Institute, Xuzhou Medical University, Key Laboratory of Bone Marrow Stem Cell, Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - K L Xu
- Blood Disease Institute, Xuzhou Medical University, Key Laboratory of Bone Marrow Stem Cell, Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - J L Qiao
- Blood Disease Institute, Xuzhou Medical University, Key Laboratory of Bone Marrow Stem Cell, Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
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Sherban A, Hussen R, Gafter-Gvili A, Atamna A, Bishara J, Raanani P, Ben Tikva Kagan K, Avni T. The Impact of Thrombocytopenia and Lymphopenia on Mortality in Patients Infected with Influenza Virus: A Retrospective Cohort Study. Acta Haematol 2023; 146:481-489. [PMID: 37557088 DOI: 10.1159/000533466] [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: 12/26/2022] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Influenza virus causes significant global annual morbidity and mortality. Thrombocytopenia is recognized as a poor prognostic factor in sepsis and is associated with mortality, while lymphopenia has been established as a poor prognostic factor in other viral infections. We aimed to assess the incidence of thrombocytopenia and lymphopenia in seasonal influenza and their effect on clinical outcomes. METHODS This single-center, retrospective, cohort study included consecutive adult patients, hospitalized in Rabin Medical Center between October 2017 and April 2018, with laboratory-confirmed influenza. Patients were grouped according to blood counts on admission: (1) thrombocytopenia (<150 K/mL), (2) lymphopenia (<0.5 K/mL), and (3) both thrombocytopenia and lymphopenia. Patients without thrombocytopenia and lymphopenia were designated as controls. The primary outcome was 30-day all-cause mortality. Risk factors were identified by univariable and multivariable analyses, using logistic regression and reported as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 625 patients were included, 112 (18%) had thrombocytopenia, 98 (15.6%) had lymphopenia, and 107 (17%) had both. The crude 30-day all-cause mortality was 7.6% (48/625). Mortality rates were 7.1% (8/112) for the thrombocytopenia group, 11.2% (11/98) for the lymphopenia group, and 14.9% (16/107) for patients with both versus 4.2% (13/308) in the control (p = 0.000 for all). In a multivariable regression model, significant thrombocytopenia (<100 K/μL) [OR 5.07 (95% CI 1.5-16.2)], age [OR 1.07 (95% CI 1.02-1.11)], time to oseltamivir [OR 1.006 (95% CI 1.002-1.11)], and significant respiratory support [OR 8.85 (3.4-22.6)] were associated with 30-day all-cause mortality. CONCLUSION Patients hospitalized with seasonal influenza and thrombocytopenia <100 K/mL on admission, have an increased 30-day all-cause mortality.
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Affiliation(s)
- Adi Sherban
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ragda Hussen
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Hematology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alla Atamna
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Internal Medicine Department C, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pia Raanani
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Hematology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Kim Ben Tikva Kagan
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tomer Avni
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Sharma G, Ponzetti M, Siddiqui JA. Editorial: Bone metastasis in the milieu of osteoimmunology. Front Immunol 2023; 14:1265434. [PMID: 37614231 PMCID: PMC10442512 DOI: 10.3389/fimmu.2023.1265434] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Gunjan Sharma
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marco Ponzetti
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Jawed A. Siddiqui
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, United States
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
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20
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Mantell BS, Azeka E, Cantor RS, Carlo WF, Chrisant M, Dykes JC, Hoffman TM, Kirklin JK, Koehl D, L'Ecuyer TJ, McAllister JM, Prada-Ruiz AC, Richmond ME. The Fontan immunophenotype and post-transplant outcomes in children: A multi-institutional study. Pediatr Transplant 2023; 27:e14456. [PMID: 36591863 DOI: 10.1111/petr.14456] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/17/2022] [Accepted: 10/07/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients after Fontan palliation represent a growing pediatric population requiring heart transplant (HTx) and often have lymphopenia (L) and/or hypogammaglobinemia that may be exacerbated by protein-losing enteropathy (PLE, P). The post-HTx effects of this altered immune phenotype are not well studied. METHODS In this study of the Pediatric Heart Transplant Society Registry, 106 Fontan patients who underwent HTx between 2005 and 2018 were analyzed. The impact of lymphopenia and PLE on graft survival, infection, rejection, and malignancy was analyzed at 1 and 5 years post-HTx. RESULTS The following combinations of lymphopenia and PLE were noted: +L+P, n = 37; +L-P, n = 23; -L+P, n = 10; and -L-P, n = 36. Graft survival between the groups was similar within the first year after transplant (+L+P: 86%, +L-P: 86%, -L+P: 87%, -L-P: 89%, p = .9). Freedom from first infection post-HTx was greatest among -L-P patients compared to patients with either PLE, lymphopenia, or both; with a 22.1% infection incidence in the -L-P group and 41.4% in all others. These patients had a significantly lower infection rate in the first year after HTx (+L+P: 1.03, +L-P: 1, -L+P: 1.3, -L-P: 0.3 infections/year, p < .001) and were similar to a non-single ventricle CHD control group (0.4 infections/year). Neither freedom from rejection nor freedom from malignancy 1 and 5 years post-HTx, differed among the groups. CONCLUSIONS Fontan patients with altered immunophenotype, with lymphopenia and/or PLE, are at increased risk of infection post-HTx, although have similar early survival and freedom from rejection and malignancy. These data may encourage alternative immunosuppression strategies and enhanced monitoring for this growing subset of patients.
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Affiliation(s)
- Benjamin S Mantell
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center of NewYork-Presbyterian, New York, New York, USA
| | - Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Waldemar F Carlo
- Division of Pediatric Cardiology, Children's of Alabama, Birmingham, Alabama, USA
| | - Maryanne Chrisant
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - John C Dykes
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Timothy M Hoffman
- Division of Pediatric Cardiology, North Carolina Children's Hospital, Chapel Hill, North Carolina, USA
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas J L'Ecuyer
- Division of Pediatric Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jennie M McAllister
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center of NewYork-Presbyterian, New York, New York, USA
| | - Adriana C Prada-Ruiz
- Division of Pediatric Cardiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center of NewYork-Presbyterian, New York, New York, USA
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Liu B, Yang Q, Cheng Y, Liu M, Ji Q, Zhang B, Yang Z, Zhou S, Liu D. Calcium phosphate hybrid micelles inhibit orthotopic bone metastasis from triple negative breast cancer by simultaneously killing cancer cells and reprogramming the microenvironment of bone resorption and immunosuppression. Acta Biomater 2023; 166:640-654. [PMID: 37236576 DOI: 10.1016/j.actbio.2023.05.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
Triple negative breast cancer (TNBC) is prone to develop drug resistance and metastasis. Bone is the most common distant metastasis site of breast cancer cell. Patients with bone metastasis from TNBC suffer from unbearable pain due to the growth of bone metastasis and bone destruction. Simultaneously blocking the growth of bone metastasis and reprogramming the microenvironment of bone resorption and immunosuppression is a promising strategy to treat bone metastasis from TNBC. Herein, we prepared a pH and redox responsive drug delivery system, named DZ@CPH, by encapsulating docetaxel (DTX) with hyaluronic acid-polylactic acid micelle then reinforcing with calcium phosphate and zoledronate for targeting to bone metastasis from TNBC. DZ@CPH reduced the activation of osteoclast and inhibited bone resorption by decreasing the expression of nuclear factor κB receptor ligand and increasing the expression of osteoprotegerin in drug-resistant bone metastasis tissue. At the same time, DZ@CPH inhibited the invasion of bone metastatic TNBC cells by regulating the apoptosis-related and invasion-related protein expression. It also increased the sensitivity of orthotopic drug-resistant bone metastasis to DTX by inhibiting the expression of P-glycoprotein, Bcl-2 and transforming growth factor-β in tissue of drug-resistant bone metastasis. Moreover, the ratio between M1 type macrophage to M2 type macrophage in bone metastasis tissue was increased by DZ@CPH. In a word, DZ@CPH blocked the growth of bone metastasis from drug-resistant TNBC through inducing the apoptosis of drug-resistant TNBC cells and reprogramming the microenvironment of bone resorption and immunosuppression. DZ@CPH has a great potential in clinical application for the treatment of bone metastasis from drug-resistant TNBC. STATEMENT OF SIGNIFICANCE: Triple negative breast cancer (TNBC) is prone to develop bone metastasis. Now bone metastasis is still an intractable disease. In this study, docetaxel and zoledronate co-loaded calcium phosphate hybrid micelles (DZ@CPH) were prepared. DZ@CPH reduced the activation of osteoclasts and inhibited bone resorption. At the same time, DZ@CPH inhibited the invasion of bone metastatic TNBC cells by regulating the expression of apoptosis and invasion related protein in bone metastasis tissue. Moreover, the ratio between M1 type macrophages to M2 type macrophages in bone metastases tissue was increased by DZ@CPH. In a word, DZ@CPH blocked vicious cycle between the growth of bone metastasis and bone resorption, which greatly improved the therapeutic effect on bone metastasis from drug-resistant TNBC.
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Affiliation(s)
- Bao Liu
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Qian Yang
- Department of pharmacy, School of Medicine, Shaanxi Energy Institute, Xianyang, 712000, China
| | - Ying Cheng
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Miao Liu
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Qifeng Ji
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Bangle Zhang
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Zhifu Yang
- Department of Pharmacy, Xijing Hospital, Air Force Medical University, Xi'an 710032, China.
| | - Siyuan Zhou
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China; Key Laboratory of Gastrointestinal Pharmacology of Chinese Materia Medica of the State Administration of Traditional Chinese Medicine, Department of Pharmacology, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China.
| | - Daozhou Liu
- Department of Pharmaceutics, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China.
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22
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Han J, Zhao Z, Wan D. Editorial: Potential effects and mechanisms of bone homeostasis on tumor bone metastasis. Front Endocrinol (Lausanne) 2023; 14:1256406. [PMID: 37564977 PMCID: PMC10411333 DOI: 10.3389/fendo.2023.1256406] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Jiyu Han
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Shanghai, China
| | - Zitong Zhao
- Department of Anesthesiology and Pain Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Daqian Wan
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Shanghai, China
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Cowley RA, Carroll AH, Pasko KBD, Rubenstein E, Tagouri YM, Weiner D. Evaluation and Treatment of Primary Spinal Epidural Lymphoma Presenting as Acute Myelopathy in a Young Adult: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00057. [PMID: 37590426 DOI: 10.2106/jbjs.cc.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE Primary spinal epidural lymphoma (PSEL) presenting as myelopathy is extremely rare, particularly within young, healthy adults. This case report describes a 26-year-old man presenting with progressive thoracic myelopathy. Magnetic resonance imaging revealed spinal epidural masses spanning T5-T10 and T12-L2 with multilevel cord compression and edema. After evaluation, the patient underwent emergent posterior decompression to prevent progressive neurological decline. Histology was consistent with diffuse large B-cell lymphoma, germinal center type. At 3 months postoperatively, the patient regained full neurologic function. CONCLUSION Although rare, PSELs should be considered in patients presenting with myelopathy to facilitate timely diagnosis and treatment.
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Affiliation(s)
- R Adams Cowley
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Austin H Carroll
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kory B D Pasko
- Georgetown University School of Medicine, Washington, District of Columbia
| | | | | | - David Weiner
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Ramachandran K, Patel Y, Arumugam T, Shetty AP, Shanmuganathan R. Giant Anomalous Cervical Spinous Process Causing Dynamic Cord Compression: An Unusual Cause for Myelopathy: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00064. [PMID: 37616446 DOI: 10.2106/jbjs.cc.23.00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
CASE A 47-year-old male patient presented with progressively worsening gait instability caused by a giant anomalous, free-floating C5 spinous process resulting in dynamic cord compression and myelopathy. The patient was successfully managed with a C5 laminectomy and total excision of the anomalous spinous process with a good functional outcome at the final follow-up. CONCLUSION Anomalies of the posterior arch of the subaxial cervical spine are relatively uncommon and asymptomatic. This case is being reported for its rarity and to highlight the role of dynamic imaging in patients presenting with congenital anomalies of the cervical spine presenting with compressive myelopathy.
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Affiliation(s)
- Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
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25
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Wlodarski MW. ERCC6L2 syndrome: attack of the TP53 clones. Blood 2023; 141:2788-2789. [PMID: 37289478 DOI: 10.1182/blood.2023020394] [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] [Indexed: 06/09/2023] Open
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26
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Qiu L, Wang Y, Liu H, Wang Q, Chen L, Liu L, Wang L, Feng Y, Chen Y. Safety and Efficacy of 68 Ga- or 177 Lu-Labeled DOTA-IBA as a Novel Theranostic Radiopharmaceutical for Bone Metastases : A Phase 0/I Study. Clin Nucl Med 2023; 48:489-496. [PMID: 36976706 DOI: 10.1097/rlu.0000000000004634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE We designed and synthesized a novel theranostic bisphosphonate radiopharmaceutical ( 68 Ga- or 177 Lu-labeled DOTA-ibandronic acid [ 68 Ga/ 177 Lu-DOTA-IBA]) for bone metastasis. In this study, the dosimetry, safety, and efficacy of 68 Ga/ 177 Lu-DOTA-IBA as a theranostic radiopharmaceutical for bone metastases were evaluated in patients with malignancy based on 68 Ga- and 177 Lu-DOTA-IBA images, blood samples, and dosimetric analysis. PATIENTS AND METHODS Eighteen patients with bone metastasis and progression under conventional therapies were included in this study. Baseline 99m Tc-MDP SPECT and 68 Ga-DOTA-IBA PET/CT were performed for comparative purposes within 3 days. After receiving 891.5 ± 301.3 MBq 177 Lu-DOTA-IBA, serial 177 Lu-DOTA-IBA SPECT bone scan was performed over 14 days. Dosimetric evaluation was performed for main organs and tumor lesions. Safety was assessed by blood biomarkers. Karnofsky Performance Status, pain score, and follow-up 68 Ga-DOTA-IBA PET/CT were performed for response evaluation. RESULTS Baseline 68 Ga-DOTA-IBA PET demonstrated a higher efficacy for detecting bone metastases compared with 99m Tc-MDP SPECT. The time-activity curves showed fast uptake and high retention of 177 Lu-DOTA-IBA in bone metastases (24 hours: 9.43 ± 2.75 %IA; 14 days: 5.45 ± 2.52 %IA). Liver, kidneys, and red marrow time-activity curves revealed a low uptake and fast clearance. The radiation-absorbed dose in bone metastasis lesions (6.40 ± 2.13 Gy/GBq) was significantly higher than that in red marrow (0.47 ± 0.19 Gy/GBq), kidneys (0.56 ± 0.19 Gy/GBq), or liver (0.28 ± 0.07 Gy/GBq), with all P 's < 0.001. Compared with baseline level, only one patient developed new grade 1 leukopenia (toxicity rate, 6%). The 177 Lu-DOTA-IBA therapy had no statistically significant effect on bone marrow hematopoietic function, liver function, and kidney function at any follow-up visit. Bone pain palliation was achieved in 82% (14/17) of patients. The 8-week follow-up 68 Ga-DOTA-IBA PET/CT demonstrated partial response in 3 patients, disease progression in 1 patient, and stable disease in 14 patients. CONCLUSIONS 68 Ga/ 177 Lu-DOTA-IBA provides a set of potential theranostic radiopharmaceuticals and may have a good prospect for the management of bone metastasis.
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Wei Y, Zheng Y. Transcutaneous electronic acupoint stimulation improves bone marrow suppression in lung cancer patients following chemotherapy: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e33571. [PMID: 37083807 PMCID: PMC10118342 DOI: 10.1097/md.0000000000033571] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the efficacy of transcutaneous electronic acupoint stimulation (TEAS) on bone marrow suppression in patients with lung cancer after chemotherapy. METHODS We conducted a comprehensive search of 6 databases until November 2022 and included 6 randomized controlled trials comprising 534 patients in our analysis. Eligible randomized controlled trials were included based on predefined inclusion criteria. The weighted mean difference (WMD) was calculated with all of the continuous outcomes. Heterogeneity among the included studies was evaluated using Cochran I2 and Q statistics. When the value of I2 was over 50%, a random-effects model was used. Egger test was used to assess publication bias, and trim and fill analysis was conducted if bias was detected. RESULTS Our analysis found that TEAS significantly increased white blood cell counts (WMD: 0.79, 95% confidence interval (CI): 0.40-1.18, P < .001), platelet counts (WMD: 45.45, 95% CI: 30.47-60.43, P < .001), and comfort score (WMD: 6.89, 95% CI: 5.12-8.66, P < .001) compared to the conventional group. However, no significant difference was observed in red blood cell counts (WMD: 0.00, 95% CI: -0.10 to 0.10, P = .97) and hemoglobin level (WMD: -0.01, 95% CI: -2.49 to 2.46, P = .99) between the 2 groups. CONCLUSIONS We tentatively conclude that TEAS can reduce bone marrow suppression risk and improve comfort in lung cancer patients undergoing chemotherapy. However, larger randomized controlled trials with more diverse patient populations and blood routine indexes are urgently needed to confirm these findings.
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Affiliation(s)
- Yi Wei
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yun Zheng
- Pulmonary and Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Lee NYS, Li M, Ang KS, Chen J. Establishing a human bone marrow single cell reference atlas to study ageing and diseases. Front Immunol 2023; 14:1127879. [PMID: 37006302 PMCID: PMC10050687 DOI: 10.3389/fimmu.2023.1127879] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionAgeing in the human bone marrow is associated with immune function decline that results in the elderly being vulnerable to illnesses. A comprehensive healthy bone marrow consensus atlas can serve as a reference to study the immunological changes associated with ageing, and to identify and study abnormal cell states.MethodsWe collected publicly available single cell transcriptomic data of 145 healthy samples encompassing a wide spectrum of ages ranging from 2 to 84 years old to construct our human bone marrow atlas. The final atlas has 673,750 cells and 54 annotated cell types.ResultsWe first characterised the changes in cell population sizes with respect to age and the corresponding changes in gene expression and pathways. Overall, we found significant age-associated changes in the lymphoid lineage cells. The naïve CD8+ T cell population showed significant shrinkage with ageing while the effector/memory CD4+ T cells increased in proportion. We also found an age-correlated decline in the common lymphoid progenitor population, in line with the commonly observed myeloid skew in haematopoiesis among the elderly. We then employed our cell type-specific ageing gene signatures to develop a machine learning model that predicts the biological age of bone marrow samples, which we then applied to healthy individuals and those with blood diseases. Finally, we demonstrated how to identify abnormal cell states by mapping disease samples onto the atlas. We accurately identified abnormal plasma cells and erythroblasts in multiple myeloma samples, and abnormal cells in acute myeloid leukaemia samples.DiscussionThe bone marrow is the site of haematopoiesis, a highly important bodily process. We believe that our healthy bone marrow atlas is a valuable reference for studying bone marrow processes and bone marrow-related diseases. It can be mined for novel discoveries, as well as serve as a reference scaffold for mapping samples to identify and investigate abnormal cells.
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Affiliation(s)
- Nicole Yee Shin Lee
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mengwei Li
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kok Siong Ang
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jinmiao Chen
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Immunology Translational Research Program, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- *Correspondence: Jinmiao Chen,
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Davies B, Mowforth OD, Yordanov S, Alvarez-Berdugo D, Bond S, Nodale M, Kareclas P, Whitehead L, Bishop J, Chandran S, Lamb S, Bacon M, Papadopoulos MC, Starkey M, Sadler I, Smith L, Kalsi-Ryan S, Carpenter A, Trivedi RA, Wilby M, Choi D, Wilkinson IB, Fehlings MG, Hutchinson PJ, Kotter MRN. Targeting patient recovery priorities in degenerative cervical myelopathy: design and rationale for the RECEDE-Myelopathy trial-study protocol. BMJ Open 2023; 13:e061294. [PMID: 36882259 PMCID: PMC10008337 DOI: 10.1136/bmjopen-2022-061294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is a common and disabling condition of symptomatic cervical spinal cord compression secondary to degenerative changes in spinal structures leading to a mechanical stress injury of the spinal cord. RECEDE-Myelopathy aims to test the disease-modulating activity of the phosphodiesterase 3/phosphodiesterase 4 inhibitor Ibudilast as an adjuvant to surgical decompression in DCM. METHODS AND ANALYSIS RECEDE-Myelopathy is a multicentre, double-blind, randomised, placebo-controlled trial. Participants will be randomised to receive either 60-100 mg Ibudilast or placebo starting within 10 weeks prior to surgery and continuing for 24 weeks after surgery for a maximum of 34 weeks. Adults with DCM, who have a modified Japanese Orthopaedic Association (mJOA) score 8-14 inclusive and are scheduled for their first decompressive surgery are eligible for inclusion. The coprimary endpoints are pain measured on a visual analogue scale and physical function measured by the mJOA score at 6 months after surgery. Clinical assessments will be undertaken preoperatively, postoperatively and 3, 6 and 12 months after surgery. We hypothesise that adjuvant therapy with Ibudilast leads to a meaningful and additional improvement in either pain or function, as compared with standard routine care. STUDY DESIGN Clinical trial protocol V.2.2 October 2020. ETHICS AND DISSEMINATION Ethical approval has been obtained from HRA-Wales.The results will be presented at an international and national scientific conferences and in a peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN Number: ISRCTN16682024.
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Affiliation(s)
- Benjamin Davies
- Department of Neurosurgery, Cambridge University, Cambridge, UK
| | | | - Stefan Yordanov
- Department of Neurosurgery, Cambridge University, Cambridge, UK
| | | | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospital, Cambridge, UK
| | - Marianna Nodale
- Cambridge Clinical Trials Unit, Cambridge University Hospital, Cambridge, UK
| | - Paula Kareclas
- Cambridge Clinical Trials Unit, Cambridge University Hospital, Cambridge, UK
| | - Lynne Whitehead
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jon Bishop
- Medical Statistician, NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Siddharthan Chandran
- Edinburgh Medical School & Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah Lamb
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Mark Bacon
- International Spinal Research Trust, London, UK
| | | | | | | | | | | | - Adrian Carpenter
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rikin A Trivedi
- Department of Neurosurgery, Cambridge University, Cambridge, UK
| | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ian B Wilkinson
- Cambridge Clinical Trials Unit, Cambridge University Hospital, Cambridge, UK
| | - Michael G Fehlings
- Department of Surgery, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Mark R N Kotter
- Department of Neurosurgery, Cambridge University, Cambridge, UK
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Dennis K, Linden K, Gaudet M. A shift from simple to sophisticated: using intensity-modulated radiation therapy in conventional nonstereotactic palliative radiotherapy. Curr Opin Support Palliat Care 2023; 17:70-76. [PMID: 36695868 DOI: 10.1097/spc.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The authors aimed to highlight trends in, and evidence underlying the use of highly conformal radiotherapy (RT) techniques in conventional nonstereotactic palliative RT. The authors reviewed palliative-intent and curative-intent studies relevant to the use of intensity-modulated radiation therapy (IMRT) for the delivery of nonstereotactic conventional regimens to the brain, head and neck, thorax, abdomen and pelvis, and bone metastases. RECENT FINDINGS The use of IMRT has become standard with certain indications for brain metastases such as hippocampus-avoiding/limiting whole brain RT. IMRT in the treatment of bone metastases is increasing at many institutions despite limited data comparing its effectiveness with that of fluoroscopy-based and three-dimensional conformal radiation therapy techniques. There is scant data describing the use of IMRT for palliation in other extracranial anatomic sites; guidance for its use in these settings must be gleaned almost exclusively from curative-intent randomized trials, consensus recommendations and contouring atlases. SUMMARY Consistent with historical technology shifts in RT practice, the uptake of highly conformal techniques such as IMRT for conventional palliative RT will likely outpace rigorous evaluations of their advantages and disadvantages relative to simpler techniques. Opportunities exist in virtually all anatomic sites for observational and randomized studies to evaluate the clinical impacts of these modern techniques in the palliative setting.
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Affiliation(s)
- Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
| | - Kelly Linden
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
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31
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Ibad HA, de Cesar Netto C, Shakoor D, Sisniega A, Liu S, Siewerdsen JH, Carrino JA, Zbijewski W, Demehri S. Computed Tomography: State-of-the-Art Advancements in Musculoskeletal Imaging. Invest Radiol 2023; 58:99-110. [PMID: 35976763 PMCID: PMC9742155 DOI: 10.1097/rli.0000000000000908] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT-based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.
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Affiliation(s)
- Hamza Ahmed Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Delaram Shakoor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - John A. Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Shadpour Demehri
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yu D, Chen P, Zhang X, Wang H, Dhuromsingh M, Wu J, Qin B, Guo S, Zhang B, Li C, Zeng H. Association of lymphopenia and RDW elevation with risk of mortality in acute aortic dissection. PLoS One 2023; 18:e0283008. [PMID: 36920980 PMCID: PMC10016706 DOI: 10.1371/journal.pone.0283008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE The study aimed to investigate whether lymphopenia and red blood cell distribution width (RDW) elevation are associated with an increased risk of mortality in acute aortic dissection (AAD). METHODS This multicenter retrospective cohort study enrolled patients diagnosed with AAD by aortic computed tomographic angiography (CTA) from 2010 to 2021 in five teaching hospitals in central-western China. Cox proportional hazards regression and Kaplan-Meier curves were used in univariable and multivariable models. Clinical outcomes were defined as all-cause in-hospital mortality, while associations were evaluated between lymphopenia, accompanied by an elevated RDW, and risk of mortality. RESULTS Of 1903 participants, the median age was 53 (interquartile range [IQR], 46-62) years, and females accounted for 21.9%. Adjusted increased risk of mortality was linearly related to the decreasing lymphocyte percentage (P-non-linearity = 0.942) and increasing RDW (P-non-linearity = 0.612), and per standard deviation (SD) of increment lymphocyte percentage and RDW was associated with the 26% (0.74, 0.64-0.84) decrement and 5% (1.05, 0.95-1.15) increment in hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality, respectively. Importantly, lymphopenia and elevation of RDW exhibited a significant interaction with increasing the risk of AAD mortality (P-value for interaction = 0.037). CONCLUSIONS Lymphopenia accompanied by the elevation of RDW, which may reflect the immune dysregulation of AAD patients, is associated with an increased risk of mortality. Assessment of immunological biomarkers derived from routine tests may provide novel perspectives for identifying the risk of mortality.
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Affiliation(s)
- Dan Yu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
- Department of Cardiac Intensive Care Unit, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
| | - Peng Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyan Zhang
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
| | - Hongjie Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
| | - Menaka Dhuromsingh
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
| | - Jinxiu Wu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Bingyu Qin
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Suping Guo
- Department of Cardiac Intensive Care Unit, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
- Department of Cardiac Intensive Care Unit, Central China Fuwai Hospital of Zhengzhou University (Fuwai Central China Cardiovascular Hospital), Zhengzhou, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Baoquan Zhang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Chunwen Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
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33
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Miyoshi T, Kondo T, Nishikori M, Kitawaki T, Kobayashi K, Fujimoto M, Yoshinaga N, Oka S, Asagoe K, Imashuku S, Takaori-Kondo A. Methotrexate-induced subacute myelopathy: a serious but treatable complication. J Clin Exp Hematop 2023; 63:251-256. [PMID: 38148015 PMCID: PMC10861375 DOI: 10.3960/jslrt.23041] [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: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/28/2023] Open
Abstract
Subacute myelopathy is a rare but serious complication of methotrexate (MTX) that may cause paraplegia. Although its underlying mechanisms have not been fully elucidated, homocysteine is thought to play a role in the pathogenesis of this adverse effect. Herein, we report the case of a 34-years old female patient with diffuse large B-cell lymphoma who developed progressive paraplegia accompanied by dysfunctional bladder and bowel movements after treatment with a modified CODOX-M/IVAC regimen, including high-dose intravenous MTX and intrathecal (IT-) MTX. Neurological symptoms gradually improved to almost normal levels within 4.5 months of onset following treatment with a combination of S-adenosylmethionine, methionine, cyanocobalamin, and folate. During chemotherapy, including high-dose MTX and IT-MTX for hematological malignancies, MTX-induced subacute neuronal damage should be carefully evaluated, and appropriate treatment should be initiated as early as possible.
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Affiliation(s)
- Takashi Miyoshi
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Tadakazu Kondo
- Division of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University, Kyoto Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Noriyoshi Yoshinaga
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Satoshi Oka
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Kohsuke Asagoe
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | | | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
ABSTRACT Epithelioid hemangioendothelioma is a low- to intermediate-grade malignant vascular tumor with a slowly progressive course and unpredictable prognosis. We report a case of epithelioid hemangioendothelioma with pleura and bone metastases on 68 Ga-FAPI-04 PET/CT in a 65-year-old woman who underwent surgery and chemotherapy.
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Affiliation(s)
- Jie Chen
- From the Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, People's Republic of China
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35
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Li YL, Chu W, Li JJ, Dong JJ, Li GQ, Jin XJ, Yao J, Liu YQ. [Animal Model Establishment and Its Mechanism of Cytarabine-Iduced Myelosuppression]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2022; 30:1376-1383. [PMID: 36208238 DOI: 10.19746/j.cnki.issn.1009-2137.2022.05.012] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To establish an optimized model of bone marrow suppression induced by cytarabine (Ara-C) in C57BL/6 mice and preliminarily explore the mechanism of myelosuppression based on the cycle and apoptosis of BMNC. METHODS C57BL/6 mice were intraperitoneally injected with Ara-C 50, 100 and 200 mg/kg for 7 days, respectively. The survival rate and body weight of C57BL/6 mice were monitored. The number of peripheral blood cells and bone marrow nucleated cells (BMNC) was detected, and the morphology of bone marrow, thymus and spleen were measured on the 7th, 14th and 21st day of the experiment. The cycle and apoptosis of BMNC were also detected by flow cytometry. RESULTS Ara-C 200 mg/kg caused 46.7% mortality in mice, and other doses had no significant effect on mortality. All doses of Ara-C induced bone marrow suppression in mice, as shown by a decrease in the number of peripheral blood cells (WBC, Neu, RBC, PLT) and BMNC (P<0.05), decrease in bone marrow hyperplasia, accompanied by immunosuppression and compensatory hematopoiesis of the spleen, and the above manifestations and duration were dose-dependent. Among them, the myelosuppression caused by Ara-C 50 mg/kg recovered quickly, and caused by Ara-C 200 mg/kg was too severe. The result of flow cytometry showed that Ara-C could cause S and G2/m arrest and increased apoptosis in BMNC. CONCLUSION Ara-C can induce myelosuppression in mice with a dose-dependent severity and duration, and the model of myelosuppression with Ara-C 100 mg/kg is more optimized. The mechanism is related to the inhibition of BMNC proliferation and the promotion of apoptosis.
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Affiliation(s)
- Ya-Ling Li
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China,Key Laboratory of Dunhuang Medicine and Transformation Constructed by Chinese Ministry of Education and Gansu Province;Lanzhou 730000, Gansu Province, China,Gansu Cancer Clinical Medical Research Center of Integated Traditional Chinese and Western Medicine, Lanzhou 730000, Gansu Province, China
| | - Wei Chu
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Jun-Jie Li
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Juan-Juan Dong
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Gao-Qin Li
- Gansu Cancer Clinical Medical Research Center of Integated Traditional Chinese and Western Medicine, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jie Jin
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Juan Yao
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Yong-Qi Liu
- Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China,Gansu Cancer Clinical Medical Research Center of Integated Traditional Chinese and Western Medicine, Lanzhou 730000, Gansu Province, China,E-mail:
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Ward MM, Yao L. Sacroiliac Bone Marrow Edema: Innocent Until Proven Guilty? Arthritis Rheumatol 2022; 74:1474-1476. [PMID: 35436388 PMCID: PMC9427687 DOI: 10.1002/art.42143] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Lawrence Yao
- Radiology and Imaging Sciences, NIH, Clinical Center, Bethesda, Maryland
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37
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Park AK, Park JC, Al-Samkari H. Pembrolizumab-Induced Acquired Amegakaryocytic Thrombocytopenia and Successful Combination Treatment With Eltrombopag, Romiplostim and Cyclosporine: A Brief Communication. J Immunother 2022; 45:321-323. [PMID: 35791464 DOI: 10.1097/cji.0000000000000428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
Pembrolizumab is a humanized antibody directed against the programmed death-1 receptor on the cell surface, resulting in a T-cell-mediated immune response against tumor cells that can be complicated by immune-related adverse events. Here we present a novel case of pembrolizumab-induced acquired amegakaryocytic thrombocytopenia (AAT) in a patient with metastatic nasopharyngeal carcinoma. AAT is an incredibly rare and challenging entity for which there is no standardized treatment. We discuss our therapeutic approach using a calcineurin inhibitor and thrombopoietin receptor agonists for successful treatment of AAT and resumption of multiagent cytotoxic chemotherapy.
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Affiliation(s)
- Albert K Park
- Department of Medicine
- Harvard Medical School, Boston, MA
| | - Jong C Park
- Division of Hematology Oncology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Hanny Al-Samkari
- Division of Hematology Oncology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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38
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Jung M, Ruschke S, Karampinos DC, Holwein C, Baum T, Gersing AS, Bamberg F, Jungmann PM. The Predictive Value of Early Postoperative MRI-Based Bone Marrow Parameters for Mid-Term Outcome after MACI with Autologous Bone Grafting at the Knee. Cartilage 2022; 13:19476035221093061. [PMID: 35993371 PMCID: PMC9393675 DOI: 10.1177/19476035221093061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to longitudinally determine the prognostic value of early postoperative quantitative 3T-MRI (magnetic resonance imaging) parameters of subchondral bone marrow for 2-year clinical and MRI outcome after matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) at the knee. DESIGN Consecutive subjects who received MACI with ABG for treatment of focal osteochondral defects received MRI follow-up 3, 6, 12, and 24 months postoperatively. Quantitative MRI included bone marrow edema-like lesion (BMEL) volume measurements and single-voxel magnetic resonance spectroscopy (MRS; n = 9) of the subchondral bone marrow. At 2-year follow-up, morphological MRI outcome included MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. Clinical outcomes were assessed using Lysholm scores. RESULTS Among a total of 18 subjects (mean age: 28.7 ± 8.4 years, n = 14 males) with defects at the medial or lateral (n = 15 and n = 3, respectively) condyle, mean BMEL volume decreased from 4.9 cm3 at 3 months to 2.0 cm3 at 2-year follow-up (P = 0.040). MRS-based bone marrow water T2 showed a decrease from 20.7 ms at 1-year follow-up to 16.8 ms at 2-year follow-up (P = 0.040). Higher BMEL volume at 6 months correlated with lower 2-year Lysholm (R = -0.616, P = 0.015) and MOCART 2.0 scores (R = -0.567, P = 0.027). Larger early postoperative BMEL volumes at 3 months (R = -0.850, P = 0.007) and 6 months (R = -0.811, P = 0.008) correlated with lower MRS-based unsaturated lipid fractions at 2-year follow-up. Furthermore, patients with early postoperative bony defects showed worse MOCART 2.0 (P = 0.044) and Lysholm scores (P = 0.017) after 24 months. CONCLUSION Low subchondral BMEL volume and optimal restoration of the subchondral bone at early postoperative time points predict better 2-year clinical and MRI outcomes after MACI with ABG.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
- Matthias Jung, Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg,
Germany.
| | - Stefan Ruschke
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports
Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich,
Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum
Rechts der Isar, School of Medicine, Technical University of Munich, Munich,
Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and
Interventional Radiology, School of Medicine, Technical University of Munich,
Munich, Germany
- Department of Neuroradiology,
University Hospital, LMU Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
| | - Pia M. Jungmann
- Department of Diagnostic and
Interventional Radiology, Medical Center—University of Freiburg, Faculty of
Medicine, University of Freiburg, Freiburg, Germany
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Galletta TJ, Loveless SK, Malsch MM, Shimamura A, Myers KC. Coronavirus disease 2019 and vaccination in patients with Shwachman-Diamond syndrome. Pediatr Blood Cancer 2022; 69:e29647. [PMID: 35253346 PMCID: PMC9088415 DOI: 10.1002/pbc.29647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Because they can experience neutropenia due to bone marrow failure, patients with Shwachman-Diamond syndrome (SDS) carry increased risk for serious infections compared with the general population; however, there has been a paucity of data on the incidence and severity of coronavirus disease 2019 (COVID-19) in patients with SDS. We compiled results from a survey distributed to participants in the SDS Registry in May-June 2021. In this report, we describe the characteristics and outcomes of patients with SDS who had COVID-19. Patients reported a short clinical course without significant complications or cytopenias. Additionally, COVID-19 vaccines were well tolerated with minor side effects.
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Affiliation(s)
- Thomas J. Galletta
- Cancer and Blood Diseases InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Sara K. Loveless
- Division of Bone Marrow Transplantation and Immune DeficiencyCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Maggie M. Malsch
- Institutional Centers for Clinical and Translational ResearchBoston Children's HospitalBostonMassachusetts
| | - Akiko Shimamura
- Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusetts
- Department of PediatricsHarvard Medical SchoolBostonMassachusetts
| | - Kasiani C. Myers
- Division of Bone Marrow Transplantation and Immune DeficiencyCincinnati Children's Hospital Medical CenterCincinnatiOhio
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
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Takahata M, Watanabe T, Endo T, Ogawa Y, Miura S, Iwasaki N. Pulsating Spinal Arachnoid Cyst as a Hidden Aggravating Factor for Thoracic Spondylotic Myelopathy: A Report of 3 Cases. JBJS Case Connect 2022; 12:01709767-202206000-00033. [PMID: 35594560 DOI: 10.2106/jbjs.cc.22.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE We report 3 cases of thoracic myelopathy caused by vertebral osteophytes and coexisting intradural spinal arachnoid cyst (SAC), which was difficult to diagnose on preoperative magnetic resonance imaging. Intraoperative ultrasound sonography revealed spinal cord impingement because of osteophytes and a pulsating intradural SAC. Repeated pincer compression on the spinal cord seemed to be associated with their paraparetic symptoms. CONCLUSION In treating patients presenting with unexplained progressive myelopathy with small ossified lesion in the thoracic spine, close attention should be paid to a coexisting SAC as a hidden aggravating factor for thoracic myelopathy.
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Affiliation(s)
- Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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41
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Pollack D, Diament M, Kotlyarova Y, Gellman Y. The Bipartite Medial Cuneiform. J Am Podiatr Med Assoc 2021; 111. [PMID: 33355668 DOI: 10.7547/20-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal to plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator.
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Liu J, Dong Y, Xu D, Zhang C, Lan T, Chang D. Progress in diagnosis of bone metastasis of prostate cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:1147-1152. [PMID: 34911846 PMCID: PMC10930230 DOI: 10.11817/j.issn.1672-7347.2021.200999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/03/2022]
Abstract
The diagnosis of bone metastasis of prostate cancer (PC) is of great significance to the treatment and prognosis of patients with PC.Bone scan is the most commonly used in the early diagnosis of bone metastasis, but its specificity is low and there is a high false positive.In recent years, with the in-depth study of the application of CT, MRI, emission computed tomography (ECT), positron emission computed tomography/computed tomography (PET/CT) and deep learning algorithm-convolutional neural networks (CNN) in the diagnosis of bone metastasis, the combined application of various auxiliary parameters in the diagnosis of bone metastasis has significantly been improved. The therapeutic effect of PC patients with bone metastasis can also be evaluated, which is expected to achieve the treatment of bone metastasis as well as diagnosis. By systematically expounding the research progress of the above-mentioned techniques in the diagnosis of bone metastasis, it can provide clinicians with new methods for the diagnosis of bone metastasis and improve the diagnostic efficiency for bone metastasis.
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Affiliation(s)
- Jun Liu
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou 730000.
- Department of Urology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050.
| | - Yongchao Dong
- Department of Urology, Sichuan Gem Flower Hospital, Chengdu 610095
| | - Dongbo Xu
- Department of Urology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050
| | - Chunlei Zhang
- Department of Urology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050
| | - Tian Lan
- Department of Urology, Pinghu Hospital, Shenzhen University, Guangdong Shenzhen 518060, China
| | - Dehui Chang
- Department of Urology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050.
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Wiens J. [Skeletal changes due to bone metastases : Morphology and selected differential diagnoses]. Radiologe 2021; 61:1115-1124. [PMID: 34709436 DOI: 10.1007/s00117-021-00908-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The detection or exclusion of bone metastases is one of the most frequent tasks faced by the radiologist. The decision has significant and long-term consequences for the patient, therapeutic decisions and prognosis. For these reasons, specialized knowledge of the morphology, diagnostics and differential diagnoses of skeletal metastases is essential for the radiologist. OBJECTIVE The various manifestations of skeletal metastases are elaborated and some representative nonmetastatic differential diagnoses are presented. IMAGING The way in which metastases are radiologically depicted depends on the primary tumor, the localization of a metastasis, the interaction between metastasis and host bone, concomitant diseases, already initiated treatment and the individual circumstances of the patient. The basis of radiological diagnostics is still projection radiography, albeit with limitations. Computed tomography (CT) and magnetic resonance imaging (MRI) are firmly established methods in diagnostic imaging. Invasive diagnostics, preferably a CT-guided biopsy, are frequently unavoidable. CONCLUSION Various radiological procedures form the basis of the diagnostics of bone metastases. In many cases a definite diagnosis, i.e. presence or absence of bone metastases, is possible. In cases in which a suspected diagnosis with justified differential diagnoses arises, the radiologist, referring physician and other specialists to be consulted should advise on the benefits, risks and therapeutic consequences of an invasive procedure, usually by CT-guided biopsy.
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Affiliation(s)
- J Wiens
- Klinik für bildgebende Diagnostik und interventionelle Radiologie, Klinikum Wolfsburg, Wolfsburg, Deutschland.
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Wang W, Chen J, Luo D, Chen J, Xu H, Chen W, Wang Y. Effects of Low-Intensity Pulsed Ultrasound on Myelosuppression of Rats Induced by Chemotherapy Drugs With Cell Cycle Specificity. J Ultrasound Med 2021; 40:1811-1822. [PMID: 33174633 DOI: 10.1002/jum.15562] [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] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the ameliorating effects of low-intensity pulsed ultrasound (LIPUS) on Sprague Dawley rat myelosuppression induced by cell cycle specificity drugs (docetaxel, mitotic phase sensitive; and etoposide, gap 2 phase sensitive). METHODS Rats were respectively administered docetaxel (100 mg/kg) or etoposide (110 mg/kg) by intraperitoneal injection for 4 consecutive days. Then the rats were divided randomly into a LIPUS group and a non-LIPUS group. In the LIPUS group, the right femoral metaphysis of rats was treated by LIPUS (acoustic intensity, 200 mW/cm2 ; frequency, 0.3 MHz; and duty cycle, 20%) for 20 minutes on 7 consecutive days from day 5. The rats of the non-LIPUS group were treated without ultrasound output. A blood cell count, an enzyme-linked immunosorbent assay, a real-time quantitative polymerase chain reaction, and hematoxylin-eosin staining were applied to detect the results. RESULTS Low-intensity pulsed ultrasound significantly promoted the counts of bone marrow nucleated cells, white blood cells, immunoglobulin A (IgA), IgG, granulocyte colony-stimulating factor, stem cell factor, and intercellular cell adhesion molecule 1 and reduced the counts of vascular cell adhesion molecule 1 whether in the docetaxel or etoposide group (P < .05). Low-intensity pulsed ultrasound only increased the expression level of IgM in the docetaxel group but decreased the level of interleukin 6 in the etoposide group (P < .05). CONCLUSIONS Low-intensity pulsed ultrasound has potential to be a noninvasive treatment for myelosuppression caused by different cell cycle-sensitive chemotherapy drugs.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Junlin Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Dong Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Haopeng Xu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yan Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Shiang T, Tai R, Watts GJ. Absence of Posttraumatic Bone Marrow Edema in the Setting of Preeclampsia. J Am Podiatr Med Assoc 2021; 111:438705. [PMID: 32584976 DOI: 10.7547/19-185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging is a powerful tool in the diagnosis of missed or occult fractures on radiographic and computed tomographic (CT) imaging, through the detection of bone marrow edema. Although radiologists often rely on bone marrow edema as a guide for diagnosing subtle underlying fractures, it is important to recognize its limitations as a diagnostic metric. We present a rare case demonstrating the absence of bone marrow edema after acute trauma and confirmed Lisfranc fracture in a patient with preeclampsia and propose an interesting physiologic mechanism to explain this manifestation.
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Paoletta M, Moretti A, Liguori S, Bertone M, Toro G, Iolascon G. Transient osteoporosis of the hip and subclinical hypothyroidism: an unusual dangerous duet? Case report and pathogenetic hypothesis. BMC Musculoskelet Disord 2020; 21:543. [PMID: 32791961 PMCID: PMC7427076 DOI: 10.1186/s12891-020-03574-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transient osteoporosis of the hip (TOH) is a rare and temporary clinical condition characterised by bone marrow edema (BME), severe pain, and functional limitation. It commonly occurs in middle-aged men or in women in the last trimester of pregnancy. TOH usually resolves with conservative therapy but may predispose to hip fracture or progression to avascular necrosis (AVN). Etiology is still unclear, although several pathophysiological mechanisms underpinning this condition has been proposed. We describe the management of an unusual case of TOH occurred in a patient with subclinical hypothyroidism. CASE PRESENTATION A clinical case of a 46-year-old man with severe pain in the left anterior thigh is presented. After a comprehensive clinical and radiological approach, a TOH was diagnosed. Moreover, biochemical assessment suggested the presence of subclinical hypothyroidism. After 3 months of treatment with clodronate, physical therapy and hormone replacement therapy (HRT) a significant improvement of clinical and radiological outcomes was observed. CONCLUSION Several pathological conditions have been related to development of TOH. In our case, we suggested for the first time a role of subclinical hypothyroidism as novel contributory factor for the onset of this condition, providing pathophysiological mechanisms and a scientific rationale for pharmacological treatment.
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Affiliation(s)
- Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy.
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Matteo Bertone
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
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Baraliakos X, Anderson JK. Reply to: Bone marrow oedema on sacroiliac/spine MRI: is it really a sign of objective inflammation warranting treatment? Clin Exp Rheumatol 2019; 37 Suppl 122:11-12. [PMID: 31858959] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/17/2018] [Indexed: 06/10/2023]
Affiliation(s)
| | - Jaclyn K Anderson
- Immunology Clinical Development, AbbVie Inc., North Chicago, IL, USA
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