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ONCORELIEF - A Digital Guardian Angel Supported by an AI System to Improve Cancer Patient Quality of Life, Wellbeing and Health Outcomes: Protocol for a Pilot Study (Preprint). JMIR Res Protoc 2023; 12:e45475. [PMID: 37083563 PMCID: PMC10163393 DOI: 10.2196/45475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND According to Europe's Beating Cancer Plan, the number of cancer survivors is growing every year and is now estimated at over 12 million in Europe. A main objective of the European Commission is to ensure that cancer survivors can enjoy a high quality of life, underlining the role of digital technology and eHealth apps and tools to achieve this. OBJECTIVE The main objective of this study is the development of a user-centered artificial intelligence system to facilitate the input and integration of patient-related biopsychosocial data to improve posttreatment quality of life, well-being, and health outcomes and examine the feasibility of this digitally assisted workflow in a real-life setting in patients with colorectal cancer and acute myeloid leukemia. METHODS A total of 60 patients with colorectal cancer and 30 patients with acute myeloid leukemia will be recruited from 2 clinical centers: Universitätsmedizin der Johannes Gutenberg-Universität Mainz (Mainz, Germany) and IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST, Italy). Psychosocial data (eg, emotional distress, fatigue, quality of life, subjective well-being, sleep problems, and appetite loss) will be collected by questionnaires via a smartphone app, and physiological data (eg, heart rate, skin temperature, and movement through step count) will be collected by a customizable smart wrist-worn sensor device. Each patient will be assessed every 2 weeks over their 3-month participation in the ONCORELIEF study. Inclusion criteria include patients with the diagnosis of acute myeloid leukemia or colorectal cancer, adult patients aged 18 years and older, life expectancy greater than 12 months, Eastern Cooperative Oncology Group performance status ≤2, and patients who have a smartphone and agree to use it for the purpose of the study. Exclusion criteria include patients with a reduced cognitive function (such as dementia) or technological illiteracy and other known active malignant neoplastic diseases (patients with a medical history of treated neoplastic disease are included). RESULTS The pilot study started on September 1, 2022. As of January 2023, we enrolled 33 patients with colorectal cancer and 7 patients with acute myeloid leukemia. As of January 2023, we have not yet started the data analysis. We expect to get all data in June 2023 and expect the results to be published in the second semester of 2023. CONCLUSIONS Web-based and mobile apps use methods from mathematical decision support and artificial intelligence through a closed-loop workflow that connects health professionals and patients. The ONCORELIEF system has the potential of continuously identifying, collecting, and processing data from diverse patient dimensions to offer health care recommendations, support patients with cancer to address their unmet needs, and optimize survivorship care. TRIAL REGISTRATION German Clinical Trials Register (DRKS) 00027808; https://drks.de/search/en/trial/DRKS00027808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45475.
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A novel approach for infeasible path optimization of distillation-based flowsheets. CHEMICAL ENGINEERING SCIENCE: X 2020. [DOI: 10.1016/j.cesx.2020.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Med 2019; 20:264-273. [PMID: 30734998 DOI: 10.1111/hiv.12711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy. METHODS Stages included in the continuum were as follows: anti-HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. RESULTS Numbers and percentages for the stages of the HCV continuum of care were as follows: anti-HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow-up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001). CONCLUSIONS In the proposed HCV continuum of care for HIV/HCV-coinfected individuals, we found major gaps at all stages, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.
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Abacavir usage patterns and hypersensitivity reactions in the EuroSIDA cohort. HIV Med 2017; 19:252-260. [PMID: 29271606 DOI: 10.1111/hiv.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Five to eight per cent of HIV-positive individuals initiating abacavir (ABC) experience potentially fatal hypersensitivity reactions (HSRs). We sought to describe the proportion of individuals initiating ABC and to describe the incidence and factors associated with HSR among those prescribed ABC. METHODS We calculated the proportion of EuroSIDA individuals receiving ABC-based combination antiretroviral therapy (cART) among those receiving cART after 1 January 2009. Poisson regression was used to identify demographic, and current clinical and laboratory factors associated with ABC utilization and discontinuation. RESULTS Between 2009 and 2016, of 10 076 individuals receiving cART, 3472 (34%) had ever received ABC-based cART. Temporal trends of ABC utilization were also heterogeneous, with 28% using ABC in 2009, dropping to 26% in 2010 and increasing to 31% in 2016, and varied across regions and over time. Poisson models showed lower ABC utilization in older individuals, and in those with higher CD4 cell counts, higher cART lines, and prior AIDS. Higher ABC utilization was associated with higher HIV RNA and poor renal function, and was more common in Central-East and Eastern Europe and lowest during 2014. During 779 person-years of follow-up (PYFU) in 2139 individuals starting ABC after 1 January 2009, 113 discontinued ABC within 6 weeks of initiation for any reason [incidence rate (IR) 14.5 (95% confidence interval (CI) 12.1, 17.5) per 100 PYFU], 13 because of reported HSR [IR 0.3 (95% CI 0.1, 1.0) per 100 PYFU] and 35 because of reported HSR/any toxicity [IR 4.5 (95% CI 3.2, 6.3) per 100 PYFU]. There were no factors significantly associated with ABC discontinuation because of reported HSR/any toxicity. CONCLUSIONS ABC remains commonly used across Europe and the incidence of discontinuation because of reported HSR was low in our study population.
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Ethnicity predicts viral rebound after travel to the tropics in HIV-infected travelers to the tropics in the Swiss HIV Cohort Study. HIV Med 2017; 18:564-572. [PMID: 28247589 DOI: 10.1111/hiv.12491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The number of HIV-infected individuals from developed countries travelling to tropical and subtropical areas has increased as a result of the clinical and survival benefits of combination antiretroviral therapy. The aim of our study was to describe the traveler population in the SHCS and to determine the frequency of viral rebound in virologically suppressed individuals after a travel episode to the tropics compared to non-travelers. METHODS Swiss HIV Cohort Study participants with at least one follow-up visit between 1 January 1989 and 28 February 2015 were eligible for inclusion in the study. The primary outcome was the occurrence of viral rebound (viral load > 200 HIV-1 RNA copies/mL) after a travel episode compared with a nontravel episode in previously suppressed individuals (≤ 200 copies/mL). All virologically suppressed patients contributed multiple travel or nontravel episodes to the analysis. Logistic regression was performed including factors associated with viral rebound. RESULTS We included 16 635 patients in the study, of whom 6084 (36.5%) had ever travelled to the tropics. Travel frequency increased over time, with travellers showing better HIV parameters than nontravellers [less advanced Centers for Disease Control and Prevention (CDC) stage and higher CD4 count nadir]. Viral rebound was seen in 477 (3.9%) of 12 265 travel episodes and in 5121 (4.5%) of 114 884 nontravel episodes [unadjusted odds ratio (OR) 0.87; 95% confidence interval (CI) 0.78-0.97]. Among these 477 post-travel viral rebounds, 115 had a resistance test performed and 51 (44%) of these showed new resistance mutations. Compared with European and North American patients, the odds for viral rebound were significantly lower in Southeast Asian (OR 0.67; 95% CI 0.51-0.88) and higher in sub-Saharan African (SSA) patients (OR 1.41; 95% CI 1.22-1.62). Travel further increased the odds of viral rebound in SSA patients (OR 2.00; 95% CI 1.53-2.61). CONCLUSIONS Region of origin is the main risk factor for viral rebound rather than travel per se. Pre-travel adherence counselling should focus on patients of SSA origin.
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Le score de Gleason est-il corrélé au score PIRADS défini par l’IRM prostatique multiparamétrique ? Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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On the advancement and software support of decision-making in focused ultrasound therapy. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2016. [DOI: 10.1002/mcda.1596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Diagnostic Performance of 18 F-FDG-PET/CT in Vascular Graft Infections. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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A new mathematical approach for handling DVH criteria in IMRT planning. JOURNAL OF GLOBAL OPTIMIZATION : AN INTERNATIONAL JOURNAL DEALING WITH THEORETICAL AND COMPUTATIONAL ASPECTS OF SEEKING GLOBAL OPTIMA AND THEIR APPLICATIONS IN SCIENCE, MANAGEMENT AND ENGINEERING 2015; 61:407-428. [PMID: 37701267 PMCID: PMC10497224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The appropriate handling of planning criteria on the cumulative dose-volume histogram (DVH) is a highly problematic issue in intensity-modulated radiation therapy (IMRT) plan optimization. The nonconvexity of DVH criteria and globality of the resulting optimization problems complicate the design of suitable optimization methods, which feature numerical efficiency, reliable convergence and optimality of the results. This work examines the mathematical structure of DVH criteria and proves the valuable properties of isotonicity/antitonicity, connectedness, invexity and sufficiency of the KKT condition. These properties facilitate the use of efficient and goal-oriented optimization methods. An exemplary algorithmic realization with feasible direction methods gives rise to a functional framework for interactive IMRT planning on DVH criteria. Numerical examples on real world planning cases prove its practical capability.
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Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg 2015; 49:455-64. [PMID: 25648371 DOI: 10.1016/j.ejvs.2014.12.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography/computed tomography with (18)F-fludeoxyglucose (FDG-PET/CT) in a population with suspected graft infection and to validate a new diagnostic imaging score for FDG-PET/CT. METHODS This was a prospective cohort study. FDG-PET/CT was performed prospectively in 34 patients with suspected graft infection, in 12 of them before the start of antimicrobial treatment. Diagnostic accuracy was assessed using a new five point visual grading score and by using a binary score. Maximum standardized uptake values (SUVmax) were calculated for quantitative measurements of metabolic activity, and cut off points were calculated using the receiver operator curve (ROC). The standard of reference was a microbiological culture, obtained after open biopsy or graft explantation. RESULTS Using the new scale, FDG-PET/CT correctly recognized 27 patients with graft infection, one patient was diagnosed as false positive, six patients were correctly classified as true negative, and no patients were rated false negative. Hence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FDG-PET/CT for the diagnosis of graft infections were 100%, 86%, 96%, 100%, and 97%, respectively. Using a previously established binary score, sensitivity, specificity, PPV, NPV, and accuracy were 96%, 86%, 96%, 86%, and 94% respectively. ROC analysis suggested an SUVmax cut off value of ≥3.8 to differentiate between infected and non-infected grafts (p < .001). Additionally, FDG-PET/CT provided a conclusive clinical diagnosis in six of seven patients without graft infection (i.e., other sites of infections). CONCLUSIONS The diagnostic accuracy of FDG-PET/CT in the detection of aortic graft infection is high. A newly introduced five point visual grading score and early imaging prior to antimicrobial treatment may further improve the diagnostic accuracy.
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Analyzing the quality robustness of chemotherapy plans with respect to model uncertainties. Math Biosci 2014; 259:55-61. [PMID: 25457799 DOI: 10.1016/j.mbs.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/07/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022]
Abstract
Mathematical models of chemotherapy planning problems contain various biomedical parameters, whose values are difficult to quantify and thus subject to some uncertainty. This uncertainty propagates into the therapy plans computed on these models, which poses the question of robustness to the expected therapy quality. This work introduces a combined approach for analyzing the quality robustness of plans in terms of dosing levels with respect to model uncertainties in chemotherapy planning. It uses concepts from multi-criteria decision making for studying parameters related to the balancing between the different therapy goals, and concepts from sensitivity analysis for the examination of parameters describing the underlying biomedical processes and their interplay. This approach allows for a profound assessment of a therapy plan, how stable its quality is with respect to parametric changes in the used mathematical model.
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Direct binding of the Alu binding protein dimer SRP9/14 to 40S ribosomal subunits promotes stress granule formation and is regulated by Alu RNA. Nucleic Acids Res 2014; 42:11203-17. [PMID: 25200073 PMCID: PMC4176187 DOI: 10.1093/nar/gku822] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Stress granules (SGs) are formed in response to stress, contain mRNAs, 40S ribosomal subunits, initiation factors, RNA-binding and signaling proteins, and promote cell survival. Our study describes a novel function of the protein heterodimer SRP9/14 and Alu RNA in SG formation and disassembly. In human cells, SRP9/14 exists assembled into SRP, bound to Alu RNA and as a free protein. SRP9/14, but not SRP, localizes to SGs following arsenite or hippuristanol treatment. Depletion of the protein decreases SG size and the number of SG-positive cells. Localization and function of SRP9/14 in SGs depend primarily on its ability to bind directly to the 40S subunit. Binding of SRP9/14 to 40S and Alu RNA is mutually exclusive indicating that the protein alone is bound to 40S in SGs and that Alu RNA might competitively regulate 40S binding. Indeed, by changing the effective Alu RNA concentration in the cell or by expressing an Alu RNA binding-defective protein we were able to influence SG formation and disassembly. Our findings suggest a model in which SRP9/14 binding to 40S promotes SG formation whereas the increase in cytoplasmic Alu RNA following stress promotes disassembly of SGs by disengaging SRP9/14 from 40S.
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Prediction of Response of Primary Tumors to Neoadjuvant Sunitinib Using Perfusion (Dce) Computed Tomography (Ct) in Metastatic Renal Cell Carcinoma (Mrcc) Patients (Preinsut Trial). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nuclear Velocity Perturbation Theory of Vibrational Circular Dichroism. J Chem Theory Comput 2013; 9:5305-12. [DOI: 10.1021/ct400700c] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mesures anatomiques postopératoires en IRM dynamique : association à la continence urinaire des néovessies iléales orthotopiques après cystoprostatectomie pour cancer de vessie. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Évaluation du statut ganglionnaire avant cystectomie totale pour cancer de la vessie infiltrant le muscle : intérêt du couple IRM de diffusion et 18FDG-TEP scanner ? Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dysfonction de vidange des ileoplasties après cystectomie : analyse par IRM mictionnelle. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morphométrie des ileoplasties après cystectomie : intérêt de l’IRM mictionnelle. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Registry for the Evaluation of the PROgnostic value of a novel integrated imaging approach combining Single Photon Emission Computed Tomography with coronary calcification imaging (REPROSPECT). Eur Heart J Cardiovasc Imaging 2012; 14:374-80. [DOI: 10.1093/ehjci/jes224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Eigensystem Representation of the Electronic Susceptibility Tensor for Intermolecular Interactions within Density Functional Theory. J Chem Theory Comput 2011; 8:106-11. [DOI: 10.1021/ct200695y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[H1N1 (2009) influenza A infection in transplant recipient patients: a comparative study versus non-transplanted patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:199-208. [PMID: 21920278 PMCID: PMC7126570 DOI: 10.1016/j.pneumo.2011.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare H1N1 (2009) influenza A infection characteristics between transplant recipient patients and non-transplanted patients. To assess the evolution of transplanted patients up to 6 months following infection. METHODS Patients diagnosed with confirmed influenza A infection from three Parisian transplant centers between September 1st, 2009 and February 15th, 2010. Clinical symptoms, biological, and radiological findings, and management were analysed and retrospectively compared between transplanted (T) and non-transplanted patients (NT). The evolution was assessed by a follow-up questionnaire, CT results 1 to 3 months after influenza infection and FEV1 variation. RESULTS Seventy patients were included. Thirteen patients had an allograft (lung: eight, kidney: four, stem cells: one): (1) hospitalization: 100% (13 out of 13) in group T, 54% (31 out of 57) in group NT (P=0.0013); (2) pneumonia: 62% (eight out of 13) in group T, 26% (eight out of 57) in group NT (P=0.004); (3) mortality rate among hospitalized patients: 7.7% (one out of 13) in the group T, 9.7% (three out of 57) in group NT (P=NS); (4) chest CT scan abnormalities remained in four lung transplanted patients; (5) a minimum 10% decrease in FEV1 was detected in four lung transplant recipients. CONCLUSION Our results suggest that H1N1(2009) influenza A infection in transplant recipient patients compared to non-transplanted patients: (1) more often leads to hospitalization; (2) is more frequently associated with pneumonia; (3) is responsible for a persistent graft functional impairment in lung transplant recipients; (4) has a low mortality rate similar to admitted non-transplanted patients.
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[Radiofrequency treatment of lung tumours]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:238-243. [PMID: 21920284 DOI: 10.1016/j.pneumo.2011.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/29/2011] [Indexed: 05/31/2023]
Abstract
Formal surgical resection is the standard treatment for patients with an operable non-small cell lung tumour and for selected patients with limited lung metastases, even if only a small number of patients are suitable for formal surgical resection due to comorbidities. CT-guided radiofrequency treatment is a minimally invasive therapeutic option that has been successfully applied to different organs, and for the lung is considered to be an alternative to surgery for patients who are not candidates for surgery. The procedure is well-tolerated and the complication rate is acceptable.
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[CT imaging of the chest]. JOURNAL DE RADIOLOGIE 2009; 90:1775. [PMID: 19953070 DOI: 10.1016/s0221-0363(09)73281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Klinik und Therapie der anogenitalen Hidradenitis suppurativa. Dermatology 2009. [DOI: 10.1159/000251847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The integration of DVH-based planning aspects into a convex intensity modulated radiation therapy optimization framework. Phys Med Biol 2009; 54:N239-46. [DOI: 10.1088/0031-9155/54/12/n02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The formulation of optimization problems in intensity-modulated radiotherapy (IMRT) planning comprises the choice of various values such as function-specific parameters or constraint bounds. In current inverse planning programs that yield a single treatment plan for each optimization, it is often unclear how strongly these modeling parameters affect the resulting plan. This work investigates the mathematical concepts of elasticity and sensitivity to deal with this problem. An artificial planning case with a horse-shoe formed target with different opening angles surrounding a circular risk structure is studied. As evaluation functions the generalized equivalent uniform dose (EUD) and the average underdosage below and average overdosage beyond certain dose thresholds are used. A single IMRT plan is calculated for an exemplary parameter configuration. The elasticity and sensitivity of each parameter are then calculated without re-optimization, and the results are numerically verified. The results show the following. (1) elasticity can quantify the influence of a modeling parameter on the optimization result in terms of how strongly the objective function value varies under modifications of the parameter value. It also can describe how strongly the geometry of the involved planning structures affects the optimization result. (2) Based on the current parameter settings and corresponding treatment plan, sensitivity analysis can predict the optimization result for modified parameter values without re-optimization, and it can estimate the value intervals in which such predictions are valid. In conclusion, elasticity and sensitivity can provide helpful tools in inverse IMRT planning to identify the most critical parameters of an individual planning problem and to modify their values in an appropriate way.
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A new concept for interactive radiotherapy planning with multicriteria optimization: first clinical evaluation. Radiother Oncol 2007; 85:292-8. [PMID: 17892901 DOI: 10.1016/j.radonc.2007.06.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 04/02/2007] [Accepted: 06/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Currently, inverse planning for intensity-modulated radiotherapy (IMRT) can be a time-consuming trial and error process. This is because many planning objectives are inherently contradictory and cannot reach their individual optimum all at the same time. Therefore in clinical practice the potential of IMRT cannot be fully exploited for all patients. Multicriteria (multiobjective) optimization combined with interactive plan navigation is a promising approach to overcome these problems. PATIENTS AND METHODS We developed a new inverse planning system called "Multicriteria Interactive Radiotherapy Assistant (MIRA)". The optimization result is a database of patient specific, Pareto-optimal plan proposals. The database is explored with an intuitive user interface that utilizes both a new interactive element for plan navigation and familiar dose visualizations in form of DVH and isodose projections. Two clinical test cases, one paraspinal meningioma case and one prostate case, were optimized using MIRA and compared with the clinically approved planning program KonRad. RESULTS Generating the databases required no user interaction and took approx. 2-3h per case. The interactive exploration required only a few minutes until the best plan was identified, resulting in a significant reduction of human planning time. The achievable plan quality was comparable to KonRad with the additional benefit of having plan alternatives at hand to perform a sensitivity analysis or to decide for a different clinical compromise. CONCLUSIONS The MIRA system provides a complete database and interactive exploration of the solution space in real time. Hence, it is ideally suited for the inherently multicriterial problem of inverse IMRT treatment planning.
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[Case no. 2. Atheroembolism of the kidney]. JOURNAL DE RADIOLOGIE 2007; 88:993-8. [PMID: 17878862 DOI: 10.1016/s0221-0363(07)89912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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[Management of the pulmonary complications of haematological malignancy]. Rev Mal Respir 2007; 24:145-54. [PMID: 17347602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The high frequency of pulmonary complications of haematological malignancy and the increasing number of patients treated for these disorders make it important that the respiratory physician has a structured diagnostic approach according to: 1 the immune deficiency due to the malignancy and/or the treatment administered; 2 the factors that can modify the risk of infection (anti infection prophylaxis and/or pre-emptive treatment); 3 co-morbidities; 4 extra-pulmonary manifestations. Two main situations can be identified: The patient is aplasic: Initially the pneumonias are predominantly of bacterial origin but may be fungal if the neutropenia is prolonged. The respiratory physician is faced with two problems: 1 the diagnosis of pneumonia; this may be helped by CT scanning; 2 The choice of antibiotics; this will depend on previous investigations. The patient is not aplasic: The lung disease may have many causes, mainly infectious but also drug related, tumoral, haemorrhagic or embolic. The main problem is the correct choice of investigations to establish an aetiological diagnosis. The collection of data according to a pre-established protocol based on simple factors (study of the notes and clinical examination) is one of the key elements for improving the prognosis of these patients whose management should be multidisciplinary following a pre-defined plan.
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[Case No. 3. Abdominal disease]. JOURNAL DE RADIOLOGIE 2006; 87:694-7. [PMID: 16858870 DOI: 10.1016/s0221-0363(06)74068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Evaluation of imaging-guided fine-needle percutaneous biopsy of renal masses. Clin Imaging 2006. [DOI: 10.1016/j.clinimag.2005.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Case #4: thoracic pathology: primary tuberculosis with mediastinal lymphatic involvement developing during treatment]. ACTA ACUST UNITED AC 2005; 86:700-3. [PMID: 16149202 DOI: 10.1016/s0221-0363(05)81436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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[Case #2: thoracic pathology: thymoma type A or medullary thymoma]. ACTA ACUST UNITED AC 2005; 86:693-4. [PMID: 16149200 DOI: 10.1016/s0221-0363(05)81434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pulmonary manifestations of multicentric Castleman's disease in HIV infection: a clinical, biological and radiological study. Eur Respir J 2005; 26:118-25. [PMID: 15994398 DOI: 10.1183/09031936.05.00130304] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of the present study was to report clinical, radiological and bronchoalveolar lavage (BAL) findings in patients with pulmonary manifestations of HIV-associated multicentric Castleman's disease (MCD). This was a retrospective study of 12 patients with histologically proven MCD. Clinical manifestations were as follows: dyspnoea (nine out of 12 cases), cough (n = 10), bilateral crackles (n = 10), together with high fever, malaise, peripheral lymphadenopathy (n = 12), and hepatosplenomegaly (n = 10). Two patients developed acute respiratory distress syndrome. Chest radiographs and computed tomography scans showed reticular (n = 7) and/or nodular (n = 7) interstitial patterns, with mediastinal lymphadenopathy (n = 9), and bilateral pleural effusion (n = 3). Fibreoptic endoscopy was normal in all cases. BAL analysis showed hypercellularity (n = 6) and/or lymphocytosis (n = 6), and human herpesvirus-8 DNA was detected in two out of two cases. Specific stains and cultures for pathogens were negative. All patients received etoposide and/or vinblastine, and improved after 2-4 days. Relapses were frequent (50 attacks in 12 patients). Six patients developed a non-Hodgkin's lymphoma, and five died. In conclusion, the pulmonary manifestation of HIV-related multicentric Castleman's disease is an acute reticulo-nodular interstitial pneumonitis, associated with severe systemic symptoms and peripheral lymphadenopathy. In bronchoalveolar lavage fluid, cellularity is not specific and human herpesvirus-8 DNA is detected. The clinical course is specific due to a rapid onset and regression, frequent relapses and a high occurrence of non-Hodgkin's lymphoma.
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SU-FF-T-112: First Evaluation of a New Multicriteria Optimization Tool-Investigation of Pareto-Surfaces for IMRT Prostate Plans. Med Phys 2005. [DOI: 10.1118/1.1997783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Drug-induced lung diseases are an increasingly frequent cause of morbidity. Over 350 drugs are now recognized as being implicated in drug-induced lung diseases. Early diagnosis is critical. Discontinuing the drug may result in regression of the adverse effect. Diagnosis is based on a history of drug exposure with a temporal relationship between the introduction of the drug and the onset of symptoms, histologic evidence of lung damage and exclusion of other causes of lung injury. Unfortunately there is no specific test available. Histologic and radiologic findings are often non specific and diagnosis can be difficult. Drugs can cause a constellation of distinct patterns of respiratory involvement and all anatomic compartments of the lungs may be involved. The most common patterns are: non specific interstitial pneumonia and fibrosis, pulmonary eosinophilia, hypersensitivity pneumonitis, pulmonary edema with or without diffuse alveolar damage, bronchiolitis obliterans organizing pneumonia, pulmonary hemorrhage and vasculitis. It is important to be familiar with their common radiologic appearances.
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Abstract
The objective of radiotherapy planning is to find a compromise between the contradictive goals of delivering a sufficiently high dose to the target volume while widely sparing critical structures. The search for such a compromise requires the computation of several plans, which mathematically means solving several optimization problems. In the case of intensity modulated radiotherapy (IMRT) these problems are large-scale, hence the accumulated computational expense is very high. The adaptive clustering method presented in this paper overcomes this difficulty. The main idea is to use a preprocessed hierarchy of aggregated dose-volume information as a basis for individually adapted approximations of the original optimization problems. This leads to a decisively reduced computational expense: numerical experiments on several sets of real clinical data typically show computation times decreased by a factor of about 10. In contrast to earlier work in this field, this reduction in computational complexity will not lead to a loss in accuracy: the adaptive clustering method produces the optimum of the original optimization problem.
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[Interpretation session in general radiology. Case No. 7: Urinary pathology. Von Hippel Lindau disease]. ACTA ACUST UNITED AC 2004; 85:441-3. [PMID: 15248330 DOI: 10.1016/s0221-0363(04)97612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study. J Clin Oncol 2004; 22:1118-25. [PMID: 15020614 DOI: 10.1200/jco.2004.04.165] [Citation(s) in RCA: 335] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare fotemustine and dacarbazine (DTIC) in terms of overall response rate (ORR) as primary end-point and overall survival, duration of responses, time to progression, time to occurrence of brain metastases (BM), and to assess safety and quality of life in patients with disseminated cutaneous melanoma. PATIENTS AND METHODS Patients received either intravenous fotemustine 100 mg/m2 weekly for 3 weeks or DTIC 250 mg/m2/d for 5 consecutive days every 4 weeks (two cycles). Nonprogressive patients received a maintenance treatment every 4 weeks (fotemustine 100 mg/m2 or DTIC 250 mg/m2 for 5 days). RESULTS Two hundred twenty-nine patients were randomly assigned to fotemustine or DTIC arms. The best ORR was higher in the fotemustine arm than in the DTIC arm in the intent-to-treat population (n=229; 15.2% v 6.8%; P=.043) and in full analysis set (n=221) (15.5% v 7.2%; P=.053). Similar median durations of responses (5.8 months with fotemustine v 6.9 months with DTIC) and time to progression (1.8 v 1.9 months, respectively) were observed. In patients without BM at inclusion, the median time to BM was 22.7 months with fotemustine versus 7.2 months with DTIC (P=.059). Median survival was 7.3 months with fotemustine versus 5.6 months with DTIC (P=.067). The main toxicity was grade 3 to 4 neutropenia (51% with fotemustine v 5% with DTIC) and thrombocytopenia (43% v 6%, respectively). No significant difference was noted for quality of life between arms. CONCLUSION ORR was higher in the fotemustine arm compared to the DTIC arm in first-line treatment of disseminated melanoma. A trend in favor of fotemustine in terms of overall survival and time to BM was evidenced.
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[Interpretation session in general radiology. Case No. 3: Urinary disease. Cyst of the seminal vesicle with agenesis of homolateral kidney]. JOURNAL DE RADIOLOGIE 2004; 85:431-2. [PMID: 15248324 DOI: 10.1016/s0221-0363(04)97608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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[Interpretation session in general radiology. Case No. 8: Cardiovascular system. Fallot tetralogy with pulmonary atresia]. JOURNAL DE RADIOLOGIE 2004; 85:444-6. [PMID: 15248331 DOI: 10.1016/s0221-0363(04)97613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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[Interpretation session in general radiology. Case No. 4: Cardiovascular system. Single ventricle treated with total cavo-pulmonary anastomosis or Fontan's procedure]. JOURNAL DE RADIOLOGIE 2004; 85:433-4. [PMID: 15248325 DOI: 10.1016/s0221-0363(04)97609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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[Radiological geriatrics: an emergent specialty and a future specialty]. JOURNAL DE RADIOLOGIE 2003; 84:1811. [PMID: 14739836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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[Chest diseases in elderly: role of imaging and clinical features]. JOURNAL DE RADIOLOGIE 2003; 84:1829-36. [PMID: 14739839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Chest x-ray is the most useful examination in the elderly as community acquired pneumonia is very frequent in this high risk population. Technical details have to be considered due to the clinical status of elderly patients. Raising arms above the head may help in the radiographic diagnosis of pneumonia. Guidelines for good radiological practice indicate that a chest x-ray should be done in patients with acute respiratory illness and dementia. Clinical and biological findings of pneumonia may be misleading in the elderly and treatment should be instituted rapidly to avoid complications. Lung cancer of elderly patients has to be investigated and treated without consideration for age. Surgery should be done whenever the tumor is removable by lobectomy. Chemotherapy may be safe even in patients older than 80 with an acceptable quality of life.
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