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Wittmann Dayagi T, Nirel R, Avrahami G, Amar S, Elitzur S, Fisher S, Gilead G, Gilad O, Goldberg T, Izraeli S, Kadmon G, Kaplan E, Krauss A, Michaeli O, Stein J, Steinberg-Shemer O, Tamary H, Tausky O, Toledano H, Weissbach A, Yacobovich J, Yanir AD, Zon J, Nahum E, Barzilai-Birenboim S. A Need for a Novel Survival Risk Scoring System for Intensive Care Admissions Due to Sepsis in Pediatric Hematology/Oncology Patients. J Intensive Care Med 2024; 39:484-492. [PMID: 37981801 DOI: 10.1177/08850666231216362] [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: 11/21/2023]
Abstract
Background: Children with hemato-oncological diseases or following stem cell transplantation (SCT) are at high risk for life-threatening infections; sepsis in this population constitutes a substantial proportion of pediatric intensive care unit (PICU) admissions. The current pediatric prognostic scoring tools to evaluate illness severity and mortality risk are designed for the general pediatric population and may not be adequate for this vulnerable subpopulation. Methods: Retrospective analysis was performed on all PICU admissions for sepsis in children with hemato-oncological diseases or post-SCT, in a single tertiary pediatric hospital between 2008 and 2021 (n = 233). We collected and analyzed demographic, clinical, and laboratory data and outcomes for all patients, and evaluated the accuracy of two major prognostic scoring tools, the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and the Pediatric Risk of Mortality III (PRISM III). Furthermore, we created a new risk-assessment model that contains additional parameters uniquely relevant to this population. Results: The survival rate for the cohort was 83%. The predictive accuracies of PELOD-2 and PRISM III, as determined by the area under the curve (AUC), were 83% and 78%, respectively. Nine new parameters were identified as clinically significant: age, SCT, viral infection, fungal infection, central venous line removal, vasoactive inotropic score, bilirubin level, C-reactive protein level, and prolonged neutropenia. Unique scoring systems were established by the integration of these new parameters into the algorithm; the new systems significantly improved their predictive accuracy to 91% (p = 0.01) and 89% (p < 0.001), respectively. Conclusions: The predictive accuracies (AUC) of the PELOD-2 and PRISM III scores are limited in children with hemato-oncological diseases admitted to PICU with sepsis. These results highlight the need to develop a risk-assessment tool adjusted to this special population. Such new scoring should represent their unique characteristics including their degree of immunosuppression and be validated in a large multi-center prospective study.
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Affiliation(s)
- Talya Wittmann Dayagi
- Division of Haematology and Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics and Data Science, Hebrew University, Jerusalem, Israel
| | - Galia Avrahami
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Amar
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Elitzur
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salvador Fisher
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Gilead
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Gilad
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tracie Goldberg
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Izraeli
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kadmon
- Department of pediatric intensive care unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eytan Kaplan
- Department of pediatric intensive care unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Krauss
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orli Michaeli
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Stein
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Steinberg-Shemer
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hannah Tamary
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Tausky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Helen Toledano
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avichai Weissbach
- Department of pediatric intensive care unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joanne Yacobovich
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf D Yanir
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jessica Zon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Nahum
- Department of pediatric intensive care unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gilad G, Shichrur K, Laiba E, Birger Y, Jaron R, Elitzur S, Avrahami G, Barzilai-Birenboim S, Yanir A, Krauss A, Stein J, Kodman Y, Feuerstein T, Marcus N, Izraeli S. A NOVEL PATHOGENIC SH2D1A MUTATION CAUSES X-LINKED LYMPHOPROLIFERATIVE DISEASE MANIFESTED BY NON-HODGKIN LYMPHOMA AND DYSGAMMAGLOBULINEMIA. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yanir AD, Krauss A, Stein J, Steinberg-Shemer O, Gilad O, Lotan SN, Dgany O, Krasnov T, Kodman Y, Feuerstein T, Mardoukh J, Fishman H, Geron I, Yacobovich J, Tamary H, Birger Y, Avrahami G, Izraeli S, Birenboim SB. Pediatric myelodysplastic syndrome with inflammatory manifestations: Diagnosis, genetics, treatment, and outcome. Pediatr Blood Cancer 2021; 68:e29138. [PMID: 34019335 DOI: 10.1002/pbc.29138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory manifestations (IM) are well described in adult patients with myelodysplastic syndrome (MDS), but the presentation is highly variable and no standardized treatment exists. This phenomenon is rarely reported in children. As more pediatric patients are hematopoietic stem cell transplantation (HSCT) candidates, the role of anti-inflammatory treatment in relation to HSCT should be defined. PROCEDURE Here, we report a series of five children from a tertiary center. We describe the clinical presentation, molecular findings, and treatment options. RESULTS All patients presented with advanced MDS with blast percentages ranging 10-30%, all had severe IM. One patient had MDS secondary to severe congenital neutropenia, the other four patients had presumably primary MDS. All four were found to harbor a PTPN11 gene driver mutation, which is found in 35% of cases of juvenile myelomonocytic leukemia (JMML). The mutation was present in the myeloid lineage but not in T lymphocytes. Three had symptoms of Behcet's-like disease with trisomy 8 in their bone marrow. All patients were treated with anti-inflammatory medications (mainly systemic steroids) in an attempt to bring them to allogeneic HSCT in a better clinical condition. All demonstrated clinical improvement as well as regression in their MDS status post anti-inflammatory treatment. All have recovered from both MDS and their inflammatory symptoms post HSCT. CONCLUSION Primary pediatric MDS with IM is driven in some cases by PTPN11 mutations, and might be on the clinical spectrum of JMML. Anti-inflammatory treatment may reverse MDS progression and improve the outcome of subsequent HSCT.
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Affiliation(s)
- Asaf D Yanir
- BMT Unit, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Krauss
- BMT Unit, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Stein
- BMT Unit, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Steinberg-Shemer
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Gilad
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Noy Lotan
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Orly Dgany
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Tatyana Krasnov
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Yona Kodman
- Immune Phenotype Laboratory, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Tamar Feuerstein
- Immune Phenotype Laboratory, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Jacques Mardoukh
- Cytogenetic Laboratory, Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Hila Fishman
- Pediatric Leukemia Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Geron
- Pediatric Leukemia Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joanne Yacobovich
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hannah Tamary
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehudit Birger
- Pediatric Leukemia Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Avrahami
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Izraeli
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Pediatric Leukemia Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai Birenboim
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krauss A, West L, Conway J, Khoury M, Halpin A, Nahirniak S, Aklabi MA, Urschel S. ABO-Incompatible Heart Transplantation in Older Children Using Immune Modulation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
To ensure accurate reference dosimetry with ionization chambers in magnetic resonance linear accelerators (MR-linacs), the influence of the magnetic field on the response of the ionization chambers must be considered. The most direct method considering the influence of magnetic fields in dosimetry is to apply an appropriate absorbed-dose-to-water primary standard. At PTB, a new water calorimeter has been designed which is capable to determine Dw,Q in an MR-linac. The new device allows the direct calibration of ionization chambers in terms of absorbed dose to water for MR-linac irradiation conditions. Hence, the correction factors [Formula: see text] can be determined which replace the current radiation-quality dependent correction factors [Formula: see text] for dosimetry in the presence of magnetic fields. In cooperation with Heidelberg University Hospital,[Formula: see text] factors were measured at the 6 MV 0.35 T Viewray MR-linac for different cylindrical ionization chambers with sensitive volumes ranging from 0.015 cm3 to 0.65 cm3. The chambers were placed both perpendicular and parallel in respect to the magnetic field. Standard uncertainties of about 0.5% were achieved.
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Affiliation(s)
- A Krauss
- Department of Dosimetry for Radiation Therapy and Diagnostic Radiology, Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, D-38116, Braunschweig, Germany
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Osinga-Blättermann JM, Krauss A. Determination of k Q factors for cylindrical and plane-parallel ionization chambers in a scanned carbon ion beam by means of cross calibration. ACTA ACUST UNITED AC 2018; 64:015009. [DOI: 10.1088/1361-6560/aaf5ac] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Thanarajasingam G, Minasian LM, Baron F, Cavalli F, De Claro RA, Dueck AC, El-Galaly TC, Everest N, Geissler J, Gisselbrecht C, Gribben J, Horowitz M, Ivy SP, Jacobson CA, Keating A, Kluetz PG, Krauss A, Kwong YL, Little RF, Mahon FX, Matasar MJ, Mateos MV, McCullough K, Miller RS, Mohty M, Moreau P, Morton LM, Nagai S, Rule S, Sloan J, Sonneveld P, Thompson CA, Tzogani K, van Leeuwen FE, Velikova G, Villa D, Wingard JR, Wintrich S, Seymour JF, Habermann TM. Beyond maximum grade: modernising the assessment and reporting of adverse events in haematological malignancies. Lancet Haematol 2018; 5:e563-e598. [PMID: 29907552 PMCID: PMC6261436 DOI: 10.1016/s2352-3026(18)30051-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [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: 01/12/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
Tremendous progress in treatment and outcomes has been achieved across the whole range of haematological malignancies in the past two decades. Although cure rates for aggressive malignancies have increased, nowhere has progress been more impactful than in the management of typically incurable forms of haematological cancer. Population-based data have shown that 5-year survival for patients with chronic myelogenous and chronic lymphocytic leukaemia, indolent B-cell lymphomas, and multiple myeloma has improved markedly. This improvement is a result of substantial changes in disease management strategies in these malignancies. Several haematological malignancies are now chronic diseases that are treated with continuously administered therapies that have unique side-effects over time. In this Commission, an international panel of clinicians, clinical investigators, methodologists, regulators, and patient advocates representing a broad range of academic and clinical cancer expertise examine adverse events in haematological malignancies. The issues pertaining to assessment of adverse events examined here are relevant to a range of malignancies and have been, to date, underexplored in the context of haematology. The aim of this Commission is to improve toxicity assessment in clinical trials in haematological malignancies by critically examining the current process of adverse event assessment, highlighting the need to incorporate patient-reported outcomes, addressing issues unique to stem-cell transplantation and survivorship, appraising challenges in regulatory approval, and evaluating toxicity in real-world patients. We have identified a range of priority issues in these areas and defined potential solutions to challenges associated with adverse event assessment in the current treatment landscape of haematological malignancies.
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Affiliation(s)
| | - Lori M Minasian
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Frederic Baron
- Division of Haematology, University of Liege, Liege, Belgium
| | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzlerand
| | - R Angelo De Claro
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Tarec C El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg Denmark
| | - Neil Everest
- Haematology Clinical Evaluation Unit, Therapeutic Goods Administration, Department of Health, Symondston, ACT, Australia
| | - Jan Geissler
- Leukaemia Patient Advocates Foundation, Bern, Switzerland
| | - Christian Gisselbrecht
- Haemato-Oncology Department, Hopital Saint-Louis, Paris Diderot University VII, Paris, France
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, London, UK
| | - Mary Horowitz
- Division of Haematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Percy Ivy
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Caron A Jacobson
- Division of Haematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Armand Keating
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Paul G Kluetz
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Aviva Krauss
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yok Lam Kwong
- Department of Haematology and Haematologic Oncology, University of Hong Kong, Hong Kong, China
| | - Richard F Little
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | | | - Matthew J Matasar
- Lymphoma and Adult BMT Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Robert S Miller
- CancerLinQ, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Mohamad Mohty
- Haematology and Cellular Therapy Department, Saint-Antoine Hospital, University Pierre & Marie Curie, Paris, France
| | | | - Lindsay M Morton
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Sumimasa Nagai
- University of Tokyo, Tokyo, Japan; Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Jeff Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Pieter Sonneveld
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Diego Villa
- Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - John R Wingard
- Division of Haematology & Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sophie Wintrich
- Myelodysplastic Syndrome (MDS) Alliance and MDS UK Patient Support Group, London, UK
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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Neidenbach RC, Diebold I, Pieper L, Freilinger S, Oberhoffer R, Krauss A, Seidel H, Sanftenberg L, Nagdyman N, Ewert P, Kaemmerer H. P2603Adults with congenital heart defects: insufficient medical primary health care in patients with genetic disorders. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R C Neidenbach
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - I Diebold
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - L Pieper
- Dresden University of Technology, Dresden, Germany
| | - S Freilinger
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - R Oberhoffer
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - A Krauss
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - H Seidel
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | | | - N Nagdyman
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - P Ewert
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
| | - H Kaemmerer
- Deutsches Herzzentrum Technische Universitat, Department of Paediatric Cardiology and Congenital Cardiac Defects, Munich, Germany
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Krauss A, Kapsch RP. Direct determination ofkQfactors for cylindrical and plane-parallel ionization chambers in high-energy electron beams from 6 MeV to 20 MeV. ACTA ACUST UNITED AC 2018; 63:035041. [DOI: 10.1088/1361-6560/aaa71e] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shkalim-Zemer V, Konen O, Levinsky Y, Michaeli O, Yahel A, Krauss A, Yaniv I, Stein J. Calcineurin inhibitor-free strategies for prophylaxis and treatment of GVHD in children with posterior reversible encephalopathy syndrome after stem cell transplantation. Pediatr Blood Cancer 2017; 64. [PMID: 28417553 DOI: 10.1002/pbc.26531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a distinct clinico-radiologic entity that can occur following allogeneic hematopoietic stem cell transplantation, often in the context of treatment with calcineurin inhibitors (CNIs). PROCEDURE We describe the results of CNI-free management of 14 children with PRES and review the clinical and radiologic manifestations of their presentation. RESULTS Discontinuation of CNIs usually resulted in remission of PRES, but patients with established graft versus host disease (GVHD) at the time when treatment was changed often experienced progressive GVHD despite administration of immune suppressive and modulating treatments. All but three patients experienced full neurologic recovery. Nine children died as a result of either GVHD, disease relapse, or severe infection. CONCLUSIONS Discontinuation of CNIs results in neurologic improvement in most cases, but superior alternative immune modulatory treatment is needed to prevent progression of established GVHD.
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Affiliation(s)
- Vered Shkalim-Zemer
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Konen
- Department of Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Orli Michaeli
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Anat Yahel
- Bone Marrow Transplant Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Aviva Krauss
- Bone Marrow Transplant Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isaac Yaniv
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Stein
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Bone Marrow Transplant Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tong G, Krauss A, Mochner J, Wollersheim S, Soltani P, Berger F, Schmitt KRL. Deep hypothermia therapy attenuates LPS-induced microglia neuroinflammation via the STAT3 pathway. Neuroscience 2017; 358:201-210. [PMID: 28687308 DOI: 10.1016/j.neuroscience.2017.06.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/08/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Abstract
Deep hypothermia therapy (HT) is a standard method for neuroprotection during complex pediatric cardiac surgery involving extracorporeal circulation and deep hypothermic cardiac arrest. The procedure, however, can provoke systemic inflammatory response syndrome (SIRS), one of the most severe side effects associated with pediatric cardiac surgery. To date, the cellular inflammatory mechanisms induced by deep HT remain to be elucidated. Therefore, we investigated the effects of deep HT (17°C) and rewarming on the inflammatory response in lipopolysaccharide (LPS) stimulated BV-2 murine microglia. Additionally, we also investigated the application of Stattic, a signal transducer and activator of transcription 3 (STAT3) activation inhibitor, as an alternative to physical cooling to attenuate the LPS-induced inflammatory response. Deep HT had no cytotoxic effect but attenuated microglia migration. IκBα degradation was delayed by deep HT resulting in the attenuation of pNF-κB p65 migration into the nucleus and significant decreases in pro-inflammatory IL-6, TNF-α, and MCP-1 expressions and secretions, as well as decreased anti-inflammatory IL-10 and SOCS3 expressions. Additionally, pStat3 was significantly down regulated under deep hypothermic conditions, also corresponding with the significant reduction in IL-6 and TNF-α expressions. Similar to the effects of HT, the application of Stattic under normothermic conditions resulted in significantly reduced IL-6 and TNF-α expressions. Moreover, attenuation of the inflammatory response resulted in decreased apoptosis in a direct co-culture of microglia and neurons. HT reduces the inflammatory response in LPS-stimulated BV-2 microglial cells, alluding to a possible mechanism of therapeutic hypothermia-induced neuroprotection. In the future, attenuating the phospho-STAT3 pathway may lead to the development of a neuroprotectant with greater clinical efficacy.
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Affiliation(s)
- G Tong
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - A Krauss
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J Mochner
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Wollersheim
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - P Soltani
- Department of Pediatric Cardiology, Charité Medical University Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Pediatric Cardiology, Charité Medical University Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - K R L Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Osinga-Blättermann J, Ankerhold U, Brons S, Greilich S, Jäkel O, Krauss A. PV-0422: Direct determination of kQ in a clinical carbon ion beam using water calorimetry. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Weisz Hubshman M, Basel-Vanagaite L, Krauss A, Konen O, Levy Y, Garty BZ, Smirin-Yosef P, Maya I, Lagovsky I, Taub E, Marom D, Gaash D, Shichrur K, Avigad S, Hayman-Manzur L, Villa A, Sobacchi C, Shohat M, Yaniv I, Stein J. Homozygous deletion of RAG1, RAG2 and 5' region TRAF6 causes severe immune suppression and atypical osteopetrosis. Clin Genet 2017; 91:902-907. [PMID: 27808398 DOI: 10.1111/cge.12916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 01/17/2023]
Abstract
Mutations of several genes have been implicated in autosomal recessive osteopetrosis (OP), a disease caused by impaired function and differentiation of osteoclasts. Severe combined immune deficiencies (SCID) can likewise result from different genetic mutations. We report two siblings with SCID and an atypical phenotype of OP. A biallelic microdeletion encompassing the 5' region of TRAF6, RAG1 and RAG2 genes was identified. TRAF6, a tumor necrosis factor receptor-associated family member, plays an important role in T cell signaling and in RANKL-dependent osteoclast differentiation and activation but its role in human OP has not been previously reported. The RAG proteins are essential for recombination of B and T cell receptors, and for the survival and differentiation of these cells. This is the first study to report a homozygous deletion of TRAF6 as a cause of human disease.
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Affiliation(s)
- M Weisz Hubshman
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Basel-Vanagaite
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
| | - A Krauss
- Bone Marrow Transplantation Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - O Konen
- Radiology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Y Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Kipper Institute of Immunology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - B Z Garty
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel.,Kipper Institute of Immunology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - P Smirin-Yosef
- Felsenstein Medical Research Center, Petach Tikva, Israel.,Genomic Bioinformatics Laboratory, Department of Molecular Biology, Ariel University, Ariel, Israel
| | - I Maya
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, Israel
| | - I Lagovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Taub
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, Israel
| | - D Marom
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Gaash
- Hemato-Oncology Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - K Shichrur
- Hemato-Oncology Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - S Avigad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel.,Hemato-Oncology Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - L Hayman-Manzur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pathology Department, Rabin Medical Center, Petach Tikva, Israel
| | - A Villa
- CNR/IRGB, UOS Milan Unit, Milan, Italy.,Humanitas Clinical and Research Center, Milan, Italy
| | - C Sobacchi
- CNR/IRGB, UOS Milan Unit, Milan, Italy.,Humanitas Clinical and Research Center, Milan, Italy
| | - M Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bioinformatics Unit, Cancer Center, Sheba Medical Center, Tel Aviv, Israel.,Genetic Institute, Maccabi Megalab, Rehovot, Israel
| | - I Yaniv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bone Marrow Transplantation Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - J Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bone Marrow Transplantation Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Osinga-Blättermann JM, Brons S, Greilich S, Jäkel O, Krauss A. Direct determination of k Q for Farmer-type ionization chambers in a clinical scanned carbon ion beam using water calorimetry. Phys Med Biol 2017; 62:2033-2054. [DOI: 10.1088/1361-6560/aa5bac] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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16
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Wuest W, May MS, Brand M, Bayerl N, Krauss A, Uder M, Lell M. Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact. AJNR Am J Neuroradiol 2015; 36:1988-93. [PMID: 26272971 DOI: 10.3174/ajnr.a4386] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/09/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Metal artifacts from dental fillings and other devices degrade image quality and may compromise the detection and evaluation of lesions in the oral cavity and oropharynx by CT. The aim of this study was to evaluate the effect of iterative metal artifact reduction on CT of the oral cavity and oropharynx. MATERIALS AND METHODS Data from 50 consecutive patients with metal artifacts from dental hardware were reconstructed with standard filtered back-projection, linear interpolation metal artifact reduction (LIMAR), and iterative metal artifact reduction. The image quality of sections that contained metal was analyzed for the severity of artifacts and diagnostic value. RESULTS A total of 455 sections (mean ± standard deviation, 9.1 ± 4.1 sections per patient) contained metal and were evaluated with each reconstruction method. Sections without metal were not affected by the algorithms and demonstrated image quality identical to each other. Of these sections, 38% were considered nondiagnostic with filtered back-projection, 31% with LIMAR, and only 7% with iterative metal artifact reduction. Thirty-three percent of the sections had poor image quality with filtered back-projection, 46% with LIMAR, and 10% with iterative metal artifact reduction. Thirteen percent of the sections with filtered back-projection, 17% with LIMAR, and 22% with iterative metal artifact reduction were of moderate image quality, 16% of the sections with filtered back-projection, 5% with LIMAR, and 30% with iterative metal artifact reduction were of good image quality, and 1% of the sections with LIMAR and 31% with iterative metal artifact reduction were of excellent image quality. CONCLUSIONS Iterative metal artifact reduction yields the highest image quality in comparison with filtered back-projection and linear interpolation metal artifact reduction in patients with metal hardware in the head and neck area.
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Affiliation(s)
- W Wuest
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M S May
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M Brand
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - N Bayerl
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - A Krauss
- Medical Imaging (A.K.), Siemens Healthcare, Erlangen, Germany
| | - M Uder
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M Lell
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
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17
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Kotsenas AL, Michalak GJ, DeLone DR, Diehn FE, Grant K, Halaweish AF, Krauss A, Raupach R, Schmidt B, McCollough CH, Fletcher JG. CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization? AJNR Am J Neuroradiol 2015; 36:2184-90. [PMID: 26251433 DOI: 10.3174/ajnr.a4416] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Metal-related artifacts from spine instrumentation can obscure relevant anatomy and pathology. We evaluated the ability of CT images reconstructed with and without iterative metal artifact reduction to visualize critical anatomic structures in postoperative spines and assessed the potential for implementation into clinical practice. MATERIALS AND METHODS We archived CT projection data in patients with instrumented spinal fusion. CT images were reconstructed by using weighted filtered back-projection and iterative metal artifact reduction. Two neuroradiologists evaluated images in the region of spinal hardware and assigned a score for the visualization of critical anatomic structures by using soft-tissue and bone windows (critical structures totally obscured, n = 0; anatomic recognition with high diagnostic confidence, n = 5). Using bone windows, we measured the length of the most pronounced linear artifacts. For each patient, neuroradiologists made recommendations regarding the optimal use of iterative metal artifact reduction and its impact on diagnostic confidence. RESULTS Sixty-eight patients met the inclusion criteria. Visualization of critical soft-tissue anatomic structures was significantly improved by using iterative metal artifact reduction compared with weighted filtered back-projection (median, 1 ± 1.5 versus 3 ± 1.3, P < .001), with improvement in the worst visualized anatomic structure in 88% (60/68) of patients. There was not significant improvement in visualization of critical osseous structures. Linear metal artifacts were reduced from 29 to 11 mm (P < .001). In 87% of patients, neuroradiologists recommended reconstructing iterative metal artifact reduction images instead of weighted filtered back-projection images, with definite improvement in diagnostic confidence in 32% (22/68). CONCLUSIONS Iterative metal artifact reduction improves visualization of critical soft-tissue structures in patients with spinal hardware. Routine generation of these images in addition to routine weighted filtered back-projection is recommended.
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Affiliation(s)
- A L Kotsenas
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - D R DeLone
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - K Grant
- Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania
| | - A F Halaweish
- Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania
| | - A Krauss
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - R Raupach
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - B Schmidt
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - C H McCollough
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - J G Fletcher
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
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18
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Prais D, Sinik MM, Stein J, Mei-Zahav M, Mussaffi H, Steuer G, Hananya S, Krauss A, Yaniv I, Blau H. Effectiveness of long-term routine pulmonary function surveillance following pediatric hematopoietic stem cell transplantation. Pediatr Pulmonol 2014; 49:1124-32. [PMID: 24574432 DOI: 10.1002/ppul.22944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/06/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pulmonary complications following hematopoietic stem cell transplantation (HSCT) are common and often subclinical. Thus, periodic pulmonary function testing (PFT) is mandatory. This study sought to evaluate the effectiveness of long-term PFT surveillance for children undergoing HSCT and identify potential risk factors. METHODS We reviewed long-term PFT for HSCT patients at a tertiary pediatric center. Inclusion criteria were PFT prior to and at least once following HSCT. RESULTS Fifty-seven patients performed 202 spirometry and 193 plethysmographic maneuvers; 41 were tested during the first year after HSCT, but only 29 were evaluated consistently long term (2-12 years). FVC and FEV(1) decreased gradually suggesting a restrictive ventilatory defect: FVC % predicted [mean ± SD] dropped from 91 ± 14% to 85 ± 17% after 0-24 months and 80 ± 19% beyond 2 years (P = 0.01) whereas FEV(1) dropped from 95 ± 16% to 88 ± 19% and 82 ± 20%, respectively (P = 0.002). A slight reduction in TLC was observed. Those undergoing allogeneic HSCT had a greater decline in FVC (P = 0.025) and FEV(1) (P = 0.025) as did those conditioned with radiation, regarding both FVC (P = 0.003) and FEV(1) (P = 0.002). Decline occurred earlier (≤2 years) after chemotherapy compared with radiation. Seven children had severe irreversible obstruction at >2 years despite therapeutic intervention. CONCLUSIONS Most survivors of childhood HSCT maintain almost normal pulmonary function although mild restrictive lung disease may develop, particularly following allogeneic HSCT and conditioning with radiation. Severe airways obstruction developed in a small minority. The surveillance protocol for PFT needs to be followed more stringently to enable intervention possibly before early subclinical changes progress and become irreversible.
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Affiliation(s)
- Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krauss A, Kapsch RP. Experimental determination ofkQfactors for cylindrical ionization chambers in 10 cm × 10 cm and 3 cm × 3 cm photon beams from 4 MV to 25 MV. Phys Med Biol 2014; 59:4227-46. [DOI: 10.1088/0031-9155/59/15/4227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Krauss A, Mochner J, Wollersheim S, Tong G, Berger F, Schmitt K. Stattic: Can a New Drug Reduce the Inflammatory Responses after Cardiopulmonary Bypass Surgery? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Fabig V, Drescher C, Krauss A, Tong G, Walker C, Berger F, Schmitt K. Cardioprotective Effect of Early Moderate Hypothermia during Ischemia. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Even-Or E, Grunspan A, Swerdlow Y, Kodman Y, Yahel A, Katz J, Krauss A, Yaniv I, Stein J. Peripheral blood stem-cell harvest using percutaneous arterial lines in children. Pediatr Blood Cancer 2013; 60:946-8. [PMID: 23109232 DOI: 10.1002/pbc.24369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/19/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autologous peripheral blood stem-cell collection (PBSCC) in children has become an integral part of contemporary treatment protocols, but the procedure is often complicated due to technical issues related to vascular access. Central line placement is often implemented to surmount this problem, but is associated with complications such as bleeding, thrombosis and pneumothorax. As an alternative we have introduced the use of radial arterial lines for PBSCC in children. PROCEDURE Data from autologous stem cell collections performed from October 2002 to December 2011 using a radial arterial line were collected. RESULTS A total of 372 PBSCC procedures were performed during the study period; an arterial line was used in 311 PBSCC's in 208 children. The average patient age and weight were 7.9 years (SD 5.4) and 28.3 kg (SD 20.4), respectively. The smallest patient was 9 months old and weighed 7 kg. The mean total volume processed was 8,593 cm(3) (SD 4,854), and the mean number of blood volumes processed was 4.3. Mean collection time for a single blood volume was 55 minutes (SD 15.5). The mean number of CD34+ cells collected per donation was 5.8 × 10(6) /kg. Ninety-seven patients (46%) required more than one collection to meet the requested CD34+ cell target. No serious adverse effects associated with vascular access occurred in this cohort. CONCLUSION Percutaneous placement of radial artery catheters can be rapidly and safely performed in very small infants and in children with difficult venous access. This technique provides a reliable platform for efficient PBSCC.
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Affiliation(s)
- Ehud Even-Or
- Bone Marrow Transplantation Unit, Schneider Children's Medical Center of Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Anton M, Kapsch RP, Krauss A, von Voigts-Rhetz P, Zink K, McEwen M. Difference in the relative response of the alanine dosimeter to megavoltage x-ray and electron beams. Phys Med Biol 2013; 58:3259-82. [DOI: 10.1088/0031-9155/58/10/3259] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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24
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Walsh MP, Duncan B, Larabee S, Krauss A, Davis JPE, Cui Y, Kim SY, Guimond M, Bachovchin W, Fry TJ. Val-boroPro accelerates T cell priming via modulation of dendritic cell trafficking resulting in complete regression of established murine tumors. PLoS One 2013; 8:e58860. [PMID: 23554941 PMCID: PMC3595211 DOI: 10.1371/journal.pone.0058860] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/07/2013] [Indexed: 11/18/2022] Open
Abstract
Although tumors naturally prime adaptive immune responses, tolerance may limit the capacity to control progression and can compromise effectiveness of immune-based therapies for cancer. Post-proline cleaving enzymes (PPCE) modulate protein function through N-terminal dipeptide cleavage and inhibition of these enzymes has been shown to have anti-tumor activity. We investigated the mechanism by which Val-boroPro, a boronic dipeptide that inhibits post-proline cleaving enzymes, mediates tumor regression and tested whether this agent could serve as a novel immune adjuvant to dendritic cell vaccines in two different murine syngeneic murine tumors. In mice challenged with MB49, which expresses the HY antigen complex, T cell responses primed by the tumor with and without Val-boroPro were measured using interferon gamma ELISPOT. Antibody depletion and gene-deficient mice were used to establish the immune cell subsets required for tumor regression. We demonstrate that Val-boroPro mediates tumor eradication by accelerating the expansion of tumor-specific T cells. Interestingly, T cells primed by tumor during Val-boroPro treatment demonstrate increased capacity to reject tumors following adoptive transfer without further treatment of the recipient. Val-boroPro -mediated tumor regression requires dendritic cells and is associated with enhanced trafficking of dendritic cells to tumor draining lymph nodes. Finally, dendritic cell vaccination combined with Val-boroPro treatment results in complete regression of established tumors. Our findings demonstrate that Val-boroPro has antitumor activity and a novel mechanism of action that involves more robust DC trafficking with earlier priming of T cells. Finally, we show that Val-boroPro has potent adjuvant properties resulting in an effective therapeutic vaccine.
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Affiliation(s)
- Meghaan P Walsh
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Krauss A, Büermann L, Kramer HM, Selbach HJ. Calorimetric determination of the absorbed dose to water for medium-energy x-rays with generating voltages from 70 to 280 kV. Phys Med Biol 2012; 57:6245-68. [DOI: 10.1088/0031-9155/57/19/6245] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bauman A, Piel M, Höhnemann S, Krauss A, Jansen M, Solbach C, Dannhardt G, Rösch F. Synthesis, labelling and evaluation of hydantoin-substituted indole carboxylic acids as potential ligands for positron emission tomography imaging of the glycine binding site of the N-methyl-d-aspartate receptor. J Labelled Comp Radiopharm 2011. [DOI: 10.1002/jlcr.1901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Bauman
- Institute of Nuclear Chemistry; Johannes Gutenberg-University; Fritz-Strassmann-Weg 2; D-55128; Mainz; Germany
| | - M. Piel
- Institute of Nuclear Chemistry; Johannes Gutenberg-University; Fritz-Strassmann-Weg 2; D-55128; Mainz; Germany
| | - S. Höhnemann
- Institute of Nuclear Chemistry; Johannes Gutenberg-University; Fritz-Strassmann-Weg 2; D-55128; Mainz; Germany
| | - A. Krauss
- Institute of Pharmacy; Johannes Gutenberg-University; Staudingerweg 5; D-55128; Mainz; Germany
| | - M. Jansen
- Institute of Pharmacy; Johannes Gutenberg-University; Staudingerweg 5; D-55128; Mainz; Germany
| | - C. Solbach
- Radiopharmacy, PET Center; University of Tübingen; Röntgenweg 15; D-72076; Tübingen; Germany
| | - G. Dannhardt
- Institute of Pharmacy; Johannes Gutenberg-University; Staudingerweg 5; D-55128; Mainz; Germany
| | - F. Rösch
- Institute of Nuclear Chemistry; Johannes Gutenberg-University; Fritz-Strassmann-Weg 2; D-55128; Mainz; Germany
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Krauss A, Nill S, Oelfke U. The comparative performance of four respiratory motion predictors for real-time tumour tracking. Phys Med Biol 2011; 56:5303-17. [DOI: 10.1088/0031-9155/56/16/015] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hofmann K, Krauss A, Nill S, Oelfke U. TU-G-BRC-09: A Comparison of Step-And-Shoot and DMLC IMRT-Delivery for Real-Time Tumor Tracking. Med Phys 2011. [DOI: 10.1118/1.3613238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Krauss A, Fast M, Nill S, Oelfke U. TU-G-BRC-07: Multileaf Collimator Tracking of Respiratory Motion Using a Novel X-Ray Monitoring System. Med Phys 2011. [DOI: 10.1118/1.3613236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fast M, Krauss A, Nill S, Oelfke U. TU-C-214-08: Position Detection Accuracy of a Novel Linac-Mounted Intra-Fractional X-Ray Imaging System. Med Phys 2011. [DOI: 10.1118/1.3613140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Krauss A, Nill S, Oelfke U. 454 poster COMPARATIVE PERFORMANCE OF RESPIRATORY MOTION PREDICTORS FOR REAL-TIME TUMOR TRACKING. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krauss A, Nill S, Oelfke U. 209 speaker MANAGEMENT OF BREATHING MOTION THROUGH MULTILEAF COLLIMATOR TRACKING. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neumuth T, Krauss A, Meixensberger J, Muensterer OJ. Impact quantification of the daVinci telemanipulator system on surgical workflow using resource impact profiles. Int J Med Robot 2011; 7:156-64. [DOI: 10.1002/rcs.383] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2011] [Indexed: 12/22/2022]
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Krauss A, Nill S, Oelfke U. SU-GG-J-09: Effective Tracking of Intrafractional Organ Motion Due to Breathing Using a Siemens 160 MLC. Med Phys 2010. [DOI: 10.1118/1.3468232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Palamountain KM, Stewart KA, Krauss A, Kelso D, Diermeier D. University leadership for innovation in global health and HIV/AIDS diagnostics. Glob Public Health 2010; 5:189-96. [PMID: 20119876 DOI: 10.1080/17441690903456274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Medical products used in the developed world often fail to adequately serve resource-limited settings where electricity, transportation and health care workers are not readily available. We suggest that the problem is not only a lack of coordinated financial resources to purchase existing medical products, but also a lack of products that are specifically designed for resource-limited settings. While donor organisations with a focus on global health are increasingly willing to bear the additional financial risk for the research and development of such high-impact medical products, corporations are still reluctant to take their best scientists and engineers away from more commercially attractive projects. Universities, on the other hand, given their teaching and research missions, are well positioned to engage in such high-risk development projects. A group of biomedical, engineering, business and social science researchers at Northwestern University (NU) propose a creative model to address significant social and health needs. The team's initial product focus is a rapid test for diagnosing infants with HIV. The NU model aligns the incentives and expertise of industry, donors and academia to innovate medical products, such as the infant HIV diagnostic test, for resource-limited settings.
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Affiliation(s)
- K M Palamountain
- Kellogg School of Management, Northwestern University, Evanston, IL, USA.
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Krauss A, Rau A, Tacke M, Nill S, Oelfke U. Real-time Tumor Position Monitoring and Dynamic Dose Adaptation: Geometric and Dosimetric Accuracy of an Integrated Tracking System. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Di Fiore JM, Arko MK, Miller MJ, Krauss A, Betkerur A, Zadell A, Kenney SR, Martin RJ. Cardiorespiratory events in preterm infants referred for apnea monitoring studies. Pediatrics 2001; 108:1304-8. [PMID: 11731652 DOI: 10.1542/peds.108.6.1304] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Episodes of apnea, desaturation, and bradycardia are common in preterm infants. Such infants who have persistent cardiorespiratory events detected by clinical bedside monitoring often are referred for overnight apnea monitoring studies. OBJECTIVE To characterize apnea, bradycardia, and desaturation events in infants referred for an overnight apnea monitoring study and compare them with corresponding events in control infants of similar age and weight with no bedside monitor alarms. METHODS Twelve-hour bedside apnea monitoring studies were performed on 68 preterm infants before hospital discharge. This population included 35 infants who were referred by their attending physicians because of persistent bedside monitor alarms (referral group) and 33 infants who had no documented cardiorespiratory events for at least 2 days before the study (control group). Each study monitored respiration via respiratory inductance plethysmography, oxygen saturation (Sao2), and heart rate. Events were defined as meeting 1 of the following criteria: apnea > or =20 seconds, bradycardia < or =80 beats per minute, or Sao2 < or =80%. RESULTS The incidence of apnea > or =20 seconds was low, with no significant difference between infant groups. Referral infants exhibited a higher occurrence of desaturation episodes (20 +/- 6 vs 6 +/- 3 episodes/12-hour study) and a higher occurrence of bradycardia episodes (4.3 +/- 0.8 vs 1.1 +/- 0.3 episodes/12-hour study) than controls. These episodes of desaturation and bradycardia were always preceded by a respiratory pause, which was shorter in the referral infants (10.0 +/- 0.4 seconds vs 12.0 +/- 1.0 seconds). Baseline Sao2 was lower in referrals than controls (95 +/- 1% vs 98 +/- 1%), and the incidence of periodic breathing was significantly higher. CONCLUSIONS Infants referred for apnea monitoring studies because of persistent bedside monitor alarms have very infrequent prolonged apnea but a higher frequency of desaturation and bradycardia in response to short respiratory pauses than infants without persistent bedside monitor alarms. Referral infants also exhibit a lower baseline Sao2. These abnormalities in oxygenation and cardiorespiratory control may be markers for subtle residual lung disease or functional central nervous system abnormalities.
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Affiliation(s)
- J M Di Fiore
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Hardt PD, Bretz L, Krauss A, Schnell-Kretschmer H, Wusten O, Nalop J, Zekorn T, Klör HU. Pathological pancreatic exocrine function and duct morphology in patients with cholelithiasis. Dig Dis Sci 2001; 46:536-9. [PMID: 11318528 DOI: 10.1023/a:1005690930325] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Most authors claim alcohol consumption to be the only relevant reason for chronic pancreatitis. However, gallstones might cause this disease, as they do cause acute pancreatitis. In this study 91 gallstone patients and 94 age-matched controls were investigated concerning exocrine pancreatic function (fecal elastase-1 concentrations). Furthermore x-rays of 100 consecutive ERCP patients were evaluated for differences concerning pancreatic duct changes between patients with and without evidence of cholelithiasis. Pathological elastase 1 levels were more frequent in gallstone patients (30,8%) as compared to age-matched controls (19%). Symptoms such as upper abdominal pain, bloating, and fat intolerance were reported more often in gallstone patients. In ERCP of gallstone patients (N = 60), 77% were found to have chronic pancreatitis according to the Cambridge classification, while in nongallstone-patients (N = 32) 47% had chronic pancreatitis. In conclusion, according to these data a pathophysiological connection between gallstones and chronic pancreatitis appears to be probable.
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Affiliation(s)
- P D Hardt
- Third Medical Department, Justus-Liebig-University, Giessen, Germany
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Lindsay L, Oliver SJ, Freeman SL, Josien R, Krauss A, Kaplan G. Modulation of hyperoxia-induced TNF-alpha expression in the newborn rat lung by thalidomide and dexamethasone. Inflammation 2000; 24:347-56. [PMID: 10850856 DOI: 10.1023/a:1007096931078] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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] [Indexed: 11/12/2022]
Abstract
The effect of high oxygen concentrations on lungs of neonatal rats was studied. In addition, some oxygen-exposed animals were treated with either dexamethasone or thalidomide. No gross histologic changes were noted in the lungs following exposure to 95% oxygen nor were there changes in the total number or the phenotypic distribution of BAL cells obtained from these lungs compared to lungs from air exposed (control) neonatal rats. The majority of the BAL cells were CD45+ leukocytes (macrophages). However, when BAL cells were exposed to LPS in vitro, TNF-alpha production was higher in cells from rats exposed to 95% oxygen compared to cells from rats exposed to ambient air. In addition, lung TNF-alpha and IL-6 mRNA levels were increased after exposure to 95% oxygen. In the lungs of animals treated with either dexamethasone or thalidomide, TNF-alpha mRNA levels were reduced, while only dexamethasone treatment also reduced IL-6 mRNA levels.
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Affiliation(s)
- L Lindsay
- Department of Neonatology, New York Hospital-Cornell Medical Center, New York 10021, USA
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Hombrink J, Fröhlich D, Glatzel M, Krauss A, Thiel HJ, Meier J, Hamann D, Mücke R, Glaser FH, Köst S. [Prevention of radiation-induced diarrhea by smectite. Results of a double-blind randomized, placebo-controlled multicenter study]. Strahlenther Onkol 2000; 176:173-9. [PMID: 10812390 DOI: 10.1007/s000660050053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 10/28/2022]
Abstract
PURPOSE Diarrhea and abdominal pain are well-known side effects abdominal or pelvic of radiation therapy that may lead to interruption of treatment in serious cases. In recent trials the silicate smectite has proven a promising drug in the prophylaxis of these adverse events. The presented trial aimed at the verification of earlier studies and the evaluation of a dose-effect relationship. PATIENTS AND METHODS Between April 1994 and May 1995, a total of 176 patients obtaining radiotherapy of the pelvis or the abdomen were evaluated in a double-blind, randomized placebo-controlled investigation regarding the prophylactic effect of smectite (= Colina) against radiotherapy-induced diarrhea. During the whole period of radiotherapy 85 patients obtained 2 x 6 g smectite daily and 91 patients received 2 x 6 g placebo. The primary end point of the analysis was the time to the first appearance of diarrhea (> or = 3 pappy stools). RESULTS All 176 patients were evaluated according to an intent-to-treat analysis. There was no significant difference between the prophylactic effects of smectite and placebo. For an explorative post-hoc analysis the total study group was split up into 2 subgroups, one with an irradiated small bowel volume < or = 837.5 ml, the other with a small bowel volume > 837.5 ml (median); the analysis indicated that the first subgroup showed a benefit for the smectite-treated patients in contrast to the placebo treatment (32 vs. 18 calendar days to the first appearance of diarrhea). This benefit was statistically not significant. CONCLUSION Prophylactic application of smectite during irradiation of the pelvis and the abdomen can delay the development of radiotherapy-induced diarrhea, a statistical significance could not be verified neither in the total study group nor in the post-hoc subgroup analysis.
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Affiliation(s)
- J Hombrink
- Abteilung für Strahlentherapie, Zentralklinikum Augsburg
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Hardt PD, Krauss A, Bretz L, Porsch-Ozcürümez M, Schnell-Kretschmer H, Mäser E, Bretzel RG, Zekhorn T, Klör HU. Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus. Acta Diabetol 2000; 37:105-10. [PMID: 11277309 DOI: 10.1007/s005920070011] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 patients with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenetic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far.
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Affiliation(s)
- P D Hardt
- Third Medical Department, Justus-Liebig-University Giessen, Germany
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Abstract
Signal transduction is controlled both by regulation of enzyme activation and by organization of enzymatic complexes with nonenzymatic adapters, scaffolds, and anchor proteins. The extracellular signal-regulated kinase (ERK) cascade is one of several evolutionarily conserved mitogen-activated protein (MAP) kinase cascades important in the regulation of growth, apoptosis, and differentiation. A two-hybrid screen was conducted to identify nonenzymatic components of this signaling cascade that might be important in regulating its activity. A protein called MP1 (MEK Partner 1) was identified that bound specifically to MEK1 and ERK1 and facilitated their activation. When overexpressed in cultured cells, MP1 enhanced activation of ERK1 and activation of a reporter driven by the transcription factor Elk-1. Expression of MP1 in cells increased binding of ERK1 to MEK1. MP1 apparently functions as an adapter to enhance the efficiency of the MAP kinase cascade.
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Affiliation(s)
- H J Schaeffer
- Department of Microbiology and Cancer Center, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA
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Shalom S, Strinkovski A, Peleg G, Druckmann S, Krauss A, Lewis A, Linial M, Ottolenghi M. An optical submicrometer calcium sensor with conductance sensing capability. Anal Biochem 1997; 244:256-9. [PMID: 9025941 DOI: 10.1006/abio.1996.9893] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/03/2023]
Abstract
The identification of chemical species and the measurement of their concentrations with high (submicrometer) spatial resolution are of considerable importance in cell biology. In this article we report the first successful development of a > or = 0.1-micron Ca2+ sensor based on a pulled micropipet, filled with a conducting porous sol-gel glass which was doped with the fluorescent calcium green 1 Ca2+ indicator. Such sensors are potentially capable of measuring Ca2+ concentrations as low as 10(-8) M, in confined volumes, with a three-dimensional resolution which exceeds approximately 0.1 micron. A major advantage of the sensor is its capability to be integrated into a multifunctional probe which will measure chemical analyte concentrations and ion conductance.
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Affiliation(s)
- S Shalom
- Division of Applied Physics, Hebrew University of Jerusalem, Israel
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Abstract
AIM To determine whether there are subclinical deficits in oxygen delivery in ventilated premature neonates. METHOD Ventilated premature neonates weighing less than 1500 g, who were transfused for anaemia or who were given colloids for clotting abnormalities (or oedema), were haemodynamically monitored during the first week of life. Calf muscle surface pH (pH) was measured in conjunction with peripheral limb blood flow by occlusion plethysmography. RESULTS Packed red blood cell transfusions corrected a subclinical regional tissue acidosis (low tpH) without affecting arterial pH or limb blood flow. This observation also correlated with an increase in regional oxygen delivery. The data were also suggestive of a pattern of pathological, supply dependent, oxygen delivery and are similar to other observations made in adults with adult respiratory distress syndrome. CONCLUSIONS Packed red blood cells increase regional oxygen delivery and tissue surface pH. In contrast, colloid infusion provided no substantial cardiovascular or metabolic benefit to these patients and should be avoided when oxygen delivery is at issue and when there may be leaky pulmonary capillaries.
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Affiliation(s)
- E F La Gamma
- Department of Pediatrics, University at Stony Brook, New York 11794-8111, USA
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Abstract
The risk-to-benefit ratio of surfactant treatment of outborn preterm infants prior, as opposed to after, transportation to a perinatal center is not known. The objective of this study was to document current practice and to examine clinical outcomes in North America. In phase I (December, 1991 to January, 1992) questionnaires were distributed to 114 perinatal centers in the United States and Canada. The centers returned 98 surveys. Over half (50.5%) of the centers report giving surfactant rescue prior to infant transport, but only a minority (9.5%) of the centers report doing so for prophylaxis. In phase II (January, 1992 to December, 1992), clinical outcomes of surfactant-eligible babies requiring interhospital transport at a university hospital were evaluated to determine which infants ultimately received surfactant and when. The infants were compared between groups and did not differ significantly in gestational age, birthweight, sex type, number of multiple births, five-minute Apgar scores, or whether antenatal steroids were used. In phase II, the 66 consecutive, ventilator-dependent, outborn infants with average, and median, gestational age of 28 weeks were compared. The infants receiving surfactant prior to transport, when compared to the infants that got it after transport (9 hours later), did not do any better. There was 6% more survival without bronchopulmonary dysplasia in the group receiving surfactant after transport (65.2% versus 59.3%, p = 0.665). The infants receiving surfactant after transport were off the ventilator sooner (95% C.I. 6.0-28.7 versus 11.8-25.9 days) and discharged from the perinatal center earlier (95% C.I. 37.8-70.8 versus 47.9-69.0 days). Furthermore, arterial blood gases before and after transport reveals that there were no short-term advantages in administering surfactant prior to transport when compared to waiting for reevaluation at the perinatal center. These findings suggest that surfactant can be used safely prior to the interhospital transport of preterm infants, but this treatment does not seem to confer benefit over waiting for reevaluation, and possible surfactant treatment, at the tertiary perinatal center.
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Affiliation(s)
- D Costakos
- Franciscan Skemp Healthcare (Mayo Health System), La Crosse, Wisconsin, USA.
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Hombrink J, Voss AC, Fröhlich D, Glatzel M, Krauss A, Glaser FH. [Therapy trends in the prevention of radiation-induced diarrhea after pelvic and abdominal irradiation. Results of a tricenter study]. Strahlenther Onkol 1995; 171:49-53. [PMID: 7839305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiotherapy induced diarrhea and convulsive pain are severe side-effects of irradiation of the pelvis and the abdomen leading often to an interruption of the treatment. Up to now these side-effects were only treated symptomatically, prophylactic therapies are not known. PATIENTS AND METHODS During the years 1992 and 1993 174 patients who obtained radiotherapy in the pelvis or the abdomen because of different malignancies were observed referring to the diarrhea-prophylactic effect of Smectite (= Skilpin). 80 patients received Smectite at the beginning of radiotherapy, 94 patients of the control group were treated with motility modifying drugs when diarrhea appeared. The following parameters were compared: Frequency, consistence and incontinence of stool, tenesmus and the onset of diarrhea. RESULTS 67.0% (n = 63) of the patients in the control group developed diarrhea, whereas in the pretreated Smectite-group only 37.5% of the cases (n = 30) developed diarrhea. The first appearance of diarrhea was at day 17 in the pretreated group and averagely at day 11 in the control group. 44% of the patients in the control group suffered from tenesmus versus 25% in the Smectite-group. CONCLUSION In comparison to the symptomatic treatment of radiation enteritis the prophylactic application of Smectite is able to reduce the diarrhea from the beginning of radiotherapy or at least to reduce the pathological frequency of stool and therefore to increase the quality of life.
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Krauss A, Rosen GA. Developing the gastroenterology certification examination. Gastroenterol Nurs 1991; 13:244-6. [PMID: 2031953 DOI: 10.1097/00001610-199101340-00019] [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: 12/29/2022] Open
Abstract
This paper describes a typical procedure for the development of credentialing examinations. Specifically, the paper provides the developmental history of the Certification Examination for Gastroenterology Nurses and Associates. In the course of the paper, a four-step approach to examination development is outlined. The steps include role delineation, item writing, examination construction and passing score determination. All phases of the examination development process are viewed in the light of their contribution to the public protection responsibility of the Certifying Board of Gastroenterology Nurses and Associates.
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Katz A, Krauss A, Krauss S, Ovsyscher I, Gueron M. [Cough associated with captopril and enalapril]. Harefuah 1989; 116:632-4. [PMID: 2551800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Persistent dry cough is not a known adverse reaction of captopril and enalapril. We present 5 patients with persistent dry cough severe enough to warrant withdrawal of the drug, which resulted in rapid and complete recovery. Challenge with the drugs induced recurrence of cough. The pathogenesis of the reaction is unknown, but possible mediators include bradykinin and prostaglandins.
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Szajnberg N, Ward MJ, Krauss A, Kessler DB. Low birth-weight prematures: preventive intervention and maternal attitude. Child Psychiatry Hum Dev 1987; 17:152-65. [PMID: 3829771 DOI: 10.1007/bf00706226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Redder A, Becker HW, Görres J, Hilgemeier M, Krauss A, Rolfs C, Schröder U, Trautvetter HP, Wolke K, Donoghue TR, Rinckel TC, Hammer JW. Capture amplitudes in the reaction 12C( alpha, gamma ) 16O at stellar energies. Phys Rev Lett 1985; 55:1262-1265. [PMID: 10031771 DOI: 10.1103/physrevlett.55.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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